To study the clinical, laboratory characteristics and outcomes of multisystem inflammatory syndrome in children (MIS-C) temporally related to coronavirus disease 2019 (COVID-19) in a resource-limited setting. All children meeting the World Health Organization case definition of MIS-C were prospectively enrolled. Baseline clinical and laboratory parameters were compared between survivors and non-survivors. Enrolled subjects were followed up for 4–6 weeks for evaluation of cardiac outcomes using echocardiography. The statistical data were analyzed using the stata-12 software. Thirty-one children with MIS-C were enrolled in an 11-month period. Twelve children had preexisting chronic systemic comorbidity. Fever was a universal finding; gastrointestinal and respiratory manifestations were noted in 70.9% and 64.3%, respectively, while 57.1% had a skin rash. Fifty-eight percent of children presented with shock, and 22.5% required mechanical ventilation. HSP like rash, gangrene and arthritis were uncommon clinical observations.The median duration of hospital stay was 9 (6.5–18.5) days: four children with preexisting comorbidities succumbed to the illness. The serum ferritin levels (ng/ml) [median (IQR)] were significantly higher in non-survivors as compared to survivors [1061 (581, 2750) vs 309.5 (140, 720.08), p value = 0.045]. Six patients had coronary artery involvement; five recovered during follow-up, while one was still admitted. Twenty-six children received immunomodulatory drugs, and five improved without immunomodulation. The choice of immunomodulation (steroids or intravenous immunoglobulin) did not affect the outcome. Most children with MIS-C present with acute hemodynamic and respiratory symptoms.The outcome is favorable in children without preexisting comorbidities.Raised ferritin level may be a poor prognostic marker. The coronary outcomes at follow-up were reassuring. Supplementary Information The online version contains supplementary material available at 10.1007/s00296-021-05030-y.

Background:“Dhat syndrome” is believed to be a culture-bound syndrome of the Indian subcontinent. Although many studies have been performed, many have methodological limitations and there is a lack of agreement in many areas.Aims:The aim is to study the phenomenology of “Dhat syndrome” in men and to explore the possibility of subtypes within this entity.Settings and Design:It is a cross-sectional descriptive study conducted at a sex and marriage counseling clinic of a tertiary care teaching hospital in Northern India.Materials and Methods:An operational definition and assessment instrument for “Dhat syndrome” was developed after taking all concerned stakeholders into account and review of literature. It was applied on 100 patients along with socio-demographic profile, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Mini International Neuropsychiatric Interview, and Postgraduate Institute Neuroticism Scale.Statistical Analysis:For statistical analysis, descriptive statistics, group comparisons, and Pearson's product moment correlations were carried out. Factor analysis and cluster analysis were done to determine the factor structure and subtypes of “Dhat syndrome.”Results:A diagnostic and assessment instrument for “Dhat syndrome” has been developed and the phenomenology in 100 patients has been described. Both the health beliefs scale and associated symptoms scale demonstrated a three-factor structure. The patients with “Dhat syndrome” could be categorized into three clusters based on severity.Conclusions:There appears to be a significant agreement among various stakeholders on the phenomenology of “Dhat syndrome” although some differences exist. “Dhat syndrome” could be subtyped into three clusters based on severity.

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Olanzapine, a 2nd generation antipsychotic, is in use in the clinical practice for nearly a decade and a half now. It is classified as a category C drug with very few reports of its toxic effects on the fetus. In general, the risk benefit analysis warrants its use in pregnancy. We report a case of microcephaly and anopthalmos associated with the use of olanzapine in pregnancy. Although a causal role cannot be unequivocally proven, it calls for larger studies to explore this issue.

BackgroundNo study from India has examined pathways to care in alcohol using population systematically.ObjectivesThe present study aimed to understand the pathways to care among alcohol-dependent individuals seeking help at a tertiary care center.Patients and MethodsIt was a cross-sectional, observational study. A total of 58 subjects diagnosed with alcohol- dependence syndrome as per DSM-IV-TR were included in the study. Pathways to care were assessed using the world health organization encounter form.ResultsFor 56.9% of the subjects, first point of contact was with a tertiary care addiction psychiatrist. Traditional healers were consulted by about 5.2% of the patients seeking help for the first time. The mean duration of main problems due to alcohol use was 5.82 ± 4.95 years. The first contact tended to be at place nearer to the patient’s residence while further contacts tended to be farther away. Family, friends and neighbours together constituted the single largest group suggesting patients to seek care.ConclusionsThere is a long time lag between the onset of alcohol use related problems and the first help seeking attempt. Of those who do decide to seek help, the proportion of those obtaining specialist help is higher than commonly believed.