Multisystem inflammatory syndrome in neonates (MIS-N) is hypothesised to be caused either following transplacental transfer of SARS-CoV2 antibodies or antibodies developed in the neonate after infection with SARS-CoV-2. In this paper, we aim to discuss the clinical manifestations, laboratory features, and management of neonates diagnosed with MIS-N. We collated information from five participating hospitals in western India. A cohort of newborn infants presenting with multi-system involvement, along with the presence of SARS-CoV2 antibodies, was identified. Current proposed international diagnostic criteria for MIS-N were used to group the cases into three categories of Most likely, Possible, and Unlikely MIS-N. A total of 20 cases were reported with a diagnosis of MIS-N, all having high titres of SARS CoV2 IgG antibodies and negative for SARS CoV2 antigens. Most likely MIS ( n = 5) cases presented with respiratory distress (4/5), hypotension and shock (4/5), and encephalopathy (2/5). Inflammatory markers like CRP (1/5), Procalcitonin (1/5), Ferritin (3/5), D-dimer (4/5), and LDH (2/5) were found to be elevated, and four of them had significantly high levels of proBNP. The majority of them (4/5) responded to immunomodulators, three neonates were discharged home, and two died. Possible MIS infants ( n = 9) presented with fever (7/9), respiratory distress (4/9), refusal to feed (6/9), lethargy (5/9), and tachycardia (3/9). ProBNP as a marker of cardiac dysfunction was noted to be elevated in four (4/9) infants, correlating with abnormal echocardiography findings in two. In the Unlikely MIS ( n = 6) category, three (3/6) infants presented with respiratory distress, one (1/6) with shock and cardiac dysfunction, and only one (1/6) with fever. All of them had elevated inflammatory markers. However, there were other potential diagnoses that could have been responsible for the clinical scenarios in these six cases. Conclusion : MIS-N requires a high index of suspicion and should be considered in a neonate presenting with two or more systems involvement, in the presence of SARS-CoV2 antibodies, along with elevated inflammatory markers, once other common neonatal conditions have been ruled out. What is Known: • Severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) associated multisystem inflammatory syndrome in children (MIS-C) is  widely reported in paediatric population, however only few reports of newborn affection. • MIS-C is known to cause by virus-induced post-infective antibody mediated immune dysregulation with severe multi-system affection. What is New: • MIS-N may present with varied clinical manifestations with multi-system involvement of variable severity with ...

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Background: Robotic percutaneous coronary intervention (R-PCI) has been shown to benefit the operator but has not shown any significant benefit to the patient. We sought to compare a large cohort of R-PCI to traditional percutaneous coronary intervention (PCI) procedures performed at a tertiary care center in the same time frame. Methods: A total of 996 consecutive patients referred for PCI between December 2017 and March 2019 were studied, of which 310 (31.1%) patients were selected to undergo R-PCI and 686 (68.9%) patients underwent traditional PCI. The coprimary study outcome measures were air kerma, dose-area product, fluoroscopy time, volume of contrast, and total procedural time. Caliper propensity-matching technique was used (caliper, 0.05) to match each R-PCI patient to the nearest traditional PCI patient without replacement. Results: Air kerma (mGy; median [interquartile range]; P ; 884 [537–1398] versus 1110 [699–1498]; P =0.002) and dose-area product (cGycm 2 ; 4734 [2695–7746] versus 5746 [3751–7833]; P =0.003) were significantly lower in the R-PCI group. There was no difference in fluoroscopy time (minutes; 5.51 [3.53–8.31] versus 5.48 [3.31–9.37]; P =0.936) and contrast volume (mL; 130 [103–170] versus 140 [100–180]; P =0.905). Total procedural time (minutes) was significantly higher in the R-PCI group (27 [21–40] versus 37 [27–50]; P <0.0005). Conclusions: R-PCI is associated with a significant decrease in radiation exposure to the patient with no increase in fluoroscopy time, as well as contrast utilization, and a minor increase in procedure duration compared with traditional PCI.

Background: Workplace violence is much prevalent across the globe in almost all institution dealing directly with general public and hospitals are no exception to it. Hospitals have high incidence of work place violence because it caters a service which attaches the emotional aspect of the patient and their escorts. The present study aims to evaluate this important issue qualitatively and quantitatively.Methods: Hundred resident doctor of clinical discipline were interviewed, and response filled in pre-designed questionnaire between 1st February 2017 to 28th February 2017.Results: A large portion of study population i.e.68% was worried about violence at the work place. Junior residents faced both physical (10.9%) and psychological violence (84.3%). Very few participants out of the study population (8%) have training in managing conflicts. About 92 (61.3%) respondents were not aware of any violence prevention policy at their workplace, 45 (30%) had no idea whether it exists or not.Conclusions: A significant proportion of the violence encountered in the clinical setting is perpetrated by relatives of the patients and it is more prevalent when gang members are present, especially in evening and night time. Most of the physical aggression and a significant proportion of the verbal aggression experienced by doctors are the result of negative media guide, poor communication, and long waiting period, presence of gang members and generally regard clinical issues arising from patient care. Training the resident doctors in good working practices, effective communication and alternative methods of resolving conflicts is generally seen as the way to reduce the likelihood of this type of aggression.