Unusual Clinical Manifestations and Outcome of Multisystem Inflammatory Syndrome in Children (MIS-C) in a Tertiary Care Hospital of North India.

Till date, there is paucity of published literature on clinical manifestations of Coronavirus disease 2019 (COVID-19) in children from low-middle-income countries (LMIC). Most of the reports are from Europe, USA or China. Our study aimed to capture data on varied and unusual clinical presentation and management of MIS-C (Multisystem Inflammatory Syndrome in Children) with COVID-19 and compare the MIS-C and non-MIS-C children. This was a single-centre cohort study of 41 COVID positive children 0-12 years age hospitalized between 1 April 2020 and 31 July 2020. Data were entered into standardized WHO Case Report Form and analysed using strata 15.0 statistical software. Twenty out of 41 children fulfilled the criteria of MIS-C. Male-to-female ratio in the cohort was 1.73:1. In MIS-C cases, predominant clinical manifestation was fever (100%), neurological manifestations (80%), lower respiratory tract infection (50%), rash (35%) and acute gastroenteritis (25%). They were categorized into Acute Encephalitis-like illness in 35%, Kawasaki-like disease, Toxic Shock-like syndrome and Comorbidity with systemic complications in 20% each. Ninety percent of MIS-C cases required oxygen supplementation with odds ratio (OR) 18 (3.22-100.48), whereas 65% required mechanical ventilation with OR 37.14 (4.08-338.10). Most of them had raised inflammatory markers and hepatic enzymes derangement. Steroids, Intravenous immunoglobulin and supportive therapy were mainstay of management for MIS-C group. Most MIS-C group children had multisystem involvement with predominant neurological manifestations at time of presentation. Delay in diagnosis and referral may have adversely affected the prognosis and outcome.

Effect of Vitamin D Supplementation on Disposition Index in Non-Diabetic Indians with Obesity: A Double-Blind Randomized Placebo-Controlled Trial.

There has been conflicting evidence regarding the potential role of vitamin D in glucose homeostasis. This double-blind randomized placebo-controlled trial was designed to investigate the effect of vitamin D3 supplementation on the disposition index in non-diabetic Indian subjects with obesity. Subjects with obesity [n = 120] were randomized to receive a monthly dose of 120,000 IU of vitamin D3 or matching placebo for 6 months. The primary outcome was a change in disposition index (DI) and secondary outcome measures were change in the homeostatic model assessment of insulin resistance and change in body composition. A total of 101 subjects [50 in the vitamin D group (VITD) and 51 in the Placebo group (PL)] completed the study. The mean baseline serum 25-hydroxyvitamin [25(OH) D] concentration was 11.6 ng/ml. There was no significant difference observed between the two groups in any of the primary or secondary outcomes. However, there were a significant increase in median serum 25(OH) D levels in the VITD group than the PL at 6 months of intervention. The results of the present study suggest that supplementation of vitamin D3 has no additional benefit over placebo on pancreatic ß-cell functions in non-diabetic Indian subjects with obesity. Further larger studies are required to confirm the results of the study. The trial is registered with the Clinical Trials Registry of India, CTRI/2015/04/005727.