Diabetic Retinopathy as a Predictor of Angiographic Coronary Atherosclerosis Severity in Patients with Type 2 Diabetes Mellitus

BACKGROUND

Diabetic retinopathy (DR) is one of the most prevalent consequences of diabetes mellitus (DM). Much emphasis has been focused on the link between DR and cardiovascular disorders in patients with type 2 diabetes (T2DM). However, there is little information about the relation between the degree of DR and coronary atherosclerosis severity in Egyptian patients.

AIM

To assess the correlation between the degree of DR and the coronary atherosclerosis severity in T2DM.

PATIENTS AND METHODS

This work included 140 diabetic patients with T2DM who underwent diagnostic coronary angiography because of suspected coronary artery disease (CAD). All participants were evaluated by history, fundus assessment, laboratory tests (lipid profile and glycated hemoglobin [HbA1c]), and selective coronary angiography. The severity of coronary artery lesion was detected by Gensini score and vessel score.

RESULTS

Patients with DR had a significantly higher Gensini score (67.86± 44.56 versus 5.93± 9.02, P < 0.001) and a vessel score (2.29± 0.86 versus 0.50± 0.66, P < 0.001). There was a significant relation between the degree of DR, Gensini score (P < 0.001), and vessel score (P < 0.001), as both scores increased according to the severity of DR. The presence and degree of retinopathy were the only independent factors linked to the severity score in multivariate linear regression analyses (P < 0.001).

CONCLUSION

The presence and degree of DR are independent predictors of severe coronary atherosclerosis. Therefore, when evaluating whether a patient with T2DM is at high risk for CAD, the DR degree should be taken into consideration.

An outbreak of acute gastroenteritis due to Aeromonas sobria in Benghazi, Libyan Arab Jamahiriya

We report an outbreak of acute diarrhoea due to Aeromonas sobria in Benghazi which occurred during a 1-month period in 1997. Of 69 patients admitted with acute gastroenteritis, 28 were positive for A. sobria based on the production of gas from glucose, the production of acetoin, hydrogen sulfide and lysine decarboxylase and on aesculin hydrolysis and fermentation of arabinose and salicin. The strains were sensitive to chloramphenicol, co-trimoxazole, tetracycline and gentamicin but resistant to ampicillin and carbenicillin. We were unable to trace the source of the infection.

Management of weapon injuries to the craniofacial skeleton

One thousand one hundred thirty-five patients suffering from different types of facial injuries caused by various weapons were treated in two university hospitals in Tehran, Iran from 1984 to 1990. The referred patients suffered from one of three types of facial injuries: soft-tissues injuries, 9.16% (N = 104); bone fractures, 18.15% (N = 206); and soft-tissue injuries and bone fractures (mixed injuries), 72.69% (N = 825). The number of male patients was greater than females (1,123 males and 12 females). Anatomically the facial injuries were classified into seven groups (lower third; middle third; upper third; lower and middle third; lower and upper third; middle and upper third; and lower, middle, and upper third). Lower-third facial injuries were the most common injuries, 72.60% (N = 824); followed by the middle-third injuries, 36.30% (N = 412); and the upper-third injuries, 20% (N = 227). The mandible was the most common site of injury in the lower-third injuries, zygomatico-orbital fractures were the most common site in the middle-third injuries, and the frontal bone was the most common site in the upper-third injuries. Of the total number of patients, 3.17% were children (N = 36) with different types of maxillofacial injuries. The majority of the injuries (52.42%; N = 595) were from bullets. The most common injuries not associated with maxillofacial injuries were head and ocular injuries. The least common were abdominal injuries. The head injuries were classified into five grades according to clinical and computed tomographic findings. Treatment of facial injuries ranged from minor repair and/or closed reduction to major soft-tissue and/or bone reconstruction. Postinjury complications were very high. The follow-up period ranged from 3 months to 3 years. The aim of this study is to add our experience in the management of facial injuries to the literature.

Craniomaxillofacial injuries: experience in Tehran

This is a retrospective study of 1,608 patients (1,575 males and 33 females) who were treated in two university hospitals in Tehran, Iran from 1984 to 1990. The injuries were classified into three types: soft tissue injuries (132 patients), bony fractures (356 patients), and mixed injuries (1,120 patients). The craniofacial injuries were classified into seven anatomical levels: lower third; middle third; upper third; lower and middle third; lower and upper third; middle and upper third; and lower, middle, and upper third). The lower third craniofacial injuries were the most common (69%, n = 1,110) followed by the middle third (42%, n = 677). Injuries to the upper third were the least common (28%, n = 452). In the lower third injuries the mandible was the most common site; lateral midface injuries were the most common site in the middle third region; and frontal bone was the most common site in upper third injuries. Most of these injuries were caused by firearms (71%, n = 1,135) during the Iraq-Iran conflict; the least common cause was assault (0.80%, n = 13). There were many associated noncraniofacial injuries, such as head and ocular injuries and abdominal injuries. The head injuries were classified into five grades according to the clinical and computed tomography findings. Treatment of the craniofacial injuries ranged from minor repair or closed reduction to major soft tissue and bony reconstruction. The postinjury complication rate was very high, especially for firearm injuries. The follow-up period ranged from 3 months to 3 years.

Ocular injuries in 367 patients with middle and upper third facial trauma: experience in Tehran

Ocular injuries are commonly associated with facial injuries. I provide a retrospective study of 367 patients who sustained severe major ocular injuries associated with middle and upper third facial injuries. These patients were selected from 1,608 patients who sustained different types of craniomaxillofacial injuries over a 7-year period (1984 to 1990). The characteristics of the ocular injuries sustained were related to the cause of the facial trauma. More than 52.04% of severe ocular injuries were associated with isolated lateral midface injuries, 42.5% were associated with middle-third injuries, and 5.44% were associated with upper third facial injuries. Among all patients 29.97% lost their vision partially or completely. The major causative factor was firearms during the Iraq-Iran war (64.03%) followed by road traffic accidents (40.15%). Sports caused a low incidence of ocular injuries. Ocular injuries were treated by the ophthalmic surgeons in cooperation with the maxillofacial surgeons and the neurosurgeons. There was an increase in the residual complications in facial or ocular injuries resulting primarily from the evacuation system. Although the psychological problems related to the ocular injuries and residual periorbital deformities were great, patients' spirituality and their beliefs gave them much patience and hope in facing these difficulties and complications. A close relationship among ophthalmic surgeons, neurosurgeons, and maxillofacial surgeons is very important to decrease the incidence of complications involving ocular injuries after craniomaxillofacial injuries.

Management and complications of middle- and upper-third facial compound injuries: an Iranian experience

Surgery for 772 patients with middle- or upper-third facial injuries was carried out between 1984 and 1990 in two university hospitals in Tehran. The most common etiological factor was firearm injuries (69.04%; n = 533), followed by road traffic accidents (24.44%; n = 189). The most common associated nonfacial injuries were head injuries (36.97%; n = 285 followed by ocular injuries (23.18%; n = 179). Treatment of middle- or upper-third facial injuries ranged from minor repair to major surgery with autogenous or allogenous grafts. The complications associated with middle- or upper-third facial injuries were either postinjury complications or postoperative complications and ranged from minor infection to loss of vision.

Osteomyelitis of the mandible in Tehran, Iran. Analysis of 88 cases

This study involved 88 cases of different types of osteomyelitis of the mandible. Sixty-nine patients had osteomyelitis after trauma, eight patients after radiotherapy, six after dental infection, and six had other causes. Thirty-three patients had septicemic infection. Multiple types of aerobic and nonaerobic microorganisms were isolated from the infection sites. Types of treatment and their results are discussed.

Diplopia caused by orbital floor blowout fracture

Diplopia caused by orbital floor blowout fractures is one of the major complications of orbital injuries. The records of 48 patients who had incurred orbital injuries were reviewed; 23 had a history of a pure orbital blowout fracture. Surgery was indicated when the vertical movement of the eye was impaired, and it was performed after complete resolution of orbital hemorrhage and edema. The maximal time before the first surgical procedure was 14 days. Two patients required a second procedure because of persistent diplopia and enophthalmos.

Pediatric facial injuries in Tehran: a review of 87 patients

Because of the Iraq/Iran conflict pediatric facial injuries were commonly seen in Iran. A series of 87 facial injuries were isolated from 1,608 patients with different types of facial injuries seen in two university hospitals in Tehran during the previous 6 years (1984-1990). Their ages ranged from 20 months to 13 years. The male-to-female ratio was 16.4:1; the highest incidence was in the lower-third region (63.21%; n = 55), and the highest incidence was in the 8- to 9-year-old age groups. Associated nonfacial injuries, clinical and computed tomographic scan findings for head injuries associated with facial injuries, treatment, and complications are reported.

Mandibular joint dysfunction otalgia caused by a bomb explosion wave

Four hundred ninety-five patients were exposed to bomb explosion waves in civilian and war areas during the Iraq/Iran conflict. These patients were referred to the Oral and Maxillofacial Surgery Clinic after complaining of temporomandibular joint dysfunction with otalgia. Treatment ranged from conservative measurement to active surgery. Generally, response was good.

Lower-third facial injuries: management and complications

I report 1,110 patients with lower-third facial injuries isolated from 1,608 patients with different types of facial injuries. Mixed injuries (bone and soft tissue) were most common (72%; n = 805). The most common site of fracture was the body of the mandible (26.12%; n = 290). One hundred sixty-three patients underwent soft-tissue and bony reconstruction with a local soft-tissue flap or an iliac bone graft, or both. Three procedures failed because of gingival tearing. Other treatments ranged from conservative treatment to different types of closed or open reduction. Postinjury and postsurgery complications were many and involved soft tissue, nerves, tongue, and bones. The follow-up period ranged from 3 months to 3 years.

Cleft lip and palate in Tehran

Seventy-nine cleft lip and/or palate births were isolated from 21,138 live births between January 1, 1983 and December 31, 1988 in one hospital in Tehran. Among these, 21 (26.58 percent) were cleft lip (CL), 45 (56.96 percent) were cleft lip and palate (CLP), and 13(16.45 percent) were cleft palate (CP). Chemical sulfur mustard gas was indicated as a major factor in 30 (37.97 percent) of the bilateral cleft lip and palate infants.

Traumatic external carotid artery aneurysm causing facial nerve paralysis. A case report

A case is reported of traumatic external carotid artery aneurysm causing facial paralysis. The aneurysm was successfully treated surgically.

Reconstruction of gunshot wounds of the mandible. 128 cases treated by autogenous iliac crest bone grafts

128 cases of mandibular reconstruction for defects due to gunshot injuries were treated by various types of autogenous iliac crest bone grafts during a period of 4 years and six months. The survival rate of these grafts was 98.43 per cent.

The incidence and composition of salivary stones (sialolithiasis) in Iran: analysis of 95 cases--a short report

In a 3 year period 95 patients with sialolithiasis were studied, giving an annual incidence of 7.3 per 1000 admissions. The male to female ratio was 2.5:1. Salivary gland stones comprised 73.68 per cent (N = 70 patients). Chemical analysis of calculi taken from 88 patients, showed that 89.77 per cent (N = 79 patients) were with phosphate salts stones, 7.98 per cent (N = 7 patients) were with oxalate salts, and 2.27 per cent (N = 2 patients) were with urate salts. Salivary gland infection was present in 91.57 per cent (N = 87 patients) of whom 75.86 per cent (N = 66 patients) and 24.14 per cent (N = 21 patients) were females. A high ambient temperature and dehydration with poor oral hygiene are probable causative factors.

Multifocal eosinophilic granuloma--a case report

A 1.5 year old Kuwaiti child male presented with a massive bilateral ulcerative lesion of palate and gingiva with massive submandibular lymphadenopathy which were proven histologically to be due to an eosinophilic granuloma. Bone survey was normal. The patient was treated by chemotherapy and irradiation locally with dramatic response and no relapse occurred in more than 18 months of follow up.

Tuberculosis of the parotid salivary gland--case report

Although pulmonary tuberculosis is not uncommon in Iran, involvement of salivary glands, especially the parotid is rare. A case is reported which was treated by surgery and chemotherapy.

Maxillofacial injuries due to road traffic accidents in Kuwait

The results of a retrospective study of the incidence and causes of 523 facial fractures seen in one hospital in Kuwait, sustained as a result of road traffic accidents alone, over a period of 38 months are presented.