A 26 year old, female presented to EMD in severe respiratory distress. Patient had history of breathlessness since past one month with h/o intrauterine death 1month back .On further investigation it was found that anti acetylcholine receptor antibody was above normal limits and was started on cholinesterase inhibitors, initially patient showed signs of improvement but later patient condition worsened and patient was diagnosed with Myasthenia gravis in crisis. Patient was started on pulse steroid therapy but patient did not show significant response, patient attenders were advised for IVIg but they could not afford the same, later patient was transferred to a center with plasmapheresis facility where plasmapheresis was done and now patient doing well and is on oral cholinesterase inhibitors. Keywords: Myasthenia crisis, anti-acetylcholine receptor antibodies

Novel corona virus(COVID-19) was first described in December 2019, identified as the cause of a clus-ter of pneumonia cases in Wuhan, a city in the Hubei Province of China. Since then world wide spread is report-ed affecting millions of people. India reported its first case of COVID-19 on January 30th in Kerala. On March 11, 2020 after spread to Spain, Italy, USA and other parts of the world, WHO declared it as a pandemic and it indi-cated widespread community transmission on at least two continents. It belongs to the order Nidovirales , family Coronaviridae , and the subfamily Orthocoronaviri-nae.Corona virus is spherical, enveloped, and the largest of positive-strand RNA viruses. It uses, the angiotensin-converting enzyme 2 (ACE2) receptor, for cell entry. The incubation period for COVID-19 is thought to be with-in 14 days following exposure. In person to person transmission, respiratory droplets were considered the main mode as it can happen through coughing, sneezing, and even while speaking. Person to person transmis-sion also occurs after touching the surface infected with respiratory droplets of an infected person, and touch-ing the face (coming in contact with a mucous membrane of eyes, nose and oral cavity). The spectrum of symptomatic infection ranges from mild to critical; most infections are not severe. It can range from a simple URTI to a complicated pneumonia. Fever(99%), Fatigue(70%), Dry cough (59 %), Ano-rexia (40%), Myalgias(35 %), Dyspnea (31 %), Sputum production (27 %) were the most common clinical fea-tures. No treatment is approved or shown effective and safe. Remdesivir, Lopinavir/ritonavir and many other antiviral drugs are in trial. Acute respiratory distress syndrome , Cardiovascular complications, Acute liver inju-ry, Cytokine release syndrome, Septic shock , Neurological complications are reported in some studies. Key words: Covid-19,Corona Virus, Infectious disease

Hemorrhagic pleural effusions is common in our clinical practice and its usually due to trauma, malignancy and pulmonary embolism. Other rare causes are Bleeding diathesis, Spontaneous hemopneumothorax, Aortic dissection or rupture, Aneurysm rupture or dissection of internal mammary artery, Post-cardiac injury syndrome, Infections like dengue hemorrhagic fever, pulmonary tuberculosis, etc. Aortic dissection is uncommon, a high index of suspicion for acute aortic dissection must be kept in mind when evaluating patients with unexplained chest or back pain. Here by presenting a case of elderly male patient with acute onset right sided chest pain with right haemorrhagic effusion and whose CT thorax revealed aortic dissection. Pleural effusion in aortic dissection is mainly due to inflammation and is a rare presentation. Keywords: Hemorrhagic pleural effusion, Pancreatitis, Cause.

Acute pulmonary embolism is a component of venous thromboembolism (VTE), which may prove fatal if not suspected and subsequently treated. Here we present a 82 year female patient with Bronchial asthma who de-teriorated and developed pulmonary thromboembolism during the hospital stay. Acute pulmonary embolism in elderly asthmatics is not very uncommon. Asthmatic presenting with acute onset of dyspnea, pulmonary embolism should be kept as a possibility. most of the time PE is not considered in differ-ential diagnosis while evaluating such patients in emergency. Pulmonary embolism requires high clinical suspi-cion, based on validated scores and requires further multi-modality investigation to confirm or rule out disease. Key words: Acute Pulmonary Embolism, Bronchial Asthma, High Clinical Suspicion

Acute poisoning with nitrobenzene causing significant methemoglobinemia is a rare yet life-threatening emergen-cy. A 20-year-old, female presented to Emergency in altered sensorium with a history of consumption of a bioor-ganic formulation. On examination she was cyanosed restless and agitated with SpO2 of 70% on room air. Blood samples drawn for ABG was chocolate brown colour on blotting paper. ABG showed metabolic acidosis with a satu-ration of 80%. Methylene blue 50mg in IV saline was given over 5 mins and oral ascorbic acid. She improved slowly after the 9th day with SpO2 of 92% on room air. She was discharged on the 17th day on oral iron, ascorbic acid, and breathing exercises. Early aggressive management of severe poisoning, strongly suspected on clinical grounds may change the outcome of the patient. Key-words: Nitrobenzene, methemoglobinemia, methylene blue, pulse oximetry