A high index of suspicion is needed in pediatric patients with neurological symptoms being the sole presenting manifestation, to diagnose infection with the Human Immunodeficiency Vims (HIV). This is a write up of two such cases who were admitted to the pediatric intensive care unit with neurological manifestations. A 6 year old previously healthy child, who initially presented with intermittent drowsiness and fluctuation in blood pressure, later during hospital stay, developed progressive motor, cognitive, visual and language difficulties. Investigations revealed the child to be HIV positive and magnetic resonance imaging (MRI) findings were consistent with progressive multifocal leucoencephalopathy. A 12 yr old child had stroke initially (for which extensive work up had been done) and later, after 8 months presented with the same complaints along with severe pneumonia. He succumbed to severe opportunistic infections. That he was HIV positive, had not been detected during the first admission as left sided weakness was the only presenting manifestation.

Probiotics are living microbes, when adequately ingested confer benefits to the host which include shortened duration of infection or decreased susceptibility to pathogens. Probiotics improve gut banier function, restore non-pathogenic digestive flora, prevent colonization by pathogenic bacteria and have role in immunomodulation. In the era of increasing antibacterial resistance and fewer new antibiotics in the research pipeline, non-antibiotic approaches like use of probiotics offer a ray of hope to clinician in the prevention of nosocomial infections in critical ill patients. Till to date, trials conducted on the role of probiotics in critically ill patients have shown significant heterogenicity in clinical outcomes, type of strain studied, dose and duration of therapy. Hence, the current data does not offer sufficient evidence to draw a conclusion regarding clinical indications of probiotics in critically ill. Well designed clinical trials are needed to validate the effects of particular probiotics given at specific dosages and for specific treatment durations. Although probiotics are generally safe in critically ill, more information is needed on safety profile of probiotics particularly in immunocompromised patients.

Asthma continues to be a chronic illness affecting millions of children worldwide. In spite of veiy good controller medications now available, Status Asthmaticus is one of the most common diagnosis among children admitted to the Pediatric Intensive Care Units. There are also a veiy wide variety of therapeutic options available to the intensivist for treating an asthma exacerbation. Although in conditions of extremes, probably it is worth to utilize all the therapies possible, more often than not, a practitioner has to choose one vs the other. In view of potential side effects of all the therapies, it is valuable to understand the evidence behind them. in this brief review we have tried to summarize the options and the research behind them.

Acute bronchiolitis is the most common lower respiratory tract infection (LRTI) in infants and children less than two years of age. It is broadly defined as a clinical syndrome characterized by upper respiratory symptoms followed by lower respiratory infection and inflammation, resulting in wheeze and crackles. Supportive care with focus on oxygenation and hydration remains the main stay of therapy. Several recent evidence-based reviews reveal that bronchodilators or corticosteroids should not be routinely used in bronchiolitis. This review presents the current status of recent therapies such as nebulized hypertonic saline, lieliox, continuous positive airway pressure (CPAP), montelukast, surfactant, and inhaled furosemide. etc.

Acute encephalitis is one of the common neurological illnesses requiring admission of children in the intensive care unit. In developing countries, acute encephalitic presentation in children often results from various infections including viral, bacterial, fungal and protozoal. With the advent of better diagnostic modalities and advances in critical care management, more cases of encephalitis beyond infection have been identified. Autoimmune encephalitis, acute disseminated encephalomyelitis, vasculitis, paraneoplastic, toxin mediated and metabolic disorders are the non-infectious causes that attribute for encephalitis and encephalopathy in children. Early identification and treatment of these disorders can lead better neurological outcome. In tins review, the various common etiologies for non-infectious encephalitis, diagnosis and management of these disorders are discussed briefly.

Antibiotics remain the single biggest weapon that we have in our fight against infections. Sepsis continues to be one of the biggest problems faced by the critically ill children. They are either admitted to the ICU with a new infection or later in their course of illness, acquile an infection termed as nosocomial infection or a hospital acquired infection. There are not veiy many new antibiotics that are available to fight the bacterial infection. At the same time the microbes are rapidly developing resistance against antibiotics of all classes, seemingly winning this war against infections. Antibiotics are one class of dings that have the potential to affect the health of not only the patient but also of the entire society over a period of time. The rise of multidrug resistant organisms is a global phenomenon. It is imperative that we cherish and protect the dings with the goal of preserving them for generations to come. We may be able to do this by exercising Antibiotic stewardship. This refers to a set of coordinated strategies to improve the use of antimicrobial medications with the goal of enhancing patient health outcomes, reducing resistance to antibiotics and decreasing unnecessary costs. Antimicrobial stewardship is the responsibility of all physicians. We can each make a difference by exercising discipline in the management of patients. It is imperative that we tiy to protect the environment of appropriate handling of waste. Hand hygiene, appropriate isolation practices, terminal cleaning are all essential practices to reduce the spread of resistance organism. Selecting the right antimicrobial looks at various aspects of the patient and the drug pharmacokinetics and pharmacodynamics. This article will examine this concept and antibiotic stewardship in general, that makes the difference between success and failure in the treatment of infections and spread of multidrug reistance.

Dengue fever is the most important Arboviral infection in the world, with an estimated 100 million cases of dengue infection worldwide eveiy year with a large proportion of patients being children (1). Encephalitis is a rare complication of dengue virus infection and may occur as a consequence of intracranial hemorrhage, cerebral edema, hyponatremia, cerebral anoxia, release of toxic products or direct viral invasion.

A high index of suspicion is needed in pediatric patients with neurological symptoms being the sole presenting manifestation, to diagnose infection with the Human Immunodeficiency Vnus (HIV). This is a write up of two such cases who were admitted to the pediatric intensive care unit with neurological manifestations. A 6 year old previously healthy child, who initially presented with intermittent drowsiness and fluctuation in blood pressine, later during hospital stay, developed progressive motor, cognitive, visual and language difficulties. Investigations revealed the child to be HIV positive and magnetic resonance imaging (MRI) findings were consistent with progressive multifocal leucoencephalopathy. A12 yr old child had stroke initially (for which extensive work up had been done) and later, after 8 months presented with the same complaints along with severe pneumonia .He succumbed to severe opportunistic infections. That he was HIV positive, had not been detected during the first admission as left sided weakness was the only presenting manifestation.