Objective: We describe the presentation, treatment and outcome of children with multisystem inflammatory syndrome with COVID-19 (MIS-C) in Mumbai metropolitan area in India. Methods: This is an observational study conducted at four tertiary hospitals in Mumbai. Parameters including demographics, symptomatology, laboratory markers, medications and outcome were obtained from patient hospital records and analyzed in patients treated for MIS-C (as per WHO criteria) from 1 May, 2020 to 15 July, 2020. Results: 23 patients (11 males) with median (range) age of 7.2 (0.8-14) years were included. COVID-19 RT-PCR or antibody was positive in 39.1% and 30.4%, respectively; 34.8% had a positive contact. 65% patients presented in shock; these children Conclusion: Initial data on MIS-C from India is presented. Further studies and longer surveillance of patients with MIS-C are required to improve our diagnostic, treatment and surveillance criteria.

Beta-thalassaemia major is a genetic blood disorder caused by the reduced synthesis of beta globin chain. The consequences of the resulting chronic anaemia are also common and include growth retardation, bone marrow expansion, extramedular hematopoiesis, splenomegaly, increased intestinal iron absorption, susceptibility to infections, and hypercoagulability. Transfusional iron overload can affect heart function by directly damaging tissue through iron deposition or via iron-mediated effects at other sites. Cardiac dysfunction is common in patients with thalassaemia and is the leading cause of mortality. The main cardiac abnormalities reported in patients with thalassaemia major (TM) and iron overload are left ventricular systolic and diastolic dysfunction, pulmonary hypertension, valvulopathies, arrhythmias and pericarditis. These cardiac abnormalities are a consequence of the general co-morbid conditions in thalassaemia but are closely related to concomitant endocrine deficiencies, hypercoagulability state and inflammatory milieu. Iron's toxicity within cells arises from its capacity to catalyse the production of reactive oxygen species that cause lipid peroxidation and organelle damage, which lead ultimately to cell death and fibrosis. With the introduction of new technologies such as cardiac magnetic resonance T2* , the early detection of cardiac iron overload and associated cardiac dysfunction is now possible, allowing time for reversal through iron chelation therapy.

Ventricular outpouching is a rare finding in prenatal sonography and the main differential diagnoses are diverticulum, aneurysm, and pseudoaneurysm in addition to congenital cysts and clefts. The various modes of fetal presentation of congenital ventricular outpouching include an abnormal four-chamber view on fetal two-dimensional echocardiogram, fetal arrhythmia, fetal hydrops, and pericardial effusion. Left ventricular aneurysm (LVA)/nonapical diverticula are usually isolated defects. Apical diverticula are always associated with midline thoracoabdominal defects (epigastric pulsating diverticulum or large omphalocele) and other structural malformations of the heart. Most patients with LVA/congenital ventricular diverticulum remain clinically asymptomatic but they can potentially give rise to complications such as ventricular tachyarrhythmias, systemic embolism, sudden death, spontaneous rupture, and severe valvular regurgitation. The treatment of asymptomatic LVA and isolated congenital ventricular diverticulum is still undefined. In this review, our aim is to outline a systematic approach to a fetus detected with ventricular outpouching. Starting with prevalence and its types, issues in fetal management, natural course and evolution postbirth, and finally the perpetual dilemma of serial observation or surgical correction is discussed.

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Background: Coronavirus disease 2019 (COVID-19) pandemic has affected both adults and children alike. It presented in cluster of cases in short period of time all across the world. In India, there were two such clusters called as first and second wave. World over mortality was more in adults than in children. But, few children also had severe disease during these waves.  Also, some presented with inflammatory state secondary to COVID-19 infection which is called as Multisystem Inflammatory syndrome in children (MIS-C). As major population affected with severe disease were older people this disease in initial phases was most studied in this population. It is thus necessary to observe and analyse disease manifestations, pattern and risk factors in children and also contrast these variables between the two waves. The objectives of the study was to compare and contrast clinico-demographic parameters and outcome predictors in children admitted with COVID-19 during the first and second waves.Methods: This is a retrospective analytical study comparing aforementioned parameters of children (with and without co-morbidity) admitted with COVID-19 infection between the two waves of pandemic in a tertiary care public pediatric hospital in Western Maharashtra.Results: First wave had 176 cases admitted over six months while the second wave had 185 cases over only three months. While proportion of cases with pneumonia requiring ICU stay was significantly higher in wave 2, those with MIS-C requiring inotropes was higher in wave 1. There was no difference in other clinico-demographic parameters of these cases irrespective of co-morbidity. Pneumonia, severe disease, hypoxia, need for inotropes or ICU care predicted poor outcome in both the waves.Conclusions: Though the pattern of presentation was different, the clinico-demographic variables and predictors of mortality were comparable between the two waves.