Correlation of SARS-Cov2 viral load with severity of COVID-19 disease in pregnant women at term: an observational study

Background: COVID-19 disease raised global health concerns especially for the pregnant women who are more susceptible to respiratory viral illnesses due to their bodily immunological and physiological changes to accommodate the foetus. The aim of the study is to evaluate the relationship between the SARS-CoV 2 specific RdRp gene Ct values ​​and the severity of the COVID-19 disease in SARS-CoV2 positive pregnant women at term. Methods: A retrospective cohort study was conducted in the Department of Microbiology, Government Medical College, Amritsar on a subset of 46 COVID-19 positive, ante natal mothers, who presented in the labour room for delivery from August 2020 to January 2022. Results: A cohort of 4.8% (46/949) women tested positive in the RT-PCR test for viral RNA. Average age of the group was 25.5years and 89.1% were asymptomatic. 10.9% women reported mild symptoms and 95% had no pre-existing co morbidities. Obstetric complications like premature rupture of membranes were 4.3%, pre-term births 17.33%. Miscarriage and IUD was recorded in 4.34% and 2.17% patients respectively. When compared to values seen in symptomatic women with fever (Ct 25.8), dyspnoea (Ct 28.7), and respiratory distress (Ct 29.1), the mean Ct value reported in asymptomatic women (27.49 SD+5.4) was identical. SARS-CoV2 was not present in any newborns. Despite 24% having low birth weights for their gestational ages, 93% of babies were asymptomatic. Conclusions: The severity of the COVID-19 illness did not correspond with the SARS CoV2 virus RdRp gene Ct levels. The presence of SARS-CoV2 did not appear to independently cause poor maternal and new-born outcomes

Strangulation injury from indigenous rocking cradle

Indigenously made rocking cradle is frequently used in rural India. We report strangulation from an indigenously made rocking cradle in an 11-month-old female child. The unique mode of injury and its mechanism have been discussed. Strangulation is an important cause of homicidal and suicidal injury in adults but in children it is usually accidental leading to death due to asphyxia as a result of partial hanging. In western countries, it is the third most common cause of accidental childhood deaths, 17% of them being due to ropes and cords. It ranks fourth amongst the causes of unintentional injury in children less than 1 year of age following roadside accidents, drowning and burns. However, in India, strangulation injury is under reported although indigenous rocking cradles are very commonly used in rural India, and they are even more dangerous than the cribs and adult beds as there are no safety mechanisms therein. We report a case of accidental strangulation following suspension from an indigenously made rocking cradle. The unique mode of injury has prompted us to report this case

Vocal cord palsy: An uncommon presenting feature of myasthenia gravis

Vocal cord palsy can have myriad causes. Unilateral vocal cord palsy is common and frequently asymptomatic. Trauma, head, neck and mediastinal tumors as well as cerebrovascular accidents have been implicated in causing unilateral vocal cord palsy. Viral neuronitis accounts for most idiopathic cases. Bilateral vocal cord palsy, on the other hand, is much less common and is a potentially life-threatening condition. Myasthenia gravis, an autoimmune disorder caused by antibodies targeting the post-synaptic acetylcholine receptor, has been infrequently implicated in its causation. We report here a case of bilateral vocal cord palsy developing in a 68-year-old man with no prior history of myasthenia gravis 2 months after he was operated on for diverticulitis of the large intestine. Delay in considering the diagnosis led to endotracheal intubation and prolonged mechanical ventilation with attendant complications. Our case adds to the existing literature implicating myasthenia gravis as an infrequent cause of bilateral vocal cord palsy. Our case is unusual as, in our patient, acute-onset respiratory distress and stridor due to bilateral vocal cord palsy was the first manifestation of a myasthenic syndrome

Takayasu's arteritis - aphasia as an initial presentation

Takayasu arteritis (TA) is an uncommon disease of young women, characterized by granulomatous vasculitis of medium and large arteries. Neurological involvement is reported in only a minority of patients and occurrence of neurological syndromes as the first manifestation of disease has been rarely reported. We present clinical, laboratory and imaging findings of a 40 years old lady with TA, who initially presented with clinical manifestations of stroke in form of aphasia. The rarity of the disease and especially such a presentation can cause considerable delay in the diagnosis and treatment

Cerebral venous thrombosis in patient of relapse of ulcerative colitis: report of a case

Amongst the various systemic complications of ulcerative colitis, cerebral venous thrombosis (CVT) is an uncommon and serious neurological complication mainly associated during episodes of relapse of ulcerative colitis. CVT is suspected to be a consequence of hypercoagulable state occurring during the disease in genetic predisposed persons. Most patients present with rapid neurological deterioration. This devastating intracranial complication requires immediate medical intervention to avoid potentially life threatening consequences. The outcome is good, provided the disease is diagnosed on time and the treatment is started early. The authors present a patient of CVT, a rare complication seen during relapse of ulcerative colitis