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Acute Necrotizing pancreatitis, a severe form of pancreatitis characterized by necrosis in and around pancreas is very rare in children and is associated with high rates of morbidity and mortality. The diagnosis of acute necrotizing pancreatitis is largely based on imaging findings. It has an incidence of 5-10% in adults with acute pancreatitis and even lesser in children. We present a case of a 3 years girl diagnosed with acute necrotizing pancreatitis associated with large bowel obstruction.

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Infantile hemangioma (IH) is the most common benign vascular tumours of infancy. These are known to cause consumptive hypothyroidism by transformation of T4 and T3 into their inactive metabolites. Here we are reporting a case of a seven month old child with hypothyroidism. The ultrasonography showed presence of normal thyroid and hemangioma in the nape of the neck. There were multiple hemangiomas of the liver. The child was treated with Levothyroxine 10mcg/kg/d, along with Prednisolone and Propranolol (2mg/kg/d) for two months. After two months, there was regression in the size of hemangiomas including the nape of neck. The thyroid function test was normal. She had started regaining her milestones of development.

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Total body water is distributed in the body as two-third in ICF and one-third in ECF which are divided by a cell membrane. ECF is further divided into effective arterial or plasma volume (25-30%) and interstitial volume (70-75%). Sodium is major solute in ECF and potassium in ICF. Total body sodium is determinant of arterial pressure and serum sodium is mainly responsible for plasma osmolality. Daily sodium requirement depends on size and age of the person. Dysnatremias are most common disorders seen in children. Hypernatremia (incidence 1-3%) is defined as plasma/serum sodium >145mEq/L and serum osmolality >295mosm/kg H2O and always associated with hypertonicity. Serum sodium is calculated by exchangeable serum sodium + exchangeable serum potassium/Total body water (TBW). Hypernatremia can only occur either due to gain in sodium or loss of water or combination of two.

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Introduction: Scrub typhus is a rickettsial disease grossly underdiagnosed in India due to lack of easily available diagnostic test. Due to delay in the diagnosis and initiation of treatment mortality is 30%.No pediatric study highlighted the cardiac complication. Objective: To study the cardiac complication of scrub typhus and electrocardiographic changes. Method: All scrub typhus fever between age group 5 yrs to 15 yrs who were admitted with high fever at two tertiary pediatric referral hospital of eastern India were evaluated for cardiac complications. Those with cardiac involvement were subjected to electrocardiography at admission, two, six and twelve weeks. Result: Eleven out of forty three cases showed features of myocarditis requiring vasopressor and five cases showed long QT without progress to ventricular tachycardia. Conclusion: Scrub typhus is a multisystem disease with a mortality upto 30% , cardiac complication is serious and observed in 26% of cases.

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Snake bite is a common but under-reported medical emergency accounting for 0.5% of all deaths with greater risk of fatal envenomation in children. In India, four species of venomous snake are most common but better classification of medically significant species is warranted. Snake venom is a mixture of peptides with enzymatic & toxic properties which mediate activation of cytokine cascades along with organ specific toxicities, manifesting into local and systemic symptoms. The syndromic approach of attributing a constellation of signs & symptoms to a particular family of venomous snake has clinical acceptance but overlaps exist. Management of snake bite victim starts with a first aid measures of reassurance, immobilization and quick transfer to hospital. Measures such as application of tourniquet, incision and suction are harmful & should not be done. On arrival at hospital, triage and stabilization of Airway, Breathing & Circulation (ABC) is done followed by a focused assessment to ascertain the severity of envenomation. Antivenom treatment is the mainstay of snake bite management. ASV should be started only when specific indications such as signs of neurotoxicity, coagulopathy, hypotension, hematuria are present. Indiscriminate use of ASV is strongly condemned. Currently 8-10 vials of ASV as initial dose with a maximum of 25 vials is recommended. There is no role of test dose of ASV. Measures to treat any ASV induced anaphylaxis should be ready prior to start of ASV treatment. Supportive treatment is as important in determining the final outcome of envenomation as ASV

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Maintaining asepsis is main component of intensive care. Adopting simple measures help in survival, decreasing morbidity, preventing hospital burden and economy health of family and nation. Various simple measures are hand washing, use of personnel protective devices, aseptic technique during procedures, and environmental cleanliness.

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C. difficile is a Gram-positive anaerobic that forms part of the normal intestinal flora of the human beings.C. difficile infection (CDI) is the most common cause of hospital acquired diarrhea/antibiotic associated diarrhea, in the adult patients.It has been reported that the pediatric CDI has been associated with increased mortality, longer hospital stay and higher costs among hospitalized children.The most important requirements to initiate active surveillance for CDI prevention areto categorise the patients as per the standard definitions, and need to rapidly detect colonisation, and cases of CDI.

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Ventilator associated pneumonia is common in adult intensive care units. Pediatric intensive care unit also faces the issue of VAP. Various factors (exogenous and endogenous) are responsible for developing VAP in critically ill patients. Diagnosing the VAP is also challenge to intensivist. Antibiotic resistance is major concern in the treatment of VAP and hence preventive strategies are key factors in management of VAP.

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