***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — The aim of this study was to evaluate the effects of hypertonic saline in stroke patients with increased intracranial pressure ( ICP ) after conventional therapy with mannitol had failed . Methods — Twenty-two episodes of ICP crisis occurred in 8 patients in whom the st and ard treatment of 200 mL of 20 % mannitol was not effective . ICP crisis was defined as an increase in ICP of 20 mm Hg ( n=18 ) , pupillary abnormality ( n=3 ) , or a combination of both ( n=1 ) . The patients were treated with 75 mL of 10 % saline over the course of 15 minutes . ICP , mean arterial blood pressure , and cerebral perfusion pressure were monitored for 4 hours . Blood gases , hematocrit , hemoglobin , pH , osmolarity , and electrolytes levels were measured before and 15 and 60 minutes after the start of infusion . Treatment was regarded as effective if ICP decreased > 10 % or the pupillary reaction had normalized . Results — Treatment was effective in all 22 episodes . The maximum ICP decrease was 9.9 mm Hg 35 minutes after the start of infusion . Thereafter , ICP began to rise again . There was no constant effect on mean arterial blood pressure , whereas cerebral perfusion pressure was consistently increased . Blood osmolarity rose by 9 mmol/L and serum sodium by 5.6 mmol/L. Potassium levels , hemoglobin , hematocrit , and pH were slightly decreased . No unexpected side effects were noted . Conclusions — Infusion of 75 mL hypertonic ( 10 % ) saline decreases elevated ICP and increases cerebral perfusion pressure in stroke patients in whom mannitol had failed . The effect on the ICP and cerebral perfusion pressure reaches its maximum after the end of infusion and is seen for 4 hours Abstract A double-blind evaluation of the effects of glycerol administration intravenously for 4 or 6 days in patients with acute stroke was completed in a stroke centre . Fifty-four patients with acute cerebral infa rct ion and eight patients with spontaneous intracerebral haemorrhage were admitted to the study . The neurological status was evaluated by use of a neurological scoring system . Patients with cerebral infa rct ion treated with glycerol showed significant improvement in neurological status compared to the patients treated with placebo ( BACKGROUND In sub-Saharan Africa , bacterial meningitis is common and is associated with a high mortality .  Adjuvant therapy with corticosteroids reduces mortality among adults in the developed world , but it has not been adequately tested in developing countries or in the context of advanced human immunodeficiency virus ( HIV ) infection . METHODS We conducted a r and omized , double-blind , placebo-controlled trial of dexamethasone ( 16 mg twice daily for 4 days ) and an open-label trial of intramuscular versus intravenous ceftriaxone ( 2 g twice daily for 10 days ) in adults with an admission diagnosis of bacterial meningitis in Blantyre , Malawi . The primary outcome was death at 40 days after r and omization . RESULTS A total of 465 patients , 90 % of whom were HIV-positive , were r and omly assigned to receive dexamethasone ( 233 patients ) or placebo ( 232 patients ) plus intramuscular ceftriaxone ( 230 patients ) or intravenous ceftriaxone ( 235 patients ) . There was no significant difference in mortality at 40 days in the corticosteroid group ( 129 of 231 patients ) as compared with the placebo group ( 120 of 228 patients ) by intention-to-treat analysis ( odds ratio , 1.14 ; 95 % confidence interval [ CI ] , 0.79 to 1.64 ) or when the analysis was restricted to patients with proven pneumococcal meningitis ( 68 of 129 patients receiving corticosteroids vs. 72 of 143 patients receiving placebo ) ( odds ratio , 1.10 ; 95 % CI , 0.68 to 1.77 ) . There were no significant differences between groups in the outcomes of disability and death combined , hearing impairment , and adverse events . There was no difference in mortality with intravenous ceftriaxone ( 121 of 230 patients ) as compared with intramuscular ceftriaxone ( 128 of 229 patients ) ( odds ratio , 0.88 ; 95 % CI , 0.61 to 1.27 ) . CONCLUSIONS Adjuvant therapy with dexamethasone for bacterial meningitis in adults from an area with a high prevalence of HIV did not reduce mortality or morbidity . In this setting , intramuscular administration was not inferior to intravenous administration of ceftriaxone for bacterial meningitis . ( Current Controlled Trials number , IS RCT N31371499 [ controlled-trials.com ] . ) Background Several reports have suggested that raised intracranial pressure ( ICP ) is a major contributor to death among children with cerebral malaria .  Mannitol , an osmotic diuretic , effectively lowers ICP and is used to treat post-traumatic raised ICP . It is not clear whether intravenous mannitol given to children with cerebral malaria improves clinical outcome . The objective of this study was to determine the effect of mannitol as adjunct therapy on the clinical outcome of children with cerebral malaria . Methods This r and omized double-blind placebo controlled clinical trial was carried out at the Emergency Paediatric ward of Mulago Hospital , Ug and a 's national referral and teaching hospital . One hundred and fifty six children aged 6 to 60 months with cerebral malaria were r and omized to either one dose of mannitol 1 g/kg or placebo , in addition to intravenous quinine . Main outcome measures included coma recovery time ; time to sit unsupported , begin oral intake ; duration of hospitalization ; death and adverse effects . Results Time to regain consciousness ( p = 0.11 ) , sit unsupported ( p = 0.81 ) , time to start oral intake ( p = 0.13 ) and total coma duration ( p = 0.07 ) were similar in both groups . There was no significant difference in the mortality between the placebo ( 13/80 or 16.3 % ) and mannitol ( 10/76 or 13.2 % ) groups : RR = 1.2 ( CI 0.5–2.7 ) . No adverse effects were observed after administration of mannitol . Conclusion Mannitol had no significant impact on clinical outcome of cerebral malaria . It is difficult to recommend intravenous mannitol as adjunct therapy for childhood cerebral malaria . Clinical registration number Clinical Trials.gov ID : Background : The burden that spontaneous bacterial meningitis ( SBM ) currently represents among HIV-1-infected patients is poorly known . Methods : We prospect ively evaluated 32 episodes of SBM in HIV-1-infected patients from the VACH ( VIH-Aplicación de Control Hospitalario ) Cohort  and compared findings with those of 267 episodes in uninfected persons , matched by age and year of infection . A group of 13,187 HIV-1-infected patients from the VACH Cohort were used to identify predictors for acquiring SBM . Results : Between 1997 and 2006 , we found 32 episodes of SBM among HIV-1-infected patients for an annual incidence rate of 62.0 cases per 100,000 population compared with 3.2 ( 3.0 to 3.4 ) per 100,000 population for uninfected patients ( P < 0.001 ) . The last CD4 ≥200/mm3 count was the only predictor for developing SBM . Compared with uninfected , HIV-1-infected patients with SBM had a greater prevalence of primary extrameningeal infection , especially pneumonia ( P = 0.02 ) , bacteremia ( P = 0.02 ) , focal neurologic signs ( P = 0.005 ) , seizures ( P = 0.06 ) , a lower cerebrospinal fluid to blood glucose ratio ( P = 0.02 ) , and a lower prevalence of nuchal rigidity ( P = 0.005 ) . Streptococcus pneumoniae was the most frequent etiologic agent among HIV-1-infected patients . HIV-1-infected patients  had neurologic complications more frequently ( P = 0.02 ) , a higher overall case fatality rate ( P = 0.004 ) , and greater incidence of neurologic sequelae ( P = 0.001 ) . Conclusions : Even in the highly active antiretroviral therapy era , the risk of developing SBM is 19 times higher among HIV-1-infected patients than among uninfected ones . It tends to present in severely immunosuppressed patients not previously vaccinated and off antiretroviral therapy , with a concomitant extrameningeal infection , bacteremia , and focal neurologic signs , and is caused by S. pneumoniae . SBM in HIV-1-infected patients carries a worse prognosis than in uninfected ones both in terms of lethality and sequelae Background and Purpose This clinical trial investigates the effectiveness of intravenous glycerol therapy in patients with acute cortical infa rct ion in whom intracerebral hemorrhage was rigorously excluded . Methods Within 48 hours of symptoms from their first ischemic stroke , 113 hospital in patients were r and omized into the trial , provided that hemorrhage was excluded by computed tomography and informed consent was obtained . Patients were stratified into alert , semicoma , and coma groups using the Glasgow Coma Scale . Treatment was allocated according to a double-blind , r and omized protocol ; 56 patients received 500 mL of 10 % glycerol in saline over 4 hours on 6 consecutive days , and 57 patients received corresponding placebo treatment with saline . Using a variety of objective scoring systems , patient follow-up was up to 6 months . Results Corresponding measures of outcome in the glycerol and placebo groups were similar . At 6 months , respective mortality rates were 17 of 56 and 16 of 57 , and mean ±SD improvements in scores were 9.98±14.40 vs 10.51±12.68 ( long-term ) , 1.12±7.20 vs 1.57±6.30 ( prognostic ) , −1.94±5.53 vs −2.06±5.34 ( Glasgow Coma Scale ) , and 21.72±23.40 vs 11.94± 18.10 ( Barthel Index rating in survivors ) . Hemolysis ( generally sub clinical ) was the only adverse effect . Conclusions There was no clinical ly or statistically significant difference in outcome between the groups ; a trend toward greater functional recovery among survivors was evident after treatment with glycerol Objectives Traumatic brain injury ( TBI ) is still a major cause of mortality and morbidity . Recent trials have failed to demonstrate a beneficial outcome from therapeutic treatments such as corticosteroids , hypothermia and hypertonic saline . We investigated the effect of a new hyperosmolar solution based on sodium lactate in controlling raised intracranial pressure ( ICP ) . Design and setting Prospect i ve open r and omized study in an adult ICU . Patients Thirty-four patients with isolated severe TBI ( Glasgow Coma Scale ≤ 8) and intracranial hypertension were allocated to receive equally hyperosmolar and isovolumic therapy , consisting of either mannitol or sodium lactate . Rescue therapy by crossover to the alternative treatment was indicated when ICP could not be controlled . The primary endpoint was efficacy in lowering ICP after 4 h , with a secondary endpoint of the percentage of successfully treated episodes of intracranial hypertension . The analysis was performed with both intention-to-treat and actual treatments provided . Measurements and results Compared to mannitol , the effect of the lactate solution on ICP was significantly more pronounced ( 7 vs. 4 mmHg , P = 0.016 ) , more prolonged ( fourth-hour-ICP decrease : −5.9 ± 1 vs. −3.2 ± 0.9 mmHg , P = 0.009 ) and more frequently successful ( 90.4 vs. 70.4 % , P = 0.053 ) . Conclusion Acute infusion of a sodium lactate-based hyperosmolar solution is effective in treating intracranial hypertension following traumatic brain injury . This effect is significantly more pronounced than that of an equivalent osmotic load of mannitol . Additionally , in this specific group of patients , long-term outcome was better in terms of GOS in those receiving as compared to mannitol . Larger trials are warranted to confirm our findings BACKGROUND Steroids are used as adjuvant treatment in childhood pyogenic meningitis to attenuate host inflammatory responses to bacterial invasion . We aim ed to assess the effectiveness of dexamethasone in management of acute bacterial meningitis in a developing country . METHODS In a double-blind , placebo controlled trial , we included 598 children with pyogenic meningitis who had been admitted to the children 's wards of the Queen Elizabeth Central Hospital , Blantyre , Malaw 
    Output:
    
Stratified analysis shows no effect modification with steroids ; we present aggregate effect estimates .
Authors ' conclusions Glycerol was the only osmotic therapy evaluated , and data from trials to date have not demonstrated an effect on death .
Glycerol may reduce neurological deficiency and deafness