Failure of postexposure prophylaxis in a girl child attacked by rabid dog severing her facial nerve causing possible direct entry of rabies virus into the facial nerve.

On January 4, 2019 an eight-year-old girl child was bitten by a suspected rabid dog over the left parotid region. After a 17-h delay, the child was brought for rabies postexposure prophylaxis (PEP) at Civil Hospital Theog and was administered complete PEP. On January 29, 2019, the child was again brought to Theog Hospital with complaints of having fever, difficulty in walking, neck drop, and ptosis. On examination, pediatrician found photophobia, phonophobia, and hydrophobia and subsequently the patient died of cardiac arrest. On postmortem examination, the facial nerve was found dissected and injured at the inner end of the parotid gland. A severed end toward the brain was swollen and edematous. The entire brain was extracted and sent to Central Research Institute Kasauli for confirmation of rabies, where it tested positive for rabies by Fluorescent Antibodies Test and Biological Test. In situations where sensitive parts such as the face are involved, a thorough wound wash with soap and water and application of antiseptics along with immediate PEP may save some lives by not allowing the virus enough time to attach to and infect the nerve cells.

Fatal non-traumatic spontaneous hemoperitoneum in second trimester of pregnancy--autopsy findings.

Spontaneous hemoperitoneum in second trimester of pregnancy is a very rare but lethal condition which demands prompt diagnosis and management for the survival of both mother and fetus. A 21-year old primigravida woman was presented at 29 weeks of pregnancy with acute abdominal pain and hypovolumic shock. In a District Hospital patient was managed conservatively and referred but was brought dead at tertiary level hospital. On autopsy gross hemoperitoneum was found without any injury and uterine artery found ruptured against the suspicion of brutal beating by the relatives of husband.