Procedural Sedation in Paediatric Practice.

Introduction: Providing sedation techniques during the performance of diagnostic and therapeutic procedures on children decreases anxiety and discomfort. A number of drugs are available for the purpose. A retrospective record study in Paediatrics department of Burdwan Medical College & Hospital showed oral triclofos and per rectal diazepam were the two commonly used drugs for the purpose. However, intranasal midazolam is claimed to be a near ideal agent for procedural sedation. So, the above study was to compare efficacy and safety of intranasal midazolam over oral triclofos and per rectal diazepam. Methods: Participants having ASA score I or II having age group 1 to 6 years requiring non-invasive or minimally invasive procedure were divided into three groups- one group received oral triclofos sodium, second group received per rectal diazepam and third group received intranasal midazolam spray prior to the procedure. Levels of sedation and recovery were scored using Ramsey sedation score and modified Aldrete scoring system respectively. Induction of sedation was defined as attainment of Ramsey sedation score of at least 3. Complete recovery was defined as a minimum score of 10 of modified Aldrete scoring system. Results: Both times of induction and recovery were significantly higher in triclofos group when compared to other two groups. Level of sedation attained was higher in per rectal diazepam group, although there was no case of over sedation. Adverse effects were comparable except for nasal irritation which was exclusively limited to midazolam group. Cost of therapy was higher with intranasal midazolam therapy than with per rectal diazepam therapy. Conclusion: Per rectal diazepam appear to be a more ideal drug for procedural sedation over intranasal midazolam and oral triclofos.

Neurotuberculosis mimicking brain tumour; A case report.

Summary: Neurotuberculosis is one of the grave complications of primary tuberculous infection. Extensive BCG vaccination of children and inadequate antituberculous drug therapy have led to the emergence of newer complex clinical pictures and diagnostic dilemma. Here we report a case of right-sided hemiparesis with features of raised intracranial tension in a sixyear- old boy. Neuroimaging revealed presence of a high grade astrocytoma. On clinical examination, right-sided cervical lymphadenopathy with discharging sinus and tenderness over right hip joint were present. On further investigation, these were proved to be of tubercular origin. All preliminary findings were in favour of disseminated tuberculosis, but the nature of CNS lesion was creating diagnostic dilemma. Etiological diagnosis of the CNS lesion was necessary, as, if it was not of tubercular origin, the management protocol would be different and with any delay we could have lost the patient. Though on routine CSF study, no AFB were present, but we confirmed the presence of mycobacterial DNA by polymerase chain reaction. Patient showed considerable improvement after being put on Anti-tubercular Treatment (ATT) and steroids. Tuberculous brain abscess is rare. Very few cases have been reported even in adults. Most reported cases are in immunocompromised patients. This case highlights the fact that tuberculous brain abscess can have atypical presentation even in immunocompetent children mimicking CNS malignancy. Careful examination and thorough investigation are required to establish the diagnosis. Timely initiation of appropriate therapy can reduce mortality and neurological sequelae.

Antinociceptive, cytotoxic and antibacterial activities of Cleome viscosa leaves

The methanol extract of the dried leaves of Cleome viscosa L., Cleomaceae, was investigated for its possible antinociceptive, cytotoxic and antibacterial activities in animal models. The extract produced significant writhing inhibition in acetic acid-induced writhing in mice at the oral doses of 250 and 500 mg/kg body weight (p<0.001) comparable to the standard drug diclofenac sodium at the dose of 25 mg/kg of body weight (p<0.001). The crude extract produced the most prominent cytotoxic activity against brine shrimp Artemia salina (LC50 28.18 μg/mL and LC90 112.20 μg/mL). The extract of C. viscosa L. exhibited significant in vitro antibacterial activity against Staphylococcus saprophyticus, Shigella sonnie, Salmonella typhi, Vibrio cholera, Streptococcus epidermidis, Shigella flexneri and Staphylococcus aureus with the zones of inhibition ranging from 10.76 to 16.34 mm. The obtained results provide a support for the use of this plant in traditional medicine and its further investigation.