Inability to work following COVID-19 vaccination-a relevant aspect for future booster vaccinations.

OBJECTIVES: COVID-19 vaccination is a key prevention strategy to reduce the spread and severity of SARS-CoV-2 infections. However, vaccine-related inability to work among healthcare workers (HCWs) could overstrain healthcare systems. STUDY DESIGN: The study presented was conducted as part of the prospective CoVacSer cohort study. METHODS: This study examined sick leave and intake of pro re nata medication after the first, second, and third COVID-19 vaccination in HCWs. Data were collected by using an electronic questionnaire. RESULTS: Among 1704 HCWs enrolled, 595 (34.9%) HCWs were on sick leave following at least one COVID-19 vaccination, leading to a total number of 1550 sick days. Both the absolute sick days and the rate of HCWs on sick leave significantly increased with each subsequent vaccination. Comparing BNT162b2mRNA and mRNA-1273, the difference in sick leave was not significant after the second dose, but mRNA-1273 induced a significantly longer and more frequent sick leave after the third. CONCLUSION: In the light of further COVID-19 infection waves and booster vaccinations, there is a risk of additional staff shortages due to postvaccination inability to work, which could negatively impact the already strained healthcare system and jeopardise patient care. These findings will aid further vaccination campaigns to minimise the impact of staff absences on the healthcare system.

Retarder action of isosorbide in a microemulsion for a targeted delivery of ceramide NP into the stratum corneum.

Ceramide [NP] is an integral component of the stratum corneum (SC) lipid matrix and is capable of forming tough and stable lamellar structures. It was proven, that in skin diseases as psoriasis or atopic dermatitis different ceramide (CER) classes, including [NP], are degraded. It is obvious that topically application of CER on impaired skin is useful for repairing the skin barrier but a tendency for low penetration due to its poor solubility in conventional dosage forms was observed. Therefore, a stable and physiologic compatible colloidal carrier system, a microemulsion (ME), was developed and characterized. The increasing knowledge of the new colloidal systems in this last decade shows their benefits in dermal application. Isosorbide (Polysorb P) was incorporated into the ME developed. It was expected that Polysorb P has a retarder potential in order to accumulate the CER in the SC, the outermost layer of the skin. Thereby the CER [NP] would be able to interact with the affected skin layers to strengthen the skin barrier. The release and penetration behavior of the CER [NP] from the ME was assessed ex vivo in a Franz diffusion cell. The results of the study showed that CER [NP] penetrate largely in the upper layers of the skin (from SC to stratum basale), which was the desired region. A recovery in the acceptor could not be detected that underlines an accumulation in upper layers. Furthermore, significantly increased values for the SC for the ME with retarder were not received. No differences in the concentrations of CER [NP] were observed. However, the toxicity of MEs was investigated using hens egg test chorioallantoic membrane (HET-CAM). For the isosorbide-containing ME no difference was obtained in comparison to the non-containing. The results showed that both MEs are safe to be used on the skin for the controlled penetration of CER [NP] into the skin. The isosorbide had no effect on the irritating effect as well as on the penetration of the used CER.

[Hypotensive cardio-circulatory failure and metabolic acidosis after suicidal intoxication with trimipramine and quetiapine. Case report and background]. / Hypotones Kreislaufversagen und metabolische Azidose nach suizidaler Mischintoxikation mit Trimipramin und Quetiapin. Fallbericht und Hintergrund.

The case of a 44-year-old female patient is reported, who ingested trimipramine and quetiapine in a suicide attempt. Initially sinus tachycardia and hypotension were seen, which resulted in a hypotensive cardio-circulatory failure despite fluid therapy and administration of catecholamines. Because of the life-threatening situation and the fact that the ingestion was 2 h prior to admission, a rapid transport to the next hospital was preferred to treatment with active charcoal. Intoxication with tricyclic antidepressants are very common in Europe and have a mortality of up to 15% in severe cases. The specific therapy consists of airway management, hemodynamic stabilization and primary elimination of the poison. Secondary detoxication is less important. The administration of the antidote physostigmine is controversial but carbo medicinalis should be given orally or via a gastric tube.

[Suicide attempt with high-dose ecstasy]. / Suizidale hochdosierte Ecstasy-Einnahme.

The case of a 16-year-old female patient is reported, who has taken in 30 tablets of Ecstasy in a suicide attempt. Initially were seen a tachycardia,hyperdynamic circulation, dehydration, leg-myocloni in the awake excited female patient. For prophylaxis of aspiration general anaesthesia and intubation with following gastric lavage were performed. During the intensive care treatment the high blood pressure persisted, although general anaesthesia and anti-hypertensive therapy was continued. After extubation the neurologic status of the patient was normal. Emergency physicians see more and more often Ecstasy-intoxications. Signs of an acute intoxication with Ecstasy are a sympathomimetic reaction with tachycardia,hypertonic blood pressure and cardiac arrhythmia as well as fever, respiratory and renal insufficiency, rhabdomyolysis, cerebral edema and convulsion. A specific antidote does not exist; the symptomatic therapy consists of airway management, hemodynamic stabilisation, primary drug-elimination and, in case of need, application of betablockers and relaxants.

Pneumatosis cystoides intestinalis: an unexpected finding in intestinal bleeding under therapy with phenprocoumon.

Pneumatosis cystoides intestinalis is a rarely observed disorder on plain abdominal X-ray or colonoscopy examination. Although causing few complaints in adults, it can nevertheless lead to gastrointestinal bleeding. In the reported case, gastrointestinal bleeding was observed with coinciding pneumatosis and phenprocoumon therapy. After stopping anticoagulant therapy, pneumatosis vanished completely, thus suggesting that phenprocoumon is probably a further cause of the cystic disease. In the known list of drugs able to provoke pneumatosis, this case adds a new mechanism of affliction different to either immunosuppression or gas production.

Aspiration: a possible severe complication in colonoscopy preparation of elderly people by orthograde intestine lavage.

Total gut lavage is a widely recommended method in preparation for colonoscopy and there are almost no reports of severe complications in the literature. Application of orthograde lavage by a nasogastric tube may be necessary in disorientated patients, assisted by slight medical sedation, if necessary. Despite absolutely correct appliance of the method, a case of severe aspiration with subsequent hypoxemia and stroke in a senile female patient, suffering from a common hiatal hernia, is described.

Ventricular fibrillation due to long QT syndrome probably caused by clindamycin.

Prolongation of QT time interval may be provoked by a limited number of drugs, especially macrolide antibiotics. We describe a case of QT time interval prolongation induced by clindamycin with subsequent repeated ventricular fibrillation and resuscitation; there is no previous report in the literature of QT time prolongation caused by lincosamides.

Fracture of the distal sesamoid bone in horses: 17 cases (1982-1992).

Medical records of 17 horses in which a distal sesamoid bone fracture was diagnosed between 1982 and 1992 were reviewed. There were 8 Standardbreds, 6 Quarter Horses, 2 Thoroughbreds, and 1 Arabian. Mean age was 4.7 years. A forelimb was affected in 15 horses, and a hind limb was affected in 2. All horses were lame, and most were grade III/V lame at the trot. In all horses, the diagnosis was confirmed by means of radiography. Five horses were treated with stall rest alone; 5 underwent neurectomy; 4 were treated with stall rest and corrective shoeing; and 1 was treated with stall rest and external coaptation. The other 2 horses were euthanatized. Two Quarter Horses, 1 treated with stall rest and corrective shoeing and the other treated with stall rest and external coaptation, returned to use as halter horses, and 2 Standardbreds treated with stall rest alone returned to racing, but at a lower level than they had raced prior to injury. One horse that underwent neurectomy could be used for pleasure riding. Long-term rest may be important in achieving a successful outcome. Pleasure horses would appear to have a better prognosis for return to use after a distal sesamoid bone fracture than do performance horses.

Lag screw fixation of noncomminuted sagittal fractures of the proximal phalanx in racehorses: 59 cases (1973-1991).

Medical records of 59 racehorses with noncomminuted midsagittal proximal phalanx fractures repaired by means of lag screw fixation between 1973 and 1991 were reviewed. Fractures were classified as short incomplete fractures (7), long incomplete fractures (32), complete fractures extending into the proximal interphalangeal joint (13), and complete fractures extending through the lateral cortex of the proximal phalanx (7). Time from fracture repair to first race following fracture repair, number of racing starts, and fastest race times before and after surgery were obtained from race records and compared among horses grouped by fracture type and between horses that returned to racing and those that did not race. Five horses with short incomplete fractures, 21 horses with long incomplete fractures, 6 horses with complete fractures extending into the proximal interphalangeal joint, and 5 horses with complete fractures extending to the lateral cortex returned to racing. A significantly lower percentage of horses returned to racing following repair of complete fractures extending into the proximal interphalangeal joint (46%), than following repair of short incomplete fractures (71%), long incomplete fractures (66%), or complete fractures extending to the lateral cortex (71%). Time from fracture to repair for horses that returned to racing (mean, 14.7 days; range, 1 to 60 days) was not significantly different from that for horses that did not race (mean, 5.8 days; range, 1 to 21 days). For all fracture groups, median number of races before injury was not significantly different from median number of races after repair, and median fastest race time before fracture was not significantly different from median fastest race time after fracture repair.

A retrospective study of 192 horses affected with septic arthritis/tenosynovitis.

The medical records of 192 horses with septic arthritis/tenosynovitis 1979-1989 were reviewed. Forty-three horses developed infection after an intra-articular injection, 46 following a penetrating wound, 25 following surgery, 66 were foals less than 6 months old, and 12 were adult horses without a known aetiology. Haematogenous infection of a joint occurs in adult horses and should be considered as a differential diagnosis in horses with an acute onset of severe lameness. The aetiology of the infection had a significant effect on the type of bacteria identified by culture. Staphylococcus was cultured from most of the horses that developed infection following a joint injection or surgery, 69% of the horses from which an organism was identified. Horses that developed infection secondary to a penetrating wound frequently provided cultures of more than one organism; Enterobacteriaceae and anaerobes were more frequently isolated in this group. The most common organisms isolated from foals were Enterobacteriaceae; E. coli was identified in more than 27% of the foals. The hock was the most frequently involved joint. Multiple treatments were used over the 10-year period of study. Survival rates were lowest in foals; only 45% survived to be released from the hospital. Survival was greater in adult horses; 85% of the horses that were treated were released from the hospital. Survival was significantly greater in horses with septic tenosynovitis; all 14 of the horses that were treated survived. Survival was not significantly affected by the joint involved or by the type of bacteria cultured from the synovial fluid.(ABSTRACT TRUNCATED AT 250 WORDS)

Open drainage, intra-articular and systemic antibiotics in the treatment of septic arthritis/tenosynovitis in horses.

Open drainage was used to treat 26 horses with persistent or severe septic arthritis/tenosynovitis. Infected synovial structures were drained through a small (3 cm) arthrotomy incision that was left open and protected by a sterile bandage. Joint lavage was performed in all 26 horses. In addition to systemic antibiotics, 23 of these horses were also treated with intra-articular antibiotics; amikacin (17 horses), gentamycin (2 horses), cefazolin (2 horses), and 2 horses were injected at different times with gentamycin and amikacin. The infection was eliminated from the involved synovial structures in 25 of 26 horses; 24 survived and were released from the hospital. The arthrotomy incisions healed by granulation in 16 horses; in 9 horses the arthrotomy incision was sutured closed once the infection was eliminated. Seventeen horses returned to soundness and resumed athletic function. Open drainage was an effective method of achieving chronic drainage from a joint or tendon sheath. It is indicated in horses that have established intra-synovial infections or in horses that do not respond to joint lavage through needles.

Lag screw and cancellous bone graft fixation of transverse proximal sesamoid bone fractures in horses: 25 cases (1983-1989).

Case records of 25 horses with transverse fractures of the proximal sesamoid bone were reviewed to evaluate the success of treatment. All fractures were repaired by use of lag screw fixation and an autogenous cancellous bone graft because the fracture fragments were considered too large for surgical removal and reconstruction of the suspensory apparatus was necessary. Radiography was performed in all cases, and the fractures were classified into 3 types: (1) proximal midbody fractures, which included all fractures in the proximal aspect of the sesamoid bone that resulted in fragments involving greater than one third but less than one half of the total mass of the sesamoid bone; (2) midbody fractures that divided the bone into 2 equal portions; and (3) distal midbody fractures, which included transverse fractures in the distal aspect of the sesamoid bone that resulted in fragments involving greater than one third but less than one half of the total mass of the sesamoid bone. Of these cases, race records were obtained for 9 Standardbreds and 5 Thoroughbreds. Postoperative performance criteria evaluated were the ability to train and start 1 race, ability to maintain preinjury class of racing, earnings per start, and the number of starts following surgery. In Thoroughbreds, fractures occurred most commonly in the right forelimb; in Standardbreds, the left hind limb was most commonly involved. The midbody fracture was the most common type in both breeds, and the distribution of fracture location within the sesamoid bone was similar for both breeds.(ABSTRACT TRUNCATED AT 250 WORDS)

Cosmetic repair of a facial deformity by use of a silicone implant in a horse.

A heat-vulcanized silicone implant was used for cosmetic repair of a facial deformity in a horse. The deformity had resulted from fracture of the frontal bone into the frontal sinus 6 months earlier. Normal facial contour was restored by suturing the sculpted implant to the periosteum over the defect. Results 1 year after surgery were excellent.

The effects of copper supplementation on the prevalence of cartilage lesions in foals.

The potential role of dietary copper in the development of cartilage defects in foals was investigated. Twenty-one mares were fed rations containing 13 ppm copper (CuC, control) or 32 ppm copper (CuS, supplemented) during the last three to six months of gestation and first three months of lactation. Their foals were fed pelleted concentrate containing 15 or 55 ppm Cu and were destroyed at 90 (5 CuC and 5 CuS foals) or 180 (6 CuC and 5 CuS foals) days. Focal cartilage lesions were found at multiple sites on necropsy. In foals killed at 90 days, there were over twice (9 versus 4) as many lesions of osteochondrosis and more than four times (9 versus 2) as many articular lesions of osteophyte formation or thinning in CuC foals compared with CuS foals. These differences were due predominantly to a higher number of lesions in one CuC foal. Two 90-day CuC foals had osteochondrosis of articular-epiphyseal (A-E) complex, one with thickenings and separation from subchondral bone and one with subchondral fibrosis. One 90-day CuS foal had a cartilage thickening of the A-E complex in the tibiotarsal joint with separation from subchondral bone. In foals killed at 180 days, there were seven times more articular lesions (21 versus 3) of osteophyte formation or thinning, nearly twice as many lesions of osteochondrosis (13 versus 8) [corrected] in the physis and over five times as many involving the A-E complex (11 versus 2) in six CuC foals compared with five CuS foals.(ABSTRACT TRUNCATED AT 250 WORDS)

Microcytosis, hypoferremia, hypoferritemia, and hypertransferrinemia in standardbred foals from birth to 4 months of age.

At birth, 24 Standardbred foals were assigned at random to 1 of 2 groups and were given a placebo supplement (group 1) or an iron supplement (248 mg of iron/treatment; group 2). Foals were given iron supplement or placebo 4 times during the second and third weeks after birth. Hematologic variables and general health were monitored until foals were 4 months old. Mean PCV in foals of both groups decreased during the first 2 weeks after birth, but values remained within adult horse reference ranges. During the first 6 weeks after birth, foal erythrocytes were smaller than adult horse erythrocytes, but foal erythrocyte glucose-6-phosphate dehydrogenase activity was greater than that in adult horses. At every measurement, indices of anisocytosis were lower in foals, compared with adult horse reference values, suggesting that foals have a homogeneous population of microcytic erythrocytes during early foalhood. In 2-week-old foals of both groups and in 4-week-old placebo-treated foals, mean serum iron concentration was lower than that in adult horses. In foals at birth and during the first 4 months, total iron-binding capacity values were above the adult reference range. In newborn foals, transferrin saturation percentage values decreased to below the reference range in foals from 2 weeks to 4 months after birth. When foals were born, serum ferritin concentration values were above the adult horse reference range, but decreased to within the reference range by the time foals were 1 day old. From 2 through 6 weeks after birth, foal ferritin concentration values were below the adult reference range.(ABSTRACT TRUNCATED AT 250 WORDS)

Recurrent torsion of the spermatic cord and scrotal testis in a stallion.

A stallion was twice referred for evaluation of scrotal swelling and signs of pain. The first admission followed a 3-year period of recurrent signs of left-sided scrotal pain and swelling. After the removal of the left testis because of testicular torsion, the stallion was returned to service. The conception rate was 82% for the next breeding season. Two years after initial surgery, the stallion again was evaluated because of acute signs of right-sided scrotal pain and swelling. Right-sided testicular torsion was detected and corrected, and the testis was sutured in place. The stallion's conception rate for the following breeding season was greater than 90%.

Reduced efficacy of anthelmintics in young compared with adult horses.

Studies on a Thoroughbred breeding farm in Ohio from 1982 to 1988 demonstrated the value of three anthelmintic pastes (ivermectin, oxibendazole, pyrantel pamoate) in controlling benzimidazole resistant cyathostomes (small strongyles) in adult horses. However, a comparison of drug efficacy in suppressing faecal egg counts for the full period between treatments showed a significant reduction in efficacy of all drugs in yearling horses compared with adults. Mean faecal egg counts of adult horses were generally kept below 100 eggs per gram (epg) of faeces when using oxibendazole or pyrantel pamoate at four to five week intervals and ivermectin at eight week intervals. By contrast, mean counts of young horses rose as high as 655 epg (oxibendazole), 729 epg (pyrantel pamoate) and 852 epg (ivermectin) within the same time period after treatment. Individual counts of treated yearlings sometimes exceeded 3,000 epg. Three distinct mechanisms appeared to be involved in the poor results in young horses. These were 1) anthelmintic refuge, 2) anthelmintic resistance, and 3) anthelmintic avoidance.

The influence of corticosteroids on sequential clinical and synovial fluid parameters in joints with acute infectious arthritis in the horse.

Infectious arthritis was induced experimentally in one tarsocrural joint of six horses by intra-articular injection of 1 ml Staphylococcus aureus-saline suspension with the addition of 200 mg methylprednisolone acetate. The corresponding contralateral joint was injected with 1 ml of saline with the addition of 200 mg methylprednisolone acetate, and served as a control. The purpose of the experiment was to examine the effect of corticosteroids on the acute clinical signs of infectious arthritis, and the associated changes in synovial fluid, to separate the effects of a steroid injection from those of infection alone. This should aid early diagnosis of infection. The progression of the infectious arthritis was assessed over nine days by clinical examination and sequential synovial fluid analysis. The corticosteroids masked the clinical signs in some horses for up to the third day although changes in the synovial fluid were present earlier. Cellular changes preceded biochemical changes initially. Leucocyte counts showed a significant increase in cell numbers after infection was established. Persistent neutrophilia, over 90 per cent, together with a pH under 6.9 were the most consistent findings in the infected synovia. Total protein values were lower in infected joints with, than those without, corticosteroids; although there was a progressive rise in total protein concentration throughout the experiment in both groups. Serum and synovial glucose difference and synovial lactate had very little diagnostic value because significant increases due to the corticosteroids were documented in the control joints.