Causes of admission and outcomes of brown hare (Lepus europaeus) leverets at wildlife rescue centres in the Czech Republic

Background Wildlife rescue centres care for orphaned and injured young as an integral part of their work. However, inappropriate interventions in nature can have a negative effect on the survival of young hares, especially when the care of these young is not very successful. The aim of this study was to assess the number of brown hare leverets admitted to rescue centres in the Czech Republic in the period from 2010 to 2019, the causes of their admission to rescue centres and their outcomes. Results We evaluated the number of brown hare leverets admitted to rescue centres in the Czech Republic in the period from 2010 to 2019 and the outcomes associated with their leaving these rescue centres. We found that the number of brown hare leverets admitted increased during the monitored period (rSp = 0.6364, p < 0.05). The most frequent reasons for admission were the admission of orphaned young (49.15%), leverets brought needlessly (19.60%) and leverets that had been bitten by other animals (18.63%). More (p < 0.05) young admitted to rescue centres died (40.76%) than were reared successfully and released back into the wild (32.40%). Leverets that had been caught needlessly or orphaned and late-born leverets survived and could be released back into the wild (38.56, 34.51 and 52%, respectively), while fatalities were recorded in most leverets bitten by another animal (65.05%) or hit in a collision with a vehicle (97.06%). Most young hares (76.92%) that were exhausted or starved at the time of admission could not be saved. Conclusions Since only a small proportion of hares in a litter survive until adulthood in the wild, young animals being found and taken needlessly to rescue centres may harm the hare population. Our results show that only around one in three healthy young hares admitted to rescue centres are reared successfully. It is, in our opinion, of fundamental importance to the protection of brown hare leverets to inform the public of this issue and prevent needless interventions into natural rearing in the wild.

Biomarker candidates for progression and clinical management of COVID-19 associated pneumonia at time of admission

COVID-19 pathophysiology is currently not fully understood, reliable prognostic factors remain elusive, and few specific therapeutic strategies have been proposed. In this scenario, availability of biomarkers is a priority. MS-based Proteomics techniques were used to profile the proteome of 81 plasma samples extracted in four consecutive days from 23 hospitalized COVID-19 associated pneumonia patients. Samples from 10 subjects that reached a critical condition during their hospital stay and 10 matched non-severe controls were drawn before the administration of any COVID-19 specific treatment and used to identify potential biomarkers of COVID-19 prognosis. Additionally, we compared the proteome of five patients before and after glucocorticoids and tocilizumab treatment, to assess the changes induced by the therapy on our selected candidates. Forty-two proteins were differentially expressed between patients' evolution groups at 10% FDR. Twelve proteins showed lower levels in critical patients (fold-changes 1.20–3.58), of which OAS3 and COG5 found their expression increased after COVID-19 specific therapy. Most of the 30 proteins over-expressed in critical patients (fold-changes 1.17–4.43) were linked to inflammation, coagulation, lipids metabolism, complement or immunoglobulins, and a third of them decreased their expression after treatment. We propose a set of candidate proteins for biomarkers of COVID-19 prognosis at the time of hospital admission. The study design employed is distinctive from previous works and aimed to optimize the chances of the candidates to be validated in confirmatory studies and, eventually, to play a useful role in the clinical practice.

Clinical Characteristics of Macrolide-Refractory Mycoplasma pneumoniae Pneumonia in Korean Children: A Multicenter Retrospective Study

Mycoplasma pneumoniae is a major causative pathogen of community-acquired pneumonia in children, and the treatment of choice is macrolides. There is an increasing trend in reports of refractory clinical responses despite macrolide treatment due to the emergence of macrolide-resistant M. pneumoniae. Early discrimination of macrolide-refractory M. pneumoniae pneumonia (MrMP) from macrolide-sensitive M. pneumoniae pneumonia (MSMP) is vital; however, testing for macrolide susceptibility at the time of admission is not feasible. This study aimed to identify the characteristics of MrMP in Korean children, in comparison with those of MSMP. In this multicenter study, board-certified pediatric pulmonologists at 22 tertiary hospitals reviewed the medical records from 2010 to 2015 of 5294 children who were hospitalized with M. pneumoniae pneumonia and administered macrolides as the initial treatment. One-way analysis of variance and the Kruskal-Wallis test were used to compare differences between groups. Of 5294 patients (mean age, 5.6 years) included in this analysis, 240 (4.5%), 925 (17.5%), and 4129 (78.0%) had MrMP, macrolide-less effective M. pneumoniae pneumonia, and MSMP, respectively. Compared with the MSMP group, the MrMP group had a longer fever duration, overall (13.0 days) and after macrolide use (8.0 days). A higher proportion of MrMP patients had respiratory distress, pleural effusion, and lobar pneumonia. The mean aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and C-reactive protein levels were the highest in the MrMP group, along with higher incidences of extrapulmonary manifestations and atelectasis (during and post infection). Pre-existing conditions were present in 17.4% (n = 725/4159) of patients, with asthma being the most common (n = 334/4811, 6.9%). This study verified that MrMP patients show more severe initial radiographic findings and clinical courses than MSMP patients. MrMP should be promptly managed by agents other than macrolides.

A Clinical Study of the Association of Thrombocytopenia with Acute Febrile Illness

Background: Thrombocytopenia accompanying acute febrile illnesses is a matter of concern because lack of prompt treatment could result in significant mortality. We in this study tried to evaluate the clinical profile of cases with acute fever and thrombocytopenia and determine the cause of fever with thrombocytopenia and the outcome of treatment of such patients in our hospital. Methods: A total of n=50 successive cases of acute febrile illness with thrombocytopenia following inclusion and exclusion criteria were included in this study. Clinical signs such as rashes, signs of dehydration, petechiae, jaundice, lymphadenopathy, hepatomegaly, splenomegaly, anemia, abdominal tenderness, altered sensorium, were noted. Investigations included CBP, ESR, LFT, RFT, serum electrolytes, Chest X-ray, USG abdomen were done. Other investigations included Dengue serology, Malaria, Widal, IgM for leptospirosis, sputum for AFB. Results: Out of n=50 patients with acute fever with thrombocytopenia, all of them had a definitive diagnosis with malaria (40%) as the commonest cause, followed by enteric fever (24%), viral fever (14%), septicemia (6%), dengue (14%), and leptospirosis (2%). 50% of the patients had platelet count in the range of 50, 000 – 1,00, 000 and 30% had platelet counts above 100000-150000. 8% of cases had platelet counts below 25000 and 12% had platelet counts between 25000-50000 at the time of admission. 10% mortality was observed. Conclusion: infections as the commonest cause of thrombocytopenia. Malaria, dengue enteric fever, leptospirosis, and other viral infections formed the major diseases in this group of population. The diagnosis of malaria was the common cause because of seasonal and regional variations. A definitive increase in platelet count was noted after the underlying cause was treated. Severe cases of septicemia with associated co-morbidities resulted in mortality.

Comparing machine learning algorithms for predicting COVID-19 mortality

Background The coronavirus disease (COVID-19) hospitalized patients are always at risk of death. Machine learning (ML) algorithms can be used as a potential solution for predicting mortality in COVID-19 hospitalized patients. So, our study aimed to compare several ML algorithms to predict the COVID-19 mortality using the patient’s data at the first time of admission and choose the best performing algorithm as a predictive tool for decision-making. Methods In this study, after feature selection, based on the confirmed predictors, information about 1500 eligible patients (1386 survivors and 144 deaths) obtained from the registry of Ayatollah Taleghani Hospital, Abadan city, Iran, was extracted. Afterwards, several ML algorithms were trained to predict COVID-19 mortality. Finally, to assess the models’ performance, the metrics derived from the confusion matrix were calculated. Results The study participants were 1500 patients; the number of men was found to be higher than that of women (836 vs. 664) and the median age was 57.25 years old (interquartile 18–100). After performing the feature selection, out of 38 features, dyspnea, ICU admission, and oxygen therapy were found as the top three predictors. Smoking, alanine aminotransferase, and platelet count were found to be the three lowest predictors of COVID-19 mortality. Experimental results demonstrated that random forest (RF) had better performance than other ML algorithms with accuracy, sensitivity, precision, specificity, and receiver operating characteristic (ROC) of 95.03%, 90.70%, 94.23%, 95.10%, and 99.02%, respectively. Conclusion It was found that ML enables a reasonable level of accuracy in predicting the COVID-19 mortality. Therefore, ML-based predictive models, particularly the RF algorithm, potentially facilitate identifying the patients who are at high risk of mortality and inform proper interventions by the clinicians.

Ergebnisse der mit der Obliteration des runden/ovalen Fensters erreichten Behandlungserfolge bei der einseitigen, akut aufgetretenen, idiopathischen sensorineuralen Hörminderung

ZusammenfassungFormerly explorative tympanotomies including sealing of the round/oval window/s have only been used in treating perilymphatic fistulas. During the last years this operation especially in the middle European countries has also been performed more and more in patients suffering from an ISSNHL. In this chapter the effect of this operation including a simultaneous systematic steroid therapy on hearing levels has been collected from data presented in literature and the results will be presented by means of a systematic review. The survey also includes the results of this operative procedure in 41 patients who have been treated by us.Based on 19 publications dealing with the above mentioned topic only 6 studies (4 of them with information about the hearing loss at the time of admission at the hospital and additionally at a follow-up examination (n = 309)) could be integrated in this study and another 2 in which the hearing gains –regardless of the initial hearing loss- according to the modified „Kanzaki“-criteria (n = 288)) have been evaluated- could be used for estimating the therapeutic effects of tympanoscopy with sealing of the round/oval windosw/s in patients with sudden deafness.The follow-up examination had to exceed a 3 weeks interval up from the time of the operation. It is shown that several methods of evaluation the median hearing loss (PTA4 and PTA5) in pure tone audiograms are suitable to be accepted for the analysis of hearing losses in order to compare the results of the treatment.In each study-group collected from literature and two study-groups of our own patients the hearing loss before therapy was significantly higher than that which had been measured at the follow-up examination.Patients in which tympanoscopy was combined with a systematic application of steroids in a „first-line-mode“ (n = 79) had a hearing loss of 94,1 dB. Their hearing improved up to a hearing level of 70,7 dB at the follow-up examination (hearing gain: 23,4 dB; n = 79). Those who first had got systematic steroids followed by the tympanoscopy („second-line-mode“) had an intitial hearing loss of 105,1 dB and a hearing gain of 38,6 dB. So the final hearing level reached 66,5 dB (n = 197).Median hearing thresholds still rose after detamponation of the external ear canal which was usually done 10 days after the operation up to the follow-up examination.Based on the modified „Kanzaki“-criteria 58,7 % of the patients had a restoration in their hearing exceeding 30 dB. In 18,7 % of the cases the hearing improvement was between 10 and 30 dB. 23,1 % of the patients didn`t profit from tympanoscopy.Indications for deciding to perform an explorative tymapnosocopy which are mentioned in literature are collected and discussed.Explorative tympanotomy including sealing of the round/oval window/s seems to be a very valuable method in treating sudden deafness especially when the hearing loss was severe, profound or even when the patients were totally deaf and the therapeutic procedure had been done sequentially after having performed a systematic steroid application before operation. Further studies have to find out if tympanoscopy used in a „first-line-mode“ can also be a method in which the hearing gain is successful enough that this form of therapy can also be recommended.

Hubungan Kepatuhan Cuci Tangan dan Penggunaan APD Perawat dengan Resiko Kejadian Healthcare Associated Infections (HAIS) pada Masa Pandemi Covid-19 di RSUD Mayjend. H.M. Ryacudu Lampung Utara

ABSTRACT: RELATIONSHIP OF HANDWASHING COMPLIANCE AND NURSE PPE USE WITH RISK OF HEALTHCARE ASSOCIATED INFECTIONS (HAIS) DURING THE COVID-19 PANDEMIC AT RSUD MAYJEN H.M. RYACUDU NORTH LAMPUNG Introduction: Infection is the invasion of the body by a pathogen or microorganism, which can cause disease or tissue damage. A hospital infection or hospital-acquired infection (HOIS) or healthcare-associated infection (HAIS) is an infection acquired during a patient's hospital stay, provided that the incubation period of the disease has not occurred at the time of admission. Objective: It is known that there is a relationship between handwashing compliance and the use of PPE for nurses with the risk of healthcare-associated infections (HAIS) during the COVID-19 pandemic at the Mayjend. H.M Ryacudu Hospital, North Lampung in 2021. Methods : The type of research used in this study is related to the descriptive nature with a cross sectional research design. The subjects of this study were all obstetrical, pediatric (perinatal and NICU) nurses, operating rooms and internal medicine at Mayjend.H.M Ryacudu Hospital, North Lampung. The number of samples used as many as 60 respondents.Results: The statistical test of nurses' compliance with the chi-square in handwashing obtained a p-value of 0.033 where the p-value < (0.033 < 0.05) then Ha, and the Odds Ration value was accepted at 0.314. By using the chi-square statistical test for nurses who use PPE, the p-value is 0.241, so the p-value < (0.241 > 0.05) and Ho is rejected, and the Odds ration value is 0.519.Conclusion: There is a relationship between handwashing compliance with the risk of health-related infections (HAIS), and there is no relationship between the use of PPE by nurses and the risk of healthcare-associated infections (HAIS) at the Mayjend H.M Ryacudu Hospital, North Lampung. Keywords: Compliance with handwashing, use of APD, HAIS INTISARI : HUBUNGAN KEPATUHAN CUCI TANGAN DAN PENGGUNAAN APD PERAWAT DENGAN RESIKO KEJADIAN HEALTHCARE ASSOCIATED INFECTIONS (HAIS) PADA MASA PANDEMI COVID-19 DI RSUD MAYJEND. H.M. RYACUDU LAMPUNG UTARA Pendahuluan : Infeksi adalah invasi tubuh oleh patogen atau mikroorganisme, yang dapat menyebabkan penyakit atau kerusakan jaringan. Infeksi rumah sakit atau infeksi yang didapat di rumah sakit (HOIS) atau infeksi terkait perawatan kesehatan (HAIS) adalah infeksi yang diperoleh selama pasien dirawat di rumah sakit, asalkan masa inkubasi penyakit belum berlangsung pada saat masuk. Tujuan : Diketahui hubungan kepatuhan cuci tangan dan penggunaan APD perawat dengan resiko kejadian healthcare associated infections (HAIS) pada masa pandemi covid-19 di RSUD Mayjend.H.M Ryacudu Lampung Utara.Metode : Jenis penelitian yang digunakan dalam penelitian ini berkaitan dengan sifat deskriptif dengan desain penelitian cross sectional. Subyek penelitian ini adalah seluruh perawat obstetri, anak (perinatal dan NICU), kamar operasi dan penyakit dalam di RSUD Mayjend.H.M Ryacudu Lampung Utara. Jumlah sample yang dipakai sebanyak 60 responden.Hasil : Uji statistik kepatuhan perawat terhadap chi-square dalam cuci tangan diperoleh nilai p sebesar 0,033 dimana nilai p < α (0,033 < 0,05) kemudian Ha, dan nilai Oods Ration diterima sebesar 0,314. Dengan menggunakan uji statistik chi-square perawat yang menggunakan APD didapatkan nilai p-value 0,241, sehingga nilai p-value < α (0,241 > 0,05) dan Ho ditolak, serta nilai Oods ration sebesar 0,519.Kesimpulan : Memiliki hubungan antara kepatuhan cuci tangan dengan risiko infeksi terkait kesehatan (HAIS), serta tidak ada hubungan antara penggunaan APD oleh perawat dengan risiko healthcare associated infections (HAIS) pada RSUD mayjend H.M Ryacudu Lampung Utara. Kata Kunci : Kepatuhan cuci tangan, penggunaan APD, HAIS

Factors Influencing College Choice of Nepalese Undergraduate Students

Background: College choice decision remains one of the major issues for the students and parents especially during the time of admission. Objective: Understanding this problem, this research, taking colleges of Tribhuvan University and Kathmandu University as the samples, assesses which of the characteristics― institutional, marketing, and social are more dominant in this decision. Method: The study, based on the primary survey; uses the questionnaire to collect data among the management students of bachelor’s level in Lalitpur and Kathmandu district, shows that academic program, quality of education, and social factors are the key factors that impact college choice decision. The study employs convenient sampling techniques. The tendency of students to make college choice decisions depends on the colleges’ academic programs that they have concentrated. Result: The results suggest that college should focus their eyes to apply different types of academic programs, adopt quality education in terms of appointing highly qualified faculties and even contribute certain margin to social support, employability of the students over the market and position of enrolment of the students in higher education. These characteristics enable the colleges to run and sustain in the long run. Conclusion: To mitigate the moderating impact on college choice, the variable gender is used, however, its impact on the relationship of college fees and college choice is not supported by the study.

Hemorrhagic Encephalitis after COVID-19 (Clinical Case)

COVID-19 is an urgent problem all over the world that affects not only the respiratory system, but also causes many neurological disorders. In connection with the clinical manifestations of COVID-19, further detailed study of neurological complications is required, such as ischemic and hemorrhagic strokes, damage to the peripheral nervous system, and inflammatory diseases of the brain. Some neurological symptoms after an illness may persist for several weeks or even months. Hemorrhagic encephalitis is one such complication of COVID-19. Taking into account the growth of COVID-19 and frequent neurological complications after a previous illness, more and more often patients will seek medical help from a specialist, such as a neurologist, psychologist, psychiatrist. The only protection against COVID-19, which causes serious complications, is vaccination. The purpose of the study was to highlight a rare case of hemorrhagic encephalitis, which developed against the background of the previous COVID-19 disease. Materials and methods. The work is based on a description of a clinical case of hemorrhagic encephalitis in a patient who has undergone COVID-19. The modern literature data on the clinical and diagnostic features and therapeutic possibilities of hemorrhagic encephalitis are presented. Results and discussion. The article examines data on the clinical manifestations of COVID-19, which can occur in both mild and severe forms, reflects the diagnostic criteria of this disease, highlights treatment approaches, discusses in detail and provides data on the main aspects of the pathogenetic mechanisms underlying development of the disease. Complications of COVID-19 have been described, not only from the central and peripheral nervous system, but also from other systems. The second part of the article is presented in the form of a clinical case of hemorrhagic encephalitis against the background of the undergone COVID-19, which was recorded in our hospital. This part of the article describes in detail the patient's complaints and anamnestic data, the data of the somatic and neurological examination at the time of admission to the hospital and in dynamics, and describes the treatment tactics. Attention is especially focused on the cognitive functions of this patient, which will become the reason for seeing a psychiatrist in the future. Conclusion. Neurological complications of COVID-19 are increasingly registered, requiring close attention from neurologists. Hemorrhagic encephalitis can be one of these complications

A mixed methods study examining perceptions by service-users of their involuntary admission in relation to levels of insight

Background: Poor insight is associated with negative attitudes to involuntary admission and care in qualitative studies. Aims: The current paper aims to examine and compare retrospective qualitative perceptions of service-users in relation to their involuntary admission with their levels of clinical insight, using a mixed methods approach. Methods: Forty two participants were assessed 3 months after the revocation of their involuntary admission. Each provided qualitative data relating to their perceptions of the coercive care process, which was analysed using content analysis, along with a quantitative measurement of insight, the Schedule for the Assessment of Insight-Expanded (SAI-E). Employing a mixed methods design and incorporating NVivo matrix coding queries, the datasets were merged to enable qualitative themes to be identified against the quantitative data. Results: Differences were observed between those with high and low insight in terms of their understanding of the need for treatment, their levels of arousal at the time of admission and how they perceived the compassion of health professionals. Certain negative perceptions of care appeared more universal and were common across those with high and low insight. Conclusion: Some negative perceptions of coercive practices appear linked to inherent elements of psychotic illness such as unawareness of illness. Individuals with higher levels of insight tended to perceive their involuntary admission and receiving a diagnosis as beneficial. Negative views that persist amongst service users with high insight levels can highlight areas for successful service improvement, including increased emphasis on non-pharmacotherapy based supports during the coercive care process.