There is a lack of scientific data to use as local evidence on resuscitation science from the Indian subcontinent and other developing countries, making it difficult to develop regional guidelines and updates on practice of resuscitation based on the context, resources, infrastructure, geographical variabilities, values, and preferences. In this report, we try to identify key problem statements and plan to expand the list related to resuscitation practices primarily for in-hospital cardiac arrest (CA) in infants and children in India. To stimulate local research and data collection on resuscitation science and practices, Indian Resuscitation Council Federation proposes the concept of National CPR Registry and post-CA care bundle in the form of a checklist targeted for Indian settings.

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Takayasu's arteritis (TA) is a rare primary vasculitis, typically affecting the aorta and its main branches causing progressive vessel wall inflammation with concentric wall thickening and stenosis producing a variety of ischemic symptoms or aneurysms. Although etiopathogenesis of this disease remains poorly understood, an autoimmune basis is widely suggested in addition to genetic and environmental factors, among which evidence implicating Mycobacterium tuberculosis (MT) has been provided. We discuss hereby a 12-year-old boy brought with refractory renovascular hypertension secondary to aortoarteritis as found on ultrasound Doppler and computed tomography angiogram, who, apart from fulfilling criteria for TA, was also found to have latent tuberculosis. He was managed with multiple antihypertensives, immunosuppressants, and antitubercular therapy, despite which he developed hypertensive crises. A renal angioplasty proved beneficial as hypertension was better controlled allowing a gradual taper of all antihypertensives over an 8-week period and improved renal blood flow and renal function.

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Digestive property intrinsic to pancreatic secretions can cut through the fascial planes and may form a pancreaticopleural fistula which is an extremely rare critical complication of pancreatitis in children. It links the pancreas with the pleural cavity through the diaphragmatic hiatus which can feed the pleural space with amylase-rich secretions and can cause recurrent pleural effusion. We report a rare case of gross left-sided pleural effusion (hemothorax) in a patient due to pancreatic etiology. The clinical presentation was deceptive since the patient presented with predominantly respiratory complaints. Many patients go through extensive pulmonary evaluation before the pancreas is recognized as the site of basic pathology. Pleural fluid amylase levels and visualizing the fistula tract from the pancreatic duct to the pleural space by radiological imaging provide the confirmation of this complication. High index of suspicion of pancreatic etiology in recurrent massive hemorrhagic pleural effusion may lead to prompt diagnosis.

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With pediatric spinal cord injuries themselves being an infrequent event worldwide, complete transection of the spinal cord forms an extremely small subset of the same. Moreover, complete transection of spinal cord without the concurrent presence of vertebral compression fractures has rarely been reported in the pediatric age group. We hereby present a pediatric case with traumatic brain injury as well as complete thoracic spinal cord transection and probe the possible mechanisms that contribute to these injuries in the pediatric age group. We also discuss the challenges faced in the diagnostic evaluation as well as the therapeutic dilemmas in the given scenario due to the multiple ongoing issues.

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Pediatric acquired aphasia is an uncommon presenting complaint in children. Because of many etiologies that may prove fatal, it is essential to take immediate essential steps for diagnoses and treatment. We are presenting a 9-year-old child who was conscious, alert and did not have any other systemic findings at presentation. After initial and then more extensive workup, he was diagnosed with herpes encephalitis. Acyclovir has been started as empirical antiviral therapy. In the course of disease, he developed status epilepticus that was controlled with multi anti-epileptic drugs. Intravenous acyclovir continued for 21 days, and anti-epilepticus medicines were given at discharge.

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Severe acute respiratory syndrome coronavirus 2 created a pandemic across the world leading to several affected cases and deaths. The current case series focuses on clinical characteristics of COVID pneumonia in eight children during the second wave. Cases with respiratory symptoms and high-resolution computed tomography findings suggestive of COVID pneumonia were included. Five had moderate-to-severe symptoms and three had mild symptoms. All the severe/moderately severe cases were obese. Two cases with moderate-to-severe disease and two cases with mild disease had comorbidities. All the children recovered and were discharged. C-reactive protein (CRP) levels were higher in accordance with severity of disease. Some cases had fatigue, weakness, acne, hypertension, intermittent fever in postdischarge period. We conclude that pediatric COVID pneumonia mostly affected obese teenagers and responded well to treatment; however, regular follow-up is essential for post-COVID complications.

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Background: Children had been affected less by COVID-19 than adults. But as the pandemic progressed more cases of severe pediatric COVID infection were reported. Aim of this study is to describe the clinical characteristics, laboratory parameters, treatments, and predictors of pediatric intensive care unit (PICU) admission among hospitalized children with SARS-CoV-2 infection. Subjects and Methods: This was a retrospective, observational study performed in a tertiary care COVID referral hospital among hospitalized children aged from 1 month to 12 years, from May 2020 to March 2021. Children treated in the pediatric ward were compared with those admitted in the PICU to assess predictors of intensive care admission. Results: Out of 447 hospitalized patients with confirmed COVID-19 infection, 92 (20.58%) required admission in the PICU. Mean age of the study population was 44.58 (16.77–72.39) months. Thirty-eight patients (8.50%) fulfilled multisystem inflammatory syndrome in children (MIS-C) diagnostic criteria. Invasive mechanical ventilation and inotropic support were needed for 28.26% and 36.96% of PICU-admitted patients, respectively. The mortality rate was 1.57%. Independent risk factors for PICU admission were infant age group, longer duration of fever (>5 days), shortness of breath, presence of shock, underlying comorbidities and higher pediatric early warning score (PEWS ≥5), poor Glasgow coma scale (GCS <7), MIS-C, elevated C-reactive protein (CRP >50 mg/L), neutrophil–lymphocyte ratio (NLR ≥4.5), and hypoalbuminemia (<2.5 g/dL). Conclusions: Clinical factors such as infancy, prolonged fever, respiratory distress at admission, shock, higher PEWS, poor GCS, and comorbidities indicate at risk for severe disease. Simple laboratory parameters such as CRP, NLR ≥4.5, and albumin may be considered as screening at admission to predict need of PICU care.

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