Shaikh Zayed Hospital

Background: The COVID-19 pandemic caused lasting disruption to healthcare systems and the mental health of frontline workers. Though the acute crisis has passed, many healthcare workers (HCWs) continue to experience long-term psychological effects, including anxiety, grief, and burnout. This mixed-methods study investigates the enduring effects of the COVID-19 pandemic on the mental health of physicians in a low-resource country. Methods: Drawing on data from the ear, nose, and throat (ENT) or otolaryngology department at a tertiary care hospital in Pakistan, the study employed an explanatory mixed-methods design, combining structured surveys and semi-structured interviews. The Hospital Anxiety and Depression Scale, the Perceived Stress Scale, and the Brief COPE Inventory were administered to 42 ENT specialists, trainees, and house officers, alongside semi-structured interviews with eight ENT physicians. Results: Survey results revealed moderate to high levels of anxiety, depression, and stress that persisted beyond the acute crisis phase of the pandemic. Interviews provided nuanced insights into the emotional burden experienced by physicians, including persistent concerns about contagion risk, professional isolation, and increased workload. Physicians described maladaptive responses and employed active coping strategies, such as seeking peer support and utilizing adaptive problem solving. Conclusions: The COVID-19 pandemic has had enduring effects on the mental well-being of physicians. Targeted interventions and policy reforms that address the ongoing pressures frontline physicians face in resource-constrained environments may help mitigate these burdens, support healthcare professionals more effectively, and improve their mental health.

While spontaneous anterograde passage of ureteric stones is well documented, retrograde migration-movement of the stone back towards the kidney is exceedingly rare. The mechanisms underlying this unusual migration pattern remain poorly understood, with only a few cases reported in the literature.

A 23-year-old female presented with acute left flank pain, imaging for which revealed a calculus in the left proximal ureter. A repeat imaging after a few weeks of medical management revealed a calculus of the same dimension at the lower pole calyx of the left kidney, with no calculus present at the initial site, indicating retrograde migration of the calculus. The patient subsequently underwent extracorporeal shockwave lithotripsy with complete stone clearance.

Retrograde migration of ureteric calculi is a rare phenomenon. Proposed mechanisms include reverse ureteral peristalsis, proximal ureteral dilation, antiperistaltic waves due to irritant stimuli, and the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on ureteric peristalsis. Awareness of this occurrence is important for appropriate diagnosis and management, as retrograde migration can affect treatment planning and outcomes.

The case highlights an unusual presentation of urolithiasis that radiologists and urologists should be aware of as this can have significant implications for clinical management.