there any relationship of age and sex to the etiology and outcome of medical coma?

As the diseases behave differently in males and females and even in different age groups, particular attention was made to classify and observe the distribution of various causes of coma according to age and sex of the patient in order to formulate our indigenous database for future reference. We studied the coma etiology with particular reference to the age and sex of the patient, and the outcome. All the 517 [312 male [60.35%] and 205 female [39.65%]] patients were divided into 7 groups according to decades from age 12 to 80 years. Patients older than 40 years predominated [318 [61.5%]]. Metabolic coma was predominant cause in almost all age groups. Structural coma was increasing progressively with the age. Poisonings were the common cause in patients under 30, representing 35.85% of all comas in the age group 12-20, and 33.70% in the group from 21-30 years. In the next two decades [31-50 years], hepatic and renal failure predominated making up more than half of all causes. Leading causes among males we re poisonings [69 cases], hemorrhagic CVA [48 cases], ischemic CVA [24 cases], renal failure [28 cases] and hepatic coma [35 cases]. Similarly among females causal distribution revealed renal failure [34 cases], followed by hepatic coma [29 cases], and hemorrhagic CVA [26 cases]. Out of the 476 [92%] patients whose outcome could be determined 297 [57.4%] were discharged after recovery and 179 [34.6%] died. Eighty out of 205 female patients died [39%], while 99 out of 312 males had a fatal outcome [31.7%]. We conclude that coma etiology has a significant effect on prognosis, while such significance could not be assigned to age or sex

Chronic rheumatic endocarditis an echocardiographic study

Chronic rheumatic endocarditis [CRE] is a major problem especially in the under developed countries'. The prevalence rate in India is about 6.4 per 1000 rural population and increases with age upto 25 years. While it has been predominantly eradicated from the west it is a common complication of rheumatic fever [RF] and the leading cause of cardiac death in the young population in the underdeveloped countries. Bland and Jones showed that following acute rheumatic fever after 20 years 45% had evidence of CRE. About 3-5% of patients with group-A beta hemolytic streptococci develop RF but the incidence increases to about 50% in the first year following the initial attack of RF and falls quite steeply reaching a plateau at 10% after 4 or 5 years. Widespread use of echocardiography and Doppler flow studies have highlighted this problem and enabled an early and accurate anatomical diagnosis. The incidence of various valvular involvement in patients with CRE presenting with cardiac murmurs is presented