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A Contrasting Result About the Etiologies of Non-traumatic Coma in A Referral Hospital in Ethiopia
Toxic and metabolic causes were identified to be the commonest causes of coma in a hospital in a developing country.
By Ermias Greffie
Dec. 21, 2015

Toxic and metabolic causes were identified to be the commonest causes of coma in a hospital in a developing country. The chance of survival was very low once a patient was admitted in the hospital with any sort of non-traumatic coma. This was the result of a poor medical infrastructure, including ICU care to support these critically ill patients.

Figure: A comatose patient being treated in the ICU

In a recent study by Dr. Mohamed A. Mohamed and his team etiologies of coma presenting without a focal neurologic deficit, mainly toxic and metabolic causes were the most common causes of non-traumatic coma, which was in contrast to most of the studies in both developed and interestingly other developing countries, which showed especially stroke to be the most common cause. In this study poisoning and metabolic coma due to organ failure was even more common than the expected infectious causes.

The mortality rate of this study was in fact the highest among similar studies. Dr. Mohamed continues "It is so unfortunate given the fact that most of these patients had reversible causes of coma. This is most likely due to the lack of resources in developing countries like Ethiopia. This lack of resource was evident by lack of drugs like antidotes for organophosphate and dialysis. This has resulted in higher mortality in our set up since these etiologies of coma are most probably treated very well in developed countries. With the continuous development of the medical care in developing countries, this high mortality of coma may decrease in the future."

Mohamed highlights "underlying medical illnesses like diabetes, hypertension, CKD and HIV were in fact not uncommon in these patients. Inadequate and/or lack of resource to treatment of these conditions might contribute to the development of conditions like uremia, which are not usually treated in developing countries"

Finally, the team recommended that hospital service in developing countries should be well equipped to diagnose and treat this life-threatening medical illness.

Authors:
Mohamed A. Mohamed, Internist, Department of Internal Medicine, University of Gondar
Nebiyu Bekele, neurologist, Department of Internal Medicine, University of Gondar
Ermias Diro, PHD, Internist, Department of Internal Medicine, University of Gondar
Ermias Shenkutie Greffie, Internist, Department of Internal Medicine, University of Gondar
Timothy Landers, PHD, school of Nursing, The Ohio state University
Helen Gebremedhin, Resident, Department of Internal Medicine, University of Gondar
Murad Mohamed, Resident, Department of Internal Medicine, University of Gondar
Habtewold Shibiru, Resident, Department of Internal Medicine, University of Gondar
Omer Abdu, Resident, Department of Internal Medicine, University of Gondar
Tesfaye Yusuf, Resident, Department of Internal Medicine, University of Gondar

Paper link:
http://www.sciencepublishinggroup.com/journal/paperinfo?journalid=151&doi=10.11648/j.cmr.20150406.16

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