Case Report: SARS-CoV-2 as an unexpected causal agent of predominant febrile hepatitis.

Background: Respiratory symptoms and pneumonia are the predominant features of Coronavirus disease 2019 (COVID-19) due to emerging SARS-CoV-2 virus, but extrapulmonary manifestations are also observed. For instance, some degree of liver injury has been described among patients requiring hospital admission for severe COVID-19. However, acute febrile hepatitis as an initial or predominant manifestation of COVID-19 has been rarely reported. Case presentation: A 34-year-old man without underlying medical conditions presented with fever of unknown origin for two weeks in the absence of respiratory symptoms or other complaints. Laboratory testing revealed isolated acute hepatitis, for which an extensive microbiological work-up did not reveal identification of the causal agent. PCR testing for SARS-CoV-2 on a nasopharyngeal swab was negative on two occasions and initial serology for SARS-CoV-2 (at 15 days from symptoms onset) was also negative. However, repeated SARS-CoV-2 serological testing at 30 days demonstrated seroconversion leading to the diagnosis of COVID-19-related hepatitis. The patient's condition progressively improved, while transaminases steadily declined and eventually returned back to normal within 30 days. Conclusions: We describe here a unique case of SARS-CoV-2 isolated febrile hepatitis in a young and previously healthy man, which was diagnosed by demonstration of seroconversion, while PCR screening was negative. This case report highlights the role of repeated serological testing for the diagnosis of extrapulmonary manifestations of COVID-19.

Association of Hashimoto's Thyroiditis and Burkitt Lymphoma: A Rare Condition to Be Considered.

We present the case of a 72-year-old woman who was diagnosed with Hashimoto's thyroiditis and who developed a low-grade fever, fatigue, and weight loss that prompted to perform a thyroid biopsy to rule out an underlying primary thyroid lymphoma. This case report offers the opportunity to review the association between Hashimoto's thyroiditis and primary thyroid lymphoma. Furthermore, it underlines the importance of considering the diagnosis of lymphoma when a thyroid mass is found in patients with an underlying Hashimoto's disease, as the timely management is essential for survival with this rare thyroid condition.

Production and Destination of Sewage Sludge in the Piemonte Region (Italy): The Results of a Survey for a Future Sustainable Management.

The management of sewage sludge originated from municipal wastewater treatment plants (WWTPs) is an urgent issue. In 2019, the local authority of the Piemonte region started a survey with the aim of collecting recent data concerning wastewater and sludge management in the WWTPs located in its own territory. The survey's results revealed that 60% of the sludge (51,000 t, as dry substance, d.s.) produced by the local WWTPs was recovered or disposed of outside of the region, and a similar amount of sludge was recovered in agriculture directly or after composting. The increase in the costs to accommodate sewage sludge in recovery or disposal plants, followed to a recent Italian Sentence (27958/2017), and the more and more stringent requirements fixed by lots of European countries for the application of sludge in agriculture, are pushing the Piemonte region authority to re-organize its own network for sludge management, with solutions based onto proximity and diversification. Whether the provisions of the current German legislation are applied in the future also in Italy, approx. 90% of sewage sludge produced into the Piemonte region should be incinerated, with a subsequent step of phosphorous recovery. The new regional plan, according to the Regional Address Deed, should consider a diversification of sludge treatment and recovery practices. On this basis, a need for new plants for around 40,000 t d.s./y could be planned.

Evaluation of Green Coffee-Roasting Biogas with Modeling Valorization of Possible Solutions.

According to the European Union Directive 2009/28/EC, the goals of obtaining 20% of all energy requirements from renewable sources and a 20% reduction in primary energy use must be fulfilled by 2020. In this work, an evaluation was performed, from the environmental and energy point of view, of anaerobic digestion as a valid solution for the treatment of the byproducts obtained from the coffee-roasting process. In particular, thermophilic anaerobic digestion tests were carried out. Output values from the laboratory were used as input for the MCBioCH4 model to evaluate the produced flow of biogas and biomethane and two different biogas valorization alternatives, namely, the traditional exploitation of biogas for heat/energy production and biomethane conversion. The results of the preliminary simulation showed that a full-scale implementation of the coffee waste biogas production process is technically feasible and environmentally sustainable. Furthermore, the performed analysis validates a general methodology for energy production compatibility planning.

Optimization of the wastewater treatment plant: From energy saving to environmental impact mitigation.

This paper outlines a multi-objective, integrated approach to analyze various possibilities for increasing energy efficiency of the largest Italian wastewater treatment plant (WWTP) at Castiglione Torinese. In this approach, wastewater and sludge treatment units are thoroughly investigated to find the potential ways for improving the energy efficiency of the system. Firstly, a multi-step simulation-based methodology is proposed to make a full link between treatment processes and the energy demand and production. Further, a scenario-based optimization approach is proposed to find the nondominated and optimized performance of the WWTP. The results prove a potential to save up to 5000 MWh of the annual energy consumption of the plant, in addition to improve the effluent quality through operational changes only. Even for what concerns the sludge line a model was proposed for the optimization of the energy recovery from the processes that in a WWTP are devoted to the management of sewage sludge. The obtained results show that the introduction of an advanced thickening stage and sludge pre-treatment would have a positive impact on the energy and greenhouse gas balance of the plant.

Enhancement of waste activated sludge (WAS) anaerobic digestion by means of pre- and intermediate treatments. Technical and economic analysis at a full-scale WWTP.

Anaerobic digestion (AD) is the most commonly applied end-treatment for the excess of waste activated sludge (WAS) generated in biological wastewater treatment processes. The efficacy of different typologies of pre-treatments in liberating intra-cellular organic substances and make them more usable for AD was demonstrated in several studies. However, the production of new extracellular polymeric substances (EPSs) that occur during an AD process, due to microbial metabolism, self-protective reactions and cell lysis, partially neutralizes the benefit of pre-treatments. The efficacy of post- and inter-stage treatments is currently under consideration to overcome the problems due to this unavoidable byproduct. This work compares three scenarios in which low-temperature (<100 °C) thermal and hybrid (thermal+alkali) lysis treatments were applied to one sample of WAS and two samples of digestate with hydraulic retention times (HRTs) of 7 and 15 days. Batch mesophilic digestibility tests demonstrated that intermediate treatments were effective in making the residual organic substance of a 7-day digestate usable for a second-stage AD process. In fact, under this scenario, the methane generated in a two-stage AD process, with an in-between intermediate treatment, was 23% and 16% higher than that generated in the scenario that considers traditional pre-treatments carried out with 4% NaOH at 70 and 90 °C respectively. Conversely, in no cases (70 or 90 °C) the combination of a 15-day AD process, followed by an intermediate treatment and a second-stage AD process, made possible to obtain specific methane productions (SMPs) higher than those obtained with pre-treatments. The results of the digestibility tests were used for a tecno-economic assessment of pre- and intermediate lysis treatments in a full scale wastewater treatment plant (WWTP, 2,000,000 p.e.). It was demonstrated that the introduction of thermal or hybrid pre-treatments could increase the revenues from the electricity sale by between 13% and 25%, in comparison with the present scenario (no lysis treatments). Conversely, intermediate treatments on a 7-day digestate could provide a gain of 26% or 32%, depending on the process temperature (70 or 90 °C).