Effect of ammonia stripping and use of additives on separation of solids, phosphorus, copper and zinc from liquid fractions of animal slurries

To increase the sustainable reuse of animal manure as fertiliser, in many cases suitable treatment techniques are needed to modify the composition and obtain a balanced nutrient content. This study was conducted to evaluate the best strategies to remove solids, P, Cu and Zn, using two additives Ca(OH)₂ and Al₂(SO₄)₃, in combination with an ammonia stripping process. The assessment was carried out on five type of liquid fractions derived from the mechanical separation of: raw pig slurry, pig digested slurry, pig digested slurry after ammonia stripping, pig and cattle digested slurry, pig and cattle digested slurry after ammonia stripping. After the addition of the chemicals, the liquid fractions were mixed and then separated using a static filter. The contents of total solids P, Cu and Zn were determined. The additives effectively improved separation efficiencies which depended on the type of slurry and additive used. The P separation efficiencies ranged from 72% to 93% using Al₂(SO₄)₃, and from 20 to 74% using Ca(OH)₂. The use of Al₂(SO₄)₃ always had a more consistent effect on the removal efficiencies than Ca(OH)₂. The ammonia stripping process, reducing the alkalinity of the digested liquid fractions, facilitated a higher concentration of elements in the separated fraction. With the addition of Al₂(SO₄)₃ to digestate after stripping the concentration of P, Cu and Zn in the solid fraction generally increased when compared to the same liquid fraction without stripping. The addition of Ca(OH)₂ might be effective in removing P before the stripping process with the additional benefit to raise pH and improve the ammonia removal efficiency. These findings indicate that solid-liquid separation of animal manure slurries, assisted by chemical additives and coupled with ammonia stripping, can be a viable option for improving the sustainable use of animal manure as a fertiliser.

From guidelines to real world: results from the National Multiple Myeloma Registry in Uruguay on 222 newly diagnosed multiple myeloma patients from 2012 to 2015

Introduction: In the last decade, substantial improvements in the understanding of the biology of multiple myeloma and the development of novel therapeutic options have led to increased response rates, progression free survival and overall survival. In underdeveloped countries, it is a huge challenge to adapt for this evolution, both in diagnostic and therapeutic aspects. Methods: We conducted a retrospective, national analysis of all patients with newly diagnosed multiple myeloma in a recent period. Diagnostic and prognostic evaluation is carried out according to international recommendations in the majority of patients. Results: The clinical presentation at diagnosis is similar to those reported internationally, although with higher rates of anemia and severe renal failure. Most patients were diagnosed in advanced Durie-Salmon stage (80%), with high ISS score (48% ISS 3). Treatment, both in candidates and non-candidates for transplantation, is conditioned by a limited supply of possibilities, scarce availability of new drugs and absence of clinical trials. This determines lower results in response depth and survival. At 32 months, overall survival was 61.8%, with a statistical difference in favor of younger patients, standard-risk MM and those treated with novel drugs. No patient received antibacterial or antifungal prophylaxis while the majority received adequate antiviral prophylaxis. Infections were the main cause of death (29.7%), overcoming the disease itself. Conclusions: This analysis allows us to raise awareness about strengths and weaknesses in our management of MM patients. There is a need to promote earlier detection, improve supportive care and reduce infection mortality. Greater availability of evidence-based recommended treatment options is required. Access to clinical trials is warranted if care is to be improved.

Influenza B virus infection complicated by life-threatening pericarditis: a unique case-report and literature review

Background

Acute pericarditis may occur frequently after viral infections. To our knowledge, influenza B virus infection complicated by pericarditis without myocardial involvement has never been reported. We report the first case of life-threatening pericarditis caused by influenza B virus infection.

Case presentation

A 48-years-old woman with trisomy 21 and ostium primum atrial septal defect was transferred from Cardiology to our Internal Medicine Department for severe pericardial effusion unresponsive to ibuprofen and colchicine. Based on the recent patient history of flu-like syndrome, and presence of pleuro-pericardial effusion, a viral etiology was suspected. Laboratory evaluation and molecular assay of tracheal aspirate identified influenza B virus. Therefore, the ongoing metilprednisolone and colchicine therapy was implemented with oseltamivir with progressive patient improvement and no evidence of pericardial effusion recurrence during follow-up.

Conclusions

Especially in autumn and winter periods, clinicians should include Influenza B virus infection on differential diagnosis of pericarditis with large pericardial effusion.

HIV-2 Infection in a Migrant from Gambia: The History of the Disease Combined with Phylogenetic Analysis Revealed the Real Source of Infection

Human immunodeficiency virus type 2 (HIV-2) infection prevalence is increasing in some European countries. The increasing migratory flow from countries where HIV-2 is endemic has facilitated the spread of the virus into Europe and other regions. We describe a case of HIV-2 infection in a migrant individual in the Asylum Seekers Centre (ASC) in Italy. The patient's virus was sequenced and found to be a typical HIV-2 genotype A virus. Bayesian evolutionary analysis revealed that the HIV-2 sequence from migrant dated back to 1986 in a subcluster, including sequences from Guinea Bissau. This was coherent with the history of the migrant who lived in Guinea Bissau from his birth until 1998 when he was 13 years old. Monitoring for HIV-2 infection in migrants from western Africa is necessary using adequate molecular tools to improve the diagnosis and understand the real origin of infection.

Diffuse maculopapular rash: A family cluster during the last Chikungunya virus epidemic in Italy

A family cluster of father, mother, and daughter with Chikungunya virus (CHIKV) infection was diagnosed during last epidemic in Italy. In temperate area, during the summer season, clinicians should consider CHIKV infection in the differential diagnosis of patients with fever, maculopapular rash, polyarthralgia, and conjunctival erythema.

MALDI-TOF MS Identification and Clustering Applied to Enterobacter Species in Nosocomial Setting

Enterobacter microorganisms cause important bacterial infections in humans. Recently, carbapenem resistant isolates carrying the blaKPC gene were described and their clonal transmission in different nosocomial outbreaks reported. In this study, the relative numbers of Enterobacter species, their antimicrobial susceptibility along 3 years of observation and the identification ability of the two most common MALDI-TOF platforms were evaluated. A clustering analysis was performed to identify changes in the microbial population within the nosocomial environment. Enterobacter were identified using two platforms (MALDI-TOF Biotyper and VITEK MS). Antimicrobial susceptibility was tested by Vitek2 Compact and MIC₅₀ and MIC₉₀ was evaluated using GraphPad software. Clustering analysis was performed by MALDI-TOF and a dendrogram was built with both platforms and compared. The most frequent species isolated were Enterobacter cloacae and Enterobacter aerogenes with a gradual increase of Enterobacter asburiae in 2017. MALDI-TOF platforms showed a very good sensitivity and specificity except for E. asburiae identification that was reliable only by MALDI-TOF MS Biotyper. An increase of resistance for Enterobacter, confirmed by the isolation of extended spectrum beta-lactamase (ESBL) strains and the emergence of E. cloacae multidrug-resistant (MDR) and carbapenem resistant strains, was observed. A clonal route of transmission involving general surgery and geriatric wards was evidenced as previously described for Klebsiella pneumoniae MDR strains in the same nosocomial setting. These data represent an important source of information about the spreading of Enterobacter in the nosocomial environment.

Impact of IFN lambda 3/4 single nucleotide polymorphisms on the cytomegalovirus reactivation in autologous stem cell transplant patients

Cytomegalovirus (CMV) infection represents one of the main cause mortality after Stem Cell Transplantation. Recently, a protective effect of the T allele of rs12979860 IL28B Single Nucleotide Polymorphisms (SNPs) against CMV infection in the allogenic stem cell transplantation was suggested. We investigate whether the rs12979860 IL28B SNP and the relative rs368234815 (IFNλ4) genotype may affect the incidence of active CMV infection in Autologous stem cell transplantation (Auto-SCT) setting. The study included 99 patients who underwent to Auto-SCT. IL28 and IFNΔ4 SNPs were correlated with CMV reactivation along with other clinical and treatment parameters. CMV reactivation by CMV DNAemia was evaluated once a week until day 100 from Auto-SCT. CMV reactivation was documented in 50% (TT-ΔG/ΔG), 35% (CC-TT/TT) and 29.2% (CT-TT/ΔG) of the patients respectively. No differences in CMV copies number were recorded at reactivation between different IL28/IFNλ4 genotypes. The analysis of patients older than 60 years showed a significantly higher incidence of active CMV infection in the TT-ΔG/ΔG (83%) population with respect to CC-TT/TT (21%) and CT-TT/ΔG (40%) patients. Our data suggest a negative role of TT-ΔG/ΔG genotype in the CMV reactivation in Auto-SCT. The exposure to rituximab and the pre-infusion presence of anti CMV IgG also significantly influenced CMV reactivation.

An acute febrile outbreak in a refugee community of an Italian asylum seeker center: lessons learned

OBJECTIVES

The management of infectious outbreaks in closed settings represents an important public health issue. An outbreak of acute febrile syndrome affecting 22 refugees resident at the Asylum Seekers Centre of Castelnuovo di Porto in Rome has been reported, and the preventive and control measures adopted have been described as an example of public health safety.

METHODS

Pharyngeal swab and whole-blood samples were collected from 22 cases observed and analyzed for standard bacterial cultures and respiratory and herpesviruses by qualitative CLART PneumoVir2 and Entherpex microarray.

RESULTS

A possible respiratory-transmitted etiology and a concomitant reactivation of multiple herpesviruses have been evidenced. The epidemiological investigation showed that the spread of the epidemic was promoted because patients were hosted in neighboring rooms or in the same room, facilitating the rapid spread of infectious disease.

CONCLUSIONS

The potential way of transmission was supposed, and preventive measures for infection control were adopted. The measures adopted are an example of best practice for outbreak management, and the microbiological surveillance is recommended for public health improvement.

Genotype I hepatitis A virus introduction in Italy: Bayesian phylogenetic analysis to date different epidemics

Despite a significant decrease in acute hepatitis A in the last 2 decades in Italy, outbreaks were observed occurring mostly in southern Italy. In this study, Bayesian phylogenetic analysis was used to analyze the origin of these epidemics. With this aim, 5 different data sets of hepatitis A virus sequences were built to perform genotyping by the neighbor-joining method to estimate the evolutionary rates by using a Bayesian Markov chain Monte Carlo approach and to investigate the demographic history by independent Markov chain Monte Carlo runs enforcing both a strict and relaxed clock. The estimated mean value of the evolutionary rate, representing Ia and Ib strains, was 1.21 × 10^-3 and 2.0 × 10^-3 substitutions/site/year, respectively. The Bayesian maximum clade credibility tree of hepatitis A virus (HAV) Ia and Ib strains showed that Italian sequences mostly formed separate clusters. The root of the time for the most recent common ancestor (tMRCA) for HAV Ia and Ib strains dated back to 1981 and to 1988, respectively, showing in both cases different epidemic entrances. Phylodynamic analysis showed that genotype Ia increased in 1997, when the Apulia epidemic started, then suffered a bottleneck, probably consequent to vaccination and to the herd immunity, followed by a new increase in virus population in the years 2013-2014 consequent to the epidemic caused by the ingestion of mixed frozen berries. A similar trend without an evident bottleneck was observed also in the case of genotype Ib. In conclusion, the Bayesian phylogenetic analysis represents a good tool to measure the effectiveness of the public health plans used for HAV control.

Susceptibility to measles in migrant population: implication for policy makers

BACKGROUND

Despite a large measles outbreak is taking place in WHO European region, currently no data are available on measles immunization coverage in the asylum seeker and migrants hosted in this area.

METHODS

Two hundred and fifty-six migrants upon their arrival in Italy on March, April and May 2016 were screened for measles virus IgG antibodies by chemiluminescence immunoassay (Liaison XL analyzer, Diasorin, Italy). The virus susceptibility in this cohort, the differences between the official country reported and the observed measles immunization coverage and the impact of current measles outbreak on the asylum seekers hosted in the largest Asylum Seeker centres of Italy, were evaluated.

RESULTS

The prevalence of subjects with positive result for measles IgG antibodies ranged between 79.9% and 100%. In Senegal, Mali, Nigeria, Pakistan and Bangladesh, the measles IgG seroprevalence observed was greater than the vaccinal coverage reported by WHO after I dose of vaccine. Based on data regarding the II dose coverage, the ASs population presented a seroprevalence greater to that expected.

CONCLUSION

On the basis of the results obtained, extraordinary screening and vaccination campaigns in the migrant population, especially in the course of large outbreaks, could represent a resource to reach an adequate measles immunization coverage and to control this infectious disease.

Nitrogen removal from digested slurries using a simplified ammonia stripping technique

This study assessed a novel technique for removing nitrogen from digested organic waste based on a slow release of ammonia that was promoted by continuous mixing of the digestate and delivering a continuous air stream across the surface of the liquid. Three 10-day experiments were conducted using two 50-L reactors. In the first two, nitrogen removal efficiencies were evaluated from identical digestates maintained at different temperatures (30°C and 40°C). At the start of the first experiment, the digestates were adjusted to pH 9 using sodium hydroxide, while in the second experiment pH was not adjusted. The highest ammonia removal efficiency (87%) was obtained at 40°C with pH adjustment. However at 40°C without pH adjustment, removal efficiencies of 69% for ammonia and 47% for total nitrogen were obtained. In the third experiment two different digestates were tested at 50°C without pH adjustment. Although the initial chemical characteristics of the digestates were different in this experiment, the ammonia removal efficiencies were very similar (approximately 85%). Despite ammonia removal, the pH increased in all experiments, most likely due to carbon dioxide stripping that was promoted by temperature and mixing. The technique proved to be suitable for removing nitrogen following anaerobic digestion of livestock manure because effective removal was obtained at natural pH (≈8) and 40°C, common operating conditions at typical biogas plants that process manure. Furthermore, the electrical energy requirement to operate the process is limited (estimated to be 3.8kWhm^-3digestate). Further improvements may increase the efficiency and reduce the processing time of this treatment technique. Even without these advances slow-rate air stripping of ammonia is a viable option for reducing the environmental impact associated with animal manure management.

Nutrient Losses during Winter and Summer Storage of Separated and Unseparated Digested Cattle Slurry

Management factors affect nutrient loss during animal manure slurry storage in different ways. We conducted a pilot-scale study to evaluate carbon (C) and nitrogen (N) losses from unseparated and digested dairy slurry during winter and summer storage. In addition to season, treatments included mechanical separation of digestate into liquid and solid fractions and bimonthly mixing. Chemical analyses were performed every 2 wk for the mixed materials and at the start and end of storage for unmixed materials. The parameters examined allowed us to estimate C and N losses and examine the factors that determine these losses as well as emission patterns. Gas measurements were done every 2 wk to determine the main forms in which gaseous losses occurred. To evaluate the effect of separation, measured losses and emissions of separated liquid and solid fractions were mathematically combined using the mass separation efficiency of the mechanical separator. Nutrient losses were mainly affected by climatic conditions. Losses of C (up to 23%) from unseparated, unmixed digestate and of N (38% from combined separated fractions and from unseparated digestate) were much greater in summer than in winter, when C and N losses were <7%. Mixing tended to significantly increase N losses ( < 0.1) only in winter. Mechanical separation resulted in lower GHG emissions from combined separated fractions than from unseparated digestate. Results indicate that to maximize the fertilizer value of digested slurry, dairy farmers must carefully choose management practices, especially in summer. For separated digestates, practices should focus on storage of the liquid fraction, the major contributor of C and N losses (up to 64 and 90% of total losses, respectively) in summer. Moreover, management practices should limit NH, the main form of N losses (up to 99.5%).

Association of early protein intake and pre-peritoneal fat at five years of age: Follow-up of a randomized clinical trial

BACKGROUND AND AIMS

The double-blind randomized European Childhood Obesity Project (CHOP) demonstrated that reduced protein content in infant formula leads to a lower body mass index (BMI) up to six years of age. Here we aimed at assessing pre-peritoneal fat, a marker of visceral fat, in children participating in the CHOP trial.

METHODS AND RESULTS

Healthy term formula-fed infants in five European countries were randomized either to higher (n = 550) or lower (n = 540) protein formulas in the first year of life. Infants who were exclusively breastfed for at least three months (n = 588) were enrolled as an observational (non randomized) group. At age 5 years, subcutaneous fat (SC) and pre-peritoneal fat (PP) were measured by ultrasound in a subgroup of 275 children. The PP fat layer was thicker in the higher compared to the lower protein group (adjusted estimated difference: 0.058 cm, 95%CI 0.002; 0.115; p = 0.043), while SC fat was not different. Girls showed a thicker SC fat layer than boys.

CONCLUSIONS

Higher protein intake in formula-fed infants appears to enhance pre-peritoneal fat tissue accumulation at the age of 5 years, but not of subcutaneous fat, which may trigger adverse metabolic and health consequences.

The PNPLA3 rs738409 C > G polymorphism is associated with the risk of progression to cirrhosis in NAFLD patients

BACKGROUND AND AIMS

The patatin-like phospholipase domain-containing 3 (PNPLA3) rs738409 C > G single nucleotide polymorphism (SNP) has been associated with steatosis and fibrosis in previous NAFLD populations in which cirrhotic patients were very poorly represented. Since not all NAFLD with fibrosis evolve to cirrhosis, we investigated the specific risk of cirrhosis conferred in NAFLD patients by carrying this SNP.

METHODS

Three groups were studied: patients with NASH-cirrhosis; patients with biopsy-proven non-cirrhotic NAFLD; healthy subjects undergoing medicine check-ups. Epidemiological, anthropometric, and clinical data were collected, and the SNP was analyzed by pyrosequencing.

RESULTS

Sixty-one patients with NASH-cirrhosis, 60 with non-cirrhotic NAFLD, and 125 healthy controls were included. Frequency of the PNPLA3 minor (G) allele was increased in patients with NASH-cirrhosis compared with non-cirrhotic NAFLD and controls (allele frequency: 0.598 versus 0.367 versus 0.2, respectively, p < 0.001), and different between the latter two groups (p < 0.001). Three-quarters (74%) of NASH cirrhotics carried at least one G allele, and almost half of them (46%) were GG homozygous. By multivariate analysis in the NAFLD population, each copy of the G allele was associated with an almost doubling of the risk of cirrhosis [OR 1.8 (1.02-3.2)], while being GG homozygous with a tripled risk compared with being CC homozygous [3.01 (1.03-10.8)].

CONCLUSIONS

In NAFLD patients, carriage of the PNPLA3G allele, and particularly of the GG genotype, is significantly associated with the risk of cirrhotic evolution. If confirmed in larger series, these results would suggest that most of NASH cases require the contribution of an altered PNPLA3 function to progress until cirrhosis.

Effect of a Biological Additive on Nitrogen Losses from Pig Slurry during Storage

Additives applied to animal manure slurries can affect the chemical composition and the biological processes of slurries during storage, with possible improvement of their management and reduction of environmental problems. Some new formulations are marketed claiming a nitrogen (N) removal effect due to denitrification, with the consequence of a reduced N content in the manure after storage. This study evaluated the effects of one of these commercial additives (BACTYcomplex) on slurry characteristics and N losses at a commercial piggery. The additive was applied to four different sectors of the piggery, each with an independent under-floor slurry pit; four other sectors served as controls without treatment. Pits were emptied every 4 wk, and the manure was analyzed for total and ammonia-N and total and volatile solids. Slurry samples from the last month of the on-farm assessment were removed and stored thermostatically in vessels external to the piggery. A subsample of slurry that was treated with the additive at the piggery was treated with an additional dose of additive at the beginning of long-term storage. The additive did not change the composition of the slurry during in-house storage (4 wk duration). During the 155 d of external thermostatic storage, the total solids content of treated slurry was reduced by 18% compared with control slurry, but the N content and composition of treated slurry was unaffected. The additive had a positive effect in accelerating the stabilization of the slurry but did not modify N losses.

Evaluation of performances of VERSANT HCV RNA 1.0 assay (kPCR) and Roche COBAS AmpliPrep/COBAS TaqMan HCV test v2.0 at low level viremia

We assess the concordance between low level HCV values obtained using the VERSANT HCV RNA 1.0 Assay (kPCR) and COBAS AmpliPrep/COBAS TaqMan HCV Quantitative Test v2.0. The correlation between the values obtained by the two RT-PCR assays for samples with quantifiable HCV RNA levels revealed that viral load measured by kPCR significantly correlated with that of the CAP/CTM (R=0.644, P<0.0001). The results show a good concordance (n=126/144, 87%); discordant results were mainly observed in the assessment of values below the lower limit of detection of the assays. These variations may have an impact on clinical decisions for patients on HCV triple therapy or interferon- free regimens. It is therefore recommended to monitor individual patients with the same test throughout treatment.

Dietary Glycemic Load and Macronutrient Intake in Healthy Italian Children

The objective is of this study is to examine the relationship of dietary glycemic load (GL) and overall glycemic index (OGI) with macronutrients intake, body mass index (BMI) and insulin sensitivity in healthy children. The subjects comprised of 105 healthy non-obese eight -years old children, 60 boys and 45 girls. A Food Frequency Questionnaire (FFQ) evaluating dietary habits, GL and OGI. Insulin sensitivity was evaluated by the homeostatic model assessment (HOMA). GL was positively associated with dietary total (correlation coefficient, r=0.57) and starch (r=0.67) carbohydrates, daily consumption of pasta and white bread, cooked potatoes, bakery products and cookies, and negatively with dietary fats (r=-0.52). OGI was positively associated with daily consumption of white bread and cookies, and negatively associated with soluble carbohydrates (r=-0.35), and consumption of fibres, proteins, fruit, legumes and carrots. No significant association was found of GL or OGI with BMI or insulin sensitivity. In healthy children, GL and OGI may represent a useful indicator of quality of diet. Asia Pac J Public Health 2005; 17(2): 88-92.

Treating Phenylketonuria: A Single Centre Experience

Hyperphenylalaninaemia (HPA) is an inherited disorder that results in raised plasma phenylalanine levels with a range of severities, including phenylketonuria (PKU). Since the first attempts at treatment using a low-phenylalanine diet and after more than 50 years of research, considerable progress has been made so we are now at a stage where mental retardation caused by high plasma phenylalanine can be prevented. We must, however, be aware of the new challenges we face in managing PKU. These include: maintaining optimal growth by providing enough phenylalanine without jeopardizing the child's psychomotor development; providing an optimal nutritional status that ensures other essential nutrients, such as long chain polyunsaturated fatty acids, are not excluded from the diet; ensuring optimal compliance to the dietary intervention; and considering patients' quality of life. New strategies, such as tetrahydrobiopterin (BH4) supplementation, need to be evaluated with regard to safety, efficacy and expected outcomes in specific types of HPA.

Oral Lactoferrin in HIV-1 Vertically Infected Children: An Observational Follow-up of Plasma Viral Load and Immune Parameters

Lactoferrin (LF) is a mammalian iron-binding glycoprotein with antiviral effects. This preliminary study evaluated 6 months' LF (3 g/day, orally) treatment in 22 human immunodeficiency virus type 1 (HIV-1) vertically infected children. Plasma viral load and CD4+ cell counts were assessed every 3 months; before, during and after LF administration. No significant changes were observed during the pre-treatment period. By 6 months, mean (± SD) plasma viral load (log10) declined from 4.54 (± 0.65) to 4.28 (± 0.60); median percentage CD4+ cell count increased from 21.5% to 24.5%. Two months after treatment discontinuation, mean plasma viral load did not differ significantly from baseline or month 6 levels, but the percentage CD4+ cell count remained significantly higher than the baseline value. LF plus antiretroviral (ARV) therapy was more effective at increasing CD4+ cell count than LF alone. None of the patients showed any new HIV-1-related symptoms at follow-up. LF might be a useful addition to ARV therapy, but further large-scale studies are required.