Their use is complicated by probe displacement, hemorrhage, and infection, which are particularly pertinent limitations in resource poor sub-Saharan Africa ( 1). However, tools for monitoring ICP are invasive and require technical proficiency to ensure safety and accuracy, and cannot therefore be placed promptly in the acutely unconscious patient at risk of herniation. Intensive monitoring of ICP may help to identify patients at risk of herniation and improve outcome. Indeed, catastrophic intracranial herniation is well described in association with a variety of encephalopathic illnesses, and is a real risk in the acute setting, including well-resourced setups. It impairs cerebral perfusion, leading to ischemic brain injury, and may result in death due to intracranial herniation. Raised ICP is common in all these encephalopathies. Predictors of poor outcome include deep coma, recurrent seizures, shock, and raised intracranial pressure (ICP). These diseases are associated with high mortality and neurocognitive sequelae among survivors. In sub-Saharan Africa, it is most frequently caused by cerebral malaria (CM), acute bacterial meningitis (ABM), and viral encephalitides. Raised TMD pulse pressure measurements are associated with death and may be useful in detecting and monitoring risk of intracranial herniation and intracranial pressure in childhood coma.Īcute coma is a common severe neurological presentation of infectious diseases in children. Adjusting for diagnosis, every 50 nl rise in both semirecumbent and recumbent CPA was associated with increased odds of death associated with intracranial herniation (OR: 1.61, 95% confidence interval (CI): 1.07, 2.41 P = 0.02 and OR: 1.35, 95% CI: 1.10, 1.66 P ≤ 0.01 respectively). We recruited 75 children (32 (43%) females median age 3.3 (IQR: 2.0, 4.3) years). We examined middle ear function using tympanometry and measured cardiac pulse (CPA) and respiratory pulse pressure amplitudes (RPA) using the TMD analyzer.
#Intra aural serial
Methods:īetween November 2007 and September 2009, we made serial TMD measurements and clinical observations on children with acute coma (Blantyre coma score (BCS) ≤ 2) on the pediatric high dependency unit of Kilifi District Hospital, and on well children presenting to the hospital’s outpatient department for routine follow-up. Microscope immersion oil is the most effective agent for immobilizing and killing intra-aural cockroaches.We explored the relationship between tympanic membrane displacement (TMD) measurements, a tool to monitor intracranial pressure noninvasively, and clinical features and death in children with acute coma in Kilifi, Kenya. Total activity was also least in the microscope oil group (F = 25.7, P <. The other agents required more than 40 seconds and were inferior to oil (F = 15.5, P <. Microscope oil killed the insects most quickly (mean, 27.2 seconds 95% confidence interval, 23.8 to 30.6). Analysis was by analysis of variance with Tukey's procedure.įour groups of 40 cockroaches each were exposed to each of the four agents. Measured variables were time to death and time-integrated activity before death. Responses of cockroaches were recorded with a video-cassette recorder and evaluated later by a blinded observer. To determine which chemical agent is most effective for immobilizing and killing intra-aural cockroaches, we carried out the following investigation.Ī model was developed in which live cockroaches were submerged in microscope immersion oil, 2% lidocaine, 4% lidocaine, or 2% viscous lidocaine in a glass beaker. The treatment of live insects in patients' ears is controversial.
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