Non Traumatic Coma in the Intensive Care Unit: Etiology and Prognosis.

Background Impaired consciousness and coma is common reason for admission into the intensive care unit .It results from many etiological factors with varying outcome. Causes may vary in different parts of the world as is the outcome depending on the availability of appropriate care to deal with those patients. Objective To identify the etiological factors responsible for non traumatic coma and also evaluate if those factors influence the prognosis. Method This is a hospital based cross sectional study carried out at Nobel Medical College, Biratnagar between December 2019 and December 2020. All the patients who were admitted into the intensive care unit with coma due to non traumatic causes were included in the study. Result One hundred seven patients were enrolled in the study with mean age of the patient 54.5±19 years. There were 61(57%) male. Forty seven (43.9%) patients died while 60(56.1%) patients survived. Common etiological factors identified were impaired renal function 32(29.9%), anoxia 30 (28%), sepsis 28(26.2%), stroke 26(24.3%), metabolic derangement 21(19.6%). Coma due to sepsis was significantly associated with mortality (p=0.001) as was impaired renal function (p =0.035), cardiac disease (p=0.016) and low Glasgow Coma Scale (p=0.046). We did not find any association between age (p=0.53), gender (p=0.94) duration of coma (p=0.75) and mortality. Conclusion Impaired consciousness is a common problem encountered in the intensive care unit with very high mortality. Low Glasgow Coma Scale, Sepsis, impaired renal function and cardiac disease were associated with higher mortality.

Outcome of Patients with Meningitis and Encephalitis at Tertiary Care Hospital in Eastern Nepal.

Background There are several etiologies of meningitis and encephalitis which must be considered in any patient presenting with fever, headache, neck stiffness and vomiting. Bacterial meningitis and viral encephalitis are medical emergencies and need urgent attention and treatment. Any delay in diagnosis and treatment has been shown to increase morbidity and mortality. Some of the survivors also have neurological sequel with a need for long term physical and occupational rehabilitation. Objective To find out common causes of meningitis, encephalitis, predictors of outcome, early and late complications of meningitis and encephalitis at Tertiary Care Hospital in Eastern Nepal. Method It is a prospective study which was conducted at Nobel Medical College Teaching Hospital from April 2015 to March 2016. Result A total of 52 patients participated in the study. Bacterial meningitis was the most common type of neuroinfection (40.4%) followed by tubercular meningitis (27%), viral encephalitis (17.3%) and viral meningitis (15.4%). Pneumococcus was the most common identified cause of meningitis accounting for 28.9% of bacterial meningitis. Japanese encephalitis was the most common identifiable cause of encephalitis accounting for 33% of cases. Low Glasgow Coma Scale at admission was significantly associated with worse neurological outcome (P<0.001). Similarly, high white blood cell count in blood was associated with worse neurological outcome (P=0.001). Conclusion Meningitis and encephalitis are neurological emergency. Prompt diagnosis and treatment is needed to improve survival. Neurological sequel is common after those infections which require long term rehabilitation.

Clinical profile of patients with recurrent seizure in tertiary care hospital in Nepal.

BACKGROUND: Epilepsy is a common and diverse disorder with many different causes. Outcomes are varied with 60-70% of newly diagnosed people rapidly entering remission after starting treatment and 20-30% developing a drug-resistant epilepsy with consequent clinical and psychosocial distress. About one third of patients with a first unprovoked seizure will have further seizures within five years, and about three quarters of those with two or three unprovoked seizures have further seizures within four years. OBJECTIVE: The aim of the study was to find out those factors which were associated with recurrence of seizure in Nepalese population. METHOD: It is a Descriptive Cross-sectional study which was conducted in Tribhuvan University Teaching Hospital from January 2013 to January 2014. RESULT: A total of 150 patients participated in the study. Neuroimaging was normal in 65(43.3%) patients. 48(32%) patients had neurocystercosis in their brain imaging, neuroinfection in 12(8%) of cases, cerebral infarction in 12(8%), Cerebral atrophy in 5(3.3%) patients, brain tumor in 4(2.7%), Mesial temporal sclerosis in 2(1.3%), tuberous sclerosis in 1(0.7%) and hypoxic brain injury in 1 (0.7%) patient. 14(9.3%) patients reported having a family history of epilepsy in first degree relative. There was statistically significant association between higher number of seizures before starting medication and increased frequency of seizure after starting medication (p<0.001). CONCLUSION: Most of the patients with recurrent seizure had identifiable cause. Neurocysticercosis was the most common cause. Higher number of seizure before starting medication was associated with increased frequency of seizure after starting medication.

Study of fibrinogen in patients with diabetes mellitus.

Patients with diabetes mellitus have 2 to 4 times increased risk for cardiovascular disease than non-diabetic patients. However this excess risk is not fully explained by the traditional cardiovascular risk factors (Hypertension, Hypercholesterolaemia, Smoking and Obesity) which are also associated with diabetes. Fibrinogen has been identified as an independent risk factor for cardiovascular disease and it is associated with traditional cardiovascular risk factors. This is a descriptive analytical cross-sectional study carried out in Tribhuvan University Teaching Hospital (TUTH) medical outpatient department and Medical ward from June 2005 to June 2006. A total of 120 consecutive patients were enrolled; 30 patients having Diabetes. Next 30 patients having both diabetes and coronary artery disease. Thirty patients having only coronary artery disease but no diabetes. And 30 patients (control) not having both diabetes and coronary artery disease. Fibrinogen was found to be significantly higher in patients with diabetes than control. Fibrinogen was significantly higher in diabetic patients with coronary artery disease than those patients who had only diabetes or coronary artery disease (p value<0.01).