Suspected twin anemia polycythemia sequence in a dichorionic, diamniotic twin pregnancy: a case report.

BACKGROUND: Twin anemia polycythemia sequence is a rare complication in monochorionic twin pregnancy. CASE PRESENTATION: We describe a case of dichorionic twin pregnancy presenting with suspected twin anemia polycythemia sequence. A 31-year-old White female, on her third pregnancy, had a routine ultrasound scan at 12 weeks gestation, which demonstrated a dichorionic twin pregnancy with one placenta located in the anterior wall and the other in the posterior wall of the uterus. At 21 weeks, a scan demonstrated a 24% growth discordance between the two fetuses with normal Doppler studies and amniotic fluid. At 27 weeks, one twin showed signs of anemia and the other polycythemia; the fetal middle cerebral artery peak systolic velocity was high in the anemic fetus and low in the polycythemic twin (1.8 and 0.5 multiples of the median). An intrauterine blood transfusion was carried out and this increased the fetal hemoglobin concentration in the anemic twin from 3.5 to 12.5 g/dL. At 29 weeks, delivery by cesarean section was carried out because of evidence from middle cerebral artery peak systolic velocity of recurrence of anemia in one twin and worsening polycythemia in the co-twin; at birth the hemoglobin concentrations were 5.6 and 24.9 g/dL, respectively. Histopathological examination confirmed dichorionicity with no communicating vessels between the two placentas. CONCLUSIONS: This is the first case of twin anemia polycythemia sequence in a dichorionic, diamniotic twin pregnancy where intrauterine blood transfusion was used to prolong the pregnancy by almost 2 weeks in a "twin anemia polycythemia sequence-like" setting.

Psychological implications of Covid-19 in healthcare workers.

BACKGROUND: The Covid-19 outbreak has led to an unprecedented burden on the healthcare infrastructure. High morbidity and mortality rates have resulted in a state of stress and distress among the general population which has also impacted health professionals. AIMS: This study was conducted to identify mental health disturbances among health professionals during the Covid-19 pandemic. MATERIALS AND METHODS: It was a cross-sectional study, conducted in a Medical College in Himachal Pradesh, India. A self-administered anonymized questionnaire was administered to the healthcare workers. Mental health status was assessed using Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS). In addition, a 15-item questionnaire was prepared to identify the probable causes of stress in HCWs during the Covid-19 Pandemic. A statistical analysis used t-test was used to find the significance of the correlation between the PHQ-ADS score and the agreement score of different factors. RESULTS: The response rate for the questionnaire was 27%. Anxiety and depression were seen in 29% of participants, ranging from mild (18.3%), moderate (4.7%), and severe (5.9%). Among females 43.7% of the participants and among males, 13.1% had anxiety and depression. High PHQ-ADS scores were seen in nursing staff (70%) and postgraduate students (30%), who were in the third decade of life. Most (81.7%) of the HCWs were concerned about transmitting the disease to their near ones. Fear of coming to the hospital and dealing with patients. CONCLUSION: Even sub-threshold syndromes among HCWs need to be identified before they evolve into overt diseases. The psychological needs of healthcare workers should be prioritized as they are key players in the fight against Covid-19.