Non-traumatic coma is a medical emergency and should be evaluated as soon as possible. Pediatric coma is more serious because of patient’s capacity of pathological stressor tolerance is limited especially in neonates.Several etiologies could be listed for loss of consciousness (LOC) and coma in childhood. According to the epidemiological studies, causes of coma are different all around the world. Glasgow Coma Scale has been used for coma scaling. In this review, we focused on some highlight causes of coma in pediatric medicine.

Coma is a state of prolonged unconsciousness. Some coma cases result from inherited disorders such as fatty-acid β, oxidation disorder, acute intermittent porphyria (due to mutations in genes CPT I, CPTII and ACADM), urea cycle defects (due to mutation in OTC gene), organic acidurias, mitochondrial diseases and familial hemiplegic migraine (due to mutations in CACNA1A, ATP1A2 and SCN1A). The evaluation of familial cases of coma or sporadic coma can be performed using next generation sequencing (NGS), a high-throughput sequencing technique that can sequence an entire genome in a single reaction. This technique has been widely applied in the genetic diagnosis of diseases. In this review, we describe some genes associated with coma or recurrent coma and discuss the role of NGS in detection of these genes.

Background: Non-traumatic coma is a common condition in children that may cause considerable morbidity and mortality. Determining the most common causes of loss of consciousness in any specific region, and any sex and age group will dramatically reduce mortality and morbidity.Objectives: The purpose of this study was to evaluate the most common causes of non-traumatic coma among children in south east of Iran.Patients and Methods: All children (aged 1 month to 15 years) hospitalized for non-traumatic coma were included in this study. All of the patients received clinical measures such as history, physical, and neurological examinations. Glasgow coma scale (GCS) was used to determine the level of consciousness and paraclinical examinations, including CBC with differential, blood biochemistry, urine analysis, and liver function tests were performed on all patients. In case of indication, blood and urine culture, brain CT (Computed Tomography) scan or brain MRI (Magnetic Resonance Imaging), lumbar puncture, metabolic study, EEG (electroencephalogram), and so forth were carried out. Finally, the data were analyzed and the most common causes of loss of consciousness were determined.Results: Among the 123 children under investigation, 76 cases were male (61.8%) and 47 females (38.2%) with the mean age of 3.2 ± 0.64 years. The most common causes of loss of consciousness among children were as follows: toxic causes in 61 patients (49.6%), infectious causes in 30 patients (24.4%), metabolic causes in 11 patients (8.9%), structural brain abnormalities in 4 patients (3.3%) and seizure in 7 children (5.7%). Moreover, 10 patients (8.1%) had other causes of loss of consciousness.Conclusions: Toxic causes with an incidence of 49.6% were the most common cause of loss of consciousness among all age groups.

Background and Aim: In the view of Islam, Hajj is so important that it is considered superior to any worship after prayer, and this importance has caused it to be included in the branches of Islam. On the other hand, some people experience coma, fainting and temporary unconsciousness during Hajj, Tamattu or Umrah, after entering the land of revelation and during rituals, due to old age, illness, air temperature, crowds, etc and they are unable to continue this worship. Worship that may be considered invalid due to the general circumstances of the task and its absence in the state of unconsciousness. The present study was formed after examining the verdict of people with coma and unconsciousness while performing Ihram and Tawaf rituals. Materials and Methods: This research has been done using the narrations and words of Shiite jurists in library documents and scientific software and has analyzed the proposed solutions by descriptive-analytical method of texts and documents. Moreover, due to the extent of the rituals, this article deals only with Ihram and Tawaf. Conclusion: The findings of the study indicate that the ruling on unconsciousness and coma during Ihram and Tawaf varies depending on the type of ritual. In the case of Ihram, with the collection of narrations indicating the permission of delaying Ihram and the permission of taking the deputy, the ruling of recommending prohibition or delaying Ihram until recovery is preferred and in the case of Tawaf, whether on the basis of discretion or on the basis of disregard in the event of a conflict of arguments, the discretion between taking the deputy and continuing the Tawaf is preferred.