Paracetamol (acetaminophen), though considered a safe, “over the counter” analgesic and antipyretic, can cause liver injury with overdose. Therapeutic misadventure is a unique problem where the existing nomogram used for acute poisoning is not applicable. In this context, early initiation of N-acetylcysteine even before a biochemical evidence of liver injury may be beneficial. A series of 6 children with this type of paracetamol overdose are presented here to increase the awareness and understanding of this problem since no such data is available from India.

This case report describes a case of H syndrome with characteristic cutaneous hyperpigmentation, hypertrichosis, sclerodermatous thickening, and multisystem involvement such as hearing loss and heart anomaly in an Indian patient. There are around 100 cases of this rare, autosomal recessive genodermatosis reported in the literature, out of which 10 cases are from the Indian population. The aim of this paper is to increase awareness about this novel inherited form of histiocytosis and insist on the role of dermatologists to identify such patients in our population where consanguinity is prevalent.

A 3 year old child was brought with fever, left parotid swelling and altered sensorium. Cultures from blood, pus and throat swab grew Burkholderia pseudomallei. A diagnosis of septicemic melioidosis with encephalopathy was made. She recovered following treatment with parenteral ceftazidime for 14 days, and 6 months of oral co trimoxazole and amoxycillin clavulanate. She is doing well on follow-up.

ObjectiveTo implement SATS (South African Triage system) in a pediatric emergency department. Tools: Nurses on triage duty applied SATS to all children attending ED during the study period; data was compiled and analysed.SATS is a validated four-category color-coded triage system. Rapid evaluation of clinical discriminators and an age-appropriate composite physiological score called Triage Early Warning Score (TEWS) constitute triage. Points are given for normal versus abnormal mobility, respiratory rate, heart rate, temperature and presence or absence of trauma. TEWS has three versions -below 3 years, 3-12 years and above 12 years. ResultsOf 3693 triaged children, 74 (2%), 469 (12.7%), 1054 (28.6%), 2096 (56.9%) were in the emergency (red), very urgent (orange), urgent (yellow) and non-urgent (green) groups respectively. 3299 children were discharged from the ED with 50 (1.51%), 383 (11.6%), 939 (28.4%), 1927 (58.4%) from red, orange, yellow, green groups respectively. Of 372 hospitalized children, 16 (4.3%), 76 (20.4%), 112 (29.7%), 168 (45.1%) were in red, orange, yellow, green groups respectively. 22 were referred to other hospitals; there were no deaths.50 of red and 383 of orange group were discharged from ED; over-triage rate was 26%. 161 of green group were hospitalized; under-triage rate was 7.6%.Mean time for triage was 4.4 minutes (range 3-5 minutes). LimitationsInter-observer variation in assigning triage codes was not studied; effectiveness of triage would depend on experience of the emergency nurse. SATS was not compared with other triage tools. ConclusionOur study supports the use of SATS as a primary triage tool in pediatric ED. Under-and over-triage rates were within the limits of ACSCOT guidelines. Percentage overtriage was higher than under-triage, thereby erring on the safe side.

An acoustic-impedance bridge designed by Zwislocki recently became available. The bridge allows the specification of the absolute acoustic impedance of the human car by yielding independent measures of acoustic reactance and resistance. This measurement of absolute impedance requires an accurate measure of the volume of the external ear. The test-retest reliability of volume measures, as well as those of resistance and reactance, was examined. Three examiners obtained volume measures by using two different techniques as well as measures of resistance and compliance (reactance) on 10 subjects in test and retest sessions. Results suggest that measurement of the volume of the ear canal is sufficiently repeatable to allow this procedure to serve as a first step in the measurement of absolute impedance with the Zwislocki bridge. Test-retest reliability of the compliance measures was also high. Test-retest measures of resistance yielded low correlations in spite of high interexaminer correlation in both sessions. It is postulated that unknown factors caused a real but nonsystematic shift in acoustic resistance over subjects, thus destroying test-retest correlation while preserving high interexaminer correlation. Further investigation is required to establish the validity of this hypothesis, but it can be concluded that the bridge itself is a reliable measuring device.