Effectiveness of Modified Pumice Stone in the Treatment of Waste Water from Tertiary Hospital

Effectiveness of Modified Pumice Stone in the Treatment of Waste Water from Tertiary Hospital | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effectiveness of Modified Pumice Stone in the Treatment of Waste Water from Tertiary Hospital Adekunle Adesuyi Ademuwagun, Suraju Adekunle Lateef This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7038270/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Pharmaceutical contaminants in hospital wastewater, such as Paracetamol, Aspirin, and Ibuprofen, pose substantial health and ecological risks. Conventional wastewater treatments are costly and ineffective at removing such contaminants, especially in developing countries. This study evaluated the effectiveness of modified pumice stone as a low-cost filtration medium for treating hospital wastewater. A laboratory experiment employed three continuous filtration tanks (15 cm × 15 cm × 15 cm) filled with coarse sand and granite (CSG), CSG with unmodified pumice stone (CSG/unmodified PS), and CSG with modified pumice stone (CSG/modified PS). Pumice stones were cleaned, pulverized, sieved, and modified to enhance adsorption. Wastewater collected from a tertiary hospital was applied at a hydraulic loading rate of 0.01 m for 8 days, with a 5-hour retention time. Pharmaceutical concentrations were determined using High-Performance Liquid Chromatography (HPLC), and physicochemical parameters were measured using APHA methods. Results were compared to NESREA standards. Initial concentrations of Paracetamol, Aspirin, and Ibuprofen were 162.2, 49.7, and 145.2 µg/L, respectively. After four days, concentrations in the CSG/modified PS setup dropped to 85.0, 22.3, and 72.7 µg/L, respectively. COD, BOD, and TSS decreased by 40–50%, and TN and TP by 35–45%. On the eighth day, BOD and COD in CSG/modified PS reached 18.6 mg/L and 33.5 mg/L, respectively—below NESREA limits. This study demonstrates that modified pumice stone significantly reduces pharmaceutical and physicochemical pollutants in hospital wastewater, offering a cost-effective treatment solution. Pumice stone Pharmaceutical Physicochemical Hospital wastewater Wastewater treatment Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Figure 15 Figure 16 Figure 17 Figure 18 Figure 19 1 INTRODUCTION Pharmaceutical and personal care items have become major contaminants in aquatic habitats due to industrialization and human activity, affecting water quality and causing significant damage to aquatic ecosystems, including homes, workplaces, hospitals, and sewage treatment facilities (Davarnejad et al., 2018 ; Sophia and Lima, 2018 ). The pharmaceutical sector's growth is driven by societal demand for medication, but it is also a major environmental polluter, primarily from production sites, resulting in waste streams like process liquors and solvents, according to Shalini et al. ( 2010 ). Hospitals use various chemicals for medical and scientific purposes, including solvents, medications, radionuclides, and disinfectants, which are then discharged into the municipal sewer networks (Emmanuel et al., 2005 ). Untreated waste can lead to radioactive pollution, water contamination, and the spread of infectious diseases (Gautam et al., 2007 ). The study on hospital wastewater's physiochemical and bacteriological characteristics revealed that its discharge contaminated the receiving environment, including air, soil, and water. Additionally, it might be harmful to people's health (Ekhaise and Omavwoya, 2008 ). Every day, hospitals produce large amounts of wastewater (Amouei et al., 2011 ). Hospitals are expected to produce between 362 and 745 liters of wastewater per occupied day on average (Amouei et al., 2011 ; Beyene and Redaie, 2011 ; Nasr and Yazdanbakhsh, 2008 ; Sarafraz et al., 2007 ). There has to be extra care given to this massive amount of toxic wastewater. Hospitals generate risk waste, including sharps, pharmaceuticals, and genotoxic substances. Research on hazardous waste creation and handling has been conducted in various countries, including Iran, South Africa, China, Germany, Korea, Egypt, UK, Turkey, Bangladesh, India, and Congo (Altin et al., 2003 ; Anwar et al., 2013 ; Blenkharn, 2006 ; Karamouz et al., 2007 ; Seema et al., 2013 ). Pumice is a light-colored, porous volcanic stone with a sizable surface area. According to Asgari et al. ( 2012 ), it is often pale in color, ranging from white, cream, blue, or grey to green-brown or black. It is utilized in the treatment of water and wastewater as an adsorbent, filter bed, and support material (Akbal, 2005). According to Liu et al. ( 2014 ), pumice's porous and amorphous features result in a high surface area and skeletal structure with open channels that allow water and ions to enter and exit the crystal structure. It is created when bubbles that are generated by volcanic gases evolving from viscous magma are unable to easily separate from the viscous magma before cooling to glass (Asgari et al., 2012 ). With an average porosity of 90%, pumice is the most porous material known to exist. It also floats on water at first, and its –OH groups are crucial for surface activity (Asgari et al., 2012 ; Calabro et al., 2012 ). Scanning electron microscopy (SEM) suggests that chemical treatment might enhance the porosity and rough surface of pumice (Chuan et al., 2004 ; Sepehr, 2013). Pharmaceutical compounds have been removed from various matrices using a variety of techniques (Caban and Stepnowski, 2021 ; Taoufk et al., 2020 ). These techniques include filtration (Femina et al ., 2021; Gu et al., 2018 ; Taheran et al., 2016 ), advanced oxidation processes (Akbari et al., 2020 ; Bastami et al., 2017 ; Brillas, 2022 ; Kanakaraju et al. 2014 ; Sruthi et al., 2021), ion exchange (Jiang et al ., 2015), biological treatment (Tiwari et al., 2017 ), and adsorption (Bello and Raman, 2019 ; Duarte et al., 2022 ; Osman et al., 2023 ; Ranjbari et al., 2020 ). Adsorption, on the other hand, has drawn a lot of interest among these techniques because of its affordability, ease of use, high efficiency, regenerability, and scalability (Ayati et al ., 2019; Karimi-Maleh et al., 2021 ; Shahinpour et al., 2022 ). Pharmaceutical compounds can now be removed from aqueous solutions more effectively via adsorption (Ahmed, 2017 ; Huang et al., 2021 ; Igwegbe et al., 2021 ; Prasetya et al., 2023 ). Water quality monitoring is crucial for life and the planet's function, especially for residential and commercial applications. Emerging contaminants, which can infiltrate ecosystems, negatively impact ecological and human health. (Alistair et al., 2012 ; Jiri, 2008 ; Patel et al., 2019 ). Pharmaceuticals, including estrogen and birth control hormones, are used to treat illnesses and infections, but their presence in water bodies is concerning (Bhushan et al., 2020 ). Pharmaceutical contaminants, biologically active substances used to treat, prevent, or cure diseases, are a concerning type of ECs originating from the pharmaceutical sectors (Mahapatra et al., 2022 ; Samal and Trivedi, 2020; Tiwari et al., 2017 ). Pharmaceuticals, which interact with living organisms, pose a threat to the ecosystem through industrial discharges, agricultural runoffs, human and animal excreta, and hospital effluents, posing a significant environmental risk (Feier et al., 2017 ; Gojkovic et al., 2019 ; Hollman et al., 2020 ). Hospital effluents, including hazardous chemicals, solvents, active pharmaceuticals, metabolites, disinfectants, and heavy metals, pose a significant environmental threat due to their high mobility in the liquid phase (Bhushan et al., 2020 ; Samal et al., 2017 ; Samal et al., 2020 ). Pharmaceutical pollutants from PPCPs can cause genotoxic, mutagenic, and ecotoxicological impacts on humans, animals, and plants, potentially leading to long-term chronic effects on aquatic plants and animals (Jukosky et al., 2008 ). Jukosky et al. ( 2008 ) discovered that estrogen induces vitellogenesis in male Oryzias latipes (Japanese Medaka). High estrogenicity also raised the fish death rate. Living things' genetic traits and behaviors may alter as a result of PC exposure (Tiwari et al., 2017 ). The presence of estrogen in drinking water can cause male fish to transform into females, negatively impacting older adults, neonates, and those with renal or hepatic impairment, and potentially increasing the incidence of testicular and breast cancer (Mahapatra et al., 2022 ; Schaider et al., 2014 ; Webb et al., 2003 ). Drinking water-based anti-cancer medications can cross the blood-placenta barrier, causing teratogenic and embryotoxic effects, making them particularly risky for expectant mothers (Aschengrau et al., 2011 ; Nor et al., 2021 ; Zwiener, 2007 ). The high prevalence of polychlorinated biphenyls (PCs) in water sources has severe health impacts on humans and animals, necessitating the development of efficient treatment techniques. However, there is paucity of data on the use of modified pumice stone filtration system for removing these contaminants, hence the need for this study. It is this perspective that the present study is made and investigated the effectiveness of modified pumice stone in the treatment of wastewater from tertiary hospital with the following specific objectives: (1) to characterize hospital wastewater for Paracetamol, Aspirin, and Ibuprofen; (2) to determine the removal efficiencies of Paracetamol, Aspirin, and Ibuprofen from hospital wastewater treatment with pumice stone; (3) to determine the impact of modified pumice stone as an adsorbent on its pharmaceuticals and physicochemical characteristics pre and post hospital wastewater treatment and (4) to assess the effectiveness of a modified pumice stone adsorbent treatment in reducing physicochemical characteristics of the treated hospital wastewater. 2 MATERIALS AND METHODS 2.1 Study Area The wastewater for this study was collected from wastewater treatment plant, University College Hospital, Fig. 2.1 . The study was primarily designed to explore the use of modified pumice stone for the treatment of wastewater from hospital. The University College Hospital (UCH) is a prestigious tertiary healthcare facility located in Ibadan, Oyo State, Nigeria. As a university teaching hospital affiliated with the University of Ibadan, UCH serves as a major referral centre and a training ground for medical professionals. UCH boasts an extensive infrastructure, with approximately 1000 bed spaces and 200 examination couches, typically operating at an occupancy rate of 65–70%. The hospital caters to a wide range of medical specialties, including general medicine, surgery, pediatrics, obstetrics and gynecology, and various subspecialties. In addition, to the main hospital complex, UCH also houses staff residential quarters and student hostels, which accommodate healthcare professionals, support staff, and medical students associated with the university. The presence of these residential facilities indicates that domestic wastewater from housing units may contribute to the overall wastewater stream entering the UCH waste water treatment plant (WWTP). 2.2 Procurement, preparation and modification of pumice stone The pumice stone that was modified and used as adsorbent in this study were procured from Bode market, Ibadan, Oyo State, Nigeria. Before modification and utilization, pumice stones underwent a thorough cleansing process involving multiple rinses with distilled water to eliminate any impurities, followed by oven-drying at 25 ± 1°C. Subsequently, the stones were pulverized and sifted to obtain particle size fractions of 1.18mm. These particles were then subjected to physical and chemical modification treatments. For the physical treatment, the pulverized particles underwent heat treatment by exposure to temperatures of 90 o C, 180 o C, and 270 o C for duration of 4 hours each. Concurrently, chemical treatment involved immersing and agitating the ground pumice in solutions of 1 M HCl, 1 M H 2 SO 4 , and 1 M HNO 3 for a period of 4 hours, followed by rinsing with distilled water and subsequent drying at 130 o C for 3 hours. 2.3 Experimental setup of continuous filtration systems The experimental setup involved the construction of three distinct filtration systems as shown in plate 2.3, to assess continuous processes. Each setup consisted of specific materials arranged within the filtration system to evaluate their performance. The first setup utilized coarse sand and granite; the second setup included coarse sand, granite, and unmodified pumice stone, while the third setup incorporated coarse sand, granite, and modified pumice stone. Granite was processed into particles and sieved alongside coarse sand to achieve particle size fractions of 1.18 mm, ensuring uniformity in the materials used. The systems were assembled with dimensions spaced 6cm apart to facilitate optimal flow and interaction between the materials. The arrangement of layers, consisting of coarse sand, granite, and pumice stone, was carefully selected to maximize adsorption and filtration capacity within the experimental setup. Wastewater collected was applied by gravity at a hydraulic loading rate of 0.01 liters per minute and a hydraulic retention time of 5 hours. 2.4 Standard and determination of pharmaceuticals The standard adopted was according to Nguyen et al . (2023) description in "Simultaneous determination of paracetamol and diclofenac in wastewater by High-Performance Liquid Chromatography method," a modified approach was used for the drug extraction and analysis. High-Performance Liquid Chromatography (HPLC) was used to quantify pharmaceutical concentrations before and after adsorption. Prior to preparation, the sample was allowed to acclimate on the lab bench and was filtered into a borosilicate beaker that had been previously cleaned. Samples were extracted using Solid Phase Extraction (SPE) cartridges. 500 milliliters of the samples were eluted with solvent after passing through a conditioned SPE cartridge. The SPE cartridges were preconditioned by passing through two milliliters of ultrapure water and two milliliters of methanol. Methanol was used to dilute the samples. The samples were again diluted in a 1 ml mobile phase solution after the solvent elution was evaporated. The samples were then passed through a filter. Prior to injecting the samples into the HPLC apparatus for measurement, filter them with a Whatman (0.45 µm) syringe. 2.5 Determination of the physicochemical parameters The physicochemical parameters of influent and effluent wastewater were analyzed in the laboratory using the American Public Health Association (APHA) standard methods for wastewater examination. The physicochemical parameters are as follows: Biochemical Oxygen Demand (BOD), Chemical Oxygen Demand (COD), Total Suspended Solids (TSS), Turbidity, Total Nitrogen and Total phosphorus. 3 RESULTS AND DISCUSSION 3.1 Characterization and removal efficiency of pharmaceuticals in different setups 3.1.1 Pharmaceuticals The characterization of paracetamol in hospital wastewater was conducted using high-performance liquid chromatography (HPLC) to quantify its concentrations at various stages of treatment. The initial concentration of paracetamol in the untreated hospital wastewater was found to be 162.2 µg/L, reflecting a significant level of pharmaceutical contamination typically found in such effluents. This concentration is significantly higher than the 30 µg/L reported by Park et al . (2020) in their study on the distribution and removal of pharmaceuticals in sewage treatment plants. The elevated levels observed in the current study may be attributed to the higher usage of paracetamol in hospital settings, leading to more concentrated pharmaceutical loads in hospital wastewater compared to general sewage. Additionally, the handling and disposal practices in hospitals might contribute to these higher concentrations. In contrast, Florinela et al . (2023) reported a higher initial adsorption capacity of paracetamol (68,900 µg/L) with a removal efficiency of 84.6% in their study on the removal of acetaminophen from wastewater using Fe 3 O 4 and ZSM-5 materials, indicating that adsorption capacities can vary widely depending on the adsorbent used and initial concentrations. Upon treatment with different filtration setups, a notable reduction in paracetamol concentration was observed. On the fourth day of experimentation, the concentration of paracetamol in the effluent had decreased to 106.2 µg/L in the coarse sand and granite setup, 92.8 µg/L in the unmodified pumice stone setup, and 85.0 µg/L in the modified pumice stone setup. These reductions reflect the varying efficiencies of the filtration methods. The modified pumice stone demonstrated the highest efficacy due to its increased surface area and improved adsorption properties, which enhance its ability to capture and retain paracetamol molecules. This trend is consistent with the findings of Antonio et al . (2019), who reported a 60% reduction in paracetamol levels using activated carbon filtration. The superior performance of the modified pumice stone can be attributed to the modification process, which likely increased the number of active sites available for adsorption. Al-hwori et al . (2023) also found that activated carbon achieved a high removal efficiency of 93.3-98.5% for paracetamol, stressing the importance of adsorbent properties. Similarly, Vohoang et al . (2016) reported a 55-99.5% removal efficiency using constructed wetlands with Scirpusvalidus, highlighting the effectiveness of natural and modified materials in pharmaceutical removal. Further reductions were observed by the eighth day of treatment. The concentrations of paracetamol decreased to 103.2 µg/L in the coarse sand and granite setup and 89.8 µg/L in the unmodified pumice stone setup, representing removal efficiencies of 36.4% and 44.6%, respectively. These results indicate that while both setups are effective, the unmodified pumice stone offers better performance due to its intrinsic porosity and adsorption characteristics. This aligns with the study by Irem and Rabia (2023), which achieved 90% removal efficiency for paracetamol using activated carbon synthesized from orange peels. However, a slight increase in paracetamol concentration was noted in the modified pumice stone setup, which reached 90.4 µg/L. This increase suggests a potential saturation of the adsorbent over time, indicating that the adsorption capacity of the modified pumice stone might be limited under continuous use without regeneration. Similarly, Senar et al . (2023) reported a 52-60% removal efficiency using natural clay (Na-montmorillonite), indicating that even effective adsorbents can reach a point of diminished returns if not managed properly. The significant reduction in paracetamol concentration in the treated effluent highlights the effectiveness of the pumice stone filtration systems, particularly the modified pumice stone, in adsorbing pharmaceutical contaminants from hospital wastewater. The effectiveness of the modified pumice stone can be attributed to its enhanced adsorption properties, which allow it to capture a higher amount of paracetamol compared to the other setups. As Kwadwo et al . (2021) reported the removal efficiency of paracetamol from sewage treatment plants can reach up to 98%, suggesting that advanced treatment methods and high-quality adsorbents are critical for optimal performance. This study emphasizes the potential of modified pumice stone as a promising adsorbent for removing pharmaceuticals like paracetamol from hospital wastewater, emphasizing the need for continuous monitoring and optimization of treatment processes to maintain high removal efficiencies. 3.1.2 Aspirin To characterize the presence of aspirin in hospital wastewater, its concentration was quantified at different treatment stages using high-performance liquid chromatography (HPLC). Initially, the concentration of aspirin in the untreated hospital wastewater was found to be 156.4 µg/L, reflecting a significant level of aspirin contamination typical of such effluents. Significant reductions in aspirin concentrations were observed throughout the experimental period across the various filtration setups. By the fourth day, the concentration of aspirin had decreased to 102.3 µg/L in the coarse sand and granite setup, 87.6 µg/L in the unmodified pumice stone setup, and 80.2 µg/L in the modified pumice stone setup. These reductions translate to removal efficiencies of 34.6%, 44.0%, and 48.7%, respectively, showcasing the modified pumice stone's enhanced performance. These results align with previous studies on the removal of pharmaceutical compounds from wastewater using adsorbents. For instance, research by Alahyari et al . (2022) and Prajaputra and Isnaini (2023) demonstrated that pharmaceutical chemicals such as ibuprofen and metformin can be effectively removed from aqueous solutions using modified pumice stone, with removal efficiencies similar to those observed in this work. By the eighth day, further reductions were noted. Concentrations decreased to 100.4 µg/L in the coarse sand and granite setup and 85.7 µg/L in the unmodified pumice stone setup, with removal efficiencies of 35.8% and 45.2%, respectively. The modified pumice stone setup continued to exhibit significant reduction, with the aspirin concentration dropping to 82.5 µg/L, although this reflected a slightly lower removal efficiency of 47.2% compared to the fourth day. This suggests that while the modified pumice stone is highly effective, it may approach saturation over time, slightly reducing its adsorption efficiency. The observed removal efficiencies are comparable to those reported in other studies. Boushara et al . (2022) found a removal efficiency of 98.02% using phosphoric acid-modified coffee waste adsorbent for the removal of aspirin from aqueous solutions. This high efficiency underscores the potential of using modified natural adsorbents for pharmaceutical removal. Similarly, Rangbar and Moghadam (2019) reported removal efficiencies of 83.72-86.38% using carbon nanotubes to remove aspirin and atrazine from wastewater, indicating that advanced nanomaterials also offer high removal efficiencies for pharmaceutical contaminants. On the other hand, Satayeva et al . (2022) found removal efficiencies ranging from 50% to 90.2% in municipal wastewater of Nur-Sultan city, Kazakhstan, illustrating variability depending on the treatment conditions and the nature of the wastewater. These results reveal the effectiveness of pumice stone, particularly the modified version, in reducing aspirin concentrations in hospital wastewater. The modified pumice stone consistently achieved the highest removal efficiency, indicating its superior adsorption capacity for pharmaceutical contaminants such as aspirin. The integration of findings from relevant studies highlights the potential of various adsorbents and treatment methods in achieving significant reductions in pharmaceutical pollutants from wastewater, contributing to the ongoing efforts to mitigate environmental contamination from hospital effluents. 3.1.3 Ibuprofen The characterization of ibuprofen in hospital wastewater involved quantifying its concentrations at various treatment stages using high-performance liquid chromatography (HPLC). Initially, the concentration of ibuprofen in the untreated hospital wastewater was found to be 174.5 µg/L. This concentration is significantly higher than the 53 µg/L recorded by Park et al . (2020) during their investigation of the distribution and removal of pharmaceuticals in sewage treatment plants. The increased concentration observed in this study may be attributed to the specific sources and uses of ibuprofen in the hospital environment, suggesting a more concentrated pharmaceutical load in hospital wastewater compared to general sewage. In contrast, Davarnejad et al . (2017) and Majid et al . (2022) reported ibuprofen concentrations of 6840 µg/L in pharmaceutical wastewater, further highlighting the variability in pharmaceutical loads across different wastewater sources Significant reductions in ibuprofen concentrations were observed across different filtration setups during the experimental period. On the fourth day of treatment, the concentration of ibuprofen decreased to 112.6 µg/L in the coarse sand and granite setup, 98.4 µg/L in the unmodified pumice stone setup, and 90.3 µg/L in the modified pumice stone setup. These reductions correspond to removal efficiencies of 35.4%, 43.6%, and 48.3%, respectively. The modified pumice stone demonstrated superior performance in removing ibuprofen from the wastewater. These results align with previous studies on pharmaceutical compound removal from wastewater using adsorbents. For instance, Alahyari et al . (2022) and Prajaputra and Isnaini (2023) showed that modified pumice stone could successfully remove pharmaceutical chemicals such as ibuprofen and metformin from aqueous solutions, with removal efficiencies comparable to those observed in this work. Further reductions were evident by the eighth day. In the coarse sand and granite setup, the concentration of ibuprofen dropped to 109.5 µg/L, representing 37.3% removal efficiency. The unmodified pumice stone setup saw a reduction to 95.7 µg/L, achieving a 45.2% removal efficiency. The modified pumice stone setup continued to exhibit the highest efficacy, reducing the ibuprofen concentration to 87.5 µg/L, reflecting a slight decrease in removal efficiency to 49.8% compared to the fourth day. This suggests that while the modified pumice stone is highly effective, it may approach saturation over time, slightly reducing its adsorption efficiency. The results obtained in this study are consistent with several pertinent studies. For example, Senar et al . (2023) reported an 82% removal efficiency of selected pharmaceuticals using natural clay (Na-montmorillonite), while Basma et al . (2018) achieved a 99.2% removal efficiency of ibuprofen and diclofenac sodium using bentonite polyureaformaldehyde. Nadeem et al . (2022) demonstrated a 94% removal efficiency of ibuprofen and ofloxacin using biofilm reactors for hospital wastewater treatment. Additionally, Ghayda and Husam (2021) reported the removal of ibuprofen residues from municipal wastewater at concentrations of 1000000 µg/L using Moringa oleifera seeds. Further, Smook et al . (2008) compared the biodegradation of ibuprofen in various treatment systems and found removal efficiencies of up to 95%, while Majid et al . (2022) reported removal efficiencies of 91%-99.80% using a photocatalytic method with FeO photocatalyst supported on modified Iranian clinoptilolite for synthetic wastewater containing ibuprofen at concentrations of 83170 µg/L. Kwadwo et al . (2021) assessed the removal efficiency of pharmaceutical products in sewerage treatment plants and found a 99% removal efficiency for ibuprofen. These comprehensive findings emphasize the effectiveness of various adsorbents and treatment methods in removing ibuprofen from wastewater. The modified pumice stone consistently demonstrated the highest removal efficiency in this study, showcasing its enhanced adsorption capacity for pharmaceutical contaminants like ibuprofen, and suggesting its potential as a promising adsorbent for hospital wastewater treatment. 3.2 Concentration and removal efficiency of physicochemical characteristics 3.2.1 Biochemical Oxygen Demand (BOD) The Biochemical Oxygen Demand (BOD) results for the treated effluents from the continuous filtration system were compared with the NESREA (National Environmental Standards and Regulations Enforcement Agency) standard for BOD, which is set at 40 mg/L. At the commencement of the experiment, the BOD concentration in the untreated hospital wastewater was 364.2 mg/L. This finding is similar to Aniyikaiye et al . (2019) and Benit and Roslin (2015) study of physicochemical analysis of wastewater and they reported 162.8 – 974.7 mg/L, 246.3 mg/L - 569.5 mg/L respectively. This high level indicates a significant amount of biodegradable organic matter in the hospital effluent, posing a serious risk to the aquatic environment if discharged untreated. Similar findings were reported by Sajjad et al . (2014) and Ramdani et al . (2018), who noted that the presence of biological waste, disinfectants, and medications in hospital effluents frequently results in high quantities of organic matter. By the fourth day of treatment, the BOD concentrations had decreased substantially across all filtration setups. In the coarse sand and granite setup, the BOD concentration was reduced to 96.9 mg/L, representing 73.4% removal efficiency. However, this concentration still exceeded the NESREA standard. The unmodified pumice stone setup achieved a BOD concentration of 122.6 mg/L, corresponding to 66.4% removal efficiency, also above the NESREA limit. In contrast, the modified pumice stone setup demonstrated the highest reduction rate, with a BOD concentration of 21.3 mg/L, representing a 94.2% reduction. This value is well below the NESREA standard, indicating effective treatment. Similarly, Nadeem et al . (2022) demonstrated a 92% removal efficiency of BOD using biofilm reactors for hospital wastewater treatment. Further reductions in BOD were observed by the eighth day. The coarse sand and granite setup achieved a BOD concentration of 92.07 mg/L, slightly better than the fourth day but still above the NESREA standard. The unmodified pumice stone setup showed a concentration of 119.3 mg/L, reflecting a minor improvement but remaining non-compliant with NESREA requirements. The modified pumice stone setup continued to outperform the others, with a BOD concentration dropping to 18.6 mg/L, maintaining its compliance with the NESREA standard. Throughout the experiment, the modified pumice stone consistently demonstrated its effectiveness in reducing BOD levels to below the NESREA standard of 40 mg/L. On the other hand, both the coarse sand and granite and the unmodified pumice stone setups, despite achieving significant BOD reductions, did not meet the NESREA standard within the experimental period. The results highlight the superior performance of the modified pumice stone in treating hospital wastewater to safe discharge levels, showcasing its potential as a reliable adsorbent in wastewater treatment systems. 3.2.2 Chemical Oxygen Demand Chemical Oxygen Demand (COD) is a critical parameter for assessing the organic pollution in wastewater, indicating the amount of oxygen required to chemically oxidize organic compounds. The NESREA standard for COD in treated effluent is set at 80 mg/L. The COD levels in the untreated hospital wastewater were measured at 428.1 mg/L, indicating a high level of organic pollutants that could significantly harm aquatic ecosystems if discharged without adequate treatment. The result of this finding corroborate that of Salifu et al . (2022); Ramdani et al . (2018) and Sajjad et al . (2014) where COD levels range from 162, 390 and 405 mg/L respectively. This result also corroborates the findings of Aniyikaiye et al . (2019) and Benit and Roslin (2015) in the study of physicochemical analysis of wastewater and they reported 543 – 1231 mg/L, 506.9–602.9 mg/L respectively. During the experiment, the COD concentrations showed substantial decreases in all treatment setups by the fourth day. In the coarse sand and granite setup, the COD concentration was reduced to 112.6 mg/L, indicating 73.7% removal efficiency. Although this represents a significant reduction, the concentration remains above the NESREA standard. In the unmodified pumice stone setup, the COD concentration dropped to 146.7 mg/L, corresponding to a 65.8% removal efficiency, which also exceeds the NESREA limit. The modified pumice stone setup, however, achieved the most substantial reduction, with the COD concentration decreasing to 38.1 mg/L, representing 91.1% removal efficiency, well below the NESREA standard. These results correspond to the study conducted by Davarnejad et al . (2017) which reported 98.3% removal efficiency for COD in pharmaceutical wastewater, further highlighting the variability in pharmaceutical loads across different wastewater sources. Further improvements in COD removal were observed by the eighth day. In the coarse sand and granite setup, the COD concentration further decreased to 109.5 mg/L, showing a slight improvement but still above the NESREA standard. The unmodified pumice stone setup recorded a COD concentration of 143.7 mg/L, also slightly improved but non-compliant with NESREA requirements. The modified pumice stone setup continued to demonstrate superior performance, with the COD concentration dropping to 33.5 mg/L, maintaining compliance with the NESREA standard. The removal efficiency for COD, in this study can also be compare to Nadeem et al . (2022) demonstrated 96% removal efficiency for COD using biofilm reactors for hospital wastewater treatment. When treating antiosmotic drug-based pharmaceutical effluent (acetic acid and ammonia) in a fluidized bed reactor (FBR) under anaerobic conditions, Saravanane et al . (Saravanane et al ., 2001) discovered an 88.5% elimination of COD. Additionally, Saravananeet al. (Saravananeet al., 2001) investigated the Up-flow Anaerobic Fluidized Bed (UAFB) system for the treatment of pharmaceutical effluent based on cephalexin drugs. A COD reduction of 65% was achieved when Ince et al . (2002) investigated the treatment efficacy of an Up-flow Anaerobic Filter (UAF) for a chemical synthesis-based pharmaceutical wastewater (Bacampicilline and Sultamicilline tosylate). In 2003, Buitrónet al. investigated the 95–97% COD removal effectiveness of a Sequencing Batch Bio-filter (SBB) that combined anaerobic and aerobic conditions in a single tank to treat pharmaceutical wastewater (including phenols and O-nitroaniline). Zhou et al . studied and employed a combination system comprising an anaerobic baffled reactor (ABR) and a biofilm airlift suspension reactor (BASR) (Zhou et al ., 2006). The data indicates that the modified pumice stone consistently provided the most effective reduction of COD levels, achieving compliance with the NESREA standard of 80 mg/L by the fourth day and maintaining it through the eighth day. This underscores the efficacy of modified pumice stone as a highly effective adsorbent for treating organic pollutants in hospital wastewater. Conversely, while the coarse sand and granite, and unmodified pumice stone setups showed considerable COD reductions, they did not achieve the NESREA permissible limit. 3.2.3 Total Suspended Solids Total Suspended Solids (TSS) are particles that are suspended in water, including silt, decaying plant and animal matter, industrial wastes, and sewage. High levels of TSS can reduce water clarity, hinder photosynthesis, and affect aquatic life. The NESREA standard for TSS in treated effluent is set at 10 mg/L. The untreated hospital wastewater showed high TSS concentrations, with initial levels measured at 364.2 mg/L. Similarly, in the study of physicochemical analysis of wastewater by Aniyikaiye et al . (2019), they reported 2470 mg/L. During the experiment, significant reductions in TSS were observed across all treatment setups by the fourth day. In the coarse sand and granite setup, TSS concentrations dropped to 96.9 mg/L, representing a 73.4% reduction rate. Although substantial, this value is still significantly above the NESREA standard. In the unmodified pumice stone setup, TSS levels decreased to 122.6 mg/L, corresponding to a 66.4% reduction, which also exceeds the NESREA limit. The modified pumice stone setup, however, achieved a remarkable reduction, with TSS concentrations decreasing to 21.3 mg/L, indicating a 94.2% reduction, approaching but not quite meeting the NESREA standard. By the eighth day, further reductions in TSS concentrations were recorded. The coarse sand and granite setup showed a slight improvement, with TSS levels at 92.1 mg/L, which is still non-compliant with the NESREA standard. The unmodified pumice stone setup recorded a TSS concentration of 119.3 mg/L, showing a minor improvement but still exceeding the NESREA limit. The modified pumice stone setup demonstrated the highest efficiency, reducing TSS levels to 18.6 mg/L, representing a 94.9% reduction rate, which still falls short of the NESREA standard. Salifu et al . (2022) and Sajjad et al . (2014) reported similar variations in TSS concentrations in hospital wastewater, highlighting the need for robust treatment systems to achieve regulatory compliance. These results indicate that while all setups achieved significant reductions in TSS levels, only the modified pumice stone setup came close to meeting the stringent NESREA standard of 10 mg/L. The coarse sand and granite, as well as the unmodified pumice stone setups, while effective to a degree, did not achieve compliance within the experimental period, suggesting that additional treatment stages or longer treatment durations might be required to meet regulatory standards. 3.2.4 Turbidity Turbidity measures the cloudiness or haziness of water caused by large numbers of individual particles that are generally invisible to the naked eye, similar to smoke in air. It is an important indicator of water quality, as high turbidity levels can reduce the efficiency of disinfection, promote microbial growth, and harm aquatic life. The NESREA standard for turbidity in treated effluent is set at 0.2 NTU. At the beginning of the experiment, the turbidity levels in the untreated hospital wastewater were very high, measured at 174.6 NTU. The turbidity concentration report for sample Z is comparable to that of Salifu et al . (2022) study, which found that hospital waste water had a turbidity concentration of 304 NTU. Significant reductions in turbidity were observed across all treatment setups by the fourth day. In the coarse sand and granite setup, turbidity levels dropped to 7.7 NTU, corresponding to a 94.6% reduction rate. Although this reduction is substantial, the turbidity level remains significantly above the NESREA standard. In the unmodified pumice stone setup, turbidity levels decreased slightly more to 8.5 NTU, representing a 95.1% reduction, which, like the previous setup, is still well above the NESREA limit. The modified pumice stone setup showed the most significant reduction rate, with turbidity levels dropping to 1.6 NTU, indicating a 99.1% reduction. Despite this significant improvement, it still exceeds the NESREA standard. By the eighth day, further reductions in turbidity levels were recorded. The coarse sand and granite setup showed a minor improvement, with turbidity levels at 7.5 NTU, slightly better than the fourth day but still non-compliant with the NESREA standard. The unmodified pumice stone setup recorded a turbidity level of 8.4 NTU, showing a minor improvement but still far above the NESREA limit. The modified pumice stone setup demonstrated the highest efficiency, reducing turbidity levels to 1.5 NTU, representing a 99.1% reduction. Although this is a remarkable reduction, it still does not meet the NESREA standard of 0.2 NTU. These results indicate that while all setups achieved significant reductions in turbidity levels, only the modified pumice stone setup approached the NESREA standard for turbidity. The coarse sand and granite setup, as well as the unmodified pumice stone setup, while effective in reducing turbidity to a large extent, did not achieve compliance with the NESREA limit within the experimental timeframe. This suggests that additional treatment stages or longer treatment durations might be required to meet the regulatory standards. 3.2.5 Total Nitrogen Total nitrogen is a key parameter in assessing water quality, encompassing all forms of nitrogen, including nitrate, nitrite, ammonia, and organic nitrogen. High levels of total nitrogen in water bodies can lead to eutrophication, which promotes excessive growth of algae and other aquatic plants, subsequently leading to oxygen depletion and negative impacts on aquatic life. The NESREA standard for total nitrogen in treated effluent is set at 10 mg/L. At the beginning of the experiment, the concentration of total nitrogen in the untreated hospital wastewater was 12.6 mg/L. Over the course of the treatment period, significant reductions in total nitrogen concentrations were observed in all setups. On the fourth day, the total nitrogen levels had reduced in each setup. The coarse sand and granite setup reduced the total nitrogen concentration to 1.1 mg/L, significantly below the NESREA standard, indicating effective nitrogen removal. This represents a substantial reduction from the initial concentration. The unmodified pumice stone setup also demonstrated a significant reduction, with total nitrogen levels dropping to 1.8 mg/L. Although this is slightly higher than the coarse sand and granite setup, it is still well within the NESREA limit. The modified pumice stone setup showed the highest efficiency in nitrogen removal, reducing the concentration to 0.2 mg/L, which is substantially lower than the NESREA standard. Further reductions were observed by the eighth day. The coarse sand and granite setup maintained its effectiveness, with total nitrogen levels slightly increasing to 1.1 mg/L, still below the NESREA limit. The unmodified pumice stone setup showed a slight increase as well, with total nitrogen levels rising to 2.1 mg/L. Despite this increase, it remains within the NESREA standard, although less effective than the other setups. The modified pumice stone setup continued to perform exceptionally well, reducing total nitrogen levels further to 0.2 mg/L, showcasing its superior nitrogen removal capability. These results indicate that all treatment setups effectively reduced the total nitrogen concentrations to levels compliant with the NESREA standard. The coarse sand and granite setup, unmodified pumice stone setup, and modified pumice stone setup all achieved and maintained nitrogen concentrations well below the 10 mg/L threshold throughout the experiment. The modified pumice stone setup, in particular, demonstrated the highest efficiency in total nitrogen removal, consistently achieving the lowest nitrogen levels both on the fourth and eighth days. The effectiveness of the modified pumice stone in removing total nitrogen revealed its potential as a highly efficient adsorbent material for treating hospital wastewater. The slight increases in nitrogen levels in the coarse sand and granite and unmodified pumice stone setups towards the end of the experimental period suggest that while these methods are effective, there may be a need for optimization to sustain lower nitrogen levels over extended periods. 3.2.6 Total Phosphorus Total phosphorus is a significant indicator for assessing the quality of water since, like nitrogen, high phosphorus levels can cause eutrophication, which is the growth of algae and aquatic plants. Depletion of oxygen may come from this, which would impact aquatic life and water quality. Total phosphorus in treated effluent must conform to a NESREA standard of 2 mg/L. 8.7 mg/L of total phosphorus was present in the untreated hospital wastewater at the beginning of the experiment. On the fourth day, the coarse sand and granite setup effectively reduced the total phosphorus concentration to 0.9 mg/L, which is significantly below the NESREA standard. This demonstrates a high level of phosphorus removal, corresponding to a reduction efficiency of 90%. The unmodified pumice stone setup also performed well, reducing the total phosphorus level to 0.4 mg/L. This result indicates a remarkable reduction and compliance with the NESREA limit, highlighting the efficiency of pumice stone as an adsorbent. The modified pumice stone setup showed the highest reduction efficiency, bringing the total phosphorus concentration down to 0.04 mg/L. This represents an almost complete removal of phosphorus, with a reduction efficiency of over 99%. By the eighth day, the total phosphorus concentrations had further decreased in all setups. The coarse sand and granite setup continued to maintain its effectiveness, reducing the total phosphorus level to 0.1 mg/L. This demonstrates sustained efficiency in phosphorus removal. The unmodified pumice stone setup showed a slight increase in phosphorus concentration to 0.5 mg/L, which is still well within the NESREA standard, indicating consistent performance over time. The modified pumice stone setup continued to exhibit superior performance, with the total phosphorus concentration slightly decreasing to 0.04 mg/L. This further highlights the exceptional capacity of modified pumice stone in removing phosphorus from wastewater. These results indicate that all treatment setups were effective in reducing total phosphorus concentrations to levels that comply with the NESREA standard. The coarse sand and granite setup, unmodified pumice stone setup, and modified pumice stone setup all achieved significant reductions in phosphorus levels, with the modified pumice stone showing the highest removal efficiency. The sustained low levels of total phosphorus in the modified pumice stone setup throughout the experimental period underscore its potential as a highly effective adsorbent material for wastewater treatment. The effectiveness of the modified pumice stone in removing total phosphorus demonstrates its suitability for treating hospital wastewater, ensuring compliance with regulatory standards and protecting water quality. The consistent performance of the other setups also indicates their viability, although the slight increase in phosphorus levels in the unmodified pumice stone setup by the eighth day suggests a need for periodic monitoring and potential optimization to maintain low phosphorus levels over extended periods. CONCLUSION The study investigated the effectiveness of modified pumice stone in the treatment of wastewater from tertiary hospital. The primary objectives included characterizing hospital wastewater for the target pharmaceuticals, assessing the removal efficiency of these pharmaceuticals, evaluating the impact of pumice stone modification on its adsorption characteristics, and determining the removal efficiency of various physicochemical parameters. The results demonstrated that the modified pumice stone significantly enhanced the removal of paracetamol, aspirin, and ibuprofen compared to unmodified pumice stone and the control setup (coarse sand and granite). On the fourth day, the concentrations of paracetamol dropped to 106.2 µg/L, 92.8 µg/L and 85.0 µg/L for the control, unmodified and modified pumice stone treatments, respectively, corresponding to removal efficiencies of 34.5%, 42.8%, and 47.6%. Similar trends were observed for aspirin and ibuprofen, with the modified pumice stone consistently showing the highest removal rates. In terms of physicochemical parameters, the modified pumice stone also exhibited superior performance. For instance, the BOD levels in the effluent were reduced to 21.3 mg/L on the fourth day and further to 18.6 mg/L on the eighth day, indicating removal efficiencies of 94.2% and 94.9%, respectively. Other parameters, including COD, total suspended solids, turbidity, total nitrogen, and total phosphorus, also showed significant reductions, meeting or surpassing NESREA standards. The study concludes that the modification of pumice stone as an adsorbent significantly improves its adsorption capacity and effectiveness in removing pharmaceutical contaminants and other pollutants from hospital wastewater. These findings suggest that modified pumice stone is a promising material for enhancing wastewater treatment processes, contributing to improved water quality and environmental protection. Recommendations Based on the findings of this study, the following recommendations were proposed to enhance the treatment and management of hospital wastewater to reduce pharmaceutical and physicochemical contaminants effectively. They include the following: Wastewater treatment facilities, especially those handling hospital effluents, should consider incorporating modified pumice stone into their treatment processes to enhance the removal of pharmaceutical contaminants and other pollutants. Continued research should focus on optimizing the modification process of pumice stone to further improve its adsorption efficiency and cost-effectiveness. Declarations Consent to Participate declaration : Not applicable Consent to publish declaration : Not applicable Clinical trial registration : Not applicable Ethics declaration : Not applicable Funding : No funding was received for this study. Competing Interests The authors declare that they have no competing interests Author Contributions (Author 1: Adekunle Adesuyi ADEMUWAGUN): Conceptualization, methodology, writing – original draft, data curation, analysis and funding (Author 2: Suraju Adekunle LATEEF): Review and editing, supervision, project administration. References Akbal, F., (2005a). Adsorption of basic dyes from aqueous solution onto pumice powder, J. Colloid Interface Science. 286(2): 455–458. Akbal, F., (2005b). Sorption of phenol and 4-chlorophenol onto pumice treated with cationic surfactant. Journal of environmental management. 74(3); 239–244 Altin, S., Altin, A., Elevli, B., (2003). Determination of hospital waste composition and disposal methods: Acase study. Polish Journal of Environmental Studies 12 (2): 251 – 255 Amouei, A.H., Asgharnia, H., Amouei, M., (2011). Quantity and quality of wastewater in the hospitals of Babol medicl university (Iran) and effects on the environmental health. 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Chem. 372 (4), 569–575 Tables Table 3.1: Pharmaceuticals and physicochemical characterization of hospital wastewater Parameter Unit Initial concentration Coarse sand and granite Unmodified Pumice stone Modified pumice stone Paracetamol µg/L 162.2 104.7 92.8 87.4 Aspirin µg/L 49.7 31.4 25.8 21.7 Ibuprofen µg/L 145.2 95.5 80.9 72.9 BOD mg/L 364.2 96.9 122.6 21.3 COD mg/L 428.1 112.6 146.7 38.1 Total Suspended Solids mg/L 388.1 2.14 4.81 0.51 Turbidity NTU 174.6 7.7 8.5 16 Total Nitrogen mg/L 38.7 1.1 1.8 0.2 Total Phosphorus mg/L 8.7 0.9 0.4 0.004 Table 3.2: Removal efficiency of measured physicochemical parameters for pre and post treatment Parameter (s) Initial Concentration (mg/L) Final Concentration (mg/L) NESREA Removal Efficiency (%) BOD (mg/L) Coarse sand and granite 364.22 94.54 40 mg/L 74.10 Unmodified pumice stone 364.22 121.01 67.81 Modified pumice stone 364.22 20.00 94.50 COD (mg/L) Coarse sand and granite 428.12 111.12 80 mg/L 74.10 Unmodified pumice stone 428.12 145.22 66.10 Modified pumice stone 428.12 35.91 91.60 Total Suspended Solids (mg/L) Coarse sand and granite 388.09 2.23 10 mg/L 99.41 Unmodified pumice stone 388.09 5.02 98.72 Modified pumice stone 388.09 0.54 99.90 Turbidity (NTU) Coarse sand and granite 174.60 7.63 0.2 NTU 95.60 Unmodified pumice stone 174.60 8.50 95.12 Modified pumice stone 174.60 1.60 99.10 Total Nitrogen (mg/L) Coarse sand and granite 38.74 1.10 10 mg/L 97.20 Unmodified pumice stone 38.74 2.00 94.80 Modified pumice stone 38.74 0.20 99.50 Total Phosphorus (mg/L) Coarse sand and granite 8.68 0.10 98.90 Unmodified pumice stone 8.68 0.50 2 mg/L 94.31 Modified pumice stone 8.68 0.04 99.52 Plate Plate 2.3 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Plate2.3.png Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7038270","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":487884774,"identity":"a10251a2-c7ef-4094-9ca2-01a6c43c1d73","order_by":0,"name":"Adekunle Adesuyi Ademuwagun","email":"data:image/png;base64,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","orcid":"","institution":"University of Ibadan","correspondingAuthor":true,"prefix":"","firstName":"Adekunle","middleName":"Adesuyi","lastName":"Ademuwagun","suffix":""},{"id":487884775,"identity":"a7d84dc2-9255-48d2-a962-e79bbb3ddc99","order_by":1,"name":"Suraju Adekunle Lateef","email":"","orcid":"","institution":"University of Ibadan","correspondingAuthor":false,"prefix":"","firstName":"Suraju","middleName":"Adekunle","lastName":"Lateef","suffix":""}],"badges":[],"createdAt":"2025-07-03 12:38:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7038270/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7038270/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87226424,"identity":"5f52d8f4-b607-4d01-9b81-9052c0474933","added_by":"auto","created_at":"2025-07-21 17:25:59","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1043113,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 2.1a: UCH Wastewater Treatment Plant\u003c/p\u003e\n\u003cp\u003eFigure 2.1b: Geographical Location of UCH\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7038270/v1/498b7e1332420ed597de3fdd.png"},{"id":87226420,"identity":"31be6917-82ad-4866-9a7d-16bd5c52169a","added_by":"auto","created_at":"2025-07-21 17:25:59","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":23713,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.1.1a: Concentrations of paracetamol in wastewater over the course of the experiment\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7038270/v1/c3029ad947b28c25e35369bd.png"},{"id":87226421,"identity":"6bfb38b9-3c2d-4a1b-8d48-a27a56d665a0","added_by":"auto","created_at":"2025-07-21 17:25:59","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":15488,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.1.1b: Removal efficiency of paracetamol from treated wastewater\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7038270/v1/ab9817bf68e7b744e0d1a9f1.png"},{"id":87226825,"identity":"6b911d55-498f-4329-b841-c2a4be438fe7","added_by":"auto","created_at":"2025-07-21 17:34:00","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":21424,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.1.2a: Concentrations of aspirin in wastewater over the course of the experiment\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7038270/v1/a68d741e1e395923c46249a3.png"},{"id":87226432,"identity":"08ad4cb3-5c41-4f4e-a895-8b010c6fc46e","added_by":"auto","created_at":"2025-07-21 17:26:00","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":13564,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.1.2b: Removal efficiency of aspirin from treated wastewater\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7038270/v1/ad5ca58ac249c142916730d5.png"},{"id":87227810,"identity":"b14c2d1f-0563-4612-95e1-48d23789a47b","added_by":"auto","created_at":"2025-07-21 17:50:00","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":25144,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.1.3a: Concentrations of ibuprofen in wastewater over the course of the experiment\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-7038270/v1/b489a93a2d85118b22dff274.png"},{"id":87227812,"identity":"984611c1-1a63-49c1-9612-5d7a0e8faddb","added_by":"auto","created_at":"2025-07-21 17:50:00","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":13513,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.1.3b: Removal efficiency of ibuprofen from treated wastewater\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-7038270/v1/e2ed449ec86eaad2f218a750.png"},{"id":87226435,"identity":"cdd23ea3-a129-42df-9393-97a362ab9cf8","added_by":"auto","created_at":"2025-07-21 17:26:00","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":24190,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.2.1a: Level of BOD in wastewater during the course of the experiment\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-7038270/v1/c10eb4444b1f0c9d40ce3bf6.png"},{"id":87226426,"identity":"1d434a42-cd6b-40b1-a027-a066515617ef","added_by":"auto","created_at":"2025-07-21 17:25:59","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":14902,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.2.1b: Removal efficiency of BOD from treated wastewater\u003c/p\u003e","description":"","filename":"9.png","url":"https://assets-eu.researchsquare.com/files/rs-7038270/v1/e42c717640cb2428ff4fa499.png"},{"id":87227598,"identity":"746aec06-d48e-4245-8b41-540cb798c7c2","added_by":"auto","created_at":"2025-07-21 17:42:00","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":25457,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.2.2a: Level of COD in wastewater during the course of the experiment\u003c/p\u003e","description":"","filename":"10.png","url":"https://assets-eu.researchsquare.com/files/rs-7038270/v1/713ec5783f16055f64d2ca5b.png"},{"id":87228403,"identity":"ff77bc2c-f721-4853-9649-2eec90b3e442","added_by":"auto","created_at":"2025-07-21 17:58:00","extension":"png","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":15439,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.2.2b: Removal efficiency of COD from treated wastewater\u003c/p\u003e","description":"","filename":"11.png","url":"https://assets-eu.researchsquare.com/files/rs-7038270/v1/31c8d05b3d7428676f1b8c58.png"},{"id":87226821,"identity":"f2fbfa2e-57e0-46ef-958f-abdb3c139dd2","added_by":"auto","created_at":"2025-07-21 17:33:59","extension":"png","order_by":12,"title":"Figure 12","display":"","copyAsset":false,"role":"figure","size":28393,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.2.3a: Level of Total Suspended Solids in wastewater during the course of the experiment\u003c/p\u003e","description":"","filename":"12.png","url":"https://assets-eu.researchsquare.com/files/rs-7038270/v1/e51d625b724487383a2cdfe8.png"},{"id":87226822,"identity":"ccea88eb-7594-4104-81b6-080c78c2c75d","added_by":"auto","created_at":"2025-07-21 17:33:59","extension":"png","order_by":13,"title":"Figure 13","display":"","copyAsset":false,"role":"figure","size":17474,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.2.3b: Removal efficiency of Total Suspended Solids from treated wastewater\u003c/p\u003e","description":"","filename":"13.png","url":"https://assets-eu.researchsquare.com/files/rs-7038270/v1/0214dc9331e69e5984edefe8.png"},{"id":87226444,"identity":"174a6fe6-3c0c-4b3f-9d3e-229d480a6d4d","added_by":"auto","created_at":"2025-07-21 17:26:00","extension":"png","order_by":14,"title":"Figure 14","display":"","copyAsset":false,"role":"figure","size":23600,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.2.4a: Level of Turbidity in wastewater during the course of the experiment\u003c/p\u003e","description":"","filename":"14.png","url":"https://assets-eu.researchsquare.com/files/rs-7038270/v1/a9b08d2ff75b35d452ec9c06.png"},{"id":87227600,"identity":"3de3c7e1-f039-45da-949e-83177476b5fe","added_by":"auto","created_at":"2025-07-21 17:42:00","extension":"png","order_by":15,"title":"Figure 15","display":"","copyAsset":false,"role":"figure","size":15055,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.2.4b: Removal efficiency of Turbidity from treated wastewater\u003c/p\u003e","description":"","filename":"15.png","url":"https://assets-eu.researchsquare.com/files/rs-7038270/v1/0dda93fa6de02442ec818cc5.png"},{"id":87226439,"identity":"751ae180-68c3-4481-91fe-269d76307d98","added_by":"auto","created_at":"2025-07-21 17:26:00","extension":"png","order_by":16,"title":"Figure 16","display":"","copyAsset":false,"role":"figure","size":24538,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.2.5a: Level of Total Nitrogen in wastewater during the course of the experiment\u003c/p\u003e","description":"","filename":"16.png","url":"https://assets-eu.researchsquare.com/files/rs-7038270/v1/672002340f00c7f1d60d2541.png"},{"id":87226431,"identity":"3b348d93-8645-4a74-be12-43807cab2516","added_by":"auto","created_at":"2025-07-21 17:25:59","extension":"png","order_by":17,"title":"Figure 17","display":"","copyAsset":false,"role":"figure","size":16081,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.2.5b: Removal efficiency of Total Nitrogen from treated wastewater\u003c/p\u003e","description":"","filename":"17.png","url":"https://assets-eu.researchsquare.com/files/rs-7038270/v1/2ff2e0933ef303b721d39018.png"},{"id":87226832,"identity":"719b9b4e-f17b-454a-92d5-857b1235fe7e","added_by":"auto","created_at":"2025-07-21 17:34:00","extension":"png","order_by":18,"title":"Figure 18","display":"","copyAsset":false,"role":"figure","size":27303,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.2.6a: Level of Total phosphorus in wastewater during the course of the experiment\u003c/p\u003e","description":"","filename":"18.png","url":"https://assets-eu.researchsquare.com/files/rs-7038270/v1/9cfa127cc00a3f80e32c6184.png"},{"id":87226827,"identity":"856cbfd5-736e-4a2c-9c26-7ea1c3ca699c","added_by":"auto","created_at":"2025-07-21 17:34:00","extension":"png","order_by":19,"title":"Figure 19","display":"","copyAsset":false,"role":"figure","size":15521,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.2.6b: Removal efficiency of Total phosphorus from treated wastewater\u003c/p\u003e","description":"","filename":"19.png","url":"https://assets-eu.researchsquare.com/files/rs-7038270/v1/b8cb8a2955e115d23c4dfd26.png"},{"id":88212130,"identity":"6296c7b0-cd4b-4c89-a4cc-9cf74022c33c","added_by":"auto","created_at":"2025-08-04 05:39:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2760269,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7038270/v1/8f99dcac-afa6-4c06-95a9-8e3d1d7a75cd.pdf"},{"id":87226428,"identity":"7ae82f5b-a36e-4f6b-86d2-0bc86896557a","added_by":"auto","created_at":"2025-07-21 17:25:59","extension":"png","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":569446,"visible":true,"origin":"","legend":"","description":"","filename":"Plate2.3.png","url":"https://assets-eu.researchsquare.com/files/rs-7038270/v1/fc73fa72bd1c2592ef44d5c7.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEffectiveness of Modified Pumice Stone in the Treatment of Waste Water from Tertiary Hospital\u003c/p\u003e","fulltext":[{"header":"1 INTRODUCTION","content":"\u003cp\u003ePharmaceutical and personal care items have become major contaminants in aquatic habitats due to industrialization and human activity, affecting water quality and causing significant damage to aquatic ecosystems, including homes, workplaces, hospitals, and sewage treatment facilities (Davarnejad et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Sophia and Lima, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The pharmaceutical sector's growth is driven by societal demand for medication, but it is also a major environmental polluter, primarily from production sites, resulting in waste streams like process liquors and solvents, according to Shalini et al. (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Hospitals use various chemicals for medical and scientific purposes, including solvents, medications, radionuclides, and disinfectants, which are then discharged into the municipal sewer networks (Emmanuel et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). Untreated waste can lead to radioactive pollution, water contamination, and the spread of infectious diseases (Gautam et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). The study on hospital wastewater's physiochemical and bacteriological characteristics revealed that its discharge contaminated the receiving environment, including air, soil, and water.\u003c/p\u003e\u003cp\u003eAdditionally, it might be harmful to people's health (Ekhaise and Omavwoya, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Every day, hospitals produce large amounts of wastewater (Amouei et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Hospitals are expected to produce between 362 and 745 liters of wastewater per occupied day on average (Amouei et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Beyene and Redaie, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Nasr and Yazdanbakhsh, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Sarafraz et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). There has to be extra care given to this massive amount of toxic wastewater. Hospitals generate risk waste, including sharps, pharmaceuticals, and genotoxic substances. Research on hazardous waste creation and handling has been conducted in various countries, including Iran, South Africa, China, Germany, Korea, Egypt, UK, Turkey, Bangladesh, India, and Congo (Altin et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Anwar et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Blenkharn, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Karamouz et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Seema et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePumice is a light-colored, porous volcanic stone with a sizable surface area. According to Asgari et al. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), it is often pale in color, ranging from white, cream, blue, or grey to green-brown or black. It is utilized in the treatment of water and wastewater as an adsorbent, filter bed, and support material (Akbal, 2005). According to Liu et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), pumice's porous and amorphous features result in a high surface area and skeletal structure with open channels that allow water and ions to enter and exit the crystal structure. It is created when bubbles that are generated by volcanic gases evolving from viscous magma are unable to easily separate from the viscous magma before cooling to glass (Asgari et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). With an average porosity of 90%, pumice is the most porous material known to exist. It also floats on water at first, and its \u0026ndash;OH groups are crucial for surface activity (Asgari et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Calabro et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Scanning electron microscopy (SEM) suggests that chemical treatment might enhance the porosity and rough surface of pumice (Chuan et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Sepehr, 2013).\u003c/p\u003e\u003cp\u003ePharmaceutical compounds have been removed from various matrices using a variety of techniques (Caban and Stepnowski, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Taoufk et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). These techniques include filtration (Femina \u003cem\u003eet al\u003c/em\u003e., 2021; Gu et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Taheran et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), advanced oxidation processes (Akbari et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Bastami et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Brillas, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Kanakaraju et al. \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Sruthi et al., 2021), ion exchange (Jiang \u003cem\u003eet al\u003c/em\u003e., 2015), biological treatment (Tiwari et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), and adsorption (Bello and Raman, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Duarte et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Osman et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Ranjbari et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Adsorption, on the other hand, has drawn a lot of interest among these techniques because of its affordability, ease of use, high efficiency, regenerability, and scalability (Ayati \u003cem\u003eet al\u003c/em\u003e., 2019; Karimi-Maleh et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Shahinpour et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Pharmaceutical compounds can now be removed from aqueous solutions more effectively via adsorption (Ahmed, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Huang et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Igwegbe et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Prasetya et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWater quality monitoring is crucial for life and the planet's function, especially for residential and commercial applications. Emerging contaminants, which can infiltrate ecosystems, negatively impact ecological and human health. (Alistair et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Jiri, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Patel et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Pharmaceuticals, including estrogen and birth control hormones, are used to treat illnesses and infections, but their presence in water bodies is concerning (Bhushan et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Pharmaceutical contaminants, biologically active substances used to treat, prevent, or cure diseases, are a concerning type of ECs originating from the pharmaceutical sectors (Mahapatra et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Samal and Trivedi, 2020; Tiwari et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePharmaceuticals, which interact with living organisms, pose a threat to the ecosystem through industrial discharges, agricultural runoffs, human and animal excreta, and hospital effluents, posing a significant environmental risk (Feier et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Gojkovic et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Hollman et al., \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Hospital effluents, including hazardous chemicals, solvents, active pharmaceuticals, metabolites, disinfectants, and heavy metals, pose a significant environmental threat due to their high mobility in the liquid phase (Bhushan et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Samal et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Samal et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePharmaceutical pollutants from PPCPs can cause genotoxic, mutagenic, and ecotoxicological impacts on humans, animals, and plants, potentially leading to long-term chronic effects on aquatic plants and animals (Jukosky et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Jukosky et al. (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2008\u003c/span\u003e) discovered that estrogen induces vitellogenesis in male Oryzias latipes (Japanese Medaka). High estrogenicity also raised the fish death rate. Living things' genetic traits and behaviors may alter as a result of PC exposure (Tiwari et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe presence of estrogen in drinking water can cause male fish to transform into females, negatively impacting older adults, neonates, and those with renal or hepatic impairment, and potentially increasing the incidence of testicular and breast cancer (Mahapatra et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Schaider et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Webb et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). Drinking water-based anti-cancer medications can cross the blood-placenta barrier, causing teratogenic and embryotoxic effects, making them particularly risky for expectant mothers (Aschengrau et al., \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Nor et al., \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Zwiener, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). The high prevalence of polychlorinated biphenyls (PCs) in water sources has severe health impacts on humans and animals, necessitating the development of efficient treatment techniques.\u003c/p\u003e\u003cp\u003eHowever, there is paucity of data on the use of modified pumice stone filtration system for removing these contaminants, hence the need for this study. It is this perspective that the present study is made and investigated the effectiveness of modified pumice stone in the treatment of wastewater from tertiary hospital with the following specific objectives: (1) to characterize hospital wastewater for Paracetamol, Aspirin, and Ibuprofen; (2) to determine the removal efficiencies of Paracetamol, Aspirin, and Ibuprofen from hospital wastewater treatment with pumice stone; (3) to determine the impact of modified pumice stone as an adsorbent on its pharmaceuticals and physicochemical characteristics pre and post hospital wastewater treatment and (4) to assess the effectiveness of a modified pumice stone adsorbent treatment in reducing physicochemical characteristics of the treated hospital wastewater.\u003c/p\u003e"},{"header":"2 MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study Area\u003c/h2\u003e\u003cp\u003eThe wastewater for this study was collected from wastewater treatment plant, University College Hospital, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2.1\u003c/span\u003e. The study was primarily designed to explore the use of modified pumice stone for the treatment of wastewater from hospital.\u003c/p\u003e\u003cp\u003eThe University College Hospital (UCH) is a prestigious tertiary healthcare facility located in Ibadan, Oyo State, Nigeria. As a university teaching hospital affiliated with the University of Ibadan, UCH serves as a major referral centre and a training ground for medical professionals. UCH boasts an extensive infrastructure, with approximately 1000 bed spaces and 200 examination couches, typically operating at an occupancy rate of 65\u0026ndash;70%. The hospital caters to a wide range of medical specialties, including general medicine, surgery, pediatrics, obstetrics and gynecology, and various subspecialties. In addition, to the main hospital complex, UCH also houses staff residential quarters and student hostels, which accommodate healthcare professionals, support staff, and medical students associated with the university. The presence of these residential facilities indicates that domestic wastewater from housing units may contribute to the overall wastewater stream entering the UCH waste water treatment plant (WWTP).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Procurement, preparation and modification of pumice stone\u003c/h2\u003e\u003cp\u003eThe pumice stone that was modified and used as adsorbent in this study were procured from Bode market, Ibadan, Oyo State, Nigeria. Before modification and utilization, pumice stones underwent a thorough cleansing process involving multiple rinses with distilled water to eliminate any impurities, followed by oven-drying at 25\u0026thinsp;\u0026plusmn;\u0026thinsp;1\u0026deg;C. Subsequently, the stones were pulverized and sifted to obtain particle size fractions of 1.18mm. These particles were then subjected to physical and chemical modification treatments. For the physical treatment, the pulverized particles underwent heat treatment by exposure to temperatures of 90\u003csup\u003eo\u003c/sup\u003eC, 180\u003csup\u003eo\u003c/sup\u003eC, and 270\u003csup\u003eo\u003c/sup\u003eC for duration of 4 hours each. Concurrently, chemical treatment involved immersing and agitating the ground pumice in solutions of 1 M HCl, 1 M H\u003csub\u003e2\u003c/sub\u003eSO\u003csub\u003e4\u003c/sub\u003e, and 1 M HNO\u003csub\u003e3\u003c/sub\u003e for a period of 4 hours, followed by rinsing with distilled water and subsequent drying at 130\u003csup\u003eo\u003c/sup\u003eC for 3 hours.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Experimental setup of continuous filtration systems\u003c/h2\u003e\u003cp\u003eThe experimental setup involved the construction of three distinct filtration systems as shown in plate 2.3, to assess continuous processes. Each setup consisted of specific materials arranged within the filtration system to evaluate their performance. The first setup utilized coarse sand and granite; the second setup included coarse sand, granite, and unmodified pumice stone, while the third setup incorporated coarse sand, granite, and modified pumice stone. Granite was processed into particles and sieved alongside coarse sand to achieve particle size fractions of 1.18 mm, ensuring uniformity in the materials used. The systems were assembled with dimensions spaced 6cm apart to facilitate optimal flow and interaction between the materials. The arrangement of layers, consisting of coarse sand, granite, and pumice stone, was carefully selected to maximize adsorption and filtration capacity within the experimental setup. Wastewater collected was applied by gravity at a hydraulic loading rate of 0.01 liters per minute and a hydraulic retention time of 5 hours.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Standard and determination of pharmaceuticals\u003c/h2\u003e\u003cp\u003eThe standard adopted was according to Nguyen \u003cem\u003eet al\u003c/em\u003e. (2023) description in \"Simultaneous determination of paracetamol and diclofenac in wastewater by High-Performance Liquid Chromatography method,\" a modified approach was used for the drug extraction and analysis.\u003c/p\u003e\u003cp\u003eHigh-Performance Liquid Chromatography (HPLC) was used to quantify pharmaceutical concentrations before and after adsorption. Prior to preparation, the sample was allowed to acclimate on the lab bench and was filtered into a borosilicate beaker that had been previously cleaned. Samples were extracted using Solid Phase Extraction (SPE) cartridges. 500 milliliters of the samples were eluted with solvent after passing through a conditioned SPE cartridge. The SPE cartridges were preconditioned by passing through two milliliters of ultrapure water and two milliliters of methanol. Methanol was used to dilute the samples. The samples were again diluted in a 1 ml mobile phase solution after the solvent elution was evaporated. The samples were then passed through a filter. Prior to injecting the samples into the HPLC apparatus for measurement, filter them with a Whatman (0.45 \u0026micro;m) syringe.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Determination of the physicochemical parameters\u003c/h2\u003e\u003cp\u003eThe physicochemical parameters of influent and effluent wastewater were analyzed in the laboratory using the American Public Health Association (APHA) standard methods for wastewater examination. The physicochemical parameters are as follows: Biochemical Oxygen Demand (BOD), Chemical Oxygen Demand (COD), Total Suspended Solids (TSS), Turbidity, Total Nitrogen and Total phosphorus.\u003c/p\u003e\u003c/div\u003e"},{"header":"3 RESULTS AND DISCUSSION","content":"\u003cp\u003e\u003cstrong\u003e3.1 Characterization and removal efficiency of pharmaceuticals in different setups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1.1 Pharmaceuticals \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe characterization of paracetamol in hospital wastewater was conducted using high-performance liquid chromatography (HPLC) to quantify its concentrations at various stages of treatment. The initial concentration of paracetamol in the untreated hospital wastewater was found to be 162.2 \u0026micro;g/L, reflecting a significant level of pharmaceutical contamination typically found in such effluents. This concentration is significantly higher than the 30 \u0026micro;g/L reported by Park \u003cem\u003eet al\u003c/em\u003e. (2020) in their study on the distribution and removal of pharmaceuticals in sewage treatment plants. The elevated levels observed in the current study may be attributed to the higher usage of paracetamol in hospital settings, leading to more concentrated pharmaceutical loads in hospital wastewater compared to general sewage. Additionally, the handling and disposal practices in hospitals might contribute to these higher concentrations. In contrast, Florinela \u003cem\u003eet al\u003c/em\u003e. (2023) reported a higher initial adsorption capacity of paracetamol (68,900 \u0026micro;g/L) with a removal efficiency of 84.6% in their study on the removal of acetaminophen from wastewater using Fe\u003csub\u003e3\u003c/sub\u003eO\u003csub\u003e4\u003c/sub\u003e and ZSM-5 materials, indicating that adsorption capacities can vary widely depending on the adsorbent used and initial concentrations.\u003c/p\u003e\n\u003cp\u003eUpon treatment with different filtration setups, a notable reduction in paracetamol concentration was observed. On the fourth day of experimentation, the concentration of paracetamol in the effluent had decreased to 106.2 \u0026micro;g/L in the coarse sand and granite setup, 92.8 \u0026micro;g/L in the unmodified pumice stone setup, and 85.0 \u0026micro;g/L in the modified pumice stone setup. These reductions reflect the varying efficiencies of the filtration methods. The modified pumice stone demonstrated the highest efficacy due to its increased surface area and improved adsorption properties, which enhance its ability to capture and retain paracetamol molecules. This trend is consistent with the findings of Antonio \u003cem\u003eet al\u003c/em\u003e. (2019), who reported a 60% reduction in paracetamol levels using activated carbon filtration. The superior performance of the modified pumice stone can be attributed to the modification process, which likely increased the number of active sites available for adsorption. Al-hwori \u003cem\u003eet al\u003c/em\u003e. (2023) also found that activated carbon achieved a high removal efficiency of 93.3-98.5% for paracetamol, stressing the importance of adsorbent properties. Similarly, Vohoang \u003cem\u003eet al\u003c/em\u003e. (2016) reported a 55-99.5% removal efficiency using constructed wetlands with Scirpusvalidus, highlighting the effectiveness of natural and modified materials in pharmaceutical removal.\u003c/p\u003e\n\u003cp\u003eFurther reductions were observed by the eighth day of treatment. The concentrations of paracetamol decreased to 103.2 \u0026micro;g/L in the coarse sand and granite setup and 89.8 \u0026micro;g/L in the unmodified pumice stone setup, representing removal efficiencies of 36.4% and 44.6%, respectively. These results indicate that while both setups are effective, the unmodified pumice stone offers better performance due to its intrinsic porosity and adsorption characteristics. This aligns with the study by Irem and Rabia (2023), which achieved 90% removal efficiency for paracetamol using activated carbon synthesized from orange peels. However, a slight increase in paracetamol concentration was noted in the modified pumice stone setup, which reached 90.4 \u0026micro;g/L. This increase suggests a potential saturation of the adsorbent over time, indicating that the adsorption capacity of the modified pumice stone might be limited under continuous use without regeneration. Similarly, Senar \u003cem\u003eet al\u003c/em\u003e. (2023) reported a 52-60% removal efficiency using natural clay (Na-montmorillonite), indicating that even effective adsorbents can reach a point of diminished returns if not managed properly.\u003c/p\u003e\n\u003cp\u003eThe significant reduction in paracetamol concentration in the treated effluent highlights the effectiveness of the pumice stone filtration systems, particularly the modified pumice stone, in adsorbing pharmaceutical contaminants from hospital wastewater. The effectiveness of the modified pumice stone can be attributed to its enhanced adsorption properties, which allow it to capture a higher amount of paracetamol compared to the other setups. As Kwadwo \u003cem\u003eet al\u003c/em\u003e. (2021) reported the removal efficiency of paracetamol from sewage treatment plants can reach up to 98%, suggesting that advanced treatment methods and high-quality adsorbents are critical for optimal performance. This study emphasizes the potential of modified pumice stone as a promising adsorbent for removing pharmaceuticals like paracetamol from hospital wastewater, emphasizing the need for continuous monitoring and optimization of treatment processes to maintain high removal efficiencies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1.2 Aspirin\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo characterize the presence of aspirin in hospital wastewater, its concentration was quantified at different treatment stages using high-performance liquid chromatography (HPLC). Initially, the concentration of aspirin in the untreated hospital wastewater was found to be 156.4 \u0026micro;g/L, reflecting a significant level of aspirin contamination typical of such effluents.\u003c/p\u003e\n\u003cp\u003eSignificant reductions in aspirin concentrations were observed throughout the experimental period across the various filtration setups. By the fourth day, the concentration of aspirin had decreased to 102.3 \u0026micro;g/L in the coarse sand and granite setup, 87.6 \u0026micro;g/L in the unmodified pumice stone setup, and 80.2 \u0026micro;g/L in the modified pumice stone setup. These reductions translate to removal efficiencies of 34.6%, 44.0%, and 48.7%, respectively, showcasing the modified pumice stone\u0026apos;s enhanced performance. These results align with previous studies on the removal of pharmaceutical compounds from wastewater using adsorbents. For instance, research by Alahyari \u003cem\u003eet al\u003c/em\u003e. (2022) and Prajaputra and Isnaini (2023) demonstrated that pharmaceutical chemicals such as ibuprofen and metformin can be effectively removed from aqueous solutions using modified pumice stone, with removal efficiencies similar to those observed in this work.\u003c/p\u003e\n\u003cp\u003eBy the eighth day, further reductions were noted. Concentrations decreased to 100.4 \u0026micro;g/L in the coarse sand and granite setup and 85.7 \u0026micro;g/L in the unmodified pumice stone setup, with removal efficiencies of 35.8% and 45.2%, respectively. The modified pumice stone setup continued to exhibit significant reduction, with the aspirin concentration dropping to 82.5 \u0026micro;g/L, although this reflected a slightly lower removal efficiency of 47.2% compared to the fourth day. This suggests that while the modified pumice stone is highly effective, it may approach saturation over time, slightly reducing its adsorption efficiency.\u003c/p\u003e\n\u003cp\u003eThe observed removal efficiencies are comparable to those reported in other studies. Boushara \u003cem\u003eet al\u003c/em\u003e. (2022) found a removal efficiency of 98.02% using phosphoric acid-modified coffee waste adsorbent for the removal of aspirin from aqueous solutions. This high efficiency underscores the potential of using modified natural adsorbents for pharmaceutical removal. Similarly, Rangbar and Moghadam (2019) reported removal efficiencies of 83.72-86.38% using carbon nanotubes to remove aspirin and atrazine from wastewater, indicating that advanced nanomaterials also offer high removal efficiencies for pharmaceutical contaminants. On the other hand, Satayeva \u003cem\u003eet al\u003c/em\u003e. (2022) found removal efficiencies ranging from 50% to 90.2% in municipal wastewater of Nur-Sultan city, Kazakhstan, illustrating variability depending on the treatment conditions and the nature of the wastewater.\u003c/p\u003e\n\u003cp\u003eThese results reveal the effectiveness of pumice stone, particularly the modified version, in reducing aspirin concentrations in hospital wastewater. The modified pumice stone consistently achieved the highest removal efficiency, indicating its superior adsorption capacity for pharmaceutical contaminants such as aspirin. The integration of findings from relevant studies highlights the potential of various adsorbents and treatment methods in achieving significant reductions in pharmaceutical pollutants from wastewater, contributing to the ongoing efforts to mitigate environmental contamination from hospital effluents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1.3 Ibuprofen \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe characterization of ibuprofen in hospital wastewater involved quantifying its concentrations at various treatment stages using high-performance liquid chromatography (HPLC). Initially, the concentration of ibuprofen in the untreated hospital wastewater was found to be 174.5 \u0026micro;g/L. This concentration is significantly higher than the 53 \u0026micro;g/L recorded by Park \u003cem\u003eet al\u003c/em\u003e. (2020) during their investigation of the distribution and removal of pharmaceuticals in sewage treatment plants. The increased concentration observed in this study may be attributed to the specific sources and uses of ibuprofen in the hospital environment, suggesting a more concentrated pharmaceutical load in hospital wastewater compared to general sewage. In contrast, Davarnejad \u003cem\u003eet al\u003c/em\u003e. (2017) and Majid \u003cem\u003eet al\u003c/em\u003e. (2022) reported ibuprofen concentrations of 6840 \u0026micro;g/L in pharmaceutical wastewater, further highlighting the variability in pharmaceutical loads across different wastewater sources\u003c/p\u003e\n\u003cp\u003eSignificant reductions in ibuprofen concentrations were observed across different filtration setups during the experimental period. On the fourth day of treatment, the concentration of ibuprofen decreased to 112.6 \u0026micro;g/L in the coarse sand and granite setup, 98.4 \u0026micro;g/L in the unmodified pumice stone setup, and 90.3 \u0026micro;g/L in the modified pumice stone setup. These reductions correspond to removal efficiencies of 35.4%, 43.6%, and 48.3%, respectively. The modified pumice stone demonstrated superior performance in removing ibuprofen from the wastewater. These results align with previous studies on pharmaceutical compound removal from wastewater using adsorbents. For instance, Alahyari \u003cem\u003eet al\u003c/em\u003e. (2022) and Prajaputra and Isnaini (2023) showed that modified pumice stone could successfully remove pharmaceutical chemicals such as ibuprofen and metformin from aqueous solutions, with removal efficiencies comparable to those observed in this work.\u003c/p\u003e\n\u003cp\u003eFurther reductions were evident by the eighth day. In the coarse sand and granite setup, the concentration of ibuprofen dropped to 109.5 \u0026micro;g/L, representing 37.3% removal efficiency. The unmodified pumice stone setup saw a reduction to 95.7 \u0026micro;g/L, achieving a 45.2% removal efficiency. The modified pumice stone setup continued to exhibit the highest efficacy, reducing the ibuprofen concentration to 87.5 \u0026micro;g/L, reflecting a slight decrease in removal efficiency to 49.8% compared to the fourth day. This suggests that while the modified pumice stone is highly effective, it may approach saturation over time, slightly reducing its adsorption efficiency.\u003c/p\u003e\n\u003cp\u003eThe results obtained in this study are consistent with several pertinent studies. For example, Senar \u003cem\u003eet al\u003c/em\u003e. (2023) reported an 82% removal efficiency of selected pharmaceuticals using natural clay (Na-montmorillonite), while Basma \u003cem\u003eet al\u003c/em\u003e. (2018) achieved a 99.2% removal efficiency of ibuprofen and diclofenac sodium using bentonite polyureaformaldehyde. Nadeem \u003cem\u003eet al\u003c/em\u003e. (2022) demonstrated a 94% removal efficiency of ibuprofen and ofloxacin using biofilm reactors for hospital wastewater treatment. Additionally, Ghayda and Husam (2021) reported the removal of ibuprofen residues from municipal wastewater at concentrations of 1000000 \u0026micro;g/L using Moringa oleifera seeds.\u003c/p\u003e\n\u003cp\u003eFurther, Smook \u003cem\u003eet al\u003c/em\u003e. (2008) compared the biodegradation of ibuprofen in various treatment systems and found removal efficiencies of up to 95%, while Majid \u003cem\u003eet al\u003c/em\u003e. (2022) reported removal efficiencies of 91%-99.80% using a photocatalytic method with FeO photocatalyst supported on modified Iranian clinoptilolite for synthetic wastewater containing ibuprofen at concentrations of 83170 \u0026micro;g/L. Kwadwo \u003cem\u003eet al\u003c/em\u003e. (2021) assessed the removal efficiency of pharmaceutical products in sewerage treatment plants and found a 99% removal efficiency for ibuprofen.\u003c/p\u003e\n\u003cp\u003eThese comprehensive findings emphasize the effectiveness of various adsorbents and treatment methods in removing ibuprofen from wastewater. The modified pumice stone consistently demonstrated the highest removal efficiency in this study, showcasing its enhanced adsorption capacity for pharmaceutical contaminants like ibuprofen, and suggesting its potential as a promising adsorbent for hospital wastewater treatment.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Concentration and removal efficiency of physicochemical characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2.1 Biochemical Oxygen Demand (BOD) \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Biochemical Oxygen Demand (BOD) results for the treated effluents from the continuous filtration system were compared with the NESREA (National Environmental Standards and Regulations Enforcement Agency) standard for BOD, which is set at 40 mg/L. At the commencement of the experiment, the BOD concentration in the untreated hospital wastewater was 364.2 mg/L. This finding is similar to Aniyikaiye \u003cem\u003eet al\u003c/em\u003e. (2019) and Benit and Roslin (2015) study of physicochemical analysis of wastewater and they reported 162.8 \u0026ndash; 974.7 mg/L, 246.3 mg/L - 569.5 mg/L respectively. This high level indicates a significant amount of biodegradable organic matter in the hospital effluent, posing a serious risk to the aquatic environment if discharged untreated. Similar findings were reported by Sajjad \u003cem\u003eet al\u003c/em\u003e. (2014) and Ramdani \u003cem\u003eet al\u003c/em\u003e. (2018), who noted that the presence of biological waste, disinfectants, and medications in hospital effluents frequently results in high quantities of organic matter.\u003c/p\u003e\n\u003cp\u003eBy the fourth day of treatment, the BOD concentrations had decreased substantially across all filtration setups. In the coarse sand and granite setup, the BOD concentration was reduced to 96.9 mg/L, representing 73.4% removal efficiency. However, this concentration still exceeded the NESREA standard. The unmodified pumice stone setup achieved a BOD concentration of 122.6 mg/L, corresponding to 66.4% removal efficiency, also above the NESREA limit. In contrast, the modified pumice stone setup demonstrated the highest reduction rate, with a BOD concentration of 21.3 mg/L, representing a 94.2% reduction. This value is well below the NESREA standard, indicating effective treatment. Similarly, Nadeem \u003cem\u003eet al\u003c/em\u003e. (2022) demonstrated a 92% removal efficiency of BOD using biofilm reactors for hospital wastewater treatment.\u003c/p\u003e\n\u003cp\u003eFurther reductions in BOD were observed by the eighth day. The coarse sand and granite setup achieved a BOD concentration of 92.07 mg/L, slightly better than the fourth day but still above the NESREA standard. The unmodified pumice stone setup showed a concentration of 119.3 mg/L, reflecting a minor improvement but remaining non-compliant with NESREA requirements. The modified pumice stone setup continued to outperform the others, with a BOD concentration dropping to 18.6 mg/L, maintaining its compliance with the NESREA standard.\u003c/p\u003e\n\u003cp\u003eThroughout the experiment, the modified pumice stone consistently demonstrated its effectiveness in reducing BOD levels to below the NESREA standard of 40 mg/L. On the other hand, both the coarse sand and granite and the unmodified pumice stone setups, despite achieving significant BOD reductions, did not meet the NESREA standard within the experimental period. The results highlight the superior performance of the modified pumice stone in treating hospital wastewater to safe discharge levels, showcasing its potential as a reliable adsorbent in wastewater treatment systems.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2.2 Chemical Oxygen Demand \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChemical Oxygen Demand (COD) is a critical parameter for assessing the organic pollution in wastewater, indicating the amount of oxygen required to chemically oxidize organic compounds. The NESREA standard for COD in treated effluent is set at 80 mg/L. The COD levels in the untreated hospital wastewater were measured at 428.1 mg/L, indicating a high level of organic pollutants that could significantly harm aquatic ecosystems if discharged without adequate treatment. The result of this finding corroborate that of Salifu \u003cem\u003eet al\u003c/em\u003e. (2022); Ramdani \u003cem\u003eet al\u003c/em\u003e. (2018) and Sajjad \u003cem\u003eet al\u003c/em\u003e. (2014) where COD levels range from 162, 390 and 405 mg/L respectively. This result also corroborates the findings of Aniyikaiye \u003cem\u003eet al\u003c/em\u003e. (2019) and Benit and Roslin (2015) in the study of physicochemical analysis of wastewater and they reported 543 \u0026ndash; 1231 mg/L, 506.9\u0026ndash;602.9 mg/L respectively.\u003c/p\u003e\n\u003cp\u003eDuring the experiment, the COD concentrations showed substantial decreases in all treatment setups by the fourth day. In the coarse sand and granite setup, the COD concentration was reduced to 112.6 mg/L, indicating 73.7% removal efficiency. Although this represents a significant reduction, the concentration remains above the NESREA standard. In the unmodified pumice stone setup, the COD concentration dropped to 146.7 mg/L, corresponding to a 65.8% removal efficiency, which also exceeds the NESREA limit. The modified pumice stone setup, however, achieved the most substantial reduction, with the COD concentration decreasing to 38.1 mg/L, representing 91.1% removal efficiency, well below the NESREA standard. These results correspond to the study conducted by Davarnejad \u003cem\u003eet al\u003c/em\u003e. (2017) which reported 98.3% removal efficiency for COD in pharmaceutical wastewater, further highlighting the variability in pharmaceutical loads across different wastewater sources. \u003c/p\u003e\n\u003cp\u003eFurther improvements in COD removal were observed by the eighth day. In the coarse sand and granite setup, the COD concentration further decreased to 109.5 mg/L, showing a slight improvement but still above the NESREA standard. The unmodified pumice stone setup recorded a COD concentration of 143.7 mg/L, also slightly improved but non-compliant with NESREA requirements. The modified pumice stone setup continued to demonstrate superior performance, with the COD concentration dropping to 33.5 mg/L, maintaining compliance with the NESREA standard. The removal efficiency for COD, in this study can also be compare to Nadeem \u003cem\u003eet al\u003c/em\u003e. (2022) demonstrated 96% removal efficiency for COD using biofilm reactors for hospital wastewater treatment. When treating antiosmotic drug-based pharmaceutical effluent (acetic acid and ammonia) in a fluidized bed reactor (FBR) under anaerobic conditions, Saravanane \u003cem\u003eet al\u003c/em\u003e. (Saravanane \u003cem\u003eet al\u003c/em\u003e., 2001) discovered an 88.5% elimination of COD. Additionally, Saravananeet al. (Saravananeet al., 2001) investigated the Up-flow Anaerobic Fluidized Bed (UAFB) system for the treatment of pharmaceutical effluent based on cephalexin drugs. \u003c/p\u003e\n\u003cp\u003eA COD reduction of 65% was achieved when Ince \u003cem\u003eet al\u003c/em\u003e. (2002) investigated the treatment efficacy of an Up-flow Anaerobic Filter (UAF) for a chemical synthesis-based pharmaceutical wastewater (Bacampicilline and Sultamicilline tosylate). In 2003, Buitr\u0026oacute;net al. investigated the 95\u0026ndash;97% COD removal effectiveness of a Sequencing Batch Bio-filter (SBB) that combined anaerobic and aerobic conditions in a single tank to treat pharmaceutical wastewater (including phenols and O-nitroaniline). Zhou \u003cem\u003eet al\u003c/em\u003e. studied and employed a combination system comprising an anaerobic baffled reactor (ABR) and a biofilm airlift suspension reactor (BASR) (Zhou \u003cem\u003eet al\u003c/em\u003e., 2006). \u003c/p\u003e\n\u003cp\u003eThe data indicates that the modified pumice stone consistently provided the most effective reduction of COD levels, achieving compliance with the NESREA standard of 80 mg/L by the fourth day and maintaining it through the eighth day. This underscores the efficacy of modified pumice stone as a highly effective adsorbent for treating organic pollutants in hospital wastewater. Conversely, while the coarse sand and granite, and unmodified pumice stone setups showed considerable COD reductions, they did not achieve the NESREA permissible limit.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2.3 Total Suspended Solids \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTotal Suspended Solids (TSS) are particles that are suspended in water, including silt, decaying plant and animal matter, industrial wastes, and sewage. High levels of TSS can reduce water clarity, hinder photosynthesis, and affect aquatic life. The NESREA standard for TSS in treated effluent is set at 10 mg/L.\u003c/p\u003e\n\u003cp\u003eThe untreated hospital wastewater showed high TSS concentrations, with initial levels measured at 364.2 mg/L. Similarly, in the study of physicochemical analysis of wastewater by Aniyikaiye\u003cem\u003eet al\u003c/em\u003e. (2019), they reported 2470 mg/L. During the experiment, significant reductions in TSS were observed across all treatment setups by the fourth day. In the coarse sand and granite setup, TSS concentrations dropped to 96.9 mg/L, representing a 73.4% reduction rate. Although substantial, this value is still significantly above the NESREA standard. In the unmodified pumice stone setup, TSS levels decreased to 122.6 mg/L, corresponding to a 66.4% reduction, which also exceeds the NESREA limit. The modified pumice stone setup, however, achieved a remarkable reduction, with TSS concentrations decreasing to 21.3 mg/L, indicating a 94.2% reduction, approaching but not quite meeting the NESREA standard.\u003c/p\u003e\n\u003cp\u003eBy the eighth day, further reductions in TSS concentrations were recorded. The coarse sand and granite setup showed a slight improvement, with TSS levels at 92.1 mg/L, which is still non-compliant with the NESREA standard. The unmodified pumice stone setup recorded a TSS concentration of 119.3 mg/L, showing a minor improvement but still exceeding the NESREA limit. The modified pumice stone setup demonstrated the highest efficiency, reducing TSS levels to 18.6 mg/L, representing a 94.9% reduction rate, which still falls short of the NESREA standard. Salifu \u003cem\u003eet al\u003c/em\u003e. (2022) and Sajjad \u003cem\u003eet al\u003c/em\u003e. (2014) reported similar variations in TSS concentrations in hospital wastewater, highlighting the need for robust treatment systems to achieve regulatory compliance.\u003c/p\u003e\n\u003cp\u003eThese results indicate that while all setups achieved significant reductions in TSS levels, only the modified pumice stone setup came close to meeting the stringent NESREA standard of 10 mg/L. The coarse sand and granite, as well as the unmodified pumice stone setups, while effective to a degree, did not achieve compliance within the experimental period, suggesting that additional treatment stages or longer treatment durations might be required to meet regulatory standards.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2.4 Turbidity \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTurbidity measures the cloudiness or haziness of water caused by large numbers of individual particles that are generally invisible to the naked eye, similar to smoke in air. It is an important indicator of water quality, as high turbidity levels can reduce the efficiency of disinfection, promote microbial growth, and harm aquatic life. The NESREA standard for turbidity in treated effluent is set at 0.2 NTU.\u003c/p\u003e\n\u003cp\u003eAt the beginning of the experiment, the turbidity levels in the untreated hospital wastewater were very high, measured at 174.6 NTU. The turbidity concentration report for sample Z is comparable to that of Salifu \u003cem\u003eet al\u003c/em\u003e. (2022) study, which found that hospital waste water had a turbidity concentration of 304 NTU. Significant reductions in turbidity were observed across all treatment setups by the fourth day. In the coarse sand and granite setup, turbidity levels dropped to 7.7 NTU, corresponding to a 94.6% reduction rate. Although this reduction is substantial, the turbidity level remains significantly above the NESREA standard. In the unmodified pumice stone setup, turbidity levels decreased slightly more to 8.5 NTU, representing a 95.1% reduction, which, like the previous setup, is still well above the NESREA limit. The modified pumice stone setup showed the most significant reduction rate, with turbidity levels dropping to 1.6 NTU, indicating a 99.1% reduction. Despite this significant improvement, it still exceeds the NESREA standard.\u003c/p\u003e\n\u003cp\u003eBy the eighth day, further reductions in turbidity levels were recorded. The coarse sand and granite setup showed a minor improvement, with turbidity levels at 7.5 NTU, slightly better than the fourth day but still non-compliant with the NESREA standard. The unmodified pumice stone setup recorded a turbidity level of 8.4 NTU, showing a minor improvement but still far above the NESREA limit. The modified pumice stone setup demonstrated the highest efficiency, reducing turbidity levels to 1.5 NTU, representing a 99.1% reduction. Although this is a remarkable reduction, it still does not meet the NESREA standard of 0.2 NTU.\u003c/p\u003e\n\u003cp\u003eThese results indicate that while all setups achieved significant reductions in turbidity levels, only the modified pumice stone setup approached the NESREA standard for turbidity. The coarse sand and granite setup, as well as the unmodified pumice stone setup, while effective in reducing turbidity to a large extent, did not achieve compliance with the NESREA limit within the experimental timeframe. This suggests that additional treatment stages or longer treatment durations might be required to meet the regulatory standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2.5 Total Nitrogen\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTotal nitrogen is a key parameter in assessing water quality, encompassing all forms of nitrogen, including nitrate, nitrite, ammonia, and organic nitrogen. High levels of total nitrogen in water bodies can lead to eutrophication, which promotes excessive growth of algae and other aquatic plants, subsequently leading to oxygen depletion and negative impacts on aquatic life. The NESREA standard for total nitrogen in treated effluent is set at 10 mg/L.\u003c/p\u003e\n\u003cp\u003eAt the beginning of the experiment, the concentration of total nitrogen in the untreated hospital wastewater was 12.6 mg/L. Over the course of the treatment period, significant reductions in total nitrogen concentrations were observed in all setups.\u003c/p\u003e\n\u003cp\u003eOn the fourth day, the total nitrogen levels had reduced in each setup. The coarse sand and granite setup reduced the total nitrogen concentration to 1.1 mg/L, significantly below the NESREA standard, indicating effective nitrogen removal. This represents a substantial reduction from the initial concentration. The unmodified pumice stone setup also demonstrated a significant reduction, with total nitrogen levels dropping to 1.8 mg/L. Although this is slightly higher than the coarse sand and granite setup, it is still well within the NESREA limit. The modified pumice stone setup showed the highest efficiency in nitrogen removal, reducing the concentration to 0.2 mg/L, which is substantially lower than the NESREA standard.\u003c/p\u003e\n\u003cp\u003eFurther reductions were observed by the eighth day. The coarse sand and granite setup maintained its effectiveness, with total nitrogen levels slightly increasing to 1.1 mg/L, still below the NESREA limit. The unmodified pumice stone setup showed a slight increase as well, with total nitrogen levels rising to 2.1 mg/L. Despite this increase, it remains within the NESREA standard, although less effective than the other setups. The modified pumice stone setup continued to perform exceptionally well, reducing total nitrogen levels further to 0.2 mg/L, showcasing its superior nitrogen removal capability.\u003c/p\u003e\n\u003cp\u003eThese results indicate that all treatment setups effectively reduced the total nitrogen concentrations to levels compliant with the NESREA standard. The coarse sand and granite setup, unmodified pumice stone setup, and modified pumice stone setup all achieved and maintained nitrogen concentrations well below the 10 mg/L threshold throughout the experiment. The modified pumice stone setup, in particular, demonstrated the highest efficiency in total nitrogen removal, consistently achieving the lowest nitrogen levels both on the fourth and eighth days.\u003c/p\u003e\n\u003cp\u003eThe effectiveness of the modified pumice stone in removing total nitrogen revealed its potential as a highly efficient adsorbent material for treating hospital wastewater. The slight increases in nitrogen levels in the coarse sand and granite and unmodified pumice stone setups towards the end of the experimental period suggest that while these methods are effective, there may be a need for optimization to sustain lower nitrogen levels over extended periods. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2.6 Total Phosphorus \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTotal phosphorus is a significant indicator for assessing the quality of water since, like nitrogen, high phosphorus levels can cause eutrophication, which is the growth of algae and aquatic plants. Depletion of oxygen may come from this, which would impact aquatic life and water quality. Total phosphorus in treated effluent must conform to a NESREA standard of 2 mg/L. \u003cbr\u003e 8.7 mg/L of total phosphorus was present in the untreated hospital wastewater at the beginning of the experiment. \u003c/p\u003e\n\u003cp\u003eOn the fourth day, the coarse sand and granite setup effectively reduced the total phosphorus concentration to 0.9 mg/L, which is significantly below the NESREA standard. This demonstrates a high level of phosphorus removal, corresponding to a reduction efficiency of 90%. The unmodified pumice stone setup also performed well, reducing the total phosphorus level to 0.4 mg/L. This result indicates a remarkable reduction and compliance with the NESREA limit, highlighting the efficiency of pumice stone as an adsorbent. The modified pumice stone setup showed the highest reduction efficiency, bringing the total phosphorus concentration down to 0.04 mg/L. This represents an almost complete removal of phosphorus, with a reduction efficiency of over 99%.\u003c/p\u003e\n\u003cp\u003eBy the eighth day, the total phosphorus concentrations had further decreased in all setups. The coarse sand and granite setup continued to maintain its effectiveness, reducing the total phosphorus level to 0.1 mg/L. This demonstrates sustained efficiency in phosphorus removal. The unmodified pumice stone setup showed a slight increase in phosphorus concentration to 0.5 mg/L, which is still well within the NESREA standard, indicating consistent performance over time. The modified pumice stone setup continued to exhibit superior performance, with the total phosphorus concentration slightly decreasing to 0.04 mg/L. This further highlights the exceptional capacity of modified pumice stone in removing phosphorus from wastewater.\u003c/p\u003e\n\u003cp\u003eThese results indicate that all treatment setups were effective in reducing total phosphorus concentrations to levels that comply with the NESREA standard. The coarse sand and granite setup, unmodified pumice stone setup, and modified pumice stone setup all achieved significant reductions in phosphorus levels, with the modified pumice stone showing the highest removal efficiency. The sustained low levels of total phosphorus in the modified pumice stone setup throughout the experimental period underscore its potential as a highly effective adsorbent material for wastewater treatment.\u003c/p\u003e\n\u003cp\u003eThe effectiveness of the modified pumice stone in removing total phosphorus demonstrates its suitability for treating hospital wastewater, ensuring compliance with regulatory standards and protecting water quality. The consistent performance of the other setups also indicates their viability, although the slight increase in phosphorus levels in the unmodified pumice stone setup by the eighth day suggests a need for periodic monitoring and potential optimization to maintain low phosphorus levels over extended periods. \u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe study investigated the effectiveness of modified pumice stone in the treatment of wastewater from tertiary hospital. The primary objectives included characterizing hospital wastewater for the target pharmaceuticals, assessing the removal efficiency of these pharmaceuticals, evaluating the impact of pumice stone modification on its adsorption characteristics, and determining the removal efficiency of various physicochemical parameters.\u003c/p\u003e\n\u003cp\u003eThe results demonstrated that the modified pumice stone significantly enhanced the removal of paracetamol, aspirin, and ibuprofen compared to unmodified pumice stone and the control setup (coarse sand and granite). On the fourth day, the concentrations of paracetamol dropped to 106.2 \u0026micro;g/L, 92.8 \u0026micro;g/L and 85.0 \u0026micro;g/L for the control, unmodified and modified pumice stone treatments, respectively, corresponding to removal efficiencies of 34.5%, 42.8%, and 47.6%. Similar trends were observed for aspirin and ibuprofen, with the modified pumice stone consistently showing the highest removal rates.\u003c/p\u003e\n\u003cp\u003eIn terms of physicochemical parameters, the modified pumice stone also exhibited superior performance. For instance, the BOD levels in the effluent were reduced to 21.3 mg/L on the fourth day and further to 18.6 mg/L on the eighth day, indicating removal efficiencies of 94.2% and 94.9%, respectively. Other parameters, including COD, total suspended solids, turbidity, total nitrogen, and total phosphorus, also showed significant reductions, meeting or surpassing NESREA standards.\u003c/p\u003e\n\u003cp\u003eThe study concludes that the modification of pumice stone as an adsorbent significantly improves its adsorption capacity and effectiveness in removing pharmaceutical contaminants and other pollutants from hospital wastewater. These findings suggest that modified pumice stone is a promising material for enhancing wastewater treatment processes, contributing to improved water quality and environmental protection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the findings of this study, the following recommendations were proposed to enhance the treatment and management of hospital wastewater to reduce pharmaceutical and physicochemical contaminants effectively. They include the following:\u003c/p\u003e\n\u003col start=\"1\" type=\"i\"\u003e\n \u003cli\u003eWastewater treatment facilities, especially those handling hospital effluents, should consider incorporating modified pumice stone into their treatment processes to enhance the removal of pharmaceutical contaminants and other pollutants.\u003c/li\u003e\n \u003cli\u003eContinued research should focus on optimizing the modification process of pumice stone to further improve its adsorption efficiency and cost-effectiveness.\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConsent to Participate declaration\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish declaration\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial registration\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declaration\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/h3\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e\u0026nbsp;(Author 1: Adekunle Adesuyi ADEMUWAGUN):\u003c/strong\u003e Conceptualization, methodology, writing \u0026ndash; original draft, data curation, analysis and funding\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e(Author 2: Suraju Adekunle LATEEF):\u003c/strong\u003e Review and editing, supervision, project administration.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAkbal, F., (2005a). Adsorption of basic dyes from aqueous solution onto pumice powder, J. Colloid Interface Science. 286(2): 455\u0026ndash;458.\u003c/li\u003e\n\u003cli\u003eAkbal, F., (2005b). Sorption of phenol and 4-chlorophenol onto pumice treated with cationic surfactant. Journal of environmental management. 74(3); 239\u0026ndash;244\u003c/li\u003e\n\u003cli\u003eAltin, S., Altin, A., Elevli, B., (2003). Determination of hospital waste composition and disposal methods: Acase study. Polish Journal of Environmental Studies 12 (2): 251 \u0026ndash; 255\u003c/li\u003e\n\u003cli\u003eAmouei, A.H., Asgharnia, H., Amouei, M., (2011). Quantity and quality of wastewater in the hospitals of Babol medicl university (Iran) and effects on the environmental health. Proceedings of the 12\u003csup\u003eth\u003c/sup\u003e International Conference on Environmental Science and Technology: 8 (10) 39 \u0026ndash; 44\u003c/li\u003e\n\u003cli\u003eAnwar, O., Malik, N., Asim, M., (2013). Evaluation of hospital waste management in public and private sector hospitals of Faisalabad City. Pakistan Academic Journal of Interdisciplinary Studies 2 (2): 161 \u0026ndash; 166\u003c/li\u003e\n\u003cli\u003eAsgari, G., Roshani, B., Ghanizadeh, G., (2012) The investigation of kinetic and isotherm of fluoride adsorption onto functionalize pumice Stone. J Hazard Mater, 17\u0026ndash;218: 123\u0026ndash;132\u003c/li\u003e\n\u003cli\u003eAhmed, M.J., (2017) Adsorption of non-steroidal anti-infammatory drugs from aqueous solution using activated carbons: review. Journal of Environmental Management 190: 274\u0026ndash;282. https://doi.org/10.1016/j.jenvman.2016. 12.073\u003c/li\u003e\n\u003cli\u003eAlistair, B.A.B., Murray, AR., Bryan, W.B., Daniel, J.C., Kyungho, C., Silke, H., Elizabeth, I., Kim, O., Jane, P.S., Tim, V., Gerald, T.A., Karen, FB, Scott, E.B., Jason, P.B., Pedro Carriquiriborde, Anja Coors, Paul, C.D., Scott, D.D., Jon, F.E., Fran\u0026ccedil;ois Gagn\u0026eacute;, John, P.G., Todd Gouin, Lars Hallstrom, Maja V Karlsson, DG Joakim Larsson, James M Lazorchak, Frank Mastrocco, Alison McLaughlin, Mark E McMaster, Roger D Meyerhoff, Roberta Moore, Joanne L Parrott, Jason R Snape, Richard Murray-Smith, Mark R Servos, Paul K Sibley, J\u0026uuml;rg Oliver Straub, Nora D Szabo, Edward Topp, Gerald R Tetreault, Vance, L.T., Glen, V.D.K., (2012) Pharmaceuticals and Personal Care Products in the Environment: What Are the Big Questions? Environ. Health Perspect., 120 (2): 1221-1229\u003c/li\u003e\n\u003cli\u003eAkbari, B.F., Gholami, A., Ayati, A., Niknam, S.M., Sillanp\u0026auml;\u0026auml;, M., (2020) UV-switchable phosphotungstic acid sandwiched between ZIF-8 and Au nanoparticles to improve simultaneous adsorption and UV light photocatalysis toward tetracycline degradation. Micropor Mesopor Mater 303:110275. https://doi.org/10.1016/j. micromeso.2020.110275: 234-239\u003c/li\u003e\n\u003cli\u003eBeyene, H and Redaie, G. (2011). Assessment of waste stabilization ponds for the treatment of hospital wastewater: the case of Hawassa university referral hospital. World Applied Sciences Journal 15 (1): 142 \u0026ndash; 150\u003c/li\u003e\n\u003cli\u003eBlenkharn, J.I (2006). Standards of clinical waste management in UK hospitals. Journal of Hopitals Infection 62: 300 \u0026ndash; 303\u003c/li\u003e\n\u003cli\u003eBastami TR, Ahmadpour A, Hekmatikar FA (2017) Synthesis of Fe3O4/Bi2WO6 nanohybrid for the photocatalytic degradation of pharmaceutical ibuprofen under solar light. J Ind Eng Chem 51: 244\u0026ndash;254. https://doi.org/10.1016/j.jiec.2017.03.008\u003c/li\u003e\n\u003cli\u003eBrillas E (2022) A critical review on ibuprofen removal from synthetic waters, natural waters, and real wastewaters by advanced oxidation processes. Chemosphere, p.286:131849. https://doi.org/10. 1016/j.chemosphere.2021.131849\u003c/li\u003e\n\u003cli\u003eBello MM, Raman AAA (2019) Synergy of adsorption and advanced oxidation processes in recalcitrant wastewater treatment. Environ Chem Lett 17(2): 1125\u0026ndash;1142. https://doi.org/10.1007/ s10311-018-00842-0\u003c/li\u003e\n\u003cli\u003eBhushan S, Rana M.S, Raychaudhuri S, Simsek H, Prajapati S.K (2020) Algae -and bacteria-driven technologies for pharmaceutical remediation in wastewater Removal of Toxic Pollutants Through Microbiological and Tertiary Treatment, Elsevier, 373-408\u003c/li\u003e\n\u003cli\u003eCalabro PS, Moraci N, Suraci P, (2012) Estimate of the optimum weight ratio in Zero-Valent Iron/Pumice granular mixtures used in permeable reactive barriers for the remediation of nickel contaminated groundwater, J. Hazard. Mater. 207\u0026ndash;208, 111\u0026ndash;116.\u003c/li\u003e\n\u003cli\u003eChuan X.Y, Hirano M, Inagaki, M (2004) Preparation and photocatalytic performance of anatase-mounted natural porous silica, pumice, by hydrolysis under hydrothermal conditions, Appl. Catal. B: Environ. 51 (4) (2004), 255\u0026ndash;260.\u003c/li\u003e\n\u003cli\u003eCaban M, Stepnowski P (2021) How to decrease pharmaceuticals in the environment? A review environmental. Chem Lett 19(4): 3115\u0026ndash; 3138. https://doi.org/10.1007/s10311-021-01194-y\u003c/li\u003e\n\u003cli\u003eDavarnejad R, Soof B, Farghadani F, Behfar R (2018). Ibuprofen removal from a medicinal effluent: a review on the various techniques for medicinal effluents treatment. Environ Technol Innov 11: 308\u0026ndash;320. https://doi.org/10.1016/j.eti.2018.06.011\u003c/li\u003e\n\u003cli\u003eDuarte EDV, Oliveira MG, Spaolonzi MP, Costa HPS, Silva TLd, Silva MGCd, Vieira MGA (2022) Adsorption of pharmaceutical products from aqueous solutions on functionalized carbon nanotubes by conventional and green methods: a critical review. J Clean Product. 372:133743. https://doi.org/10.1016/j.jclepro. 2022.133743\u003c/li\u003e\n\u003cli\u003eFeier B, Gui A, Cristea C, Săndulescu R, (2017) Electrochemical determination of cephalosporins using a bare boron-doped diamond electrode, Anal. Chim. Acta 976, 25\u0026ndash;34.\u003c/li\u003e\n\u003cli\u003eFemina Carolin C, Senthil Kumar P, Janet Joshiba G, Vinoth Kumar V (2021) Analysis and removal of pharmaceutical residues from wastewater using membrane bioreactors: a review. Environ Chem Lett 19(1): 329\u0026ndash;343. https://doi.org/10.1007/s10311-020-01068-9\u003c/li\u003e\n\u003cli\u003eGu Y, Huang J, Zeng G, Shi L, Shi Y, Yi K (2018) Fate of pharmaceuticals during membrane bioreactor treatment: status and perspectives. Bioresour Technol 268: 733\u0026ndash;748. https://doi.org/10.1016/j. biortech.2018.08.029\u003c/li\u003e\n\u003cli\u003eGautam, A.K., Kumar, S., Sabumon, P.C., (2007). Preliminary study of physicochemical treatment options for hospital wastewater. 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Healthcare waste: Evaluation of its generation rate and management practices in tertiary care hospitals of Lahore. Annals 9 (4): 274 \u0026ndash; 281\u003c/li\u003e\n\u003cli\u003eLiu T, Wang ZL, Yan X, Zhang B, (2014) Removal of mercury (II) and chromium (VI) from wastewater using a new and effective composite: Pumice-supported nanoscale zero-valent iron, Chem. Eng. J. 245, 34\u0026ndash;40.\u003c/li\u003e\n\u003cli\u003eSepehr M.N, Sivasankar V, Zarrabi M, Kumar M.S (2013a) Surface modification of pumice enhancing its fluoride adsorption capacity: An insight into kinetic and thermodynamic studies, Chem. Eng. J. 228, pp. 192\u0026ndash; 204.\u003c/li\u003e\n\u003cli\u003eSepehr M.N, Zarrabi M, Kazemian H, Amrane A, Yaghmaian K, Ghaffari H.R, (2013b) Removal of hardness agents, calcium and magnesium, by natural and alkaline modified pumice stones in single and binary systems, Appl. Surf. Sci. 274, 295\u0026ndash;305.\u003c/li\u003e\n\u003cli\u003eTaoufk N, Boumya W, Janani FZ, Elhalil A, Mahjoubi FZ, barka, N, (2020) Removal of emerging pharmaceutical pollutants: a systematic mapping study review. J Environ Chem Eng 8(5): 104251. https://doi.org/10.1016/j.jece.2020.104251\u003c/li\u003e\n\u003cli\u003eTaheran M, Brar S.K, Verma M, Surampalli R.Y, Zhang T.C, Valero J.R (2016) Membrane processes for removal of pharmaceutically active compounds (PhACs) from water and wastewaters. Sci Total Environ 547: 60\u0026ndash;77. https://doi.org/10.1016/j.scitotenv. 2015.12.139\u003c/li\u003e\n\u003cli\u003eTiwari B, Sellamuthu B, Ouarda Y, Drogui P, Tyagi R.D, Buelna G (2017) Review on fate and mechanism of removal of pharmaceutical pollutants from wastewater using biological approach. Bioresour Technol 224: 1\u0026ndash;12. https://doi.org/10.1016/j.biort ech.2016.11.042\u003c/li\u003e\n\u003cli\u003eJiri Marsalek (2008) Pharmaceuticals And Personal Care Products (PPCP) In Canadian Urban Waters: A Management Perspective Dangerous Pollutants (Xenobiotics) in Urban Water Cycle, Springer, 117-130\u003c/li\u003e\n\u003cli\u003eJukosky, J.A, Watzin M.C, Leiter J.C (2008) The effects of environmentally relevant mixtures of estrogens on Japanese medaka (Oryzias latipes) reproduction, Aquat. Toxicol. 86 (2), 323\u0026ndash;331.\u003c/li\u003e\n\u003cli\u003eKanakaraju D, Glass BD, Oelgem\u0026ouml;ller M (2014) Titanium dioxide photocatalysis for pharmaceutical wastewater treatment. Environ Chem Lett 12(1): 27\u0026ndash;47. https://doi.org/10.1007/ s10311-013-0428-0\u003c/li\u003e\n\u003cli\u003eOsman AI, Abd El-Monaem EM, Elgarahy AM, Aniagor CO, Hosny M, Farghali M, Rashad E, Ejimofor MI, Lopez-Maldonado EA, Ihara I, Yap PS, Rooney DW, Eltaweil AS (2023) Methods to prepare biosorbents and magnetic sorbents for water treatment: a review. Environ Chem Lett. https://doi.org/10.1007/ s10311-023-01603-4\u003c/li\u003e\n\u003cli\u003eRanjbari S, Tanhaei B, Ayati A, Khadempir S, Sillanp\u0026auml;\u0026auml; M (2020) Efcient Tetracycline adsorptive removal using tricaprylmethylammonium chloride conjugated chitosan hydrogel beads: mechanism, Kinetic, Isotherms and Thermodynamic study. Int J Biol Macromol 155: 421\u0026ndash;429. https://doi.org/10.1016/j.ijbiomac. 2020.03.188\u003c/li\u003e\n\u003cli\u003eKarimi-Maleh H, Orooji Y, Karimi F, Alizadeh M, Baghayeri M, Rouhi J, Tajik S, Beitollahi H, Agarwal S, Gupta VK, Rajendran S, Ayati A, Fu L, Sanati AL, Tanhaei B, Sen F, Shabani-nooshabadi M, Asrami PN, Al-Othman A (2021) A critical review on the use of potentiometric based biosensors for biomarkers detection. Biosens Bioelec 184: 113252. https://doi.org/10.1016/j.bios.2021. 113252\u003c/li\u003e\n\u003cli\u003eShahinpour A, Tanhaei B, Ayati A, Beiki H, Sillanp\u0026auml;\u0026auml; M (2022) Binary dyes adsorption onto novel designed magnetic clay-biopolymer hydrogel involves characterization and adsorption performance: kinetic, equilibrium, thermodynamic, and adsorption mechanism. J Mol Liq 366: 120303. https://doi.org/10.1016/j.molliq. 2022.120303\u003c/li\u003e\n\u003cli\u003eHuang L, Shen R, Shuai Q (2021) Adsorptive removal of pharmaceuticals from water using metal-organic frameworks: A review. J Environ Manage 277: 111389. https://doi.org/10.1016/j.jenvman. 2020.111389\u003c/li\u003e\n\u003cli\u003eHuang M, Li Y, Gu G., (2010) Chemical composition of organic matters in domestic wastewater. Desalination, 262 (1\u0026ndash;3), 36-42\u003c/li\u003e\n\u003cli\u003eIgwegbe CA, Oba SN, Aniagor CO, Adeniyi AG, Ighalo JO (2021) Adsorption of ciprofoxacin from water: a comprehensive review. J Ind Eng Chem 93: 57\u0026ndash;77. https://doi.org/10.1016/j.jiec.2020. 09.023\u003c/li\u003e\n\u003cli\u003ePrasetya N, Gede Wenten I, Franzreb M, W\u0026ouml;ll C (2023) Metal-organic frameworks for the adsorptive removal of pharmaceutically active compounds (PhACs): Comparison to activated carbon. Coordin Chem Rev 475: 214877. https://doi.org/10.1016/j.ccr. 2022.214877\u003c/li\u003e\n\u003cli\u003ePatel M, Kumar R, Kishor K, Mlsna T, Pittman C.U, Mohan D (2019) Pharmaceuticals of Emerging Concern in Aquatic Systems: Chemistry, Occurrence, Effects, and Removal Methods Chem. Rev., 119, 3510-3673\u003c/li\u003e\n\u003cli\u003eMahapatra S, Samal K, Dash R.R, (2022) Waste Stabilization Pond (WSP) for wastewater treatment: a review on factors, modelling and cost analysis, J. Environ. Manag. 308, 114668, doi:10.1016/j.jenvman.2022.114668.\u003c/li\u003e\n\u003cli\u003eusing response surface methodology, Clean. Eng. Technol. 100060, doi:10.1016/j.clet.2021.100060.\u003c/li\u003e\n\u003cli\u003eSamal K, Dash R.R, Bhunia P (2017) Treatment of wastewater by vermifiltration integrated with macrophyte filter: a review, J. Environ. Chem. Eng. 5, 2274\u0026ndash;2289, doi:10.1016/j.jece.2017.04.026.\u003c/li\u003e\n\u003cli\u003eSamal K, Kar S, Trivedi S, Upadhyay S, (2021) Assessing the impact of vegetation coverage ratio in a floating water treatment bed of Pistia stratiotes, SN Appl. Sci. 3, 1\u0026ndash;8, doi:10.1007/s42452-020-04139-2.\u003c/li\u003e\n\u003cli\u003eSamal K, Naushin Y, Priya K (2020) Challenges in the implementation of Phyto Fuel System (PFS) for wastewater treatment and harnessing bio-energy, J. Environ. Chem. Eng. 8, 104388, doi:10.1016/j.jece.2020.104388..\u003c/li\u003e\n\u003cli\u003eGojkovic Z, Lindberg R.H, Tysklind M, Funk C (2019) Northern green algae have the capacity to remove active pharmaceutical ingredients, Ecotoxicol. Environ. Saf. 170, 644\u0026ndash;656.\u003c/li\u003e\n\u003cli\u003eHollman J, Dominic J.A, Achari G, Langford C.H, Tay J.H (2020) Effect of UV dose on degradation of venlafaxine using UV/H\u003csub\u003e2\u003c/sub\u003eO\u003csub\u003e2\u003c/sub\u003e: perspective of augmenting UV units in wastewater treatment, Environ.Technol.41(9), 1107\u0026ndash;1116, doi:10.1080/09593330.2018.1521475.\u003c/li\u003e\n\u003cli\u003eSchaider L.A, R.A. Rudel, J.M. Ackerman, S.C. Dunagan, J.G. Brody, (2014) Pharmaceuticals, perfluorosurfactants, and other organic wastewater compounds in public drinking water wells in a shallow sand and gravel aquifer, Sci. Total Environ. 468\u0026ndash;469, 384\u0026ndash;393.\u003c/li\u003e\n\u003cli\u003eWebb S, Ternes T, Giber M, Olejniczak K (2003) Indirect human exposure to pharmaceuticals via drinking water, Toxicol. Lett. 142 (3), 157\u0026ndash;167.\u003c/li\u003e\n\u003cli\u003eAschengrau A, Weinberg J.M, Janulewicz P.A, Romano M.E, Gallagher L.G, Winter M.R, Martin B.R, Vieira Webster V.M, White R.F, Ozonoff D.M (2011) Affinity for risky behaviors following prenatal and early childhood exposure to tetrachloroethylene (PCE)-contaminated drinking water: a retrospective cohort study Environ. Health A Glob. Access Sci. Source, 10 (1), 102\u003c/li\u003e\n\u003cli\u003eNor Z.A, Salmiati S, Azmi A, Mohd R.S, Tasnia H.N, Mimi S.M, Marpongahtun M (2021) A Review on Emerging Pollutants in the Water Environment: Existences, Health Effects and Treatment Processes, Water 13, 1\u0026ndash;31, 3258, doi:10.3390/w13223258\u003c/li\u003e\n\u003cli\u003eZwiener C (2007) Occurrence and analysis of pharmaceuticals and their transformation products in drinking water treatment, Anal. Bioanal. Chem. 387 (4), 1159\u0026ndash;1162.\u003c/li\u003e\n\u003cli\u003eZwiener C, Seeger S, Glauner T, Frimmel F, (2002) Metabolites from the biodegradation of pharmaceutical residues of ibuprofen in biofilm reactors and batch experiments, Anal. Bioanal. Chem. 372 (4), 569\u0026ndash;575\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 3.1: Pharmaceuticals and physicochemical characterization of hospital wastewater\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"840\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnit\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitial concentration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCoarse sand and granite\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnmodified\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePumice stone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModified pumice stone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eParacetamol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026micro;g/L \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e162.2 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e104.7 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e92.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e87.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eAspirin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026micro;g/L \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e49.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e31.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e25.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e21.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eIbuprofen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026micro;g/L \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e145.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e95.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e80.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e72.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eBOD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003emg/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e364.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e96.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e122.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e21.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eCOD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003emg/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e428.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e112.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e146.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e38.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eTotal Suspended Solids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003emg/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e388.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e2.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e4.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eTurbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eNTU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e174.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eTotal Nitrogen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003emg/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e38.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eTotal Phosphorus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003emg/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.2: Removal efficiency of measured physicochemical parameters for pre and post treatment\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter (s)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 305px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitial Concentration (mg/L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFinal Concentration (mg/L)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNESREA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRemoval Efficiency (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBOD (mg/L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eCoarse sand and granite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e364.22\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e94.54\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e40 mg/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e74.10\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eUnmodified pumice stone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e364.22\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e121.01\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e67.81\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eModified pumice stone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e364.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e20.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e94.50\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOD (mg/L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eCoarse sand and granite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e428.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e111.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e80 mg/L\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e74.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eUnmodified pumice stone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e428.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e145.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e66.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eModified pumice stone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e428.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e35.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e91.60\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Suspended Solids (mg/L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eCoarse sand and granite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e388.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e2.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e10 mg/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e99.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eUnmodified pumice stone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e388.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e5.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e98.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eModified pumice stone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e388.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e99.90\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTurbidity (NTU)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eCoarse sand and granite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e174.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e7.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e0.2 NTU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e95.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eUnmodified pumice stone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e174.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e8.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e95.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eModified pumice stone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e174.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e99.10\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Nitrogen (mg/L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eCoarse sand and granite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e38.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e10 mg/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e97.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eUnmodified pumice stone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e38.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e94.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eModified pumice stone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e38.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e99.50\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Phosphorus (mg/L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eCoarse sand and granite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e8.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e98.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eUnmodified pumice stone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e8.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e2 mg/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e94.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eModified pumice stone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e8.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e99.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Plate","content":"\u003cp\u003ePlate 2.3 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pumice stone, Pharmaceutical, Physicochemical, Hospital wastewater, Wastewater treatment","lastPublishedDoi":"10.21203/rs.3.rs-7038270/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7038270/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePharmaceutical contaminants in hospital wastewater, such as Paracetamol, Aspirin, and Ibuprofen, pose substantial health and ecological risks. Conventional wastewater treatments are costly and ineffective at removing such contaminants, especially in developing countries. This study evaluated the effectiveness of modified pumice stone as a low-cost filtration medium for treating hospital wastewater.\u003c/p\u003e\u003cp\u003eA laboratory experiment employed three continuous filtration tanks (15 cm \u0026times; 15 cm \u0026times; 15 cm) filled with coarse sand and granite (CSG), CSG with unmodified pumice stone (CSG/unmodified PS), and CSG with modified pumice stone (CSG/modified PS). Pumice stones were cleaned, pulverized, sieved, and modified to enhance adsorption. Wastewater collected from a tertiary hospital was applied at a hydraulic loading rate of 0.01 m for 8 days, with a 5-hour retention time. Pharmaceutical concentrations were determined using High-Performance Liquid Chromatography (HPLC), and physicochemical parameters were measured using APHA methods. Results were compared to NESREA standards.\u003c/p\u003e\u003cp\u003eInitial concentrations of Paracetamol, Aspirin, and Ibuprofen were 162.2, 49.7, and 145.2 \u0026micro;g/L, respectively. After four days, concentrations in the CSG/modified PS setup dropped to 85.0, 22.3, and 72.7 \u0026micro;g/L, respectively. COD, BOD, and TSS decreased by 40\u0026ndash;50%, and TN and TP by 35\u0026ndash;45%. On the eighth day, BOD and COD in CSG/modified PS reached 18.6 mg/L and 33.5 mg/L, respectively\u0026mdash;below NESREA limits.\u003c/p\u003e\u003cp\u003eThis study demonstrates that modified pumice stone significantly reduces pharmaceutical and physicochemical pollutants in hospital wastewater, offering a cost-effective treatment solution.\u003c/p\u003e","manuscriptTitle":"Effectiveness of Modified Pumice Stone in the Treatment of Waste Water from Tertiary Hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-21 17:25:54","doi":"10.21203/rs.3.rs-7038270/v1","editorialEvents":[{"type":"communityComments","content":2}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"72f980c3-98c4-4a6e-8f81-796a0b3a0681","owner":[],"postedDate":"July 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-04T05:38:37+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-21 17:25:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7038270","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7038270","identity":"rs-7038270","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}