A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened. Coma patients exhibit a complete absence of wakefulness and are unable to consciously feel, speak or move. Comas can be medically induced. Clinically, a coma can be defined as the inability to follow a one-step command, it can be defined as a score of ≤ 8 on the Glasgow Coma Scale lasting ≥ 6 hours. For a patient to maintain consciousness, the components of wakefulness and awareness must be maintained. Wakefulness describes the quantitative degree of consciousness, whereas awareness relates to the qualitative aspects of the functions mediated by the cortex, including cognitive abilities such as attention, sensory perception, explicit memory, the execution of tasks and spatial orientation and reality judgment. From a neurological perspective, consciousness is maintained by the activation of the cerebral cortex—the gray matter that forms the outer layer of the brain and by the reticular activating system, a structure located within the brainstem.

The term ‘coma’, from the Greek κῶμα koma, meaning deep sleep, had been used in the Hippocratic corpus and by Galen. Subsequently, it was hardly used in the known literature up to the middle of the 17th century; the term is found again in Thomas Willis’ influential De anima brutorum, where lethargy, ‘coma’, carus and apoplexy are mentioned. The term carus is derived from Greek, where it can be found in the roots of several words meaning soporific or sleepy, it can still be found in the root of the term ‘carotid’. Thomas Sydenham mentioned the term ‘coma’ in several cases of fever. General symptoms of a person in a comatose state are: Inability to voluntarily open the eyes A non-existent sleep-wake cycle Lack of response to physical or verbal stimuli Depressed brainstem reflexes, such as pupils not responding to light Irregular breathing Scores between 3 and 8 on the Glasgow Coma Scale Many types of problems can cause coma. Forty percent of comatose states result from drug poisoning. Certain drug use under certain conditions can damage or weaken the synaptic functioning in the ascending reticular activating system and keep the system from properly functioning to arouse the brain.

Secondary effects of drugs, which include abnormal heart rate and blood pressure, as well as abnormal breathing and sweating, may indirectly harm the functioning of the ARAS and lead to a coma. Given that drug poisoning is the cause for a large portion of patients in a coma, hospitals first test all comatose patients by observing pupil size and eye movement, through the vestibular-ocular reflex.. The second most common cause of coma, which makes up about 25% of cases, is lack of oxygen resulting from cardiac arrest; the Central Nervous System requires a great deal of oxygen for its neurons. Oxygen deprivation in the brain known as hypoxia, causes sodium and calcium from outside of the neurons to decrease and intracellular calcium to increase, which harms neuron communication. Lack of oxygen in the brain causes ATP exhaustion and cellular breakdown from cytoskeleton damage and nitric oxide production. Twenty percent of comatose states result from the side effects of a stroke. During a stroke, blood flow to part of the brain is blocked.

An ischemic stroke, brain hemorrhage, or tumor may cause restriction of blood flow. Lack of blood to cells in the brain prevent oxygen from getting to the neurons, causes cells to become disrupted and die; as brain cells die, brain tissue continues to deteriorate, which may affect the functioning of the ARAS. The remaining 15% of comatose cases result from trauma, excessive blood loss, hypothermia, abnormal glucose levels, many other biological disorders. Furthermore, studies show that 1 out of 8 patients with traumatic brain injury experience a comatose state. Injury to either or both of the cerebral cortex or the reticular activating system is sufficient to cause a person to enter coma; the cerebral cortex is the outer layer of neural tissue of the cerebrum of the brain. The cerebral cortex is composed of gray matter which consists of the nuclei of neurons, whereas the inner portion of the cerebrum is composed of white matter and is composed of the axons of neuron. White matter is responsible for perception, relay of the sensory input via the thalamic pathway, many other neurological functions, including complex thinking.

The RAS, on the other hand, is a more primitive structure in the brainstem which includes the reticular formation. The RAS has the ascending and descending tract; the ascending track, or ascending reticular activating system, is made up of a system of acetylcholine-producing neurons, works to arouse and wake up the brain. Arousal of the brain begins from the RF, through the thalamus, finally to the cerebral cortex. Any impairment in ARAS functioning, a neuronal dysfunction, along the arousal pathway stated directly above, prevents the body from being aware of its surroundings. Without the arousal and consciousness centers, the body cannot awaken, remaining in a comatose state; the severity and mode of onset of coma depends on the underlying cause. There are two main subdivisions of a coma: diffuse neuronal. A structural cause, for example, is brought upon by a mechanical force that brings abo

Medical fetishism

Medical fetishism refers to a number of sexual fetishes involving objects, practices and situations of a medical or clinical nature. In sexual roleplay a hospital or medical scene involves the sex partners assuming the roles of doctors, nurses and patients to act out specific or general medical fetishes. Medical fantasy is a genre in pornography, though the fantasy may not involve pornography or sexual activity. Medical fetishism may involve sexual attraction to respiratory therapy involving oxygen via nasal cannula or any sort of masks, medical practitioners, medical uniforms, hospital gowns, intimate examinations, diapering, injections, medical devices, dental objects, medical restraints, medical gags; some people eroticize about intimate examinations as part of a medical fetish, as such are a common service offered by professional dominants. An intimate examination can form part of a scene in medical play where the nurse or doctor inflicts one or more embarrassing and humiliating quasi-medical procedures on the patient.

Frozen or heated objects are introduced to the patient's body to simulate the uncomfortable sensations that can occur during a real examination. Examinations may include an examination and intrusion of the anus, urethra, or vagina, as well as handling and twisting of the penis, testicles and nipples. Quite strap on play is incorporated, as this can heighten the intimacy, the sensations of the patient; this may be a prelude to administration of an enema. Before examination, the patient can be placed in physical restraints and gagged, wear some form of embarrassing clothing. Temperature taking fetish is a sexual fetish for rectal thermometers; this may include the sexual attraction to the equipment, environments or scenarios/situations. Sexual arousal from the desire to take another's temperature or have one's temperature taken is what surrounds the fetish. While rectal temperature taking is more prominent, there is an interest in oral temperature taking. Anesthesia fetishism is a sexual fetish for anesthesia.

This may include the sexual attraction to the equipment, substances, environments or situations. Sexual arousal from the desire to administer anesthesia, or the sexual desire for oneself to be anesthetized are two forms in which an individual may exist as an arbiter of the fetish. Older-style anesthesia masks of black rubber, still in occasional use today, are one of the more common elements fetishized, have earned the nickname Black Beauty by many fetishists. Anesthesia fetish is considered edgeplay when realised outside the boundaries of fantasy, may result in various degrees of harm, or death. Fantasies are elaborated by the viewing of images and reading of stories of anesthetic inductions. Edgeplay may involve obtaining and scening with various anesthesia-related paraphernalia—usually anesthesia masks for breathplay, the acquisition of anesthetics for anesthetizing others or being anesthetized oneself, the occupation of a medical setting or environment for the same practice; some anesthesia fetishists who seek to be anesthetized may feign or induce medical conditions in an attempt to obtain general anesthesia from medical personnel.

This is considered safer than playing with anesthetic agents outside of a medical setting, but may be an abuse of all concerned. The Internet has enabled people with this rare paraphilia to discuss the subject and exchange anesthesia-related multimedia. Playing doctor Paraphilia Amputation fetishism Klismaphilia List of fictional nurses Gary L. Albrecht, "Encyclopedia of disability, Volume 2", Sage Publications, 2006, ISBN 0-7619-2565-1, p. 1437 Midori, "Wild Side Sex: The Book of Kink Educational, And Entertaining Essays", Daedalus Publishing, 2005, ISBN 1-881943-22-4, p. 211


Mootsinyane is a community council located in the Mohale's Hoek District of Lesotho. Its population in 2006 was 9,995; the community of Mootsinyane includes the villages of Anone, Bompolasi, Boritsa, Fika-la-Tšoene, Ha'Mamaqabe, Ha Beka, Ha Khoai, Ha Lebele, Ha Leketa, Ha Lekhafola, Ha Lengau, Ha Make, Ha Makhalanyane, Ha Makoae, Ha Malephane, Ha Matoli, Ha Mocheko, Ha Moena, Ha Moena, Ha Moena, Ha Mohapi, Ha Mohlomi, Ha Mokhoele, Ha Mokoto, Ha Molibeli, Ha Mothiba, Ha Nkieane, Ha Ntee, Ha Pholo, Ha Pita, Ha Raisa, Ha Ralikhomo, Ha Ramokhongoana, Ha Ramonethi, Ha Ramothobi, Ha Ramothobi, Ha Ramothobi, Ha Raqoatha, Ha Sebothama, Ha Seliane, Ha Sentšo, Ha Sethunya, Ha Setulo, Ha Shalane, Ha Thabo, Ha Tsela, Ha Tsela, Ha Tsietsi, Khokhotsaneng, Letlapeng, Lithipeng, Litšoeneng, Marakong, Matolong, Matsatsaneng, Mohloareng, Motse-Mocha, Motse-Mocha, Phuthing, Sebataolong, Sekoaing, Taung, Thaba-Bosiu, Tlaling, Tsekong and Tšieng. Google map of community villages