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Introduction: Invasive candidiasis (IC) can be a life-threatening infection in immunocompromised patients, particularly those with cancer, hematologic diseases and/or hematopoietic stem cell transplantation (HSCT) recipients. The objective of this study was to evaluate the effectiveness of micafungin in patients with hematologic malignancies or HSCT recipients, relevant to clinical presentation of IC, in real-life practice in Greece. Methods: ASPIRE was a phase IV, multicenter, non-interventional, prospective cohort study, conducted at ten tertiary hospitals in Greece, in adults with hematologic disease. Micafungin treatment for IC or prophylaxis for Candida infection was administered per standard clinical practice until a clinical outcome (success or failure) was reached. Treatment success was defined by the EORTC/MSG criteria for invasive fungal infections (IFI) and was assessed by the investigator. Treatment discontinuation and safety were also evaluated. Results: One hundred forty-three patients were enrolled. Median age was 62; 85 (59.4%) patients were male, and 133 (93.0%) had Greek ethnicity. One hundred twenty-six (88.1%) patients had hematologic malignancies, and 21 (14.7%) had received HSCT. Prophylaxis was administered to 74 (51.7%) patients [median (range) dose: 50 (50–150) mg/day] with no signs of IFI. Overall, 52 (36.4%) patients with possible IFI at baseline received micafungin treatment [100 (50–125) mg/day] versus 12 (17.2%) with probable [100 (75–150) mg/day] and 5 (3.5%) with confirmed [125 (100–150) mg/day] IFI. Treatment success was 91.6% (95% CI 85.80–95.59; n = 131) overall and 90.5% (n = 67) in patients receiving prophylaxis. Median time on treatment was 13 days. Treatment discontinuation (n = 26; 18.2%) was not related to adverse events. No treatment-related serious adverse events were reported. Conclusion: Micafungin treatment for IC or prophylaxis for Candida infection was effective and well tolerated in patients with hematologic disorders in clinical practice in Greece. These results demonstrate that micafungin could be used more widely for prophylaxis. Further work is required to determine the efficacy and safety of micafungin for the management of IFIs in hematologic settings. Funding: Astellas Pharma Inc. [ABSTRACT FROM AUTHOR]

The ecological integrity of rivers ultimately depends on flow regime. Flow degradation is especially prominent in Mediterranean systems and assessing environmental flows in modified rivers is difficult, especially in environments with poor hydrologic monitoring and data availability. In many Mediterranean countries, which are characterized by pronounced natural variability and low summer flows, water management actions usually focus on prescribing minimum acceptable flows estimated by hydrologic methods. In this study, a comparative assessment of environmental flow estimation methods is developed in a river with poorly monitored flows and limited understanding of past reference conditions. This assessment incorporates both a hydrologic and a fish habitat simulation effort that takes into consideration hydrologic seasonality in a Greek mountainous river. The results of this study indicate that especially in data scarce regions the utilization of biotic indicators through habitat models, may provide valuable information, beyond that achievable with hydrologic methods, for developing regional environmental flow criteria. Despite the widespread use of the method, challenges in transferability of fish habitat simulation provide undefined levels of uncertainty and may require the concurrent use of different assessment tools and site-specific study. [ABSTRACT FROM AUTHOR]

Environmental flow assessments (EFAs) are widely researched and applied worldwide. However, model-based frameworks integrating the flow requirements of multiple ecosystem components have been primarily developed for perennial watercourses, being inherently inapplicable in intermittent rivers (IR), which are common worldwide and may dominate arid, semi-arid and mediterranean-climate regions. In this study, we conceptualized and pilot-applied a model-based EFA in a naturally intermittent Mediterranean river reach (Evrotas, southern Greece), guided by two fundamental principles: (1) environmental flows in IR should be delivered during specific aquatic states (AS) and (2) baseflows should be provided during prolonged dry periods to prevent artificial deviation from the natural AS-sequence. The habitat preferences of benthic macroinvertebrates and of three endemic fish species were evaluated, and a two-dimensional hydrodynamic-habitat model was applied to simulate habitat suitability at various discharges. We modelled the baseflow required to maintain disconnected water pools during dry periods and the optimal baseflow required to ensure the presence of suitable habitats after flow resumption. The results show that baseflows at the 25th percentile of the abundant-riffles state can provide adequate habitat for the IR-specific communities. During prolonged dry periods, surface-groundwater interactions should be also considered for robust predictions. We highlight the use of hydrodynamic-habitat models in IR-based EFAs as a key-tool to estimate the AS timing and duration and, consequently, the timing-duration of the respective environmental flow components. Future studies should, inter alia, (1) include the aquatic-riparian vegetation to provide information on high flows-floods, and (2) incorporate groundwater models to account for surface-groundwater interactions towards a widely accepted IR-specific EFA framework. [ABSTRACT FROM AUTHOR]