Background: A case is reported of acute headache and vomiting which was started from day before hospital admission in a 49 year old man. This is the first known reported case of organophosphate induced bilateral angle closure glaucoma. Case presentation: This case presents a 49 year old who had admitted to A&E department with headache and blurred vision and vomiting. Intra ocular pressure (IOP) of the right eye of the patient was 22 mm Hg and the left eye was 34 mm Hg. Visual acuity of the right eye was reported 3/10 and the left eye was reported 4/10. Patient was treated by peripheral iridotomy with the diagnosis of acute bilateral angle-closure glaucoma and the patient's symptoms were completely resolved one hour after treatment. Conclusion: Acute bilateral angle closure glaucoma is reported as side effect of many drugs but this shows it was occurred after injection of atropine for poisoning with organophosphate pesticide.
Background and aim
Altered level of consciousness(LOC) is a common complaint in patients admitted to the emergency department(ED). Altered LOC occurs with various causes. Emergent diagnosis and treatment of patients with altered LOC are vital to prevent irreversible brain damage. In this study, we aimed to acquire a better vision of non-traumatic altered LOC’s prevalent etiologies. The association between patients’ initial condition and survival was also assessed.
Methods
This prospective cohort study enrolled 1000 patients with altered LOC referred to two tertiary hospitals in 2020 and 2021. Patients with ALOC who had GCS < 14, and a final diagnosis, were included and followed for a month. We also collected all initial data gathered by ED triage and investigated the association of these entities with survival and their distribution among different final diagnoses.
Results
We studied 1000 patients. 52.4% of the population consisted of males. The mean age was 59.85 ± 16.06. Sepsis(38.3%) was the most common etiology, followed by: stroke(9.2%), heart failure(8%), myocardial infarction(7.3%), meningitis(7.2%), hepatic encephalopathy(6.5%) and alcohol intoxication(5.8%). Deceased patients had higher pulse rates(P = .030) and lower blood glucose(P = .049) and blood pressure(P = .001) at admission. Prior history of stroke(P = .003) and hyperlipidemia(P = .012) were associated with reduced survival odds.
Conclusion
Our data reveal high one-month mortality(56%) in patients with altered LOC. Also, patients with hyperlipidemia and a history of previous stroke seem to have worse outcomes. Due to this high mortality rate, patients with altered LOC should be treated intensively and prioritized, especially in crowded EDs.
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