Does the Progression of the COVID-19 Pandemic Have an Influence on the Mental Health and Well-Being of Young People? A Cross-Sectional Multicenter Study

The COVID-19 pandemic has been shown to have impaired the mental health and well-being of young people. This study, for the first time, explores these aspects in young people with and without a migratory background during the extended course of the pandemic and restrictive measures, comparing two countries with a high COVID-19 prevalence: Austria and Turkey. Methods: The authors used the “Psychological General Well-being” index as part of an anonymous online survey with 3665 participants (ages 15–25), recruited from both countries during the first and the second waves of the pandemic, collecting data on individual experiences and problems encountered during the pandemic. Results: Mental health (b = 0.06, p < 0.023) and general psychological well-being worsened with the progression of the pandemic. Participants with financial problems had the most severe negative effect on mental health (b = 0.12, p < 0.001). Furthermore, females living in Turkey, both natives (b = −0.21, p < 0.001) and migrants (b = 0.25, p < 0.001), reported a more deteriorated mental health status over time. Conclusions: The extended pandemic duration and resultant “lockdown” restrictions have negatively affected the mental health of young people to varying degrees, depending on country of residence and migration background. A strong “recovery plan” that considers group-specific needs and vulnerabilities is urgently needed.

815. Short-Course vs. Extended-Course Perioperative Antibiotic Prophylaxis in Patients Receiving Unilateral Primary Total Knee Arthroplasty

Background International guidelines recommend up to 24 hours of perioperative antibiotic prophylaxis (AP) in joint replacement procedures. However, some observational studies support AP beyond 24 hours for the prevention of surgical site infections (SSI) and prosthetic joint infections (PJI), and this practice is also observed in our institution. This study aims to evaluate the incidence of SSI and PJI in patients receiving short- vs extended-course AP after unilateral primary total knee arthroplasty (TKA) at our center. Methods This was a retrospective cohort study of patients who underwent elective unilateral primary TKA from October to December 2019 at Singapore General Hospital. Patients were excluded if they received antibiotics for reasons other than post-operative AP or underwent other procedures in addition to unilateral primary TKA. Data was collected from electronic medical records and patients who received a short-course of AP (≤24 hours) were compared with patients who received an extended-course of AP. Primary outcomes were 30-day SSI and 30-day PJI rates. Secondary outcome was the impact of duration of AP on length of stay. Statistical analysis was performed using SPSS software version 20. Results There were 394 patients included in the study. 247 received short-course and 147 received extended-course AP. There were no differences in demographics (Table 1). Amongst those who received extended-course AP, median duration was 7 (IQR 4, 8) days, during which 119 (81.0%) patients switched from intravenous to oral route of antibiotics. Between the short- and extended-course arms, there were no differences observed in 30-day SSI (6.9% vs 6.1%, p=0.769) or PJI rates (0.4% vs 0.7%, p=0.999). However, extended-course AP was associated with a longer median length of stay (4 [IQR 3, 6] vs 5 [IQR 4, 7] days, p=0.001). In a subgroup analysis of 106 diabetic patients, there were no differences in 30-day SSI rates (12.3% vs 9.8%, p=0.763) and 30-day PJI rates (0% vs 2.4%, p=0.387) between both groups. Conclusion In this single center study, short-course AP in elective TKA was safe and effective. Extending AP did not reduce SSI or PJI rates, even in diabetic patients. In addition, extending AP was associated with increased length of stay, which translates to higher healthcare costs. Disclosures All Authors: No reported disclosures

Mycotic aortic aneurysm formation following intravesical BCG treatment for transitional cell carcinoma of the bladder

Mycotic aneurysms are rare and if left untreated, can have devastating outcomes. In this case, a 72-year-old man presented to hospital with fevers, night sweats and abdominal pain. A CT scan revealed the development an infrarenal pseudoaneurysm over the course of 8 weeks, increasing from 2.8 cm to a 3.1 cm. The aneurysm was not present on a CT scan performed 6 months earlier. The patient underwent an emergency endovascular repair of the aortic aneurysm (EVAR) and was placed on broad-spectrum antibiotics. Intra-aortic blood cultures aspirated adjacent to the aneurysm and tissue biopsy confirmed tuberculosis bovis as the cause of the mycotic aneurysm. The patient had been treated with intravesical BCG for transitional cell carcinoma of the bladder several months prior. The patient was treated with an extended course of antituberculosis medication. He recovered well and was back to his baseline function within weeks.

Perianal Actinomycosis: A Surgeon’s Perspective and Review of Literature

Actinomycosis is a serious suppurative, bacterial infection caused by the gram-positive anaerobic Actinomyces species. Primary perianal actinomycosis is rare and challenging for the colorectal surgeon. We aimed to present our experience and compare this with available literature. All patients with isolated Actinomyces on microbiology reports, between January 2013 and February 2021, were identified and reviewed. Data collection was retrospective based on electronic patient records. The site of infection and treatment strategy were examined. Perianal cases were evaluated in depth. All publications available in the literature were interrogated. Fifty-nine cases of positive actinomycosis cultures were reviewed. Six cases of colonization were excluded. Actinomyces turicensis was the most common organism isolated. Five cases of perianal actinomycosis were identified requiring prolonged antibiotic and surgical therapy. Twenty-one studies, most case reports, published since 1951 were also reviewed. Diagnosis of perianal actinomycosis may be challenging but should be suspected particularly in recurrent cases. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium. An extended course of antibiotic therapy (months) is required for eradication in certain cases.

Duration of Prophylactic Antibiotic and Prosthetic Joint Infection in a Developing Country: a Retrospective Cohort Study

BackgroundPerioperative antibiotic prophylaxis is one of the standard measures for preventing periprosthetic joint infection (PJI). In developing countries, poor surgical environment and patient hygiene are often cited as reasons for prolonged antibiotic duration without any evidence to support its effectiveness. The aim of this study was to investigate the infection rate after TKA compared between standard course (≤24 hours) and extended course (>24 hours) of perioperative antibiotic prophylaxis in a developing country.MethodsThis retrospective study included patients who underwent unicompartmental knee arthroplasty or total knee arthroplasty during January 2013 to December 2018. A total of 3,316 patients were included. Of those, 1,284 and 2,032 patients received standard and extended course of antibiotic prophylaxis, respectively. The incidence of PJI was compared between groups, and we also analyzed for factors significantly associated with PJI.ResultsPJI developed in 0.5% (6/1,284) of the standard course group, and in 1.2% (24/2,032) of the extended course group. The difference and 95% confidence interval for the difference between groups was -0.714% (-1.338% to -0.043%), which confirms the noninferiority status of the standard course group compared to the extended course group. Longer hospital length of stay significantly associated with higher infection rate (p=0.000). Postoperative wound infection was not found to be associated with age, body mass index, American Society of Anesthesiologists classification, blood transfusion, or surgery type.ConclusionTwenty-four hours of perioperative antibiotic prophylaxis was found to be adequate for PJI prevention in a developing country setting.Trial registrationEthical approval and consent to participate: The study was approved by the Institutional review board of Siriraj Hospital, Mahidol university. [SIRB 847/2559(EC3)]

278 Duration of Prescription of Dexamethasone in COVID-19 Pneumonitis

Aim The RECOVERY trial showed the effectiveness of using 10 days of dexamethasone for patients hospitalised with Covid-19 disease who required oxygen or mechanical ventilation while an inpatient. This QIP sought to measure compliance with this recommendation. Method Live data was obtained using University Hospital Crosshouse’s electronic prescribing system (JAC). The audit was limited to patients on Ward 2D, which at time of writing was one of the hospitals COVID 19 wards. The first audit was performed on Friday 13/11/20 at 18:00. All dexamethasone prescriptions had the duration of the prescription assessed (at the time all patients were on oxygen therapy for COVID-19 infection). Patients with a course longer than 10 days with explicit documentation to continue past 10 days were counted as a correct prescription in this audit. For the second cycle results were shared with middle tier doctors working on Ward 2D 16/11/20. Notices were also left on all computers on the ward with the message “Please ensure your patient is only prescribed a total of 10 days of dexamethasone unless an extended course is clinically indicated”. A third cycle was carried out 01/12/20. Notices were left on all computers in the combined assessment unit with the same message as above. Results It found most patients were receiving more than the 10 days due to prescription errors (86%). Teaching on the COVID ward resulted in 83% of the prescriptions being correct. Teaching in the receiving unit of the hospital resulted in no change. Conclusions Prescriptions of dexamethasone for Covid-19 patients requiring oxygen on ward 2D were found to be longer than the advised 10 days shown to be effective in the Recovery trial. Teaching on the ward was found to be an effective method to decrease prolonged courses of dexamethasone.

Rokitansky diverticulum with esophageo-spinal fistula leading to infective spondylodisciitis – A case report and review of literature

Background- Infective thoracic spondylodiscitis secondary to spontaneous perforation of the esophageal diverticulum is a rare condition. Case Report- A 56-year-old lady with cystic lung disease and pulmonary arterial hypertension of nine years duration and progressive dysphagia for two years was diagnosed with mid-esophageal diverticulum five months prior to presentation. The lady presented with infrascapular chest wall pain of one month’s duration and dyspnoea and wheezing of 15 days duration. Imaging showed a mid-esophageal diverticulum at T4-T5 level with a sinus tract extending to the T2-T3 disc, reduced T2-T3 disc height with endplate irregularities, and contrast enhancement of T2-T5 vertebral bodies suggestive of spondylodiscitis. Although a percutaneous vertebral biopsy was inconclusive, the blood culture grew Streptococcus Pseudoporcinus. The esophageal diverticulum was managed with an endoluminal stent and the infective spondylodisciitis was managed with an extended course of antibiotics led to the healing of both lesions. Conclusions- A Rokitansky mid-esophageal diverticulum with esophageo-spinal fistula causing infective spondylodisciitis is a rare condition. A combined management of the leaking esophageal diverticulum using an esophageal endoluminal metallic stent and an extended course of antibiotics to treat the infective spondylodisciitis led to a good outcome.

Rokitansky diverticulum with esophageo-spinal fistula leading to infective spondylodisciitis – A case report and review of literature

Background- Infective thoracic spondylodiscitis secondary to spontaneous perforation of the esophageal diverticulum is a rare condition. Case Report- A 56-year-old lady with cystic lung disease and pulmonary arterial hypertension of nine years duration and progressive dysphagia for two years was diagnosed with mid-esophageal diverticulum five months prior to presentation. The lady presented with infrascapular chest wall pain of one month’s duration and dyspnoea and wheezing of 15 days duration. Imaging showed a mid-esophageal diverticulum at T4-T5 level with a sinus tract extending to the T2-T3 disc, reduced T2-T3 disc height with endplate irregularities, and contrast enhancement of T2-T5 vertebral bodies suggestive of spondylodiscitis. Although a percutaneous vertebral biopsy was inconclusive, the blood culture grew Streptococcus Pseudoporcinus. The esophageal diverticulum was managed with an endoluminal stent and the infective spondylodisciitis was managed with an extended course of antibiotics led to the healing of both lesions. Conclusions- A Rokitansky mid-esophageal diverticulum with esophageo-spinal fistula causing infective spondylodisciitis is a rare condition. A combined management of the leaking esophageal diverticulum using an esophageal endoluminal metallic stent and an extended course of antibiotics to treat the infective spondylodisciitis led to a good outcome.

Superior mesenteric vein and portal vein thrombosis in a patient with COVID-19: a rare case

A 68-year-old man was referred to the general surgeons on account of his abdominal pain of unknown cause. He had contracted COVID-19, 9 days prior. CT chest abdomen and pelvis revealed an extensive thrombus extending from the portal vein to the superior mesenteric vein. Further investigation ruled out haematological causes, and COVID-19 was determined to be the cause. He was treated with an extended course of therapeutic dose low molecular weight heparin under the guidance of the haematology team. He was discharged once he was clinically stable and pain-free, with a plan to be followed up by both the surgeons and haematologists. This case highlights the different ways in which COVID-19 presents, and the need for clearer guidance on the treatment and prevention of thromboembolism in COVID-19.