Microbiota of skin and study of its resistance in vitro

Ištirtas eterinių aliejų Lavandula angustifolia, Thymus vulgaris ir Melaleuca alternifolia poveikis nuo žmogaus odos išskirtiems ir išaugintiems in vitro Geotrichum sp., Fusarium sp., Phoma sp. Efektyviausiai visas tris tirtąsias grybų rūšis veikė čiobrelio Thymus vulgaris, o silpniausiai – tikrosios levandos Lavandula angustifolia eterinis aliejus. Fusarium sp. ir Geotrichum sp. nebuvo labai jautrūs farmakologiškai pripažintam fungicidui – pražangalapio mirtenio Melaleuca alternifolia aliejui. Nustatyta, kad skirtingos dermatofitų rūšys yra specifiškai jautrios juos veikusiems aliejams.This study investigated the impact of the essential oils Levandula angustifolia, Thymus vulgaris and Melaleuca alternifolia in vitro on the microscopic fungi Geotrichum sp., Fusarium sp., Phoma sp. isolated from the human skin. The most efficient of all three studied oils on species of fungi were thyme (Thymus vulgaris), and the least was lavender (Levandula angustifolia) essential oil. Fusarium sp. and Geotrichum sp. were not very sensitive to pharmacologically recognized fungicides in Melaleuca alternifolia oil. The study showed that different species of dermatophytes are specifically sensitive to particular oils that they come into contact with

Factors determining parents' decisions to bring their children to the pediatric emergency department for a minor illness

Background: The number of children visiting Emergency Departments (EDs) is increasing in Lithuania; therefore, the aim of this study was to determine the factors influencing the parental decision to bring their child to the ED for a minor illness that could be managed in a primary healthcare setting, and to compare parents' and medical professionals' attitudes toward a child's health status and need for urgent care. Material/Methods: A prospective observational study was performed at the tertiary-level teaching Children's Hospital in Vilnius. A total of 381 patients' parents were interviewed using an original questionnaire based on Andersen's behavioral model of healthcare utilization; in addition, the medical records of patients were reviewed to identify factors that might have an impact on parental decisions to bring their child to the ED for a minor health problem. The study participants were enrolled from October 1, 2013 to August 31, 2014. The urgency of medical care needed to be provided to the patients was evaluated by a tertiary-level triage system. Results: Based on the assessment of the triage nurses, the need for emergency care to patients was distributed as follows: 298 patients (78.2%) needed non-urgent care and 83 patients (21.8%) needed urgent care. More than one-third (38.8%) of the parents reported that they came to the ED due to their child's urgent care need and worsened child's health; however, the opinion of ED professionals indicated only a fifth of patients required urgent care. Parents who brought their children to the ED without physician referral were five times more likely to visit the ED during evening hours and on weekends (OR= 5.416; 95% CI, 3.259-8.99; p<0.001). The decision to come to the ED without visiting a primary care physician was made more often by parents with a higher income (OR= 2.153; 95% CI, 1.167-3.97) and those who came due to children having rash (OR= 4.303; 95% CI, 1.089-16.995) or fever (OR= 3.463; 95% CI, 1.01-11.876). Older parents were 2.07 (95% CI, 1.1224-3.506) times more likely to evaluate their child's health unfavorably than younger parents. Conclusions: We identified predisposing, enabling, and need factors that influenced the parents' decision to bring their child to the ED for minor health problems that could be managed by a primary care physician. Parents assessed their child's condition more critically and thought that their child required urgent medical aid more frequently than healthcare professionals

Unscheduled return visits to a pediatric emergency department

Background and objective: Return visits (RVs) to a pediatric emergency department (ED) within a short period after discharge have an influence on overcrowding of the ED and reveal some weaknesses of the health care system. The aim of this study was to determine the rate of RVs and factors related to RVs to the pediatric ED in Lithuania. Materials and methods: A retrospective study in an urban, tertiary-level teaching hospital was carried out. Electronic medical records of all patients (n = 44 097) visiting the ED of this hospital between 1 January and 31 December 2013 were analyzed. Demographic and clinical characteristics of patients who return to the ED within 72 h and those who had not visited the ED were compared. Factors associated with RVs were determined by multivariable logistic regression. Results: Of the overall ED population, 33 889 patients were discharged home after the initial assessment. A total of 1015 patients returned to the ED within 72 h, giving a RV rate of 3.0%. Being a 0–7-year old, visiting the ED during weekdays, having a GP referral, receiving of laboratory tests and ultrasound on the initial visit were associated with greater likelihoods of returning to the ED. Patients who arrived to the ED from 8:01 a.m. to 4:00 p.m. and underwent radiological test were less likely to return to the ED within 72 h. Diseases such as gastrointestinal disorders or respiratory tract/earth–nose–throat (ENT) diseases and symptoms such as fever or pain were significantly associated with returning to the ED. The initial diagnosis corresponded to the diagnosis made on the second visit for only 44.1% of the patients, and the highest rate of the congruity in diagnosis was for injuries/poisoning, surgical pathologies (77.2%) and respiratory tract diseases (76.9%). Conclusions: RVs accounted for only a small proportion of visits to the ED. RVs were more prevalent among younger patients and patients with a GP referral as well as performed more often after discharging from the ED in the evening and at night

Mitigating arrhythmia risk in Hydroxychloroquine and Azithromycin treated COVID-19 patients using arrhythmia risk management plan

Aims: To assess cardiac safety in COVID-19 patients treated with the combination of Hydroxychloroquine and Azithromycin using arrhythmia risk management plan. Methods and results: We retrospectively examined arrhythmia safety of treatment with Hydroxychloroquine and Azithromycin in the setting of pre-defined arrhythmia risk management plan. The data was analyzed using R statistical package version 4.0.0. A two-tailed p-value<0.05 was considered significant. 81 patients were included from March 23rd to May 10th 2020. The median age was 59 years, 58.0% were female. The majority of the study population (82.7%) had comorbidities, 98.8% had radiological signs of pneumonia. Fourteen patients (17.3%) experienced QTc ≥ 480 ms and 16 patients (19.8%) had an increase of QTc ≥ 60 ms. Seven patients (8.6%) had QTc prolongation of ≥ 500 ms. The treatment was discontinued in 4 patients (4.9%). None of the patients developed ventricular tachycardia. The risk factors significantly associated with QTc ≥ 500 ms were hypokalemia (p = 0.032) and use of diuretics during the treatment (p = 0.020). Three patients (3.7%) died, the cause of death was bacterial superinfection with septic shock in two patients, and disseminated intravascular coagulation with multiple organ failure in one patient. None of these deaths were associated with cardiac arrhythmias. Conclusion: We recorded a low incidence of QTc prolongation ≥ 500 ms and no ventricular tachycardia events in COVID-19 patients treated with Hydroxychloroquine and Azithromycin using cardiac arrhythmia risk management plan