Delayed presentation of a huge abdominopelvic mass during the COVID-19 pandemic

Background Giant ovarian cysts are rare in developed countries due to advanced achievements in medical diagnostics. However, in the midst of the coronavirus disease 2019 (COVID-19) pandemic, patients with non-COVID-19-related illnesses tend to delay their health-seeking attention;thus, they had presented late. Case presentation A 25-year-old single lady complained of a 3-month worsening abdominal pain and distention. She was initially well but neglected the symptoms due to the COVID-19 situation, yet came to our attention after she developed obstructive symptoms. A computed tomography (CT) scan of the abdomen revealed a huge cystic lesion from the pelvic area, which later was found to be from the right ovary upon urgent laparotomy exploration. The histopathological examination was consistent with mucinous cystadenoma of the ovary. Discussion Acute non-COVID-19-related emergencies have decreased, as evidenced by reduced visits to the Emergency Department, and the number of abdominal CT scans. An emergency case like a huge abdominopelvic mass deserves an extensive radiologic examination as clinical assessment alone may not be adequate. Preoperative CT is superior to ultrasonography in getting the extent of the lesion, local infiltration, staging purpose, and surgical intervention. Pathology with a variety of spectrums such as mucinous neoplasm deserves to be investigated, evaluated, and resected even during the COVID-19 pandemic. Conclusion A giant abdominopelvic cystic mass can present emergency havoc during the COVID-19 pandemic. Urgent surgical intervention is mandatory by using full protection and exercising extreme precaution, regardless of the preoperative screening to avoid unnecessary viral transmissions.

Omental Infarction: Challenges in Managing Acute Abdomen During COVID-19 Pandemic

Acute abdomen is a common surgical emergency, yet is challenging especially during the COVID-19 pandemic. This article highlights the challenging management of acute abdomen and issues on preoperative nasopharyngeal swab testing, aerosol-generating procedures and non-operative management. A 36-year-old gentleman presented with acute right iliac fossa pain which was diagnosed as simple acute appendicitis and was managed non-operatively. He progressed well initially, but after 2 days, he developed localized abdominal guarding. The diagnosis was revised to perforated appendicitis and he was pushed to the operation theatre on the same day. Since the swab test was negative, we performed the surgery as a non-COVID-19 patient. To our surprise, the intraoperative finding was consistent with spontaneous omental infarction and mild appendicitis. Appendicectomy with omentectomy was done and the final diagnosis was consistent with acute omental infarction. Performing surgery on patients with active COVID-19 infection can lead to a high pulmonary complication and mortality rate. All cases require COVID-19 status as the screening prerequisites prior to admission and surgical intervention. Emergency cases such as acute abdomen warrant a surgical intervention regardless of COVID-19 status but with full personal protective equipment. Managing acute abdomen is challenging during the COVID-19 pandemic. The direction is towards non-operative management unless it is contraindicated. Omental infarction must be considered as one of the differential diagnoses for any patient with unexplained acute abdominal pain which warrants imaging assessment. (English) [ FROM AUTHOR] Akut karın yaygın bir cerrahi acildir, ancak özellikle COVID-19 pandemisi sırasında büyük zorluk oluşturmuştur. Bu makale, akut karının zorlu yönetimini ve ameliyat öncesi nazofaringeal sürüntü testi, aerosol oluşturan prosedürler ve ameliyatsız yönetim ile ilgili konuları vurgulamaktadır. Otuzaltı yaşında erkek akut sağ iliak fossa ağrısı ile başvurdu, basit akut apandisit tanısı aldı ve ameliyatsız tedavi edildi. Başlangıçta iyi ilerledi, ancak 2 gün sonra lokalize karın koruması geliştirdi. Tanısı perfore apandisit olarak revize edildi ve aynı gün ameliyathaneye sevk edildi. Swab testi negatif çıktığı için ameliyatı COVID-19 negatif hasta olarak gerçekleştirildi. Ílginç olarak;intraoperatif bulgu spontan omental enfarktüs ve hafif apandisit ile uyumluydu. Apendektomi ile omentektomi yapıldı ve kesin tanı akut omental enfarktüs ile uyumluydu. Aktif COVID-19 enfeksiyonu olan hastalarda ameliyat yapmak, yüksek pulmoner komplikasyon ve ölüm oranına neden olabilir. Tüm vakalar, kabul ve cerrahi müdahale öncesinde tarama önkoşulu olarak COVID-19 durumunu gerektirir. Akut karın gibi acil durumlar, COVID-19 durumundan bağımsız olarak ancak tam kişisel koruyucu ekipmanla cerrahi müdahale gerektirir. COVID-19 salgını sırasında akut karın yönetimi zordur. Genel eğilim, kontrendike olmadığı sürece ameliyatsız yönetime yöneliktir. Omentum enfarktüsü, açıklanamayan akut karın ağrısı olan ve görüntüleme değerlendirmesini garanti eden herhangi bir hasta için ayırıcı tanılardan biri olarak düşünülmelidir. (Turkish) [ FROM AUTHOR] Copyright of Gazi Medical Journal is the property of Gazi Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Obstetric challenges during COVID-19 pandemic: A narrative review.

The severe acute respiratory coronavirus 2 (COVID-19) pandemic impacts the health of women at reproductive age in different ways, starting from pregnancy planning to post-delivery. This narrative review summarises the challenges to obstetric practice posed by the severe acute respiratory coronavirus 2 (COVID-19) pandemic. In this paper, we highlight the impacts of COVID-19 to obstetric practice globally and the efforts taken to address these challenges. Further study is critical to investigate the effects of COVID-19 on pregnancy, the outcome of COVID-19 positive pregnant women, and the safety of vaccination during pregnancy and breastfeeding.

Relationships between Psychopathology, Psychological Process Variables, and Sociodemographic Variables and Comparison of Quarantined and Non-Quarantined Groups of Malaysian University Students in the COVID-19 Pandemic.

The COVID-19 pandemic has had considerable psychological health impacts across the globe. This study aimed to establish the psychological process variables underlying psychopathology in Malaysian public university students during the national Movement Control Order (MCO). The aim was to craft structured and sustainable psychological support programs with these students. We conducted a cross-sectional study involving Malaysian university students subjected to the Malaysian MCO. Structured questionnaires measuring sociodemographic factors, measures of depression, anxiety, stress, psychological mindedness, psychological flexibility and state mindfulness were employed. A total of 515 students participated in this study with 12 students (2.3%) being quarantined at the time. Many of them scored 'moderate' or above on the Depression, Anxiety and Stress Scale (DASS) with 20.2%, 25.0% and 14.2%, respectively. Quarantined students had higher depressive symptoms, with female students scoring significantly higher for depression, anxiety, and stress. Multiple regressions suggested gender and quarantine status predicted depression scores. However, only gender significantly predicted anxiety and stress. Psychological flexibility and psychological mindedness (Insight subscale) are significantly correlated with depression, anxiety, and stress, with psychological mindedness predicting all three psychopathologies. This study demonstrates that gender, psychological flexibility, and psychological mindedness are key demographic and psychological factors impacting students. Targeting psychological flexibility and psychological mindedness may enable timely prevention and intervention programs for our students to support their mental and physical health as we move through, and out of, the pandemic.

Fear of COVID-19 and COVID-19 Stress and Association with Sociodemographic and Psychological Process Factors in Cases under Surveillance in a Frontline Worker Population in Borneo.

COVID-19 stress and fear of COVID-19 is an increasingly researched construct in the general population. However, its prevalence and association with sociodemographic factors and psychological process variables has not been explored in frontline workers under surveillance in a Bornean population. This study was a cross-sectional study using a sociodemographic questionnaire incorporating two specific epidemiological risk variables, namely specific questions about COVID-19 surveillance status (persons under investigation (PUI), persons under surveillance (PUS), and positive cases) and the nature of frontline worker status. Furthermore, five other instruments were used, with three measuring psychopathology (namely depression, anxiety and stress, fear of COVID-19, and stress due to COVID-19) and two psychological process variables (namely psychological flexibility and mindfulness). Kruskal-Wallis and Mann-Whitney tests were performed to assess if there were significant differences in psychopathology and psychological process variables between sociodemographic and epidemiological risk variables. Hierarchical multiple regression was further performed, with depression, anxiety, and stress as dependent variables. There were significant differences in the fear of COVID-19 between positive cases, PUI, and PUS. The fear of COVID-19 scores were higher in positive cases compared to in PUS and PUI groups. Upon hierarchical multiple regression, mindfulness and psychological flexibility were significant predictors of depression, anxiety, and stress after controlling for sociodemographic and epidemiological risk factors. This study demonstrates that exposure to COVID-19 as persons under investigation or surveillance significantly increases the fear of COVID-19, and brief psychological interventions that can positively influence mindfulness and psychological flexibility should be prioritized for these at-risk groups to prevent undue psychological morbidity in the long run.

The challenges and risk of laboratory handling on a histology specimen during COVID-19 pandemic.

The Coronavirus Disease 2019 (COVID-19) pandemic has taken the world into turmoil by surprise. The rapid spreading of this virus has led to an exponential increase in the number of cases. It has created a public health disaster, causing a collapse of the health system in every part of the world. Many sectors in the health area are affected, including histopathology services. The challenges and risk of viral transmission can come from various aspects and levels. For COVID-19 tests, there are even cases of no direct contact with the specimens; the specimens received infection from individuals of unknown status. The fixatives used for histopathology specimens are believed to be inactivated viruses, which can be an inactivate coronavirus. Even so, precautions have to be put in place to prevent the spread of infection to laboratory personnel, especially to those handling underfixed and fresh frozen cytology samples. Precautions must also be taken when dealing with histopathology services, by wearing full personal protective equipment and by executing other standard safety measures. The purpose of this review is to highlight the challenges faced in managing histopathology services in our centre during the COVID-19 pandemic.

Case report: Ballotable abdominal mass in a child - Definitely renal in origin?

INTRODUCTION AND IMPORTANCE: The differential diagnosis of a paediatric abdominal mass can be extensive, as it potentially involves multiple organs including gastrointestinal, genitourinary, endocrine, and gynaecological systems. Hence, a systematic approach to history taking and physical examination is needed to clinch the diagnosis. Specifically, the approach for assessing, investigating, and managing a ballotable left hypochondrial mass in a child can be challenging. CASE PRESENTATION: We report a 10-year-old Dusun girl presenting with left hypochondrial pain and noted a left hypochondrial mass on examination. This report highlights the role of clinical imaging during the pre-operative and post-operative phases. CLINICAL DISCUSSION: Ultrasound and CT imaging was useful in determining that the tumor originated from the tail of the pancreas. The presence of a definite capsule with internal solid-cystic components helped narrowed the differential diagnosis to solid pseudopapillary neoplasm (SPN) of the pancreas. MR liver was useful to rule out liver metastasis in this child. INTERVENTION AND OUTCOME: The patient was scheduled for laparotomy and tumour excision at a regional paediatric centre. Successful excision of the tumor en-mass was performed and the child's subsequent recovery was uneventful. CONCLUSION: Clinical imaging plays a critical role in the diagnosis and management of paediatric solid organ tumours. Other than renal origin, suspicion of pancreatic tail origin should be considered by clinicians when encountering a ballotable left abdominal mass.

A Non-severe Coronavirus Disease 2019 Patient With Persistently High Interleukin-6 Level.

Interleukin 6 (IL-6) is one of the markers of immune system activation indicating existent infection and inflammation. We present here a case of a 55-year-old male COVID-19 patient with an unusual high level of interleukin 6 (IL-6). Further investigation revealed he had hepatocellular carcinoma (HCC) with underlying hepatitis B. He did not present with respiratory symptoms although a baseline chest x-ray showed changes, and the patient was categorized as Class 3A of COVID-19. Routine investigations proceeded with high-resolution computed tomography and IL-6 to monitor for progression to severe COVID-19. Notably, there was a high IL-6 level but other parameters did not show he was in severe COVID-19. In this report, we conclude that elevated IL-6 level in a COVID-19 patient is not necessarily associated with severe COVID-19.