ABSTRACT
Cytomegalovirus infection is a common occurrence in the immunocompromised host and can affect any organ of the human body. Clinical presentation is extremely variable and nonspecific, which makes diagnosis difficult. Post COVID patients are immunocompromised due to viral infection, uncontrolled diabetes, poor nutrition, hyper-catabolic state, and use of immunosuppressive drugs like steroids and tocilizumab. We are presenting a clinical spectrum of seven post COVID patients who were readmitted to the hospital with variable clinical spectrums. Early suspicion and appropriate pharmacological interventions were necessary to make the right diagnosis and achieve a positive outcome. Materials and methods: This is a retrospective analysis of seven post COVID patients admitted in our hospital since 15th January to 1 August 2021. All post COVID patients were investigated and only those were positive by PCR and serology for CMV was analyzed. Results: All seven patients were previously treated in hospital for severe COVID associated pneumonia and readmitted with various CMV related complications. Three out of seven patients died and four survived. All patients were having multisystem involvement with predominantly affected respiratory system in the form of pneumonia and reappearance of ground glass lesions in HRCT and increased demand of oxygen. Conclusion: CMV-associated complications are underdiagnosed in post COVID patients and this is one of the etiologies of re-hospitalization of such patients. Clinical spectrum is wide and nonspecific therefore strong clinical suspicion and early investigation can provide an opportunity for optimal therapeutic intervention for the suffering patient.
ABSTRACT
Introduction: The pandemic of Coronavirus Disease 2019 (COVID-19) had a significant impact on obstetric surgeries. Obstetric surgical procedures during the COVID-19 pandemic affect individuals who are suspected or proven to be high-risk endeavors. Aim: To evaluate the demographic characteristics, indications, intraoperative and postoperative complications, and foetomaternal outcomes in the women who had an Emergency Peripartum Hysterectomy (EPH) during the first and second waves of the COVID-19 at a tertiary care centre in North India. Materials and Methods: This was a retrospective cohort study, conducted in the Department of Obstetrics and Gynaecology at a tertiary care centre in Uttar Pradesh, India, including women who underwent EPH operated from March 2020 to May 2021 in terms of demographic characteristics, indications, intraoperative and postoperative complications, and foetomaternal outcomes. Information about their self-reported health issues due to traumatic birth (when they came for a follow-up visit at five weeks) were also obtained. Simple frequency, percentage, and proportion were calculated using descriptive statistics. Results: A total number of 1827 deliveries were conducted and out them 11 cases underwent emergency peripartum hysterectomy at our institute during the time frame of the COVID-19 pandemic. All of the patients were in their 20s or 30s, with ages ranging from 21 to 34. All of these were unplanned pregnancies and arrived at various gestational ages. Eight cases had the previous scarring on the uterus, with six women having morbidly adhered placenta. All of the women in the study cohort were unbooked, and 72.73 % (eight out of 11) of them were referred to our centre because they had high-risk factors. Due to substantial blood loss, five females required Critical Care Unit (CCU) support. The study sample had a poor newborn outcome, with three early neonatal deaths out of 11 deliveries. As a part of their 5th-week follow-up, after the women had been stabilized and discharged from the ICU, they were asked to share their major issues related to health, psychological status and social interaction. The main worries revolved around the newborn child's and COVID-19 positive husband's health. Pregnant women who delivered during the COVID-19 pandemic had a significant rate of postpartum depression and Post-traumatic Stress Disorder (PTSD). Conclusion: The predominant cause of EPH in the study population was a morbidly adherent placenta. It is critical to protect women's physical and psychological health during traumatic childbirth in order to mitigate the pandemic's already-existing harmful impacts.