Complications from Infective Corneal Conditions Treated by Tarsorrhaphy

Background: Complications from infective corneal conditions are an important cause of blindness in adults and children. The eyelids play a major role in the pathogenesis of staphyloma and the perforation of descemetoceles. Tarsorrhaphy could, therefore, be beneficial in treating serious complications from infective corneal conditions. Method: The case records of 46 patients (47 eyes) who were treated by tarsorrhaphy were analyzed in terms of demography, bacteriological studies and pre- and post-surgical intervention visual acuity. Result: The best pre-surgical intervention vision ‘hand movement' improved to 6/60 or better while the worst result was cosmetically amenable phthisis bulbi. Conclusion: Tarsorrhaphy restored some useful vision in otherwise hopeless cases of infective corneal conditions. [Nig. J. Ophthalmology Vol.11(1) 2003: 42-44

Public exposure to natural radioactivity and radon exhalation rate in construction materials used within Greater Accra Region of Ghana

The natural radioactivity of 238U, 232Th, 40K, radiological hazards and 222Rn exhalation rate in building materials used within Greater Accra Region of Ghana, have been measured using Gamma spectrometry and CR-39. The results obtained are as follows 238U (2.6–47.1 Bq/kg), 232Th (3.6–43.0 Bq/kg), 40K (62.8–1222.2 Bq/kg), radium equivalent (32.7–174.3 Bq/kg), internal hazard index (0.04–0.51), external hazard index (0.04–0.23), activity concentration index (0.10–0.63 mSv/y) absorbed dose rate (9.5–76.3 nGy/h), outdoor effective doses (11.6–93.6 μSv/y), indoor effective doses (46.5–374.1 μSv/y,) and excess lifetime cancer risk (0.04 × 10−3–0.33 × 10−3). 222Rn exhalation rate (3.1 × 10−5–11.4 × 10−5 Bq/m2 h), 222Rn activity (17.4–42.6 Bq/m3), effective radium (0.19–0.64 Bq/kg). Positive correlation was found between 238U and 222Rn. The results were discussed in terms of limits to the accepted natural radioactivity levels and compared with similar studies reported in other countries. The gneiss rocks recorded excess lifetime cancer risk values of (0.32 × 10−3 and 0.33 × 10−3) greater than the world value of 0.29 × 10−3 proposed by UNSCEAR, 2000. With exception gneiss rocks from Shai hills which recorded high value of cancer risk as compare to the world average value, all the studied building materials do not pose any radiological effects to the people of Greater Accra Region when used for construction. Keywords: HPGe, CR-39, 222Rn, NORMS, Construction material

Competitiveness of Root Crops for Accelerating Africa’s Economic Growth, 12th Triennial Symposium of International Society for Tropical Root Crops Africa Branch (ISTRCAB), Accra, Ghana, 30 September- 5 October 2013

Book of Abstracts and Programm

Competitiveness of Root Crops for Accelerating Africa’s Economic Growth, 12th Triennial Symposium of International Society for Tropical Root Crops Africa Branch (ISTRCAB), Accra, Ghana, 30 September- 5 October 2013

Book of Abstracts and Programm

Clinical Impact of External Laryngeal Manipulation during Laryngoscopy on Tracheal Intubation Success in Critically Ill Children

© Copyright 2017 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. Objectives: External laryngeal manipulation is a commonly used maneuver to improve visualization of the glottis during tracheal intubation in children. However, the effectiveness to improve tracheal intubation attempt success rate in the nonanesthesia setting is not clear. The study objective was to evaluate the association between external laryngeal manipulation use and initial tracheal intubation attempt success in PICUs. Design: A retrospective observational study using a multicenter emergency airway quality improvement registry. Setting: Thirty-five PICUs within general and children\u27s hospitals (29 in the United States, three in Canada, one in Japan, one in Singapore, and one in New Zealand). Patients: Critically ill children (\u3c 18 years) undergoing initial tracheal intubation with direct laryngoscopy in PICUs between July 1, 2010, and December 31, 2015. Measurements and Main Results: Propensity score-matched analysis was performed to evaluate the association between external laryngeal manipulation and initial attempt success while adjusting for underlying differences in patient and clinical care factors: age, obesity, tracheal intubation indications, difficult airway features, provider training level, and neuromuscular blockade use. External laryngeal manipulation was defined as any external force to the neck during laryngoscopy. Of the 7,825 tracheal intubations, the initial tracheal intubation attempt was successful in 1,935/3,274 intubations (59%) with external laryngeal manipulation and 3,086/4,551 (68%) without external laryngeal manipulation (unadjusted odds ratio, 0.69; 95% CI, 0.62-0.75; p \u3c 0.001). In propensity score-matched analysis, external laryngeal manipulation remained associated with lower initial tracheal intubation attempt success (adjusted odds ratio, 0.93; 95% CI, 0.90-0.95; p \u3c 0.001). Conclusions: External laryngeal manipulation during direct laryngoscopy was associated with lower initial tracheal intubation attempt success in critically ill children, even after adjusting for underlying differences in patient factors and provider levels. The indiscriminate use of external laryngeal manipulation cannot be recommended

Cricoid Pressure during Induction for Tracheal Intubation in Critically Ill Children: A Report from National Emergency Airway Registry for Children

© 2018 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. Objectives: Cricoid pressure is often used to prevent regurgitation during induction and mask ventilation prior to high-risk tracheal intubation in critically ill children. Clinical data in children showing benefit are limited. Our objective was to evaluate the association between cricoid pressure use and the occurrence of regurgitation during tracheal intubation for critically ill children in PICU. Design: A retrospective cohort study of a multicenter pediatric airway quality improvement registry. Settings: Thirty-five PICUs within general and children\u27s hospitals (29 in the United States, three in Canada, one in Japan, one in Singapore, and one in New Zealand). Patients: Children (\u3c 18 yr) with initial tracheal intubation using direct laryngoscopy in PICUs between July 2010 and December 2015. Interventions: None. Measurements and Main Results: Multivariable logistic regression analysis was used to evaluate the association between cricoid pressure use and the occurrence of regurgitation while adjusting for underlying differences in patient and clinical care factors. Of 7,825 events, cricoid pressure was used in 1,819 (23%). Regurgitation was reported in 106 of 7,825 (1.4%) and clinical aspiration in 51 of 7,825 (0.7%). Regurgitation was reported in 35 of 1,819 (1.9%) with cricoid pressure, and 71 of 6,006 (1.2%) without cricoid pressure (unadjusted odds ratio, 1.64; 95% CI, 1.09-2.47; p = 0.018). On multivariable analysis, cricoid pressure was not associated with the occurrence of regurgitation after adjusting for patient, practice, and known regurgitation risk factors (adjusted odds ratio, 1.57; 95% CI, 0.99-2.47; p = 0.054). A sensitivity analysis in propensity score-matched cohorts showed cricoid pressure was associated with a higher regurgitation rate (adjusted odds ratio, 1.01; 95% CI, 1.00-1.02; p = 0.036). Conclusions: Cricoid pressure during induction and mask ventilation before tracheal intubation in the current ICU practice was not associated with a lower regurgitation rate after adjusting for previously reported confounders. Further studies are needed to determine whether cricoid pressure for specific indication with proper maneuver would be effective in reducing regurgitation events

Family Presence During Pediatric Tracheal Intubations

Family-centered care, which supports family presence (FP) during procedures, is now a widely accepted standard at health care facilities that care for children. However, there is a paucity of data regarding the practice of FP during tracheal intubation (TI) in pediatric intensive care units (PICUs). Family presence during procedures in PICUs has been advocated. To describe the current practice of FP during TI and evaluate the association with procedural and clinician (including physician, respiratory therapist, and nurse practitioner) outcomes across multiple PICUs. Prospective cohort study in which all TIs from July 2010 to March 2014 in the multicenter TI database (National Emergency Airway Registry for Children [NEAR4KIDS]) were analyzed. Family presence was defined as a family member present during TI. This study included all TIs in patients younger than 18 years in 22 international PICUs. Family presence and no FP during TI in the PICU. The percentage of FP during TIs. First attempt success rate, adverse TI-associated events, multiple attempts (≥ 3), oxygen desaturation (oxygen saturation as measured by pulse oximetry <80%), and self-reported team stress level. A total of 4969 TI encounters were reported. Among those, 81% (n = 4030) of TIs had documented FP status (with/without). The median age of participants with FP was 2 years and 1 year for those without FP. The average percentage of TIs with FP was 19% and varied widely across sites (0%-43%; P < .001). Tracheal intubations with FP (vs without FP) were associated with older patients (median, 2 years vs 1 year; P = .04), lower Paediatric Index of Mortality 2 score, and pediatric resident as the first airway clinician (23%, n = 179 vs 18%, n = 584; odds ratio [OR], 1.4; 95% CI, 1.2-1.7). Tracheal intubations with FP and without FP were no different in the first attempt success rate (OR, 1.00; 95% CI, 0.85-1.18), adverse TI-associated events (any events: OR, 1.06; 95% CI, 0.85-1.30 and severe events: OR, 1.04; 95% CI, 0.75-1.43), multiple attempts (≥ 3) (OR, 1.03; 95% CI, 0.82-1.28), oxygen desaturation (oxygen saturation <80%) (OR, 0.97; 95% CI, 0.80-1.18), or self-reported team stress level (OR, 1.09; 95% CI, 0.92-1.31). This result persisted after adjusting for patient and clinician confounders. Wide variability exists in FP during TIs across PICUs. Family presence was not associated with first attempt success, adverse TI-associated events, oxygen desaturation (<80%), or higher team stress level. Our data suggest that FP during TI can safely be implemented as part of a family-centered care model in the PICU