SARS-CoV-2 in water services: Presence and impacts.

The occurrence of human pathogenic viruses in aquatic ecosystems and, in particular, in internal water bodies (i.e., river, lakes, groundwater, drinking water reservoirs, recreational water utilities, and wastewater), raises concerns regarding the related impacts on environment and human health, especially in relation to the possibility of human exposure and waterborne infections. This paper reviews the current state of knowledge regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presence and persistence in human excreta, wastewaters, sewage sludge as well as in natural water bodies, and the possible implications for water services in terms of fecal transmission, public health, and workers' risk. Furthermore, the impacts related to the adopted containment and emergency management measures on household water consumptions are also discussed, together with the potential use of wastewater-based epidemiology (WBE) assessment as a monitoring and early warning tool, to be applied in case of infectious disease outbreaks. The knowledge and tools summarized in this paper provide a basic information reference, supporting decisions makers in the definition of suitable measures able to pursue an efficient water and wastewater management and a reduction of health risks. Furthermore, research questions are provided, in order to direct technical and public health communities towards a sustainable water service management in the event of a SARS-CoV-2 re-emergence, as well as a future deadly outbreak or pandemic.

[Multifocal inflammatory pseudotumor of the liver]. / Pseudotumore infiammatorio multifocale del fegato.

Inflammatory pseudotumor of the liver is a rare entity of unknown etiology; fewer than 80 cases have been reported in the world literature. Its appearance on the computerized tomography, ultrasound and magnetic resonance have been previously described as nonspecific, and clinical presentation is not helpful in the diagnosis. This is why the diagnosis usually is made after laparotomy and often after the excision of the tumor. Several recent reports show that drug therapy is effective and lead to tumor regression, while other authors believe that an aggressive approach should be taken, due to the potential adverse impact of its vascular invasive and biliary obstructive nature. Herein we describe a case of this clinical entity, which occurred in a 52 years old patient, where the operative examination showed bilobar involvement, treated with right hepatectomy and contra-lateral tumor excision in the clinical suspect of hepatocellular carcinoma. The detailed clinical, radiological and pathological picture is described. At 6 months follow-up the patient conditions are excellent. On the basis of the available literature, we discuss the clinical features and the therapeutical problems of such rare clinical entity, and propose a selected use of liver biopsy when the clinical suspicion of pseudotumor can be considered, in order to achieve a preoperative diagnosis and therefore to avoid surgery.