Contraindications for applying the mask were decreased consciousness, facial trauma and anatomical variations (e.g. tracheotomy, bearded men) that made application of the mask impossible.
In the past, we relied on clinical signs that have relatively low diagnostic accuracy (47% to 87%), especially when the patient had a decreased consciousness level, neurological deficit, other associated injuries, or was under the influence of drugs or medications [2].
Intrathecal saline infusion is used in urgent cases such as intractable pain or decreased consciousness.
Six children had concurrent CM and SMA and were categorized as "CM", and five children with SMA exhibited decreased consciousness but did not meet study criteria for CM.
This study represents a significant extension to previous studies of endothelial biomarkers in malaria as it includes a retinopathy-confirmed group of children with cerebral malaria and also includes children with decreased consciousness due to other febrile illnesses.
Efforts were made to minimize bias by selecting subjects from a single population (children presenting to QECH), and by using two types of controls, uncomplicated malaria illness (outpatient) and non-malarial febrile illness with decreased consciousness (inpatient).
The results of this study are encouraging, and suggest that a limited panel of endothelial biomarkers may be useful in differentiating between retinopathy positive CM and non-malarial febrile illness with decreased consciousness.
In this study, we included a NMFI group with decreased consciousness, which approximates the clinically ideal control group, i.e. children with incidental parasitemia and coma (bacterial meningitis, viral encephalopathy, etc).. CM is a clinical definition based on the presence of malaria parasitemia and coma with no other identifiable cause.
Plasma samples were tested from children recruited with uncomplicated malaria (UM; n = 32), cerebral malaria with retinopathy (CM-R; n = 38), clinically defined CM without retinopathy (CM-N; n = 29), or non-malaria febrile illness with decreased consciousness (CNS; n = 24).
Because of decreased consciousness, a lumbar puncture was performed and clear cerebrospinal fluid (CSF) was obtained.
