The Impact of COVID-19 on Primary Care: A Scoping Review.

The COVID-19 pandemic had a severe impact on various aspects of everyday life, including healthcare provision. The aim of the scoping review was to collate, summarize, and discuss this literature, in light of the impact COVID-19 had on Primary care. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) four-stage process framework for reporting was followed. A total of 31 studies were included in this review. Based upon our review we found COVID-19 pandemic on Primary Care, has made significant effects on 1) service redesign, 2) long-term illness care provision, 3) healthcare staff well-being and 4) the post-pandemic future of Primary Care. The COVID-19 outbreak has demonstrated, how a pandemic can drastically change the process of healthcare provision within the community, as evidenced by the change in consultation styles with patients, the impact on the physical and mental wellbeing of health workers, a shift from isolated practice to teamwork, as well as the ability of healthcare workers to seek prompt help with their health. Studies have demonstrated progress in knowledge and experience gained by healthcare workers when tackling COVID-19, and how these can be implemented in possible future pandemics affecting Primary Care, however, further research is required within this sphere.

A Rare Case of Klippel-Trénaunay Syndrome.

The Klippel-Trénaunay syndrome (KTS) is a rare form of a birth disorder that includes capillary malformation, hypertrophy of bones and soft tissues, and tortuous varicosities, as well as hypertrophy of the capillaries resulting in hemangiomas and port wine discoloration. KTS is also known as angio-osteohypertrophy syndrome and dysplastic angiopathy. In this case report, we describe the case of a 13-year-old female with multiple superficial varicosities on the medial aspect of her left leg since birth. Computed tomography angiogram assessed and identified abnormal venous drainage in the lower limb. Klippel-Trénaunay-Weber syndrome (KTWS) differs from KTS in that KTWS involves arteriovenous malformations.

Concomitant Presence of Spermatic Cord and Testicular Non-Hodgkin's Lymphoma With Recurrence: A Case Report on a Rare Entity.

Primary testicular non-Hodgkin's lymphoma (PTNHL) with contiguous involvement of the spermatic cord is a rare occurrence and presentation of the disease, and it mostly involves elderly men between the sixth and eighth decades of life. PTNHL is a rare form of primary testicular malignancy that accounts for 1% of all non-Hodgkin's lymphoma cases and 5-10%of all testicular malignancies. This case report discusses a 73-year-old man who presented with right-sided inguinoscrotal swelling for six months, which had progressively increased in size. The patient was referred to the surgical department, and the examination revealed a hard-palpable mass with thickening of the cord. The initial imaging included an ultrasound, demonstrating a heteroechoic mass inseparable from the right testis with evidence of mild increased internal vascularity. Due to the high suspicion of malignancy, a right orchidectomy was performed. The patient subsequently developed another swelling after seven months, over the right inguinal region, which had progressively increased in size. MRI of the pelvis and CT of the abdomen and chest revealed a lobulated, intermediate intense lesion in the right inguinoscrotal region. This case report demonstrates the importance of radiological imaging in assessing and detecting the characteristics of concomitant lesions by using various imaging modalities and assessing the extent of spread. In addition, radiological imaging helps in the early diagnosis of the disease and facilitates prompt and early treatment to achieve favorable outcomes for the patient. The radiologist should include a differential diagnosis of PTNHL when imaging for a painless inguinoscrotal mass.

Elevated troponin level and nonspecific ST-segment and T-wave changes in a suspected acute pancreatitis patient, post-SARS-Cov-2 infection: A case report.

The case report describes a post-COVID-19 patient with severe right upper quadrant (RUQ) pain, moderate epigastric pain, high troponin levels, and nonspecific ST-segment and T-wave changes on electrocardiogram (ECG).

Zinner Syndrome.

Zinner syndrome is a less common birth anomaly of the Wolffian duct consisting of unilateral kidney absence, ipsilateral ejaculatory duct obstruction, and seminal vesicle cyst. A failure of embryogenesis of the ureteric bud between the fourth and 13th week of gestation results in Zinner syndrome. Conservative treatment is recommended for asymptomatic patients, whereas invasive treatment is reserved for symptomatic patients and for those who have failed conservative treatment. In this case report, we describe the non-specific presentation of lower abdominal pain and dysuria, as well as episodes of hematuria and new-onset hypertension, in a male patient, who was otherwise deemed healthy, with no other previous medical or surgical history. An imaging study and laboratory investigations were performed, and the patient was detected to have left renal agenesis and hypointense/hyperintense cysts in the left seminal vesicle of the left kidney. The findings supported the diagnosis of Zinner syndrome. The patient did not present with any symptoms or findings that would suggest infertility at the time of the study. Zinner syndrome is a rare cause of painful micturition and hematuria in males and can be diagnosed using ultrasound (USS), computer tomography (CT), and magnetic resonance imaging (MRI) techniques. Zinner syndrome should be considered as a differential diagnosis in male patients with unilateral renal agenesis and cystic pelvic masses. Patients who are asymptomatic typically undergo conservative treatment and are followed up to prevent infertility. For patients with symptomatic cysts who fail to respond to conservative treatment or whose cysts are larger than 5 cm in diameter, surgical intervention is recommended (open or laparoscopic surgery and ejaculatory duct balloon dilatation).

Extraskeletal Ewing's Sarcoma With Vertebral Metastasis: A Case Report.

Ewing's sarcoma (ES) is the second most common osseous tumor in young patients after osteosarcoma. All primitive neuroectodermal tumors (PNET) and Askin tumors are members of Ewing's sarcoma family of tumors (ESFT), which all have aberrant translocations between the 11th and 22nd chromosomes. Only one in five cases of Ewing's sarcoma occurs as extraskeletal. In this report, we describe a young female with a palpable lump on her spine who presented with paravertebral and thoracic extraskeletal Ewing's sarcoma (EES). Over six months, the swelling gradually increased in size, and the patient reported episodes of episodic pain and fever. Examining the swelling, a non-reducible, non-tender ovoid lump measuring approximately 8 cm x 5 cm was found to have smooth margins and be slightly mobile. The use of magnetic resonance imaging (MRI) helped diagnose, plan surgical resections, assess neoadjuvant chemotherapy effectiveness, and detect local recurrences and metastatic spread of the tumor. The differential diagnosis of EES included embryonal rhabdomyosarcoma and lymphoma. The use of immunohistochemical markers further differentiated the diagnoses. In conclusion, it should be noted that EES, though rare, should be considered when evaluating soft tissue lumps of neoplastic characteristics, in children or adolescents. Considering the poor prognosis of this disease, early detection is essential. The MRI plays a vital role in diagnosing cancer, staging it locally, assessing response to neoadjuvant therapy, and identifying local recurrences and metastases.

Fibro-Adipose Vascular Anomaly: A Case Report and Literature Review.

A fibro-adipose vascular anomaly (FAVA) is a complex venous malformation characterized by intramuscular fibrofatty replacement and dilation of veins. As FAVA is a rare entity and associated with a complex constellation of vascular anomalies, it is often misdiagnosed. This report discusses a case of a 26-year-old woman who presented with swelling on the lateral aspect of the right thigh. FAVA was diagnosed on the basis of radiological and histopathological examinations. After en-bloc resection of the mass, the patient's pain and ability to move significantly improved. We describe the clinical, radiological, and pathological aspects of FAVA, as well as its management.

A Novel Arthroscopic Technique for Intraoperative Mobilization of Synovial Mesenchymal Stem Cells.

BACKGROUND: Mesenchymal stem cells (MSCs) have emerged as a promising candidate for tissue regeneration and restoration of intra-articular structures such as cartilage, ligaments, and menisci. However, the routine use of MSCs is limited in part by their low numbers and the need for methods and procedures outside of the joint or surgical field. PURPOSE: To demonstrate feasibility of a technique in which minimally manipulated synovial MSCs can be mobilized during knee arthroscopy, thereby showing proof of concept for the future evaluation and clinical use of native joint resident MSCs in single-stage joint repair strategies. STUDY DESIGN: Descriptive laboratory study. METHODS: Patients (n = 15) undergoing knee arthroscopy who were free from synovitis or active inflammation were selected. Three samples of irrigation fluid were collected from each patient at inception of the procedure, after an initial inspection of the joint, and after agitation of the synovium. MSC numbers were evaluated by colony forming unit-fibroblastic assay. The phenotype of synovial fluid resident and synovial-mobilized MSCs was determined by flow cytometry, and their functionality was determined by trilineage differentiation. Adhesion of culture-expanded mobilized MSCs to fibrin scaffolds was also evaluated to ascertain whether mobilized MSCs might concentrate at sites of bleeding. RESULTS: Normal irrigation during arthroscopy depleted resident synovial fluid MSCs (4-fold decrease, n = 15). Numbers of MSCs mobilized through use of a purpose-made device were significantly higher (105-fold) than those mobilized through use of a cytology brush (median of 5763 and 54 colonies, respectively; P = .001; n = 15). The mobilized cellular fraction contained viable MSCs with proliferative potential and trilineage differentiation capacity for bone, cartilage, and fat lineages, and cultured daughter cells exhibited the standard MSC phenotype. Following culture, mobilized synovial MSCs also adhered to various fibrin scaffolds in vitro. The technique was simple and convenient to use and was not associated with any complications. CONCLUSION: Numbers of functional MSCs can be greatly increased during arthroscopy through use of this technique to mobilize cells from the synovium. CLINICAL RELEVANCE: This study highlights a novel, single-stage technique to increase joint-specific, synovial-derived MSCs and thereby increase the repair potential of the joint. This technique can be undertaken during many arthroscopic procedures, and it supports the principle of integrating mobilized MSCs into microfracture sites and sites of bleeding or targeted repair through use of fibrin-based and other scaffolds.