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Respiratory failure is a consequence of malfunction of the respiratory system including neuronal and cellular aspects. The most common causes in children are pneumonitis, vasculitis, pulmonary edema, cystic fibrosis, tuberculosis, asthma, foreign-body aspiration, and respiratory infections of the upper and lower airways. Reduced immunological response due to critical illness, atrophy, and increased intestinal epithelial barrier permeability results in increased susceptibility to infections and the spread of pathogens. The search strategy included a PubMed search for articles from 2000 to 2022. Malnutrition is acquired in 50% of patients admitted to the pediatric intensive care unit, with the added burden of nutritional deficits worsening preexisting malnutrition. Nutrition forms an essential component in managing respiratory conditions, with the potential to change outcomes. Enteral nutrition (EN) can reduce inflammatory cytokine activation and release, as well as maintain gastrointestinal (GI) mucosal integrity, which lowers systemic bacterial invasion and sepsis. Therefore, EN should be the preferred mode of nutrition (when clinically indicated) to parenteral nutrition. ASPEN guidelines recommend the administration of a minimum of 1.5 g/kg/ day of protein in critically ill children. Reduction in the respiratory quotient may be achieved by lowering the carbohydrate intake in infants suffering from prolonged lung disease; however, a balance of carbohydrate and fat ratios is recommended. Immunonutrition helps in reducing inflammation and pro-inflammatory cytokine levels. During pediatric acute respiratory distress syndrome, an essential target to improve lung inflammation is the GI tract. However, no disease-specific recommendation for probiotics and immunonutrients has been established in children yet.

Rhinophyma is the most common form of phymatous rosacea, typically seen in men. It may appear de novo (without preceding inflammatory changes) or occur in patients with preexisting papulopustular rosacea. It is characterized by slow, bulbous, reddish-purple, painless enlargement of lower two-third of nose with rugose peau d’orange surface resulting from the enlargement of the sebaceous glands and subcutaneous tissue, which does not resolve spontaneously. Though benign, it causes lot of cosmetic and psychological concern. Commonly used treatment modalities include debulking by surgical excision, electrosurgery, carbon dioxide laser ablation, cryosurgery, or dermabrasion. Here we report a case series of three patients with Grade 3 rosacea as per National Rosacea Society grading, treated by radio frequency with good improvement.