Dengue Shock Syndrome Complicating High Risk Twin Pregnancy during Late Gestation: Extinguishing Fuel added Flames

Incidence of Dengue has been on the up rise ever since the second wave of the pandemic of COVID19 has ended introducing an old enemy on the frontline to the health care professionals.A 28 year old Gravida 2 Parity 0 Living 0 Abortion 1 with twin pregnancy presented with fever along with chills and retro orbital pain along with body ache since two days in the emergency department with the gestational age of 36 weeks.She tested positive for Dengue NS1 antigen.Patient was having thrombocytopenia and was managed with intravenous fluids,platelet and blood transfusion and was taken for caesarian section and she delivered twins with normal birth weight.During the post operative period the patient went into dengue shock syndrome and which was managed with fluids and inotropic support and patient ultimately recovered and was discharged on day seventeen of admission .This case report emphasises on the importance of prompt detection and management of dengue in a case of high risk pregnancy such as twin pregnancy.After extensive review of literature we found that this is the first case report to report the association of twin pregnancy with dengue shock syndrome making it an important topic of discussion.

Post covid hypothalamic- pituitary-adrenal axis dysfunction manifesting as perinatal depression: A case series

Since 2019, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV2) has led to major impact on both the physical as well as mental health. Although the health care facilities aim to provide treatment for the respiratory, cardiovascular as well as neurological manifestations, its huge impact on the mental wellness of patients is somewhat neglected. Perinatal depression is a commonly encountered psychological disorder. Various factors can aggravate or trigger post-partum depression. COVID-19 is one of such triggers. There is microglial cell activation leading to neuroinflammation along with Hypothalmo-pituitary Axis Dysfunction in COVID-19 leading to neuropsychiatric manifestations. Also similarity in genes for Angiotensin Convertase Enzyme 2 and Dopa Decarboxylase leads to reduction in Dopamine and Serotonin in COVID-19 patients leading to Depression. While complications like HELLP Syndrome and Intra Uterine Death remain well reported in association with COVID-19, Post-Partum Depression remains an underreported post COVID sequalae. Thus, we report a case series of COVID-19 positive pregnant patients who suffered from postpartum depression later as a Post COVID sequalae and were successfully treated with antidepressants and cognitive behavioral therapy preventing any complications.