Risk management of hazardous substances in a circular economy.

The ambitions for a circular economy are high and unambiguous, but day-to-day experience shows that the transition still has many difficulties to overcome. One of the current hurdles is the presence of hazardous substances in waste streams that enter or re-enter into the environment or the technosphere. The key question is: do we have the appropriate risk management tools to control any risks that might arise from the re-using and recycling of materials? We present some recent cases that illustrate current practice and complexity in the risk management of newly-formed circular economy chains.

Towards a proportionality assessment of risk reduction measures aimed at restricting the use of persistent and bioaccumulative substances.

International chemicals legislation aims at adequately controlling persistent organic pollutants (POPs) and substances of very high concern (SVHCs), such as persistent, bioaccumulative, and toxic (PBT) and very persistent and very bioaccumulative (vPvB) substances, with a view to progressively substitute these substances with suitable less-hazardous alternatives. Using cost-effectiveness analysis (CEA) to assess the (dis)proportionality of measures to control such substances (collectively called "PBT" in the present paper) requires benchmarks. The present paper provides building blocks for possible benchmarks by looking at the cost-effectiveness estimates for regulatory measures that have been applied or considered for various PBT substances.

PBT assessment using the revised annex XIII of REACH: a comparison with other regulatory frameworks.

There is no uniform Persistent, Bioaccumulative, Toxic (PBT) or very Persistent, very Bioaccumulative (vPvB) assessment of chemicals in Europe, as the various regulatory frameworks use only limited or dissimilar PBT assessments, or none at all. The European REACH Regulation requires a PBT/vPvB assessment for all chemical substances that are produced within or imported into the EU in amounts exceeding 10 tonnes per year, using the criteria as described in REACH Annex XIII. However, not all substances on the EU market need to be screened according to these criteria under REACH.

Overwhelming primary Epstein-Barr virus infection requiring corticosteroid treatment.

A 20-year-old woman presented with a 2-week history of fever and malaise. Physical examination was unremarkable. Viral infection was suspected and Epstein-Barr virus serology confirmed acute infectious mononucleosis.

Hydroxychloroquine as a glucose lowering drug.

The authors report a remarkable glucose lowering side effect of the often used drug hydroxychloroquine (Plaquenil) in an otherwise healthy non-diabetic patient, who presented with severe hypoglycaemia. Although the mechanism has not been clarified yet, increased insulin sensitivity as well as decreased insulin degradation is suggested to contribute to the reduction in serum glucose levels. Clinicians prescribing this drug must be warranted and check glucose levels in the initial phase.

[Unusual use of nutmeg].

A 20-year-old woman with borderline personality disorder was referred to the emergency department by a psychiatric clinic. After taking 10 g of nutmeg she complained of stomach ache and dizziness. A physical examination showed mild hypothermia and sinus tachycardia.

[Acrodermatitis chronica atrophicans: late manifestation of Lyme borreliosis].

A 71-year-old man was referred to our outpatient clinic because of arthralgia and swelling of his right hand. He also showed a subcutaneous nodule on his left knee. A second patient, a 57-year-old woman, was referred because of painful skin of her legs.