COVID-19-induced Acute Psychosis Resulting in a Suicide Attempt: A Case Report.

INTRODUCTION: Psychosis associated with coronavirus disease 2019 (COVID-19) has been previously, but infrequently, reported in the literature. We present a rare case of COVID-19-associated severe psychosis and suicide attempt in an 80-year-old male with no personal or known family history of psychiatric disease. Our patient's symptoms appeared to be longer lasting than most other reported cases in the available literature. CASE REPORT: After a COVID-19 diagnosis, our patient experienced fluctuating, long-lasting psychiatric symptoms over a six-month period. During this time, he was unable to function independently. Suggested mechanisms involve a multifactorial combination of neuroinflammation and increased societal stress due to the direct and indirect effects of the virus, respectively. CONCLUSION: More research is needed to help identify risk factors, prognostic indicators, and a standard of care for psychosis associated with COVID-19.

Rare atypical presentation of a polymicrobial gastropericardial fistula.

We present the unique case of a gastropericardial fistula with a rare, delayed presentation in a man in his 70s. Relevant surgeries include Watchman Left Atrial Appendage Closure device placement 1 year prior to arrival and gastric bypass surgery 20 years prior to arrival. The patient presented to the emergency department with weakness, diarrhoea and left knee pain. He was admitted for cellulitis of the left lower extremity, prosthetic septic arthritis of the left knee and group G streptococcus bacteraemia. His hospital course was complicated by acute chest pain and dyspnoea. Imaging revealed pneumopericardium. Oesophagogastroduodenoscopy visualisation confirmed the diagnosis of gastropericardial fistula. The patient could not be transferred to a tertiary centre for definitive management because of the effect of the COVID-19 pandemic on tertiary hospital volumes. After pericardial drainage and administration of antimicrobials without improvement, the patient was discharged to hospice care at his request and died 1 day after discharge.

Perforated diverticulitis of the sigmoid colon contained within an inguinal hernia sac.

We present a patient with perforated diverticulitis contained within an inguinal hernia sac-a diagnostic and treatment dilemma. A 61-year-old man presented to the emergency department with left testicular and groin pain, and loose stool. CT imaging showed a left inguinal hernia containing a perforated segment of sigmoid colon. A segmental sigmoidcolectomyy and end colostomy Hartmannn's procedure) was performed after reducing the incarcerated inguinal contents. The inguinal hernia was not repaired because of faecal contamination of the hernia sac and risk for recurrence. Pathological examination of theresectedd bowel specimen showed perforated sigmoid diverticulitis in an inguinal hernia sac. The patient had an uneventful recovery and is awaiting definitive inguinal hernia repair andtakedownn of his colostomy.