Impact of chronic liver disease upon admission on COVID-19 in-hospital mortality: Findings from COVOCA study

Background Italy has been the first Western country to be heavily affected by the spread of SARS-COV-2 infection and among the pioneers of the clinical management of pandemic. To improve the outcome, identification of patients at the highest risk seems mandatory. Objectives Aim of this study is to identify comorbidities and clinical conditions upon admission associated with in-hospital mortality in several COVID Centers in Campania Region (Italy). Methods COVOCA is a multicentre retrospective observational cohort study, which involved 18 COVID Centers throughout Campania Region, Italy. Data were collected from patients who completed their hospitalization between March-June 2020. The endpoint was in-hospital mortality, assessed either from data at discharge or death certificate, whilst all exposure variables were collected at hospital admission. Results Among 618 COVID-19 hospitalized patients included in the study, 143 in-hospital mortality events were recorded, with a cumulative incidence of about 23%. At multivariable logistic analysis, male sex (OR 2.63, 95%CI 1.42–4.90; p = 0.001), Chronic Liver Disease (OR 5.88, 95%CI 2.39–14.46; p<0.001) and malignancies (OR 2.62, 95%CI 1.21–5.68; p = 0.015) disclosed an independent association with a poor prognosis, Glasgow Coma Scale (GCS) and Respiratory Severity Scale allowed to identify at higher mortality risk. Sensitivity analysis further enhanced these findings. Conclusion Mortality of patients hospitalized for COVID-19 appears strongly affected by both clinical conditions on admission and comorbidities. Originally, we observed a very poor outcome in subjects with a chronic liver disease, alongside with an increase of hepatic damage

Use of hydroxychloroquine in hospitalised COVID-19 patients is associated with reduced mortality: Findings from the observational multicentre Italian CORIST study

Background: Hydroxychloroquine (HCQ) was proposed as potential treatment for COVID-19. Objective: We set-up a multicenter Italian collaboration to investigate the relationship between HCQ therapy and COVID-19 in-hospital mortality. Methods: In a retrospective observational study, 3,451 unselected patients hospitalized in 33 clinical centers in Italy, from February 19, 2020 to May 23, 2020, with laboratory-confirmed SARS-CoV-2 infection, were analyzed. The primary end-point in a time-to event analysis was in-hospital death, comparing patients who received HCQ with patients who did not. We used multivariable Cox proportional-hazards regression models with inverse probability for treatment weighting by propensity scores, with the addition of subgroup analyses. Results: Out of 3,451 COVID-19 patients, 76.3% received HCQ. Death rates (per 1,000 person-days) for patients receiving or not HCQ were 8.9 and 15.7, respectively. After adjustment for propensity scores, we found 30% lower risk of death in patients receiving HCQ (HR=0.70; 95%CI: 0.59 to 0.84; E-value=1.67). Secondary analyses yielded similar results. The inverse association of HCQ with inpatient mortality was particularly evident in patients having elevated C-reactive protein at entry. Conclusions: HCQ use was associated with a 30% lower risk of death in COVID-19 hospitalized patients. Within the limits of an observational study and awaiting results from randomized controlled trials, these data do not discourage the use of HCQ in inpatients with COVID-19

Lopinavir/Ritonavir and Darunavir/Cobicistat in Hospitalized COVID-19 Patients: Findings From the Multicenter Italian CORIST Study

Background: Protease inhibitors have been considered as possible therapeutic agents for COVID-19 patients. Objectives: To describe the association between lopinavir/ritonavir (LPV/r) or darunavir/cobicistat (DRV/c) use and in-hospital mortality in COVID-19 patients. Study Design: Multicenter observational study of COVID-19 patients admitted in 33 Italian hospitals. Medications, preexisting conditions, clinical measures, and outcomes were extracted from medical records. Patients were retrospectively divided in three groups, according to use of LPV/r, DRV/c or none of them. Primary outcome in a time-to event analysis was death. We used Cox proportional-hazards models with inverse probability of treatment weighting by multinomial propensity scores. Results: Out of 3,451 patients, 33.3% LPV/r and 13.9% received DRV/c. Patients receiving LPV/r or DRV/c were more likely younger, men, had higher C-reactive protein levels while less likely had hypertension, cardiovascular, pulmonary or kidney disease. After adjustment for propensity scores, LPV/r use was not associated with mortality (HR = 0.94, 95% CI 0.78 to 1.13), whereas treatment with DRV/c was associated with a higher death risk (HR = 1.89, 1.53 to 2.34, E-value = 2.43). This increased risk was more marked in women, in elderly, in patients with higher severity of COVID-19 and in patients receiving other COVID-19 drugs. Conclusions: In a large cohort of Italian patients hospitalized for COVID-19 in a real-life setting, the use of LPV/r treatment did not change death rate, while DRV/c was associated with increased mortality. Within the limits of an observational study, these data do not support the use of LPV/r or DRV/c in COVID-19 patients

Eco-friendly and cost-effective strategies for metals recovery from printed circuit boards

The possible optimization of metal recovery from Printed Circuit Boards (PCBs)and Central Processing Units (CPUs)has been investigated. Usual practice is to recover primarily the metals with the highest market price. In contrast, the present work shows how strategic considerations of the value share (%)of metals content and data regarding the environmental impact of their recovery can instruct about the best strategies to adopt, pointing at the metals to be recovered as a priority depending on the case. An accurate PCBs\u2019 characterization carried out through microwave digestion with a mixture of HNO3, HF and HCl, is a first essential step of the procedure. Then, metals are recovered through chemical leaching with different chemical substances, exploiting both chemical and physical steps. A proposal is presented to improve the environmental and economic sustainability of the treatment of PCBs, which provides for the initial recovery of Cu, Pb and Sn from the whole boards, through leaching with 6M HNO3, followed by the recovery of gold and other precious metals from the board components once removed and appropriately crushed. Although unusual, the recovery procedure can be adapted accordingly, allowing greater profits, easier management and higher metals recovery rates

Raw materials recovery from spent hydrochloric acid-based galvanizing wastewater

The composition of spent hydrochloric acid-based pickling liquors, deriving from the galvanizing industry, greatly depends on how long the bath has been used for pickling. We considered solutions containing 40\u201350\u202fg\u202fL 121 of iron and zinc (as FeCl2 and ZnCl2) and 130\u2013220\u202fg\u202fL 121 of chloride, and used tri-butyl phosphate (TBP) and di-(2-ethylhexyl) phosphoric acid (D2EHPA) in kerosene as extraction solutions. From the spent liquors, zinc was selectively extracted and then recovered from the organic phase by using water or dilute hydrochloric acid. By using the kinetic results obtained for TBP and D2EHPA, recovery selectivity of zinc over iron (\u3b1Zn/Fe) was estimated to be of 16.7 and 0.5, respectively. According to the McCabe & Thiele diagram for an organic to aqueous ratio of 2, three stages of extraction are sufficient to remove about 98% of the zinc from a real solution. The remaining solution of FeCl2 can be used to recover HCl and FeSO4 through the so-called \u201csulphuric acid distillation\u201d. Finally, the recovered HCl can be used as a raw material, together with limestone, to produce CaCl2. Overall, an integrated process to recover the above-mentioned raw materials (Zn salts, FeSO4\ub77H2O and CaCl2) is presented: all products have been obtained in a ready-to-sell form, minimizing the waste according to the strategies of the \u201ccircular economy\u201d and the \u201cnear-zero discharge\u201d of hazardous chemicals

Metals recovery from Printed Circuit Boards: the pursuit of environmental and economic sustainability

The possible optimization of metal recovery from Printed Circuit Boards (PCBs) and Central Processing Units (CPUs) has been investigated. Usual practice is to primarily recover metals with the highest market price. In contrast, the present work shows how strategic considerations of the value share (%) of metals content and data regarding the environmental impact of their recovery can instruct about the best strategies to adopt, pointing at the metals to be recovered as a priority depending on the case. An accurate PCBs\u2019 characterization carried out through microwave digestion with a mixture of HNO3, HF and HCl, is a first essential step of the procedure. Then metals are recovered through chemical leaching with different chemical substances, exploiting both chemical and physical steps. In particular, a proposal to improve environmental and economic sustainability of the PCBs\u2019 treatment is presented, which contrary to expectations first considers the recovery of Cu, Pb and Sn by leaching with 6M HNO3, followed only later by the recovery of gold and other precious metals. Although unusual, the recovery procedure can be adapted accordingly, allowing more profits, easier management and higher metals recovery rates

Enhancements in Biomass-to-Liquid processes: Gasification aiming at high hydrogen/carbon monoxide ratios for direct Fischer-Tropsch synthesis applications

The Fischer-Tropsch process is one of the possible routes to produce synthetic liquid fuels and chemicals employed on large scale in Gas-to-Liquid and Coal-to-Liquid processes, after appropriate transformation of respective fossil sources into syngas. However, syngas can be produced by biomass gasification as well. One of the main problems is the need to ensure high H2/CO ratio to allow the Fischer-Tropsch reaction to occur, operation commonly achieved by resorting to a Water-gas shift step. The present work reports an experimental study on biomass gasification. The aim was to set up a more efficient Biomass-to-Liquid process, which ensures a high H2/CO ratio syngas suitable for Fischer-Tropsch synthesis directly from biomass gasification. In this way, it is possible to remove the Water-gas shift section and consequently make biofuels production more attractive, reducing costs and plant complexity. Two types of biomass have been tested: softwood from forest residues and fast growing crops. Moreover, a bubbling fluidized bed reactor and an indirect gasifier with internal circulating fluidized bed have been used. Gasification tests have been conducted by running gasifiers with both inert and catalytic bed materials. The results have shown that, using the direct gasifier with catalytic bed and a proper configuration, H2/CO molar ratio of 2 can been obtained even at low temperature and low steam/biomass ratio, whereas this is not the case in the indirect one. However, tests suggest that an inverted configuration would make it possible to obtain values near two also with indirect gasifiers, resulting in a new interesting approach

Removal of polyethylene glycols from wastewater: A comparison of different approaches

Physicochemical methods such as adsorption on activated carbon, oxidation with either ozone or Fenton reagent, and chemical precipitation (coagulation), were assessed for the removal of polyethylene glycol (PEG) from wastewater. This contaminant is rarely investigated due to its low toxicity, although its presence limits the use of large water resources. The experimental tests showed that adsorption on activated carbon is well approximated by a Langmuir isotherm, and influenced by contact time, PEG molecular weight, pH, temperature, and initial PEG concentration. Ozonation allowed fragmenting the polymeric chains but was unable to remove completely the PEG, while about 85% of the total organic carbon (TOC) was removed by Fenton oxidation reaction by using a ratio between H2O2 and FeII close to 4. Coagulation did not produce results worthy of note, most likely because the uncharged PEG molecule does not interact with the iron hydroxide flocs. However, when performed after the Fenton oxidation (i.e., by simply raising the pH to values > 8), it allowed a further reduction of the residual TOC, up to 96% of the total, in the best case. Based on the resources used by each process studied and in consideration of the effectiveness of each of them, a semi-quantitative comparison on the sustainability of the different approaches is proposed

Heavy metals removal and recovery from hazardous leather sludge

The tanning industry is one of the oldest industries in the world and is known for the production of a wide variety of toxic waste (aqueous and solid) containing chromium salts and other heavy metals. Solid waste is produced during the conversion of putrescible collagen fibres into finished non-putrescible leather products. In this process, the use of a variety of chemicals during the fleshing or trimming phases, results in different hazardous waste, such as wet blue leather, crust leather, chrome shaving, finished leather off-cuts, and unusable chrome spilt. In the present study, we deal with the treatment of these hazardous leather sludge and the recovery of heavy metals contained in them. The leather sludge was pyrolyzed in a torch plasma reactor at a temperature of 1,400-1,500 \ub0C producing an inert solid residue. However, the high temperatures involved induce the volatilization of some metals, which condense to form hazardous dusts (21.8% Zn, 0.70% Cr, 4,080 ppm Pb and 123 ppm Cd) that have to be properly dealt with. Numerous leaching tests have been conducted to maximize the amount of the individual components solubilized from the powder. Then, different treatment strategies have been combined for the recovery of the main metals: precipitation for Pb and Zn, and adsorption on chitosan for Cd