A RARE PRESENTATION OF EWING SACROMA AS A PRIMARY INTRADURAL EXTRAMEDULLARY MASS IN PAEDIATRIC PATIENT Ewing sarcoma (ES) is a highly malignant bone tumor that accounts for 25% of all bone tumors in childhood. Primary spinal ES is very uncommon. Primary intradural extramedullary Ewing sarcoma (IEES) is even rarer, and high clinical suspicion is vital to guide accurate management and tissue diagnosis. A 10-year-old boy presented with a 3-week history of non-specific back pain, which worsened and impaired his regular activities. Urgent magnetic resonance imaging (MRI) revealed a thoracic intradural extramedullary mass causing regional compression. Tumor debulking surgery was performed, and histopathological examination of the excised mass was consistent with ES. Early recognition and management of highly aggressive tumors are essential, more so in critical regions such as the spine. Our case emphasises the need to consider ES as a differential diagnosis for spinal tumors in intradural extramedullary locations in the pediatric age group, as the aim of treatment should be curative and not palliative due to high 5-year survivability.

INTRODUCTION: Disease outbreaks such as the COVID-19 pandemic significantly heighten the psychological stress of healthcare workers (HCWs). The objective of this study was to understand the factors contributing to the perceived stress levels of HCWs in a public primary care setting during the COVID-19 pandemic, including their training, protection and support (TPS), job stress (JS), and perceived stigma and interpersonal avoidance. METHODS: This cross-sectional study using an electronic self-administered questionnaire was conducted at the National Healthcare Group Polyclinics in March 2020. Data was collected anonymously. Analysis was performed using regression modelling. RESULTS: The response rate was 69.7% (n = 1,040). The mean perceived stress level of HCWs in various departments ranged from 17.2 to 20.3. Respondents who reported higher perceived stress were those who made alternative living arrangements, were more affected by the current pandemic, reported higher JS and were Muslims. Respondents who reported lower perceived stress were those who had been through the severe acute respiratory syndrome epidemic in 2003 and H1N1 pandemic in 2009 as HCWs, and those who had higher confidence in the organisation's TPS. CONCLUSION All HCWs, regardless of their scope of work, were similarly stressed by the current pandemic compared to the general population. Improving the confidence of HCWs in their training, protection and the support of personal protective equipment, and retaining experienced HCWs who can provide advice and emotional support to younger colleagues are important. Adequate psychological support for HCWs in the pandemic can be transformed into reserves of psychological resilience for future disease outbreaks.
COVID-19/epidemiology* ; Cross-Sectional Studies ; Health Personnel/psychology* ; Humans ; Influenza A Virus, H1N1 Subtype ; Pandemics ; Primary Health Care ; SARS-CoV-2 ; Stress, Psychological

At present, surgical treatment is the only curative option for gallbladder (GB) cancer. Many efforts therefore have been made to improve resectability and the survival rate. However, GB cancer has a low incidence, and no randomized, controlled trials have been conducted to establish the optimal treatment modalities. The present guidelines include recent recommendations based on current understanding and highlight controversial issues that require further research. For T1a GB cancer, the optimal treatment modality is simple cholecystectomy, which can be carried out as either a laparotomy or a laparoscopic surgery. For T1b GB cancer, either simple or an extended cholecystectomy is appropriate. An extended cholecystectomy is generally recommended for patients with GB cancer at stage T2 or above. In extended cholecystectomy, a wedge resection of the GB bed or a segmentectomy IVb/V can be performed and the optimal extent of lymph node dissection should include the cystic duct lymph node, the common bile duct lymph node, the lymph nodes around the hepatoduodenal ligament (the hepatic artery and portal vein lymph nodes), and the posterior superior pancreaticoduodenal lymph node. Depending on patient status and disease severity, surgeons may decide to perform palliative surgeries.
Cholecystectomy, Laparoscopic/*methods ; Gallbladder Neoplasms/epidemiology/mortality/*surgery ; Humans ; Incidental Findings ; Laparotomy ; Liver Neoplasms/secondary/*surgery ; Lymph Node Excision/*methods ; Lymph Nodes/pathology/surgery ; Lymphatic Metastasis/*pathology ; Survival Rate