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Highlights The COVID-19 outbreak has had a significant impact on caregiver strain compared to perceived strain before the pandemic. Prevalence of depressive symptoms is high among caregivers of children with special needs. Negative perception of homecare therapy is associated with higher perceived strain and poor mental health. Not using tele-rehabilitation and perception of it being a poor medium for rehabilitation pose greater mental health risks.

We came across three rare cases of incarcerated hernia, with different presentations. The first case was an elderly female, who presented with an incarcerated incisional hernia on the right lower iliac region diagnosed on contrast enhanced computed tomography (CT); the contents were the small bowel and the perforated tip of the appendix. In the second case of inguinal incarcerated hernia, ultrasonography showed the inflammed appendix in the subcutaneous plane of the hernial sac, which is very rarely diagnosed pre-operatively and was confirmed during surgery. Inflammed appendix with gangrenous tip was found in the inguinal hernial sac. In yet another case of incarcerated inguinal hernia, the contents were a gangrenous part of the ascending colon and transverse colon, with the tip of the inflamed appendix--also only rarely observed. The colon extended to the scrotum in this case. We could find no description within the existing medical literature on either transverse or ascending colon as contents in inguinal hernia although transverse colon alone has been reported in four cases. The surgical options for dealing with the appendix in an Amyand's hernia depend on the mode of presentation. The presence of a normal appendix does not require an appendicectomy to be performed, but its removal is necessary if inflamed.

Context:Superior mesenteric artery syndrome is a life- threatening upper gastrointestinal disorder due to compression of duodenum as it poses a difficult diagnostic dilemma. Third part of duodenum is in fixed compartment bounded anteriorly by the root of mesentery and superior mesentery artery and posteriorly by the aorta and lumbar spine. On barium contrast study and abdominal computerized tomography (CT) showed the dilatation of second part of duodenum and compression of the third part of duodenum between aorta and superior mesentery artery.Case Report:A 22 year young asthenic man admitted with the complaint of recurrent abdominal pain, epigastric fullness, and vomiting and weight loss. Abdominal examination revealed epigastric fullness and hyper peristaltic bowel sounds. Upper gastrointestinal barium study showed a dilated stomach with dilated second part of the duodenum and cut off at the third part of duodenum with no intrinsic mucosal abnormalities. There was no relief of obstruction in the left lateral decubitus or prone position. Conservative treatment was tried for one month but failed. Intra-operative findings confirmed the extrinsic obstruction of third part of duodenum with distension of 2nd part. A retrocolic duodenojejunostomy, side to side anastomosis done. In post-operative follow up, patient was symptom free.Conclusion:Superior mesentery artery syndrome is a life threatening disease. It should be treated as soon as possible. Conservative trial can be given but Surgery is the treatment of the choice.

ObjectivesTo determine the prevalence and factors associated with depression, anxiety and stress among healthcare workers (HCWs) during COVID-19 pandemic.DesignCross-sectional online survey.SettingHCWs from four major hospitals within the Regional Health Authorities of Trinidad and Tobago.Participants395 HCWs aged ≥18 years.Main outcome measuresDepression, anxiety and stress scores.ResultsAmong the 395 HCWs, 42.28%, 56.2% and 17.97% were found to have depression, anxiety and stress, respectively. In the final stepwise regression model, contact with patients with confirmed COVID-19, p<0.001 (95% CI 3.072 to 6.781) was reported as significant predictors of depression. Further, gender, p<0.001 (95% CI 2.152 to 5.427) and marital status, p<0.001 (95% CI 1.322 to 4.270) of the HCWs were considered to be correlated with anxiety. HCWs who had contact with patients with suspected COVID-19 had lower depression, p<0.001 (95% CI −5.233 to −1.692) and stress, p<0.001 (95% CI −5.364 to −1.591).ConclusionsThis study has depicted the prevalence and evidence of depression, anxiety and stress among HCWs during the COVID-19 pandemic. The findings of the study will serve as supportive evidence for the timely implementation of further planning of preventative mental health services by the Ministry of Health, for frontline workers within the public and private health sectors.