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Objavljeno v DiRROS: 18.11.2025; Ogledov: 124; Prenosov: 59
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Ključne besede: skin, coenzyme Q10, collagen peptides, skin health, dermis density
Objavljeno v DiRROS: 18.11.2025; Ogledov: 177; Prenosov: 97
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Povzetek: Children constitute 6–10% of all patients attending the emergency department (ED) by emergency medical services (EMS). However, discordant EMS use in children occurs in 37–61% with fever as an important risk factor. We aimed to describe EMS utilisation among febrile children attending European EDs. This study is part of an observational multicentre study assessing management and outcome in febrile children up to 18 years (MOFICHE) attending twelve EDs in eight European countries. Discordant EMS use was defined as the absence of markers of urgency including intermediate/high triage urgency, advanced diagnostics, treatment, and admission in children transferred by EMS. Multivariable logistic regression analyses were performed for the association between (1) EMS use and markers of urgency, and (2) patient characteristics and discordant EMS use after adjusting all analyses for the covariates age, gender, visiting hours, presenting symptoms, and ED setting. A total of 5464 (15%, range 0.1–42%) children attended the ED by EMS. Markers of urgency were more frequently present in the EMS group compared with the non-EMS group. Discordant EMS use occurred in 1601 children (29%, range 1–59%). Age and gender were not associated with discordant EMS use, whereas neurological symptoms were associated with less discordant EMS use (aOR 0.2, 95%CI 0.1–0.2), and attendance out of office hours was associated with more discordant EMS use (aOR 1.6, 95%CI 1.4–1.9). Settings with higher percentage of self-referrals to the ED had more discordant EMS use (p < 0.05). Conclusion: There is large practice variation in EMS use in febrile children attending European EDs. Markers of urgency were more frequently present in children in the EMS group. However, discordant EMS use occurred in 29%. Further research is needed on non-medical factors influencing discordant EMS use in febrile children across Europe, so that pre-emptive strategies can be implemented.
Ključne besede: emergency medical services, emergency care, children, fever, paediatrics
Objavljeno v DiRROS: 17.11.2025; Ogledov: 154; Prenosov: 56
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Povzetek: Background: Optimization of antimicrobial stewardship is key to tackling antimicrobial resistance, which is exacerbated by overprescription of antibiotics in pediatric emergency departments (EDs). We described patterns of empiric antibiotic use in European EDs and characterized appropriateness and consistency of prescribing. Methods: Between August 2016 and December 2019, febrile children attending EDs in 9 European countries with suspected infection were recruited into the PERFORM (Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management) study. Empiric systemic antibiotic use was determined in view of assigned final “bacterial” or “viral” phenotype. Antibiotics were classified according to the World Health Organization (WHO) AWaRe classification. Results: Of 2130 febrile episodes (excluding children with nonbacterial/nonviral phenotypes), 1549 (72.7%) were assigned a bacterial and 581 (27.3%) a viral phenotype. A total of 1318 of 1549 episodes (85.1%) with a bacterial and 269 of 581 (46.3%) with a viral phenotype received empiric systemic antibiotics (in the first 2 days of admission). Of those, the majority (87.8% in the bacterial and 87.0% in the viral group) received parenteral antibiotics. The top 3 antibiotics prescribed were thirdgeneration cephalosporins, penicillins, and penicillin/β-lactamase inhibitor combinations. Of those treated with empiric systemic antibiotics in the viral group, 216 of 269 (80.3%) received ≥1 antibiotic in the “Watch” category. Conclusions: Differentiating bacterial from viral etiology in febrile illness on initial ED presentation remains challenging, resulting in a substantial overprescription of antibiotics. A significant proportion of patients with a viral phenotype received systemic antibiotics, predominantly classified as WHO Watch. Rapid and accurate point-of-care tests in the ED differentiating between bacterial and viral etiology could significantly improve antimicrobial stewardship.
Ključne besede: antimicrobial stewardship, pediatric emergency care, antibiotic prescription, AWaRe, infectious diseases
Objavljeno v DiRROS: 17.11.2025; Ogledov: 120; Prenosov: 85
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Povzetek: The aim of the study was to determine the spatial distribution and assess uranium and thorium contamination in the soils of North Macedonia. Topsoil samples (0–30 cm) were collected from 995 locations across the country on a 5 × 5 km grid. The soil samples were analysed by inductively coupled plasma–mass spectrometry (ICP-MS) using the total digestion method. The distribution of uranium and thorium in the soils is discussed according to the country’s 8 statistical regions, 15 major geological formations and 13 pedological units. The average uranium content is 2.1 mg/kg, ranging from <0.1 to 13 mg/kg (median 2.0 mg/kg), while the average thorium content is 9.3 mg/kg, ranging from 0.20 to 92 mg/kg (median 9.5 mg/kg). The spatial distribution patterns of U and Th in the soils of North Macedonia are very similar and are determined by geology (parent material and mineralisation). High uranium (2.9–13 mg/kg) and thorium (42–92 mg/kg) contents were found mainly in soils in the areas of Neogene and Palaeozoic igneous rocks and Neogene clastites (Pelagonian, East Macedonian zone), as well as in the Kratovo-Zletovo Massif in the north-eastern part of the country and in the Kožuf Mountains in the central and southern parts, where Neogene igneous rocks predominate. According to the pedological units, the hydromorphic soils (mean content of 2.9 mg/kg U and 12 mg/kg Th) in the valleys of the country’s main rivers, which predominate in the western part, were the richest for these elements.
Ključne besede: uranium, thorium, soil, statistical regions, geological formation, pedological units, North Macedonia
Objavljeno v DiRROS: 17.11.2025; Ogledov: 108; Prenosov: 36
Celotno besedilo (2,40 MB)