An investigation of the effects of procalcitonin testing on antimicrobial prescribing in respiratory tract infections in an Irish university hospital setting: a feasibility study

BACKGROUND

Diagnostic uncertainty and a high prevalence of viral infections present unique challenges for antimicrobial prescribing for respiratory tract infections (RTIs). Procalcitonin (PCT) has been shown to support prescribing decisions and reduce antimicrobial use safely in patients with RTIs, but recent study results have been variable.

METHODS

We conducted a feasibility study of the introduction of PCT testing in patients admitted to hospital with a lower RTI to determine if PCT testing is an effective and worthwhile intervention to introduce to support the existing antimicrobial stewardship (AMS) programme and safely decrease antimicrobial prescribing in patients admitted with RTIs.

RESULTS

A total of 79 patients were randomized to the intervention PCT-guided treatment group and 40 patients to the standard care respiratory control group. The addition of PCT testing led to a significant decrease in duration of antimicrobial prescriptions (mean 6.8 versus 8.9 days, P = 0.012) and decreased length of hospital stay (median 7 versus 8 days, P = 0.009) between the PCT and respiratory control group. PCT did not demonstrate a significant reduction in antimicrobial consumption when measured as DDDs and days of therapy.

CONCLUSIONS

PCT testing had a positive effect on antimicrobial prescribing during this feasibility study. The successful implementation of PCT testing in a randomized controlled trial requires an ongoing comprehensive education programme, greater integration into the AMS programme and delivery of PCT results in a timely manner. This feasibility study has shown that a larger randomized controlled trial would be beneficial to further explore the positive aspects of these findings.

RIFM fragrance ingredient safety assessment, 2-decanone, CAS Registry Number 693-54-9

The existing information supports the use of this material as described in this safety assessment. 2-Decanone was evaluated for genotoxicity, repeated dose toxicity, reproductive toxicity, local respiratory toxicity, phototoxicity/photoallergenicity, skin sensitization, and environmental safety. Data from read-across analog 2-heptanone (CAS # 110-43-0) show that 2-decanone is not expected to be genotoxic. Data on read-across analog 2-heptanone (CAS # 110-43-0) provide a calculated margin of exposure (MOE) > 100 for the repeated dose toxicity and reproductive toxicity endpoints. The skin sensitization endpoint was completed using the dermal sensitization threshold (DST) for non-reactive materials (900 μg/cm²); exposure is below the DST. The phototoxicity/photoallergenicity endpoints were evaluated based on ultraviolet (UV) spectra; 2-decanone is not expected to be phototoxic/photoallergenic. For the local respiratory endpoint, a calculated MOE >100 was provided by the read-across analog 4-methyl-2-pentanone (CAS # 108-10-1). The environmental endpoints were evaluated; for the hazard assessment based on the screening data, 2-decanone is not persistent, bioaccumulative, and toxic (PBT) as per the International Fragrance Association (IFRA) Environmental Standards. For the risk assessment, 2-decanone was not able to be risk screened as there were no reported volumes of use for either North America or Europe in the 2015 IFRA Survey.

New hints towards a precision medicine strategy for IDH wild-type glioblastoma

Glioblastoma represents the most common primary malignancy of the central nervous system in adults and remains a largely incurable disease. The elucidation of disease subtypes based on mutational profiling, gene expression and DNA methylation has so far failed to translate into improved clinical outcomes. However, new knowledge emerging from the subtyping effort in the IDH-wild-type setting may provide directions for future precision therapies. Here, we review recent learnings in the field, and further consider how tumour microenvironment differences across subtypes may reveal novel contexts of vulnerability. We discuss recent treatment approaches and ongoing trials in the IDH-wild-type glioblastoma setting, and propose an integrated discovery stratagem incorporating multi-omics, single-cell technologies and computational approaches.

RIFM fragrance ingredient safety assessment, 2-phenylpropionaldehyde, CAS Registry Number 93-53-8

The existing information supports the use of this material as described in this safety assessment. 2-Phenylpropionaldehyde was evaluated for genotoxicity, repeated dose toxicity, developmental and reproductive toxicity, local respiratory toxicity, phototoxicity/photoallergenicity, skin sensitization, and environmental safety. Data on read-across analogs 3-phenylbutanal (CAS # 16251-77-7) and isopropylphenylbutanal (CAS # 125109-85-5) show that this material is not expected to be genotoxic. Data from the target material provide a calculated margin of exposure (MOE) >100 for the repeated dose toxicity endpoint and a No Expected Sensitization Induction Level (NESIL) of 380 μg/cm² for the skin sensitization endpoint. The developmental and reproductive toxicity and the local respiratory toxicity endpoints were completed using the threshold of toxicological concern (TTC) for a Cramer Class I material (0.03 mg/kg/day and 1.4 mg/day, respectively). The phototoxicity/photoallergenicity endpoints were evaluated based on ultraviolet (UV) spectra; 2-phenylpropionaldehyde is not expected to be phototoxic/photoallergenic. The environmental endpoints were evaluated; 2-phenylpropionaldehyde was found not to be persistent, bioaccumulative, and toxic (PBT) as per the International Fragrance Association (IFRA) Environmental Standards, and its risk quotients, based on its current volume of use in Europe and North America (i.e., Predicted Environmental Concentration/Predicted No Effect Concentration [PEC/PNEC]), are <1.

RIFM fragrance ingredient safety assessment, 3,7-dimethyl-3,6-octadienal, CAS registry number 55722-59-3

The existing information supports the use of this material as described in this safety assessment. 3,7-Dimethyl-3,6-octadienal was evaluated for genotoxicity, repeated dose toxicity, developmental and reproductive toxicity, local respiratory toxicity, phototoxicity/photoallergenicity, skin sensitization, and environmental safety. Data from read-across analog citral (CAS # 5392-40-5) show that 3,7-dimethyl-3,6-octadienal is not expected to be genotoxic and provided a calculated margin of exposure (MOE) >100 for the repeated dose toxicity and developmental and reproductive endpoints. Data from the read-across analog citronellal (CAS # 106-23-0) provided 3,7-dimethyl-3,6-octadienal a No Expected Sensitization Induction Level (NESIL) of 7000 μg/cm² for the skin sensitization endpoint. The phototoxicity/photoallergenicity endpoints were evaluated based on ultraviolet (UV) spectra; 3,7-dimethyl-3,6-octadienal is not expected to be phototoxic/photoallergenic. The local respiratory toxicity endpoint was evaluated using the threshold of toxicological concern (TTC) for a Cramer Class I material, and the exposure to 3,7-dimethyl-3,6-octadienal is below the TTC (1.4 mg/day). The environmental endpoints were evaluated; 3,7-dimethyl-3,6-octadienal was found not to be persistent, bioaccumulative, and toxic (PBT) as per the International Fragrance Association (IFRA) Environmental Standards, and its risk quotients, based on its current volume of use in Europe and North America (i.e., Predicted Environmental Concentration/Predicted No Effect Concentration [PEC/PNEC]), are <1.

RIFM fragrance ingredient safety assessment, phenylacetaldehyde, CAS Registry Number 122-78-1

The existing information supports the use of this material as described in this safety assessment. The material (phenylacetaldehyde) was evaluated for genotoxicity, repeated dose toxicity, developmental and reproductive toxicity, local respiratory toxicity, phototoxicity, skin sensitization, and environmental safety. Data show that phenylacetaldehyde is not genotoxic and provide a calculated margin of exposure (MOE) > 100 for the repeated dose and developmental and reproductive toxicity endpoints. Data from phenylacetaldehyde provided a No Expected Sensitization Induction Level (NESIL) of 590 μg/cm² for the skin sensitization endpoint. The local respiratory toxicity endpoint was completed using the threshold of toxicological concern (TTC) for a Cramer Class I material, and the exposure to phenylacetaldehyde was below the TTC (0.03 mg/kg/day, 0.03 mg/kg/day, and 1.4 mg/day, respectively). The phototoxicity/photoallergenicity endpoint was completed based on data and ultraviolet (UV) spectra; phenylacetaldehyde is not expected to be phototoxic/photoallergenic. The environmental endpoints were evaluated; phenylacetaldehyde was not found to be persistent, bioaccumulative, and toxic (PBT) as per the International Fragrance Association (IFRA) environmental standards and its risk quotients, based on its current volume of use in Europe and North America (i.e., Predicted Environmental Concentration/Predicted No Effect Concentration [PEC/PNEC]) are <1.

Impact heat driven volatile redistribution at Occator crater on Ceres as a comparative planetary process

Hydrothermal processes in impact environments on water-rich bodies such as Mars and Earth are relevant to the origins of life. Dawn mapping of dwarf planet (1) Ceres has identified similar deposits within Occator crater. Here we show using Dawn high-resolution stereo imaging and topography that Ceres' unique composition has resulted in widespread mantling by solidified water- and salt-rich mud-like impact melts with scattered endogenic pits, troughs, and bright mounds indicative of outgassing of volatiles and periglacial-style activity during solidification. These features are distinct from and less extensive than on Mars, indicating that Occator melts may be less gas-rich or volatiles partially inhibited from reaching the surface. Bright salts at Vinalia Faculae form thin surficial precipitates sourced from hydrothermal brine effusion at many individual sites, coalescing in several larger centers, but their ages are statistically indistinguishable from floor materials, allowing for but not requiring migration of brines from deep crustal source(s).