ED90 of spinal 2-chloroprocaine 1% in ambulatory knee arthroscopy up to 45 min: a randomized biased-coin- up-and-down sequential allocation trial

BackgroundA short acting spinal anesthetic facilitates smooth flow since quick recovery of motor function will facilitate unassisted ambulation. The aim of this study was to estimate the effective dose (ED90) of intrathecal 2-chloroprocaine 1% in outpatient knee arthroscopy.MethodsTwo cohorts were included in two different hospitals. In cohort I, a randomized biased-coin up-and-down design with 40 patients was used to find the ED90. Four dose-levels of plain 2-chloroprocaine 1% were used: 25, 30, 35 and 40 mg. The identified primary outcome, the ED90, was validated in 50 patients in cohort II with an open label design. Secondary outcomes included time to complete recovery from motor and sensory block with spinal injection as time zero, peak sensory block level, urine retention and time until hospital discharge.ResultsForty patients were included in the final analysis in cohort I. The ED90 was estimated at 27.8 mg, successful spinal anesthesia was obtained in 38 patients (95%). Fifty patients were included in the final analysis in cohort II, 49 patients had successful anesthesia with a fixed round dose of 28 mg. In this Cohort, peak sensory block was T10/T11 (range: (L4–T4)). The median time to full recovery of the motor block was 60 min (45–60) and 90 min (75–105) for the sensory block. The mean time to hospital discharge was 2.9 hours (0.7).ConclusionThe ED90 of 2-chloroprocaine 1% in knee arthroscopy was estimated to be 27.8 mg. In an external population, the ED90 resulted in successful anesthesia in 98% of the patients (95% CI 89% to 100%).Trial registration numberNetherlands Trial Registry (NL6769).

An Analysis of Factors Influencing Regional Resilience to Disaster Using the Resilience Cost Index

Natural disasters whose scale of damage exceeds the level that regional governments can afford are increasing. As such disasters have increased, the damage to local communities tends to be prolonged. Accordingly, it is important to prevent prolonged disaster damage and secure resilience to ensure quick recovery from the damage. This study analyzed the regional factors that can affect resilience to disaster, quantifying the regional resilience of each sigungu administrative district in Korea that suffered damage from natural disasters during the period 2010-2017 using the resilience cost index (RCI). We investigated the relationship between change in resilience cost index by year and changes in regional factors by year to identify the regions where industrial diversity was secured so as to reduce the exposure of each industry to disaster, budgets for social welfare were increased, and participation in volunteer activities was expanded, all of which tend to improve regional resilience.

Impact of the COVID 19 Pandemic on Radiological Imaging in Germany

Purpose To analyze the impact of the COVID-19 pandemic in 2020 on the radiological imaging volume in Germany. Materials und Methods In this retrospective multicenter study, we analyzed CT and MRI examinations of 7 radiology institutes across Germany from January to December 2020. The imaging volume was compared to 2019 (Wilcoxon-Mann-Whitney test). Modality, patient service locations, and examined body parts were assessed in consideration of time periods of the pandemic. In addition, correlation with the incidence of SARS-CoV-2 cases and associated death was performed (Spearman-test). Results In total, in 2020, imaging volume declined by 4 % (n = 8314) compared with 2019 (p < 0.05). The hard lockdown during the first pandemic wave (calendar week 12–16, March 22 – April 19) revealed the highest decrease with 29 % (n = 894, p < 0.01), with the greatest decrease in CT (36 % vs. MRI 26 %), outpatients (38 %, p < 0.01), and imaging of the spine and extremities (51–72 %, < 0.05 – p < 0.01). Examinations referred from the emergency department (–13 %, p < 0.05) and CT of the chest (–16 %, p < 0.05) were least affected. With the end of the first wave, gradual normalization of the imaging volume was observed and persisted until the end of the observation period. A reduction of imaging volume negatively correlated with the incidence of SARS-CoV-2-positive cases and associated deaths (r = 0.28 and 0.49, p < 0.05 and p < 0.001). Conclusion The COVID-19 pandemic was associated with a significant temporary decline in imaging volume. After the first lockdown period, a quick recovery was observed with radiologic imaging examinations steadily approaching prior-year figures. Key points: Citation Format

Mobilitási szokások változásai a Covid19-világjárvány idején - Changing mobility behaviour during the Covid19 pandemic

A Covid19-világjárvány jelentős recessziót eredményezett a turizmus szektorban. A korlátozó intézkedések enyhítése mellett a lakosság hozzáállása is nagyban befolyásolja a válságból való a kilábalást, ezért kutatócsoportunk az egyes közlekedési módokkal kapcsolatos társadalmi attitűdök, a világjárvány alatti turisztikai szokások, valamint a járvány enyhülését, megszűnését követő utazási motiváció feltárását tűzte ki célul. A kutatási célok megvalósításához kvalitatív (6 fókuszcsoportos interjú) és kvantitatív adatfelvételi módszereken alapuló, utóbbi esetében a felnőtt magyarországi lakosságra vonatkozóan reprezentatív (n=3025), kutatás készült. A kutatásba bevont alanyok szerint a járvány teljes leküzdéséig legfeljebb a belföldi turizmus iránti kereslet erősödhet, azt követően azonban a nemzetközi turizmus hirtelen fellendülése valószínűsíthető. A kérdőíves, reprezentatív megkérdezés alapján a lakosság körében óvatos, kockázatkerülő magatartás mutatkozik. A válaszadók jelentős része arról számolt be, hogy jövőbeni utazásai során, a Covid19-világjárványt követő időszakban is körültekintőbb lesz a higiéniai szabályok betartásával kapcsolatban. A szigorúbb egészségvédelmi intézkedések iránti erősödő igény tudatában érdemes újragondolni a közlekedési és turisztikai szolgáltatások konstrukcióját (pl. repülőgépek férőhelye, egészségügyi ellenőrzések, szálláshelyek és egyéb szolgáltatók hosszú távú járványügyi védekezése), ami nagyban befolyásolhatja a szektor fellendülését. The Covid19 outbreak has led to a significant recession in the tourism sector. The recovery from the crisis, in addition to the restrictive measures, is also heavily influenced by the attitudes of society. Based on this, our research team aimed to explore changes in social attitudes towards different modes of transport and tourism-related consumption. To achieve this, data collection in two phases: qualitative (6 focus group interviews) and quantitative representative (n=3025) surveys were conducted. Focus group interviews indicated that domestic tourism will be stronger until the Covid19 pandemic is over, but a quick recovery of international tourism is expected afterwards. The survey revealed cautious, risk-averse attitude among the respondents. A significant proportion of subjects reported that they would be more careful about hygiene during travel, even when the pandemic is over. With this mind, transport and tourism services may need to rethink (e.g., empty middle seats on flights, health checks, epidemic prevention by different tourism service providers) to ensure the recovery of the sector.

646 Acute peri-myocarditis following COVID-19 Pfizer-Biontech vaccine second dose delivery in a male teenager: the good prognosis and unusual ECG

Aims Myocarditis due to COVID-19 mRNA vaccine is an uncommon side effect and the cases seem to have occurred predominantly in young adults under 30 years old. The estimated incidence is 12.6 cases per one million second dose m-RNA vaccine delivery. Methods and results A 17-years-old male was admitted at our department after 18 days COVID-19 Pfizer-BioNtech vaccine second dose delivery with persistent chest pain without respiratory symptoms and, ST-elevation and PR-depression in V3–V6 at the ECG on 3 August 2021. He had no history of heart disease. Physical examination didn’t show anything relevant except for mildly tachycardic heart sounds. In addition blood test showed increase in C-reactive protein, cardiac troponin and N-terminal-pro-B-type natriuretic peptide. An echocardiography showed widespread hypokinesia with reduced left ventricular ejection fraction and highly echogenic pericardium. During the first day cardiac magnetic resonance (CMR) was performed, which showed mild diffuse myocardial oedema on T2-weighted images and T2 mapping and two thin areas of delayed enhancement with non-ischaemic pattern in the lateral wall with involvement of the pericardial sheets confirming peri-myocarditis diagnosis. After 24 h, the ECG showed spread and deep T-waves with QTc prolongation. We performed multiple ECG during the days after to assess morphology changes and QTc. The patient has been asymptomatic for all the hospitalization and on day 7 was performed an echocardiography which describe a full recovery in terms of kinesia and left ventricular ejection fraction. He was discharged asymptomatic with ‘better’ but still negative T-waves and QTc normalization. Two months after discharge CMR was repeated and showed normal left ventricular function without myocardial oedema and pericardial involvement, but with persistent the areas of delayed enhancement with non-ischaemic pattern in the lateral wall. Conclusions In this case report we describe an uncommon COVID-19 m-RNA Vaccine side effect. The first issue is the timing of presentation. On 19 July 2021, AIFA stated that myocarditis is a very uncommon side effect and it usually presents within 14 days after 2nd dose delivery. Our patient was admitted at our department after that time period, probably because we reported the ending part of the myocarditis presented with symptoms of pericarditis; indeed we didn’t report the cardiac troponin plateau but only the descending cardiac troponin wave and we attend a very quick recovery. The second issue in the unique ECG with a very quick evolution (Tako-Tsubo morphology like) which could be characteristic of this kind of Myocarditis. Third, the good progress of the inflammation and quick recovery. Surely is a serious side effect but it’s still less frequent and with better prognosis than COVID-19 Myocarditis. European Medicines Agency (EMA) and Centers for Disease Control and Prevention (CDC) recently stated authorized COVID-19 vaccines advantages are still above risks in all age groups beyond 12 y/o. Why is myocarditis a side effect, Why are adolescent males affected the most and Why is the onset after second dose of m-RNA vaccine are questions still unanswered.

P-P33 Quality of Life Assessment in Patients undergoing Robot Assisted Pancreaticoduodenectomy

Background Robot-assisted pancreaticoduodenectomy has recently gained attention as there is evidence from high volume centres suggests better outcomes and quick recovery. This study aimed to evaluate the quality of life after robotic-assisted pancreaticoduodenectomy Methods The study included the first 12 consecutive patients who underwent robotic pancreaticoduodenectomy. The RAND SF 36-Item health survey form was used to assess the quality of life through a one-hour face-to-face interview carried out by a junior doctor from a different team with no prior involvement in patient care. The interview was carried out at least three months postoperative period. Each item in the subscale was recorded with a pre-coded numeric value. The comparison was made between preoperative periods' scores defined by the onset of disease symptoms to surgery and the postoperative follow-up score. The SF-36 survey questions were supplemented with additional items such as postoperative pain, emotional wellbeing, and fatigue status. Results Analysis of SF-36 domains showed better quality of life postoperatively than the baseline, as evidenced by the mean physical functioning score from 82.91 to 90 and mean general health score from 37.9 to 69.5 postoperatively. 91.66% of the patients reported that they felt better at the time of study and were happy overall. Conclusions Robotic-assisted pancreaticoduodenectomy shows a better quality of life than in the preoperative period, which can be attained in a brief postoperative period.

Vegetation Resilience under Increasing Drought Conditions in Northern Tanzania

East Africa is comprised of many semi-arid lands that are characterized by insufficient rainfall and the frequent occurrence of droughts. Drought, overgrazing and other impacts due to human activity may cause a decline in vegetation cover, which may result in land degradation. This study aimed to assess drought occurrence, vegetation cover changes and vegetation resilience in the Monduli and Longido districts in northern Tanzania. Satellite-derived data of rainfall, temperature and vegetation cover were used. Monthly precipitation (CenTrends v1.0 extended with CHIRPS2.0) and monthly mean temperatures (CRU TS4.03) were collected for the period of 1940–2020. Eight-day maximum value composite data of the normalized difference vegetation index (NDVI) (NOAA CDR—AVHRR) were obtained for the period of 1981–2020. Based on the meteorological data, trends in rainfall, temperature and drought were determined. The NDVI data were used to determine changes in vegetation cover and vegetation resilience related to the occurrence of drought. Rainfall did not significantly change over the period of 1940–2020, but mean monthly temperatures increased by 1.06 °C. The higher temperatures resulted in more frequent and prolonged droughts due to higher potential evapotranspiration rates. Vegetation cover declined by 9.7% between 1981 and 2020, which is lower than reported in several other studies, and most likely caused by the enhanced droughts. Vegetation resilience on the other hand is still high, meaning that a dry season or year resulted in lower vegetation cover, but a quick recovery was observed during the next normal or above-normal rainy season. It is concluded that despite the overall decline in vegetation cover, the changes have not been as dramatic as earlier reported, and that vegetation resilience is good in the study area. However, climate change predictions for the area suggest the occurrence of more droughts, which might lead to further vegetation cover decline and possibly a shift in vegetation species to more drought-prone species.

540. Does Remdesivir Impact the Clinical Outcome of Patients with COVID 19 Infection?

Background Remdesivir (RDV), was included for the treatment of mild to moderate COVID-19 since July 2020 in our institution, following the initial results from ACTT-1 interim analysis report. With the adoption of RDV, there seems to be anecdotal evidence of efficacy as evidenced by early fever defervescence, quick recovery when on oxygen with decreased need for ventilation and ICU care. We aimed to study the impact of RDV on clinical outcomes among patients with moderate to severe COVID –19. Methods Nested case control study in the cohort of consecutive patients with moderate to severe COVID – 19. Cases were patients initiated on RDV and age and sex- matched controls who did not receive RDV were included. The primary outcome was in-hospital mortality. Secondary outcomes were, duration of hospital stay, need for ICU, duration of oxygen therapy and need for ventilation. Results A total of 926 consecutive patients with COVID – 19 were included, among which 411 patients were cases and 515 controls. The mean age of the cohort was 57.05±13.5 years, with male preponderance (75.92%). The overall in-hospital mortality was 22.46%(n=208). On comparison between cases and controls there was no statistically significant difference with respect to primary outcome [22.54% vs. 20.78%, (p value: 0.17)]. Progression to non-invasive ventilation (NIV) was higher among the controls [24.09% vs. 40.78% (p value: &lt; 0.001*)]. Progression to invasive ventilation was also higher among the controls [5.35% vs. 9.71% (p value: 0.014*)]. In subgroup analysis among critically ill patients, the use of RDV showed decrease in mortality (OR 0.32 95% CI; 0.13 – 0.75 p value – 0.009*). Conclusion RDV did not decrease the in-hospital mortality among moderate to severe COVID – 19. However, there seems to be a significant reduction in mortality in critically ill patients. Disclosures All Authors: No reported disclosures

Laparoscopic cystectomy with lymphadenectomy and ileoconduitis creation: А case report

Relevance: Radical cystectomy remains the «gold standard» of muscle-invasive and locally advanced bladder cancer treatment. The article describes the capacity and technique of laparoscopic cystoprostatectomy with lymphadenectomy and the creation of ileoconduitis in bladder cancer since the authors could not find publications on conducting laparoscopic cystoprostatectomy with the creation of an ileoconduitis in oncological and urological clinics in Kazakhstan by domestic specialists. The purpose was to describe an attempt to reproduce the method of open radical cystectomy laparoscopically as accurately as possible. Results: In the described case, the patient diagnosed with bladder cancer T2N0M0 IIst underwent surgery in the form of laparoscopic cystectomy with lymphadenectomy and the creation of ileoconduitis. This method of surgical intervention is minimally invasive, less traumatic, and ensures quick recovery in the postoperative period. Conclusion: Laparoscopic execution of radical cystectomy allows preserving the advantages of minimally invasive interventions without losing the reliability of the well-proven open surgery. Currently, the implementation of such minimally invasive surgical interventions is possible in many clinics in Kazakhstan, equipped with endoscopic video equipment, if there are specialists experienced in open surgery

California Wildfire Exposure, Vulnerability, and Mental Health: Who gets to recover and who does not?

One of the various aftereffects of persistent climate change is an upsurge in the frequency, severity, and effect of wildfires on the wellbeing of suffering communities. The destruction and wreckage of one's home, properties, and the surrounding neighborhood, as well as the threat to one's psychological safety and the safety of loved ones, can have long-term effects on survivors' mental health. The central goal of this study, therefore, is threefold. Firstly, identify the significant qualitative and quantitative studies that examine the impacts of wildfire on mental health. This study mainly focuses on studies that capture the effects of wildfire, smoke, and air quality in California and how that affected the local communities based on their vulnerability determinants. Secondly, the study examines both types of studies to find common grounds regarding the most vulnerable population and their mental health, their ability to seek professional help, and barriers to the road to recovery. Finally, this study provides evidence-based strategies for including more vulnerable members of society in receiving sufficient and timely psychological care to recover from PTSD, trauma, distress, and hopelessness. Migrant farmworkers, particularly younger female Hispanic and indigenous workers, suffer from the wildfire's long-term stress, PTSD, depression, and emotional distress. Furthermore, the continued COVID-19 deepens the gap, social stigma, and barriers to receiving sufficient mental health care to recover and rehabilitate traumatic wildfire exposure. A localized mental healthcare support system based on equity, with flexible infrastructure and greater accessibility, promises to be more efficient and advantageous for underrepresented and vulnerable individuals seeking mental health treatment and quick recovery.