Fallopian tube block induced secondary infertility in a case of unicornuate uterus treated successfully: A long covid sequalae?

Infertility arising from infections is alarming cause of secondary infertility which is growing in number by the day. Mullerian anomalies can result in female infertility. A unicornuate uterus with a rudimentary horn is an abnormality induced by a faulty mullerian duct fusion. On Hysterosalpingogram, the uterine cavity has a spindle-shaped that tapers at the tip and drains in to a single oviduct. A 30 years old female with secondary infertility post COVID 19 infection, which upon investigated turned out to be unicornuate uterus with single fallopian tube on left side cornual block visualized in fallopian tube. All the causes of fallopian tube block including pelvic inflammatory disease, tuberculosis, trauma and bacterial infections were ruled out yielding COVID19 as the probable cause of infertility. Fallopian tube cannulation was done following which she conceived spontaneously. Elective encirclage done at 12 weeks and she was asked to report at 37 completed weeks for cervical stitch removal. After that emergency LSCS done. She delivered baby boy of 2.7kg with APGAR score 9/10. We concluded that angiotensin convertase enzyme 2 receptor were present on the fallopian tube might be responsible for post COVID fallopian tube blockage which is a topic for further studies. Prompt detection and management of long COVID sequelae in the form of infertility, particularly in predisposed people who are more likely to develop such difficulties, is thus critical to preserve infertility.

Implication of chronic obstructive pulmonary disease on the severity and outcome of covid-19 in rural India;Is COPD the hidden culprit amongst the havoc: A cross sectional study

COVID-19 (Coronavirus infectious disease 2019) denotes an ever changing and varied disease which has crippled the health care systems throughout the world. There have been studies conducted across the globe to establish the important factors for severity and mortality associated with COVID-19. We tried to study the effect of chronic obstructive pulmonary disease (COPD) on the severity as well as outcome of COVID-19. Material and methods: A total of 180 patients with COVID-19 were enrolled in this study and were then screened for history of COPD. There were 49 patients with history of COPD and 131 patients with no history of COPD. Inflammatory markers and HRCT scores were assessed for all the patients and they were followed up to study the outcome. Result: COPD was significantly associated HRCT Score, inflammatory markers and outcome. The mean HRCT Score for patients with COPD was more in COPD group (15.39 +/- 4.65) when compared with Non-COPD group (9.39 +/- 3.98). Mortality was also significantly higher in patients with COPD (67.3%) when compared to the patients without COPD (3.3%). Conclusion: We conclude that COPD is an important factor which has to be considered while treating the patients of COVID-19 especially in the rural India where lockdown restrictions and lack of knowledge have provided hinderance in achieving optimal follow up as there is increased severity and mortality associated with it.

COVID-19 Induced Immunosuppression resulting in Pulmonary Mucormycosis: A Long COVID sequalae

With increasing incidence of Severe Acute Respiratory Distress Virus 2(SARS -CoV -2) in India, there has been growing reports of super infections in post covid 19 period. Long COVID refers to persistence of COVID19 symptoms for weeks to months. While most common manifestation of long COVID is fatigue and ill health, it may lead to development of life-threatening complications like Pulmonary Mucormycosis. We report a case of 54 year young, non-diabetic previously healthy male who had moderate COVID19 treated with low dose steroids and recovered completely, only to present with hemoptysis 3 months later on High Resolution Computed Tomography Scan of the Chest and Rhizopus fungi on bronchoalveolar lavage confirming Post Covid Pulmonary Mucormycosis in non-immunocompromised host. Patient was managed with dual antifungal therapy intravenous Liposomal Amphotericin B and Posaconazole for 3 weeks, followed by oral Posaconazole.

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.

Covid-19 with fatal spontaneous subdural bleed and status epilepticus in a primigravida: A lethal encounter

Since 2019, The Coronavirus Disease (COVID19) has emerged as a global health concern. Various kinds of disorders like the vascular involvement along with neurological complications continue to be reported worldwide. In this case report we describe the case of a 28 year old Female who was antenatal (6.5 months) presented with Genereliazed Tonic Clonic Convulsions of duration more than 30 minutes which upon investigations turned out to be a case of subdural bleed and upon Nasopharyngeal swab testing revealed to be COVID19 positive case. Though the patient underwent urgent craniotomy and evacuation of hematoma was done, the patient ultimately succumbed leading to maternal mortality. Thus, this case report is an attempt to draw attention towards the maternal mortality caused due to COVID19 which we tend to overlook.

Metabolic Ketoacidosis in a Gravida Diagnosed with COVID-19: A Case Report

We present a case of term pregnancy which presented with chief complaint of Breathlessness, chest pain as well as a one day history of vomiting. She tested positive for COVID19 through reverse transcriptase polymerase chain reaction of nasopharyngeal swab and the symptoms were attributed to Pneumonia caused due to COVID19.However,the arterial blood gas showed metabolic acidosis with high anion gap. This was a non lactate acidosis with no hypoxemia. Most reasonably the state of pregnancy with increased energy demands along with increased metabolic maternal demand due to infection coupled with maternal starvation had resulted in this Ketoacidosis. In view of non progression of labor caesarian section was carried out and a healthy neonate was delivered. There was an initial improvement in maternal ketoacidosis post partum however optimal management of COVID19 pneumonia required oxygen support and use of corticosteroids. Thus we highlight how an unusual metabolic demands of pregnancy might mimic COVID19.

Fatal HELLP syndrome in pregnancy: A sequelae of Long COVID?

The coronavirus disease resulted by infection with severe acute respiratory syndrome-Coronavirus 2 (SARS-CoV-2) was initiated in China in during the end of 2019 and spread exponentially as a global health Pandemic. The current pandemic (COVID-19) caused by SARS-CoV-2 novel coronavirus lead to high mortality and morbidity in terminally ill patients. We present a link between maternal severe acute respiratory syndrome-Coronavirus 2 (SARS-CoV-2) infections in the peripartum period and rapid maternal deterioration with coagulopathy. Also, we wish to draw attention towards the overlap which is significant between the clinical findings of COVID19 and HELLP Syndrome along with importance of persistence of inflammation over 3 months after COVID19 known as "Long COVID".

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.

COVID-19 associated Platypnea Orthodexia syndrome in a young male

Platypnea -orthodexia syndrome is a rare syndrome which is described as breathlessness during the upright posture which is relieved in supine position. Its causes range from cardiac causes to pulmonary causes with few non cardiopulmonary etiologies. COVID-19 can have a wide range of pulmomonary manifestations ranging from acute respiratory distress syndrome to fibrosis of the lung. It is a rare finding of COVID-19. Here, we describe a case of 32 year old male who had respiratory distress due to COVID-19 infection and later suffered from platypneaorthodexia syndrome during his recovery phase. He was managed with chest physiotherapy along with oxygen support with which he improved and was discharged in stable condition. Platypnea Orthodexia is hence a rare manifestation of COVID-19 which must be diagnosed in time so that it can be managed in time with supportive therapy.

COVID-19 induced severe respiratory failure in early gestation with favourable outcome: A close escape

A small percentage of pregnant females suffer from respiratory failure during the course of their pregnancy which amounts to about 2 percent of all pregnancies. Usually the cause for this respiratory failure remains preeclampsia or amniotic fluid embolism. However, with the ongoing pandemic, an emerging cause of respiratory failure is Infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV 2). Chest wall compliance is decreased in pregnancy hence making it further difficult to fight COVID-19. We present a case of 31 year old pregnant female with gestational age of 28 weeks who presented with acute respiratory failure with severe hypoxia due to COVID-19. She was treated with non invasive ventilation, remdesavir, steroids and other supportive measures. She was given incentive spirometry and her oxygen saturation imporved drastically. Ultimately she was shifted on high flow oxygen and was discharged in stable condition making it a close escape. Thus we showcase the importance of diagnosing COVID-19 induced respiratory failure early and the substantial role of incentive spirometry in COVID-19 which is an underrated aspect of chest rehabilitation during the ongoing pandemic.

Cytokine storm treated successfully with immunoglobulin therapy in a pregnant COVID-19 patient

Ever since its emergence Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV 2) has caused an enormous amount of morbidity and mortality. Pregnancy being a high risk state is also being affected by this lethal pandemic causing an increased risk of rising maternal mortality. The treatment strategies for managing COVID-19 in pregnant female remains limited with no definite treatment available. With the growing evidence of Lymphocytopenia in COVID-19 there has been a emergence of immunoglobulin (IVIg) as a relatively safe treatment option in immunodeficient states such as pregnancy. Though research remains limited in the aspect of immunoglobulin therapy in pregnancy a risk versus benefit ratio might allow use of immunoglobulin therapy. We present a case of COVID-19 associated cytokine storm with lymphocytopenia in a Pregnant female which was successfully treated with immunoglobulin therapy.

Post natal covid-19 induced severe acute respiratory distress syndrome managed with monoclonal antibody and prone ventilation

A 28 year old female who primigravida presented with high grade fever and breathlessness since one day with a saturation of 70 percent on room air. She required an urgent Cesarean section. She later tested positive for COVID-19. HRCT Chest showed extensive bilateral ground glass opacity with a CT Severity Score of 23/25 and CORAD 6. In view of raised inflammatory markers was managed with Monodonal Antibody against Interleukin 6 and Prone Ventilation along with other supportive measures. The patient ultimately recovered thus showcasing the miracle of early administration of monoclonal antibody and the effect of prone ventilation in a case of severe acute respiratory distress syndrome seen in Post Natal Period thus preventing maternal mortality.

Premature ovarian failure - A long COVID sequelae

Ever since its emergence since 2019, Coronavirus Disease 2019 (COVID-19) has brought the healthcare setup down with its burden of varied appearance and presentation. It can lead to a severe disease with respiratory distress syndrome along with hypercoagulability and various neurological complications. There has been an emergence of a large population of patients who develop a subsequent long term disease known as "long-COVID' which is thought to be secondary to chronic tissue inflammation. We Report a case a 34-year-old female who was infected with COVID-19 12 months back and presented with infertility as a post COVID sequelae. This is the first case report linking Ovarian Failure with COVID-19 in our knowledge.

Intractable Singultus: Atypical presentation of COVID 19

Singultus are involuntary manoeuvre that involve the reflex arc of swallowing and can be further divided into acute singultus (<48 hours) or persistent singultus (>48hours). We present a case series of three patients of different age groups who presented with the chief complaint of persistent hiccup not responding to treatment. Other than Hiccup which was episodic physical examination of the patient were unremarkable. However, Reverese Transcriptase Polymerase Chain Reaction for COVID-19 was Positive and High-Resolution CT Scan of the Chest was able to demonstrate Ground Glass Opacities scattered throughout the lung. The patients did not respond to primary treatment for hiccups and were treated with antiviral and other supportive measures. All the three patients recovered and were later discharged in stable condition. Thus, this case series showcases the importance of keeping COVID-19 as an important differential diagnosis of persistent hiccup to be prompt in reaching the diagnosis in this atypical presentation but to also be vigilant of unexpected exposure for the physician himself.