INFLUENCE OF IRRATIONAL PRESCRIPTION OF ANTIBACTERIAL THERAPY ON THE PROGNOSIS OF TREATMENT AND SURVIVAL IN PATIENTS WITH COVID-19

IIntroduction. The COVID-19 pandemic became a major challenge for healthcare systems around the world. The development and improvement of basic treatments for coronavirus patients is important to improve public health and improve quality of life after recovery. The aim of the study: to determine the frequency and structure of prescribing antibacterial drugs in the prehospital and hospital stages, used in patients with COVID-19. Assess the relationship between irrational use of antibacterial drugs with the length of hospital stay of patients with coronavirus disease, the risk of transfer to the intensive care unit (ICU) and mortality. Materials and methods: Statistical, retrospective analysis of 400 case histories of patients with COVID-19 who were treated at the Municipal Non-Profit Enterprise «Kyiv City Clinical Hospital №17» (KNP «KMKL#17») for the period from September 2020 to November 2021 with severe coronavirus disease. Results: 400 medical charts were selected for the study, which were divided into two groups according to the purpose of antibacterial therapy. Of the group of patients who received pre-hospital antibacterial therapy (200 people), indications for its appointment had only 7 % of patients. Among the group receiving antibacterial drugs there is a prolongation of the length of stay in the hospital, the risk of transfer to ICU increases. There is also higher risk of mortality in patients of group 1 (14,5 %), compared with group 2 (8 %), whose antibacterial drugs were not prescribed at the prehospital stage. Conclusion: as a result of the study it was found that patients who were unreasonably prescribed antibacterial therapy prolongs the period of general hospitalization by 2.3 ± 0.8 days, increasing the need for transfer of patients due to deterioration to ICU by an average of 13 %, increase in the incidence of antibiotic-associated diarrhea by 7-8 %, and there is a tendency to increase mortality from COVID-19. Antibacterial drugs should be used only on the basis of indications in the case of proven bacterial co-infection (superinfection) or reasonable suspicion of it in patients with respiratory disease caused by SARS-CoV-2 and in no case should be prophylactic.

Akaki Tsereteli’s unknown letter about repressions of year 1906

Part of Akaki Tsereteli’s creative legacy is still spread in different foundations or private collections. Difficulty about finding these writings is that some documents in various binders do not have description. Currently foundations are intensively being studied in order to create digital catalogues and whenever this process is finished, many interesting documents will be displayed. “Burning down Imereti during movement” is one of Akaki’s public letters which remained unknown until today. It will be published after 115 years in corresponding value of the writer's new academic publication of his works. Manuscript is being held at Kutaisi’s historic museum.“Burning down Imereti during movement” is about revolutionary movements and its echoes in Georgia, which took place in the years 1905-1907. On the one hand it is a bold protest against King’s cruel policy; Also, the article contains Akaki Tsereteli’s especially significant observations and thoughts about ongoing political processes.In the first paragraph of the article there is a very interesting observation of the author. According to his words, the Russian empire from the very beginning intended absolute occupation and annexation of Georgia. According to that, the friendly condition which led King Irakli of Kartli-Kakheti to let Russians in our country without war and blood, was definitely going to break. Akaki thought that everything that was done by Russian governance in our country, was provocative and its goal was to drag Georgian people into armed conflict.Events occurred in 1905 led to logical conclusions. Georgian nobles decided to officially demand national autonomy. On their emergency gathering they created an appropriate document and presented it to the emperor. Surely, the empire would not let Georgia restore their autonomy. They needed a reason to finally destroy us and the reason found out to be that revolutionary movement which was widespread not only in Russia, but also its subordinate countries including Georgia.According to Akaki Tsereteli, a significant part of society was against Georgia’s partaking in revolt from the beginning. They had reasonable suspicion that if the revolutionary movement would be defeated, this would totally change the perspective of Georgian-Russian relationship. Unfortunately, following events proved the correctness of this assumption - Georgians were pled guilty for separatism and it led to very brutal repressions. The events that occurred in Georgia were outrageous for Akaki. That is why he makes fun of Russia in his article and boldly declares that the decision of the government - campaigning against unarmed and helpless people, is worthless and unseemly.

15. Police powers, public order, and terrorism

Each Concentrate revision guide is packed with essential information, key cases, revision tips, exam Q&As, and more. Concentrates show you what to expect in a law exam, what examiners are looking for, and how to achieve extra marks. This chapter discusses the law on police powers. These include the role of the police, the organization of the police in England and Wales, police areas, the powers and functions of Police and Crime Commissioners, the Mayor’s Office for Policing and crime in London, the Police and Criminal Evidence Act 1984 and its Codes of Practice, which contain rules concerning police powers of stop, search, entry, seizure of property, arrest, detention, and treatment of suspects; the meanings of reasonable suspicion and public place, and information which must be given on arrest.

Stop-and-Frisk Policing

Stop and frisk is a proactive policing strategy that is widely used by police departments across the globe. In the United States, the origins of stop and frisk are rooted in the English practice of allowing night watchmen to stop and question individuals who were deemed suspicious. This ability to stop and question suspicious individuals serves two primary purposes. First, it gives law enforcement officers the ability to identify individuals who are looking to engage in criminal activity, stop those individuals, and prevent them from committing a criminal offense. Second, it may have a deterrent effect if potential offenders refrain from criminal offending because they do not want to risk being stopped. By the early 20th century, the implementation of stop and frisk in the United States varied by state. The Uniform Arrest Act, proposed in 1942, sought to standardize the practice. While several states adopted the Uniform Crime Act, which stipulated the circumstances under which a stop and frisk could occur, most states failed to do so. The practice of stop and frisk also faced constitutional challenges, with plaintiffs alleging violations of the Fourth Amendment’s prohibitions against unreasonable searches and seizures. In 1968, the US Supreme Court affirmed the constitutionality of stop and frisk. When law enforcement officers can establish reasonable suspicion, they can stop and question an individual. If there is reasonable suspicion to believe that a stopped individual possesses a weapon or poses a threat, law enforcement officers can also conduct a frisk. Stop and frisk has faced significant criticism and has been the subject of several class-action lawsuits, particularly in New York City. First, there is significant concern that nonwhite pedestrians are more likely than white pedestrians to be stopped, frisked, and subjected to the use of force. Next, stop and frisk may reduce perceptions of legitimacy and trust in law enforcement. The practice may also have adverse health consequences for those who are subjected to it or are in fear of being subjected to it. Finally, it is unclear whether stop and frisk prevents crime. It is also important to note that stop and frisk faces these same criticisms in other nations. The literature cited in this article summarizes key pieces on stop and frisk.

Mutual Deference Between Hospitals and Courts

This Article explores the phenomenon of “mutual deference” between the medical and legal systems to show that placing mandated reporting responsibilities on clinicians results in lasting harm for families. On the medical side, clinicians are obligated to defer any “reasonable suspicion” that a child may be at risk to the legal system; their concern may be mild or severe, medical or nonmedical in nature. But the legal system, comprised of lay-people in the field of medicine, is illequipped to evaluate a medical concern, and so defers back to the clinician’s report when making critical decisions around family integrity. Thisdeference often functions to elevate a clinician’s “reasonable suspicion” to a finding of “imminent risk,” justifying needless and prolonged separation of families. More systemically, mutual deference creates and reinforces medical and legal associations between low-income communities of color and notions of child maltreatment. Mutual deference insulates the medical reporter and the legal system from liability while imposing tremendous harm on the families caught in the middle. That mandated reporting laws discourage clinicians from considering this harm when deciding whether to report a family reflects the extent to which the family regulation system has prioritized prosecution over supporting families. Efforts to re-envision how society’s support for and protection of families can move away from state-sanctioned violence and towards strengthening families within their communities must begin with removing mandated reporter responsibilities from medical providers.

Ictal Swearing as a Lateralizing Value for the Dominant Hemisphere in Temporal Lobe Epilepsy

Ictal swearing, as an epileptic manifestation, has rarely been reported. Despite its poor localization value and unclear mechanism, several previous studies have reported that it frequently originates from the temporal lobe and more often from the non-dominant hemisphere. Herein, we report a case of a 41-year-old right-handed man with a history of stereotypical manifestation of ictal swearing with a left (dominant) hemisphere origin, confirmed by video electroencephalography monitoring. Reasonable suspicion that repetitive swearing could be a manifestation of seizures is important for clinicians not to misdiagnose the disease.

Police Stop and Frisk and the Impact of Race: A Focal Concerns Theory Approach

The findings of this study outline the racial differences in stop and frisk decisions by Illinois officers in consent searches and those based upon reasonable suspicion within the context of the elements of focal concerns theory. The analysis for this study was performed using propensity score matching (PSM) and allowed the researchers to create a quasi-experimental design to examine the race of the citizen and police decision making. According to our analysis of official Illinois law enforcement data, Black citizens, particularly males, were less likely to give their consent to a stop and frisk search. Black male citizens were also more likely to be stopped and searched due to an assessment of reasonable suspicion by the officer. Elements of focal concerns theory were also factors in pedestrian stops under conditions of consent and reasonable suspicion. Citizens judged as blameworthy were more likely to be stopped and frisked under conditions of consent and reasonable suspicion. The effect of a verbal threat and the officer’s prior knowledge about the citizen had even more significant impacts.

Reasonable suspicion in reporting child maltreatment: a survey among German healthcare professionals

Background With regular contacts to the general child population, healthcare professionals could play an important role in the detection of child maltreatment. However, a majority of child maltreatment cases go unnoticed by the healthcare system. Child protection legislations usually offer terms like “reasonable suspicion” to corner a threshold that warrants reporting to child protection services (CPS) is defined as. The indistinct legal terminology leads to marked differences in the interpretation of this threshold. Therefore, we aimed to systematically assess the understanding of reasonable suspicion and subsequent handling of cases in the German context. Methods A cross-sectional online survey was conducted among 2485 physicians and psychotherapists working with children and adolescents. Field access was gained by German professional associations. Via case vignettes, predictors of thresholds for reporting were assessed. Results The probability of a report to CPS increased positively with the degree of suspicion for maltreatment. However, even if participants were certain that child maltreatment occurred, 20% did not chose to report to CPS. Training in child protection lowered the professionals’ threshold for reasonable suspicion; experience with child protection cases and good knowledge of the legal framework increased the likelihood to report an alleged situation of child maltreatment to CPS. Conclusion Our data show that a significant proportion of health care professionals are uncertain about estimating reasonable suspicion and on how to proceed when there are strong indications for child maltreatment Therefore, data point towards the relevance of training in child protection among healthcare professionals in order to improve detection and adequate handling of cases of child maltreatment.

Unusual Presentation and Rare Comorbidity of Graves-Basedow’s Disease in Children

Graves’-Basedow’s disease (GD) is a well-defined hyperthyroid disorder caused by circulating antibodies that results the overproduction of thyroid hormones. All but a few children present with some degree of thyroid gland enlargement and most have two or more signs of excessive thyroid activity, such as tremor, irritability/nervousness, tachycardia etc. Fully developed clinical picture is easy to recognize while often the onset is insidious. Thyroid hormones affect many body systems, so signs and symptoms of Graves’ disease can be wide ranging. A survey on PubMed literature was conducted to gather all published pediatric Graves-Basedow’s cases with unusual presentation at the time of diagnosis. We found all together 70 manuscripts with relevant information from 1978 to 2020 but mainly adult cases. One third of them were found to meet the criteria we focused on and were included in this paper, though in some situation the unusual findings do not consist part of hyperthyroidism, the rare manifestation is only a coexistence, or the serious disease even precedes the GD. Dermatopathy, hepatic dysfunction, impaired fluid balance, concomitant disorders in thyrotoxicosis, tricky laboratory findings, a phenomenon of metamorphic thyroid autoimmunity, peculiarities of thyroid dysfunction in children with Down syndrome, apparent associations, and reconstitution GD are highlighted in this chapter. Awareness about the relation of these remote findings to GD, or frequent coexistence with GD is important for early diagnosis. Finally, a reasonable suspicion for Graves’ disease may ultimately help to prevent unnecessary investigations and treatment.