Only five species account for 92% of cases of candidemia (Candida albicans, C. glabrata, C. tropicalis, C. parapsilosis, and C. krusei); however, their distribution varies in population-based studies ...conducted in different geographical areas. C. albicans is the most frequent species, but considerable differences are found between the number of cases caused by C. glabrata and C. parapsilosis. Studies from Northern Europe and the USA reported a high number of cases caused by C. glabrata, whereas studies from Spain and Brazil demonstrated a lower number of cases caused by C. glabrata and a higher number of cases attributed to C. parapsilosis. Globally, the frequency of C. albicans is decreasing, while that of C. glabrata and C. krusei is stable, and C. parapsilosis and C. tropicalis are increasing. Patient characteristics and prior antifungal therapy also have a considerable influence on the distribution and frequency of Candida spp., regardless of the geographical area. C. albicans is more frequent in patients aged up to 18 years, the frequency of C. parapsilosis decreases with age, and C. glabrata is more common in the elderly. Finally, the presence of horizontal transmission of Candida spp. isolates (reported mainly in patients from the adult medical and post-surgical ICU, patients from oncology–haematology units, and neonates) can affect species distribution.
EUCAST has revised the definition of the susceptibility category I from ‘Intermediate’ to ‘Susceptible, Increased exposure’. This implies that I can be used where the drug concentration at the site ...of infection is high, either because of dose escalation or through other means to ensure efficacy. Consequently, I is no longer used as a buffer zone to prevent technical factors from causing misclassifications and discrepancies in interpretations. Instead, an Area of Technical Uncertainty (ATU) has been introduced for MICs that cannot be categorized without additional information as a warning to the laboratory that decision on how to act has to be made. To implement these changes, the EUCAST-AFST (Subcommittee on Antifungal Susceptibility Testing) reviewed all, and revised some, clinical antifungal breakpoints.
The aim was to present an overview of the current antifungal breakpoints and supporting evidence behind the changes.
This document is based on the ten recently updated EUCAST rationale documents, clinical breakpoint and breakpoint ECOFF documents.
The following breakpoints (in mg/L) have been revised or established for Candida species: micafungin against C. albicans (ATU = 0.03); amphotericin B (S ≤/> R = 1/1), fluconazole (S ≤/> R = 2/4), itraconazole (S ≤/> R = 0.06/0.06), posaconazole (S ≤/> R = 0.06/0.06) and voriconazole (S ≤/> R = 0.06/0.25) against C. dubliniensis; fluconazole against C. glabrata (S ≤/> R = 0.001/16); and anidulafungin (S ≤/> R = 4/4) and micafungin (S ≤/> R = 2/2) against C. parapsilosis. For Aspergillus, new or revised breakpoints include itraconazole (ATU = 2) and isavuconazole against A. flavus (S ≤/> R = 1/2, ATU = 2); amphotericin B (S ≤/> R = 1/1), isavuconazole (S ≤ /> R = 1/2, ATU = 2), itraconazole (S ≤/> R = 1/1, ATU = 2), posaconazole (ATU = 0.25) and voriconazole (S ≤/> R = 1/1, ATU = 2) against A. fumigatus; itraconazole (S ≤/> R = 1/1, ATU = 2) and voriconazole (S ≤/> R = 1/1, ATU = 2) against A. nidulans; amphotericin B against A. niger (S ≤/> R = 1/1); and itraconazole (S ≤/> R = 1/1, ATU = 2) and posaconazole (ATU = 0.25) against A. terreus.
EUCAST-AFST has released ten new documents summarizing existing and new breakpoints and MIC ranges for control strains. A failure to adopt the breakpoint changes may lead to misclassifications and suboptimal or inappropriate therapy of patients with fungal infections.
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•Roofing slates are metamorphic rocks used for building covers.•They have an important presence in European Architectural Heritage.•So far, there are no reliable data on its ...performance under fire conditions.•We submitted different types of roofing slates to temperatures up to 900 °C.•Results show a decrease on the bending strength and an aesthetical change to red hue.
Fire is a major destructive agent for dimension stone. Practically all historic buildings have suffered one or more fires over the course of their lifespan. There are numerous studies on the effect of fire on stone. Generally speaking, these effects can be divided into aesthetic and structural. Aesthetic effects involve a color shift to reddish hues, due to the oxidation processes triggered by temperature increase. Moreover, structural effects involve the formation of cracks and delaminations that may cause the rock to disintegrate. However, even though roofing slates are a group of metamorphic rocks that are widely represented in the historical architectural heritage of many European countries, none of the scientific studies alluded to above have taken them into account. The present study examines 6 lithotypes, covering the metamorphic range of rocks used as roofing slates. The roofing slates were subjected to a heating test reaching 900 °C, and then analyzed using X-ray diffraction and fluorescence, Thermogravimetric and Differential Thermal analyses, and were also tested for bending strength and water absorption following the European standard for roofing slates, EN 12326. All samples studied exhibited a reduction in their bending strength, together with an increase in water absorption. Likewise, the oxidation processes triggered by the high temperatures induced a general oxidation of the iron, lending all of the samples a reddish hue. On the other hand, the roofing slate samples proved to be non-combustible and did not release any toxic or hazardous fumes.
•Al2O3:C (commercial) and Al2O3:Cr,Ni display thermoluminescence (TL) red emission at 650 nm at doses higher than 10 mGy.•Al2O3:C shows sensitivity to radiation, linear dose response (10-100 mGy), ...thermal stability and tiny fading (up to 672 h).•Al2O3:Cr,Ni exhibits similar TL dosimetric features to Al2O3:C, but fades exponentially (~70%) after 672 hours of storage.•Tmax-Tstop test indicates the coexistence of a continuous and discrete trap system in both Al2O3:C and Al2O3:Cr,Ni materials.
We herein report on the radiation effect on the red thermoluminescence (TL) emission of synthetic Al2O3:C (commercial TLD-500 supplied by Harshaw) and Al2O3:Cr,Ni (grown by the Verneuil method). The materials were previously characterized by cathodoluminescence (CL), displaying significant differences in the UV-IR spectral emission range related to the presence of dopants. Whilst the CL curve of C-doped alumina exhibits four wavebands peaked at 325 (due to F+ centers) 411 (F centers), 648 (Fe3+) and 785 nm (Ti3+), the Al2O3:Cr,Ni sample shows a narrow, sharp, high intensity maximum at 692 nm with two vibronic side bands of lower intensity at 679 nm and 713 nm attributed to the R-lines of Cr3+. The red TL emission at 650 nm of both materials indicates that they could potentially be used as dosimeters since (i) are sensitive to ionizing radiation at doses over 10 mGy; (ii) show a linear dose response in the range of 10–100 mGy with regression coefficients of 0.999 and (iii) can be reusable with negligible variation in the intensity (never higher than±0.8%) and no observed changes in the shape of the TL curves. The red glow emission intensity corresponding to the C-doped sample hardly changes with the storage time, however Al2O3:Cr,Ni fades significantly (ca 70%), up to ~700 h of storage following a behavior that can be fitted to a decreasing exponential function. Tmax-Tstop test suggests the coexistence of continuous and discrete trap systems in both compounds.
•Investigating UVC radiation to extend lifetime of healthcare items containing PP.•FTIR and Raman spectroscopy suggest negligible PP degradation post-UVC treatment.•Commercial dosimeters support ...UVC-induced TL response under PP materials.•Consistent UVC detection method after one-hour PP materials exposure.•Underscoring the role of UVC to prolong PP lifetime for plastic pollution reduction.
This study investigates the application of ultraviolet C (UVC) radiation to extend the lifetime of healthcare items containing polypropylene (PP), particularly personal protective equipment (PPE). The main objectives involve assessing possible PP damage from UVC exposure and detecting UVC treatment within PP samples. FTIR spectroscopy and Raman spectroscopy reveal slight degradation in UVC-irradiated PP samples, demonstrating resilience post-treatment. Investigations using commercial thermoluminescence dosimeters (TLD-100, TLD-200, TLD-400 and GR-200) positioned under varying thicknesses of PP (0.20 and 0.80 mm) identify TLD-100 as a promising UVC detector. Conversely, TLD-200 and TLD-400 do not prove to be effective detectors, exhibiting similar behavior to the dosimeters without a plastic sample. And GR-200 does not possess the capability to differentiate between ionizing and non-ionizing components of UVC radiation. This research emphasizes the role of UVC to prolong the lifetime of healthcare items containing PP, thus aiding in efforts to reduce plastic pollution.
•Exploring UVC-PS interactions in post-packaging treatment for healthcare applications.•FTIR and Raman spectroscopy reveal negligible PS degradation following UVC irradiation.•Commercial dosimeters ...confirm UVC-induced TL response through PS materials.•Analysis of TL emissions unveils distinct patterns among commercial dosimeters.•A reliable UVC detection methodology for healthcare materials after exposure.
The interaction between ultraviolet C radiation (UVC) and polystyrene (PS) materials has been investigated, particularly in post-packaging irradiation processes for healthcare applications. Effective UVC penetration through PS materials, regardless of their thickness (0.16 and 0.40 mm) has been observed. However, the penetration effectiveness could be affected by the thickness of the PS material. Achieving optimal post-packaging UVC treatment requires a thorough evaluation of chemical composition and material thickness, especially in pharmaceutical and medical packaging industries.
Preliminary results reveal minimal degradation in UVC-irradiated PS packaging samples, as supported by FTIR and Raman spectroscopy characterization. Minor variations could be attributed to intrinsic PS materials properties and/or their respective background, rather than the influence of UVC radiation. Consequently, PS materials exhibit resilience under the experimental conditions following UVC irradiation treatment. Furthermore, a comprehensive analysis of thermoluminescence (TL) emissions evaluates several commercial dosimeter materials for UVC radiation detection. The TLD-100 and TLD-200 dosimeters show potential as UVC detectors, displaying distinct responses linked to the non-ionizing component of UVC radiation at 310 °C and in the range of 150–250 °C, respectively. However, the TLD-400 and GR-200 dosimeters are not suitable for UVC detection due to their spread TL emissions considering intensity and curve shape.
This UVC-TL analysis consistently detects radiation in the proposed commercial dosimeter materials one-hour post-exposure, providing assurance that healthcare materials have been irradiated. Such analysis enhances reliability during extended UVC exposures, offering valuable insights for industries employing UVC-irradiated materials, particularly in healthcare applications.
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These European Society for Clinical Microbiology and Infectious Diseases and European Confederation of Medical Mycology Joint Clinical Guidelines focus on the diagnosis and management of ...mucormycosis. Only a few of the numerous recommendations can be summarized here. To diagnose mucormycosis, direct microscopy preferably using optical brighteners, histopathology and culture are strongly recommended. Pathogen identification to species level by molecular methods and susceptibility testing are strongly recommended to establish epidemiological knowledge. The recommendation for guiding treatment based on MICs is supported only marginally. Imaging is strongly recommended to determine the extent of disease. To differentiate mucormycosis from aspergillosis in haematological malignancy and stem cell transplantation recipients, identification of the reverse halo sign on computed tomography is advised with moderate strength. For adults and children we strongly recommend surgical debridement in addition to immediate first-line antifungal treatment with liposomal or lipid-complex amphotericin B with a minimum dose of 5 mg/kg/day. Amphotericin B deoxycholate is better avoided because of severe adverse effects. For salvage treatment we strongly recommend posaconazole 4 × 200 mg/day. Reversal of predisposing conditions is strongly recommended, i.e. using granulocyte colony-stimulating factor in haematological patients with ongoing neutropenia, controlling hyperglycaemia and ketoacidosis in diabetic patients, and limiting glucocorticosteroids to the minimum dose required. We recommend against using deferasirox in haematological patients outside clinical trials, and marginally support a recommendation for deferasirox in diabetic patients. Hyperbaric oxygen is supported with marginal strength only. Finally, we strongly recommend continuing treatment until complete response demonstrated on imaging and permanent reversal of predisposing factors.
Mycoses summarized in the hyalohyphomycosis group are heterogeneous, defined by the presence of hyaline (non-dematiaceous) hyphae. The number of organisms implicated in hyalohyphomycosis is ...increasing and the most clinically important species belong to the genera Fusarium, Scedosporium, Acremonium, Scopulariopsis, Purpureocillium and Paecilomyces. Severely immunocompromised patients are particularly vulnerable to infection, and clinical manifestations range from colonization to chronic localized lesions to acute invasive and/or disseminated diseases. Diagnosis usually requires isolation and identification of the infecting pathogen. A poor prognosis is associated with fusariosis and early therapy of localized disease is important to prevent progression to a more aggressive or disseminated infection. Therapy should include voriconazole and surgical debridement where possible or posaconazole as salvage treatment. Voriconazole represents the first-line treatment of infections due to members of the genus Scedosporium. For Acremonium spp., Scopulariopsis spp., Purpureocillium spp. and Paecilomyces spp. the optimal antifungal treatment has not been established. Management usually consists of surgery and antifungal treatment, depending on the clinical presentation.
The Subcommittee on Antifungal Susceptibility Testing (AFST) of the ESCMID European Committee for Antimicrobial Susceptibility Testing (EUCAST) has determined breakpoints for isavuconazole and ...Aspergillus and for itraconazole and Candida spp., released a new document summarizing existing and new minimum inhibitory concentration ranges for quality control strains and revised the method documents for yeast and mould susceptibility testing. This technical note is based on the EUCAST isavuconazole and itraconazole rationale documents, version 1.0 of the routine and extended internal quality control for antifungal susceptibility testing as recommended by EUCAST, and the E.Def 7.3, E.Def 9.2 and E.Def 9.3 method documents (http://www.eucast.org).
This paper reports the thermal effect on the luminescence emission of commercially available paracetamol (4-(acetylamino)phenol) tablets when exposed to ionizing radiation in the 1–20 Gy range. The ...sample was previously analyzed using techniques such as environmental scanning microscopy, Raman spectroscopy, thermal X-ray diffraction (TXRD), differential thermal analysis, thermogravimetry analysis and cathodoluminescence. The results show a significant stability of thermoluminescence (TL) emission. Reusability TL test involving successive cycles of irradiation (10 Gy) and readout (up to 130 °C) and dose–response and
T
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studies indicate a null damage on the monoclinic structure of paracetamol due to the beta radiation exposure and/or thermal treatments. The behavior observed from the
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T
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test indicates very close energy levels denoting a continuum in the trap system that is supported by the activation energy values (1.06–1.33 eV) estimated by the initial rise method. There is no variation in the lattice structure of paracetamol samples when thermally treated up to 170 °C according to the structural parameters
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o
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angle and the cell volume calculated by the Rietveld refinement technique from the TXRD profiles.
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