Ovarian Hyperstimulation and Maternal Virilisation with Successful Pregnancy Outcome: A case report

Hyperreactio luteinalis (HL) and ovarian hyperstimulation syndrome (OHSS) during pregnancy are both benign conditions where the ovaries are enlarged with presence of multiple thin-walled cysts. Differential diagnosis is ovarian malignancy. Hyperandrogenism with resultant maternal virilization could be seen in some cases of HL as well as in androgen secreting tumours. We report the case of a 41 years old lady underwent ovulation induction due to secondary infertility. She had recurrent hospital admission with abdominal pain and huge multicystic enlargement of both ovaries. She developed virilisation features by 35 weeks of pregnancy. Lower segment caesarean section was done at 36 weeks gestation for breech presentation with intra uterine growth restriction. Magnetic resonance imaging (MRI) confirmed benign nature of the cysts. Ovarian cysts and hyperandrogenism gradually resolved by three months of delivery. Awareness, judicious imaging and close monitoring in such cases can result in live birth and avoid oophorectomies. Keywords: Hyperandrogenism; Hirsuitism; Virilism; Polycstic ovary syndrome; Ovarian hyper stimulation; Ovulation induction; Hyperreactio luteinalis; Ovarian cysts

COVID-2019 Pneumonia: Severity and distribution of lung changes observed on the initial chest X-ray as an indicator of final outcomes

Objectives: This study aimed to assess the correlation between the severity of the initial chest x-ray (CXR) abnormalities in patients with a confirmed diagnosis of COVID-19 and the final outcomes. Methods: This retrospective study was conducted at the Royal Hospital, Oman between mid-March and May 2020 and included patients who had been admitted with a confirmed diagnosis of COVID-19 and had a final outcome. Serial CXRs were identified and examined for presence, extent, distribution and progression pattern of radiological abnormalities. Each lung field was divided into three zones on each CXR and a score was allocated for each zone (0 is normal and 1–4 is mild–severe). The scores for all six zones per CXR examination were summed to provide a cumulative chest radiographic score (range: 0–24). Results: A total of 64 patients were included; the majority were male (89.1%) and the mean age was 50.22 ± 14.86 years. The initial CXR was abnormal in 60 patients (93.8%). The most common finding was ground glass opacity (n = 58, 96.7%) followed by consolidation (n = 50, 83.3%). Most patients had bilateral (n = 51, 85.0%), multifocal (n = 57, 95.0%) and mixed central and peripheral (n = 36, 60.0%) lung abnormalities. The median score of initial CXR for deceased patients was significantly higher than recovered patients (17 versus 11; P = 0.009). Five CXR evolution patterns were identified: type I (initial radiograph deteriorates then improves), type II (fluctuate), type III (static), type IV (progressive deterioration) and type V (progressive improvement). Conclusion: A higher baseline CXR score is associated with higher mortality rate and poor prognosis in those with COVID-19 pneumonia. Keywords: SARS-CoV-2; COVID-19; X-ray Film; Pneumonia; Prognosis; Oman.