Incidence of COVID-19 infection among fully vaccinated employees of South Cotabato Provincial Hospital (SCPH) from May to October 2021

Background@#Incidents of COVID-19 infection after being fully vaccinated has been surfacing in the course of vaccinations. There is a common misconception that fully vaccinated individuals are immune to COVID-19 virus and thus cannot get infected. The risk for COVID-19 infection in fully vaccinated people could not be eliminated completely as long as the virus continues to spread throughout the community with the development of new strains.@*Objective@#This study aimed to determine the incidence of COVID-19 infection among fully vaccinated employees of South Cotabato Provincial Hospital (SCPH), City of Koronadal from May to October 2021.@*Methods@#This study employed non-comparative and descriptive research design to determine the incidence of COVID-19 infection among fully vaccinated employees of South Cotabato Provincial Hospital (SCPH) from May to October 2021. It determined the incidence of the disease in terms of severity, symptoms, and duration of symptoms with respect to Sinovac and AstraZeneca vaccines.@*Results@#Results showed that COVID-19 infections following a full dose of vaccine in hospital-based individuals were evident. Among the employees of SCPH who were inoculated by AstraZeneca and Sinovac, 18 and 141 respectively, were infected within six (6) months after the second dose. Females and those aged 35-54 years old have higher breakthrough infections than their counterparts. The Administrative and the Ward Departments ranked first and second with high percentages of COVID-19 breakthrough infections, respectively.@*Conclusion@#Therefore, COVID-19 infections among fully vaccinated respondents are prevalent with a relatively high infection of 159. Females and those aged 35-54 years old as well as Nurses, Nursing Attendants, and Administrative Staff are among those who had higher percentages of breakthrough infections.

Investigating the impacts of extraneous water on wastewater treatment plants.

To demonstrate the effects of increased extraneous water on operation, purification, and energy efficiency, two wastewater treatment plants (WWTPs) have been investigated in detail under the research project 'Sealing of sewer pipes - Effects on the purification performance of WWTPs and their impact on the local water balance'. Both treatment plants, after evaluating and analyzing the measurement data and information about them, were compared in the light of existing literature and other practical investigations. Furthermore, the results were assessed with respect to transferability to other treatment plants. In WWTP 1, extraneous water reduction led to lower energy consumption of certain plant components such as the pumping station and aeration. An increased percentage of extraneous water had an impact on the wastewater characteristics (e.g. organic load) in WWTP 2. A decrease in extraneous water increases the concentration of biodegradable matters; however, an increase in extraneous water increases the loads in the effluent. The results are in accordance with the theoretical approaches described in the literature and confirm the correlations between extraneous water and purification efficiency and energy consumption of WWTPs.

Endovascular treatment of ruptured abdominal aortic aneurysm: is there a long-term benefit at follow-up?

AIM: Several studies have shown the feasibility of endovascular repair of ruptured abdominal aortic aneurysms (rEVAR). However, the role and value of rEVAR remains controversial due to selection bias and lack of long-term results. In the present study we describe our short- and long-term results of treating patients with rEVAR irrespective of hemodynamic condition and challenging anatomy. METHODS: In April 2006 we started the single centre prospective non-randomised Ruptured Aneurysm Study (RASA). During a four year enrolment period all consecutive patients presenting with infrarenal ruptured AAA (rAAA, N.=117) were assessed for preferential rEVAR treatment. A rAAA was defined as extravasation of blood or hematoma outside the AAA due to transmural tear in the infrarenal abdominal aorta wall documented by preoperative computed tomography (CT) angiography examination or during open repair. Patients with challenging anatomy (infrarenal neck length below 15 mm and neck angulation above 60 degrees) were included as part of a damage control concept. Complication and mortality rates were studied at 30 days and yearly afterwards. RESULTS: Thirty-five patients (33% of all admitted rAAA) were treated with rEVAR and 42% of them were considered hemodynamically unstable (systolic blood pressure <100 mmHg) and 30% had challenging AAA anatomy. The mortality rate at 30 days in the rEVAR group was 17%, in the open repair group 31%, and in the entire rAAA group (including abstained patients) 36%. During the first 30 days, 18 rEVAR patients experienced complications with nine re-interventions as a result. Long-term mortality of the rEVAR patients was 34% after a median follow-up of 3.4 years. All deaths after one year follow-up were non-AAA related. Multivariate analysis shows that Hardman index, presence of peripheral arterial obstructive disease and lowest systolic blood pressure during surgery are independently associated with long-term survival. Challenging rAAA anatomy was not associated with impaired survival. CONCLUSION: Our study shows that rEVAR is feasible irrespective of hemodynamic condition and that it is associated with relative low mortality rates. Challenging rAAA anatomy may not affect overall long-term survival, but six out of ten patients remain unsuitable for rEVAR because of inappropriate anatomy.

The Anaconda AAA stent graft system: 2-year clinical and technical results of a multicentre clinical evaluation.

INTRODUCTION: This study reports the technical and mid-term clinical results of the second-generation Anaconda AAA Stent Graft System endovascular device for treatment of abdominal aortic aneurysm (AAA). The design of the Anaconda AAA Stent Graft System is characterised by a three-piece system consisting of two proximal independent saddle-shaped nitinol self-expandable rings with hooks fixation, zero body support and vacuum-cleaner tube leg design. METHODS: From July 2002 to April 2005, a total of 61 patients with AAA were enrolled in a multicentre, prospective, non-randomised controlled design study. All patients received a second-generation Anaconda AAA Stent Graft System. They entered a standard follow-up protocol at discharge for 3, 6, 12 and 24 months. Follow-up data included survival; rupture-free survival; incidence of aneurysm rupture, death from aneurysm rupture, aneurysm-related death; freedom from aneurysm expansion; freedom from Types I and III endoleaks; endograft patency and technical and clinical success rates. RESULTS: Successful access to the arterial system was achieved in all patients. The primary technical success was 59 out of 61 and the primary assisted technical success was 60 out of 61. All endovascular grafts were patent without significant twists, kinks or obstructions. Migration was not observed in any of the grafts. During the first 30-day period, two serious adverse events (3%), both not related to the procedure, were observed. Nine patients (15%) needed a secondary intervention; two of these interventions were related to stent graft (3%). The mean aneurysm sac diameter decreased significantly from 57 mm pre-operative to 45mm after 24 months, without aneurysm growth. There was one Type I endoleak at initial implantation, which was corrected using a proximal extension cuff. In total, three Type II endoleaks were still present after 24 months without any signs of aneurysm growth. CONCLUSION: The design features of the second-generation Anaconda AAA Stent Graft System are effective in the treatment of AAAs on mid-term evaluation.

Towards a VR trainer for EVAR treatment.

Endovascular repair of aortic abdominal aneurysms (AAA) is more and more becoming part of clinical practice. Up to approximately 30 clinical procedures however are necessary to obtain the surgical skills to make the procedure reliable and safe. The current study aims to generate a VR trainer to speed up the training process of experienced vascular surgeons to become experienced EVAR (endovascular AAA repair) surgeons by introducing a VR environment. This manuscript describes the contents and validation of the first step in the VREST - EVAR trainer, i.e. the proper definition of the knowledge and skills that need to be transferred.

Validation of open-surgery VR trainer.

VREST (Virtual Reality Educational Surgical Tools) is developing a universal and autonomous simulation platform which can be used for training and assessment of medical students and for continuing education of physicians. With the VREST - Virtual Lichtenstein Trainer, simulating the open surgery procedure of the inguinal hernia repair according to Lichtenstein, the validation of the simulator is ongoing. Part of this trajectory is the evaluation of the transfer of training of the virtual incision making. One group of students trained incision making on the VREST platform where the control group did not. In an experiment both groups has to perform several incision tasks on a manikin. The results are not available yet but will be presented at the MMVR14 conference.

Open surgery in VR: inguinal hernia repair according to Lichtenstein.

VREST (Virtual Reality Educational Surgical Tools) is developing a universal and autonomous simulation platform which can be used for training and assessment of medical students and for continuing education of physicians. A workstation consisting of two haptic devices and a 3D vision system is part of the VREST platform. Another part of the platform is a generic software environment in which lessons can be built by the teacher and performed by their students. Using the platform one can see, feel and decide as in reality. With the assessment tool the progress and skills of the students can be supervised. The first lesson build on the VREST platform is an inguinal hernia repair according to Lichtenstein. This is an open surgery procedure. The VREST platform is used prior to the first operating room surgery of the resident. Interactive models and case dependent feedback is used to enlarge the residents' cognition. This should reduce the training time in the operating room.

The EAG tool: a decision support system for selection of abdominal aorta aneurysm endografts.

This article describes a decision support system (the EAG tool = Effective AAA Graftmanship) that assists the vascular surgeon in deciding whether a patient is fit for an endograft procedure and that assists the vascular surgeon in selecting the proper graft and in planning the endograft procedure. The EAG tool is the first step in the development of a learning environment for AAA procedures. As such the EAG tool is part of the VREST development project aiming to create a complete set of Virtual Reality Educational Surgical Tools. The EAG tool has been validated by using the expert knowledge of five experienced AAA physicians: three vascular surgeons and two interventional radiologists. In over 3,000 assessments, the EAG tool showed a false-positive rate of 0.2%, or in other words: in only 1 out of 500 cases the EAG tool indicated the possible use of an endograft, whereas the combined group of experts believed that it was not possibe. The EAG tool proved to be more prudent than the group of experts in having a false-negative rate of 3.7%. The EAG tool thus proved to be useful in daily clinical practice. Further developments are ongoing to use the EAG tool in a learning environment, specifically for unexperienced physicians.

[Local and regional in-hospital trauma care following fireworks depot explosion in Enschede]. / De lokale en regionale intramurale traumaopvang bij de Enschedese vuurwerkramp.

UNLABELLED: On Saturday 13 May, 2000 at about 15:30 h, the Dutch city of Enschede was struck by the explosion of a midtown firework depot. Twenty-two people were killed and almost 1,000 people were wounded. A complete district with 1,000 houses was destroyed. In total, 527 victims were treated in one of the regional hospitals, 76 (14%) of whom were admitted and 451 (84%) were treated as outpatients. Of the clinically treated victims, 11 patients were triaged as T1 and needed immediate intervention, 63 patients were triaged as T2 where treatment within six hours was indicated, and two T3 patients did not need urgent treatment. The outpatients mainly suffered secondary blast injuries to the head and extremities due to flying debris. Of the 11 T1 patients, 10 underwent acute surgery; intervention radiology was performed in one patient. The injuries of the severely wounded T1 patients consisted of penetrating thoracic, abdominal and skull injuries, as well as blunt abdominal trauma and compound fractures. Two patients from the disaster area underwent acute vascular surgery for acutely burst aortic aneurysms. The in-hospital trauma care was characterised by the spontaneous arrival of a large number of extra medical personnel. The regional distribution of the trauma patients was adequate. The regional capacity of the emergency rooms, IC-units and operating facilities proved to be sufficient. Routing of lightly-wounded patients was found to be important. The communication in all phases of the disaster management appeared to be poorly structured. CONCLUSION: During the initial trauma care, the routing of vast numbers of ambulant, lightly-wounded patient, as well as extra doctors and nurses, needs careful planning.

Effect of L364.718 during suckling on the sensitivity to the hypophagic effect of cholecystokinin in adult rats.

1. In the present study it was investigated whether drugs acting at the cholecystokinin (CCK)-A receptor given to rat pups may result in long-lasting changes in body weight or regulation of food intake controlled by CCK. 2. From day 3 to day 10 of life, male and female Wistar rat pups were treated with the CCK-A receptor antagonist L-364.718 and the CCK-A + B agonist CCK-8S. 3. In adult rats, treated with L364.718 during suckling, the sensitivity to the acute hypophagic action of CCK-8S was weaker or abolished compared to adults treated with saline during suckling. In adult rats given CCK-8S during suckling acute treatment with CCK-8S reduced food intake to the same extent as in the group treated with saline postnatally. 4. These data show that early postnatal treatment with the CCK-A receptor antagonist L364.718 has an impact on the hypophagic response to CCK-8S in later life.

Obesity induced by unspecific early postnatal overfeeding in male and female rats: hypophagic effect of CCK-8S.

The response to cholecystokinin (CCK) as a satiety peptide in obesity or anorexia has been tested mainly in extreme models of food intake control. In the present study, the effect of CCK-8S on food intake was investigated in a nongenetic and less-stressful model of obesity due to unspecific early postnatal overfeeding in male and female rats. Reducing the normal litter size of ten to three newborn rats on day 3 of life led to an enhanced food intake resulting in an increased body weight until adulthood. Freely fed male and female, normal and obese rats were given 10 micrograms/kg CCK-8S i.p. on day 41 and 40 micrograms/kg CCK-8S on day 91 of life and food intake was measured for 24 h. Compared with treatment with saline (i.p.) 1 day before the test, the lower dose of 10 micrograms/kg CCK-8S reduced food intake for 2 h in normal, but not in obese rats. Conversely, the higher dose of 40 micrograms/kg CCK-8S reduced food intake in both normal and obese rats for 2 h, but this effect was more evident in the obese rats. Moreover, the satiating effect of CCK-8S was more pronounced and longer lasting in male than in female rats. In summary, the data suggest that the response to CCK-8S differs in normal and obese rats and depends on sex.