Four Cases of Multisystem Inflammatory Syndrome in Adults Associated with SARS-COV-2 Infection - An Overview of Clinical Features, Diagnosis and Treatment.

The varied spectrum of presentation of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is intriguing. Multisystem inflammatory syndrome in children (MIS-C) is a well described and documented condition that is associated with the active or recent COVID-19 infection. A similar presentation in adults is termed as Multisystem inflammatory syndrome in Adults (MIS-A). With only very limited cases reported from the west, MIS-A is considered a rare and serious complication of COVID-19. However, it is not as uncommon as we think. Many cases go undiagnosed for lack of COVID -19 like symptoms and unawareness among treating clinicians about this newer clinical entity. Further, antibody testing and inflammatory markers are not easily available in many of the Indian hospitals especially in rural India where the second wave had been intense, thereby making it difficult for the diagnosis of MIS-A. Also, there is no clear treatment guideline for MIS-A unlike MIS-C where the treatment protocol is well laid out. Awareness about MIS-A among treating clinicians can thus help in further evaluation and increased identification of the syndrome at the early stages thereby helping in the early institution of treatment. Our tertiary COVID care hospital in South India which has handled about 5200 cases of COVID-19 is been able to identify 04 cases of MIS-A proving that this clinical entity is not as rare as it is thought but lacks reporting and prompt identification. Here we describe 04 cases of MIS-A and strive to bring in the various aspects of it, including the clinical presentation, laboratory markers, diagnostic criteria and treatment considerations in this post second wave of the COVID-19 pandemic in India.

Metal enrichment in beach sediments from Chennai Metropolis, SE coast of India.

A survey on the Partially Extracted Trace Metals (PETMs) concentration (Fe, Mn, Cr, Cu, Ni, Co, Pb, Zn, Cd) in beach sediments is reported for the first time from 57 different locations in Chennai Metropolitan City of Southeast coast of India. The concentration of PETMs suggests that they are mainly concentrated with organic matter in the crowded part of the industrial regions in the beaches from the northern part rather than the tourist beaches in the southern part of the city. The comparison on enrichment of trace metals indicates higher values of Pb, Ni in the beaches than lowest effect level (LEL) and effects range low (ERL) than the tourist beaches.