Prognostic value of initial Glasgow coma score in comatosed patients on medical floor

An open non-randomized prospective observational study of comatosed patients was conducted to correlate initial Glasgow Coma Score [GCS] with the outcome in patients having medical coma at Mayo Hospital, Lahore between January 2002 to September 2003. A total of 273 patients were followed throughout their hospital stay to determine the outcome after the current episode of coma. A thorough history and examination was obtained for each case. The 3 category Glasgow Coma Score was recorded as an indication of the degree of unconsciousness. One of three possible outcome categories was established, recovery [discharge], death, and referral or self discharge [by attendants] against medical advice. The outcome of 248 patients [90.84%] was established i.e. 152 [61.29%] were discharged after recovery and 96 [38.71%] died. The remaining 25 [09.16%] patients were lost to follow up. Four subcategories of the Glasgow Coma Score were made, at 3-point intervals. In the lowest score category [score 3-5] there was 59.67% mortality and only 30.66% patients were successfully treated and discharged. In the category of GCS 6-8, 30.91% died and 60% were discharged, while in the 9-11 category, 26.47% died and 66.18% were discharged. In the highest score category [12-15], 27.27% deaths occurred, probably related to the severity of main event, and 62.50% were discharged. The depth of coma as reflected by the initial GCS can reliably be used to predict the outcome in comatosed patients

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

Frequency of asymptomatic spontaneous bacterial peritonitis in chronic liver disease patients with first presentation of ascites

This study is done to assess the frequency of asymptomatic spontaneous bacterial peritonitis in chronic liver disease patients with first presentation of ascites. Design: Case control study. Place and duration of study: This study was carried out on patients attending Medical special ward Services hospital and PTCL medical center Lahore from June 2002 to October 2003. Patients and method: One hundred and fifty chronic liver disease patients with first presentation of ascites were screened for presence of asymptomatic spontaneous bacterial peritonitis. 9.3% of patients in this study had asymptomatic spontaneous bacterial peritonitis. Asymptomatic spontaneous bacterial peritonitis can be present in first presentation of ascites in chronic liver disease patients. It is suggested that this condition should be actively sought in all chronic liver disease patients who develop ascites for the first time. Further studies should be done to assess for prognostic implications of treating such cases

Serum gastrin and its correlation with hyperacidity in patients of duodenal ulcer

Fasting serum gastrin levels were studied in 70 patients of duodenal ulcer. The mean level was 122,92 pg/ml +/- 74.38. In 30 of these patients the post-prandial serum gastrin was also performed, and found to be 131.97 pg/ml which was not significantly high to be of diagnostic value. In 20 of these patients, both serum gastrin and the acid output studies were carried and, but no correlation was found between them except that, the higher acid outputs were accompanied with higher serum gastrin levels

Intestinal pseudo obstruction

The syndrome of intestinal pseudo obstruction is a continuing challenge to the clinician. It is thought to be a rare disease, but it appears to be more common than is generally recognised and should be diagnosed by having a higher index of suspicion. Colonoscopy, Serial plain supine films and gastro grafin enemas are useful diagnostic aids in excluding other conditions; treatment in experienced hands can avoid unnecessary surgery and hence reduce surgical morbidity and mortality

Surgical history of intestinal obstruction

Hippocrates observed and treated Intestinal obstruction. Praxagoras [350 BC] probably performed the earliest recorded operation for intestinal obstruction. However, non-operative treatment remained the general rule including reduction of Hernias, opium for pain, orally administered mercury lead shot. Electrical stimulation and gastric lavage in an endeavour to overcome the obstruction, surgery became more frequently used for intestinal obstruction amid considerable debate in the nineteenth century