Changing epidemiology of acute liver failure in Italy: a single-center experience over 25 years.

BACKGROUND: Acute liver failure (ALF) is a rare but often lethal syndrome. In Italy, recent data on its incidence and causes are lacking. We report here the epidemiological analysis of ALF cases observed in Campania, a Southern Italian region, over the last 25 years. METHODS: Medical records of ALF cases hospitalized from 1992 to 2018 were retrospectively analyzed. RESULTS: Two hundred ten ALF cases occurred during 1992-2018: 103 (49%) hepatitis B virus (HBV)-related (including 5 cases also infected with Delta virus), 39 (19%) from undetermined cause, 36 (17%) drug-induced, 11 (5%) Wilson's disease-associated, 8 (4%) hepatitis A virus (HAV)-related and 12 (6%) from other causes. Separate time-periods analysis of data showed a significant progressive decrease in ALF incidence mainly attributable to a decline of HBV and other viruses etiology. Already before 2010, HAV or Delta virus-related cases have no longer been observed. No hepatitis C or E virus-related ALF was detected through the study period. A progressive decrease in frequency of ALF due to undetermined causes or drug was also evident. CONCLUSIONS: A decrease in ALF incidence and a changing in its etiology were observed in Campania during 1992-2018. Both results were likely mainly due to 1991 introduction of HBV universal vaccination and may be considered generalizable nationwide.

Environmental impact of strawberry production in Italy and Switzerland with different cultivation practices.

In this study, the environmental impact of strawberry production in Italy and Switzerland was evaluated using the Life Cycle Assessment (LCA) approach. The main differences between the two countries are the cultivation practices: crop cycle duration (1 year in Switzerland and 2 or 3 years in Italy), soil management and cultivation in open and protected fields. For all the environmental impact categories evaluated with LCA, strawberry production in Switzerland shows higher impacts respect to the Italian production. The impact reduction related to the Italian production in open fields without soil sterilisation ranges from 96% (for photochemical oxidant formation) to 35% (for freshwater eutrophication). For Swiss production, soil sterilisation is by far the main environmental hotspot for all the evaluated environmental effects except for toxicity-related impact categories and for resources consumption (i.e. manufacturing, maintenance and disposal of tunnel). Conversely, the main hotspot in Italy differs depending on the considered categories. Moreover, the 3-years cycle duration has a higher impact respect to the 2-years one because of the low yield in the third year that worsens the outcomes. Finally, sensitivity and uncertainty analysis were performed. The environmental results are deeply affected by yield variation and only slightly by changes in the life span of the tunnels while the uncertainty related to the selection of the data source, the model imprecision, and the variability of data does not affect significantly the results, except for the toxicity-related impact categories.