Prevalence and factors associated with chronic diabetic complications among patients attending primary health care, a multi-centric study in Kuwait

A substantial proportion of patients with diabetes develop long-term macrovascular and microvascular complications. Many risk factors have identified for development and progression of these complications. The aim of the present study was to determine the prevalence of these complications among adult diabetic patients attending primary health care centers in Kuwait and to identify factors that could be associated with especially those factors that can be considered avoidable. This study was carried out in five primary health care centers representing the five health regions in Kuwait. The sample included 704 adult diabetic patients who had been diabetic for at least 2 years. The first phase of study was a cross sectional study to determine the prevalence of chronic diabetic complications. The second one was a case-control study, whereas all patients with chronic diabetic complications [case group, n = 434] were compared to diabetic patients free from chronic complications [control group, n = 270] to determine the associated factors with cases. Analysis was initially carried out based on a series of univariate comparisons followed by multiple logistic regression analysis. Out of 704 diabetic patients 61.6% n= had one or more chronic diabetic complications. Cardiovascular complications were diagnosed in 30.3%, nephropathy in 12.4%, neuropathy in 32.1%, lower limb complications in 21.9%, and retinopathy in 30.7% of patients. Logistic regression analysis revealed that age, nationality, type and duration of diabetes, glycemic control, hypertension, obesity, physical exercises, and compliance with diet recommendations were proved as significant predictors of these complications. The high economic burden raised by diabetes and its complications challenges the Kuwaiti health care system to prevent the development and progression of diabetic complications. The study identified a group of predictor factors as hypertension and hyperglycemia, enhancement of patient' compliance with regular follow-up visit, the role of health care providers in supplying patients with health information groups of patients who needed priorities of screening programs for development of complication

[ temporo-Parietal fascia pedicle flap. Bringing intofocus on applications in maxillo-Facial surgery]

The temporo-parietal fascia pedicule flap, described by DUFOURMENTEL in 1958, find many indications in head and neck reconstructive surgery. the authors remember the benifits of this flap through many illustrations in different anatomic regions: 1-auricular region [ear reconstruction]; 2-mastoid region; 3-parotidis region; 4-orbito-froton-palpebral region; 5- cheeck and labial commissure region. Reviewing the applications of this flap in maxillo-facial surgery will allow an assesment of adequate operative technique, indications, advantages and limits

Prevalence of rheumatic heart disease among school children in Alexandria, Egypt: a prospective epidemiological study

The aim of this work was to study the epidemiologic features of Rheumatic Heart Disease [RHD] among basic education students in Alexandria, including the demographic and clinical profiles as well as risk factors for RHD development. A stratified random sampling technique was used to allocate 5465 school children in the six educational zones of Alexandria. Clinical RHD cases were confirmed by using chest X-ray, ECG and echocardiography. Factors related to occurrence of RHD were studied using a case control design. Thirty four RHD cases [with an estimated prevalence of 6.2/1000 students] were diagnosed. Low socioeconomic status, chronic tonsillitis, positive family history of acute rheumatic fever/RHD and paternal consanguinity were significantly associated with the occurrence of RHD. Almost all previously diagnosed cases were enrolled in a prophylaxis program, with a defaulter rate of 31%. More than half of the identified cases had moderately severe valvular lesions. We recommend the implementation of an educational program targeted to both parents and teachers; the training of upgrading of school health physicians, and the standardization of secondary prophylaxis programs nationwide, with emphasis on assurance of compliance

Acute rheumatic fever: is it a real health problem?

Acute rheumatic fever [ARF] is still considered a major health problem in Egypt as it is in many developing countries. Its importance arises from the fact that it may lead to chronic disabling heart diseases. In Egypt, ARE situation is described by being malignant. This is because of its high incidence severity of the cardiac involvement proved by high incidence of cardiac complications in the initial attack, early and frequent development of mitral stenosis and need for early surgery. The aim of this study was to assess the magnitude of ARF by estimation of its incidence among students aged 5-15 years, as well as to study socioeconomic and demographic characteristics of the affected children. A randomly selected 5465 students representing primary and preparatory school children in the six educational zones of Alexandria were followed up for the scholastic year 1993-94. ARF cases that fulfilled the revised Jones criteria were interviewed and a nested case control approach was followed to collect data from cases and controls. During the follow up period, 6 ARF cases fulfilling the revised Jones criteria occurred, and accordingly the estimated incidence rate of ARF was 109.3/100,000 students. The mean age of cases was 12 +/- 1.3 years. Two thirds of cases were females. Two cases were detected through home visits of students who were absent from school for >1 week. Two cases were recurrences among 29 RHD cases who were registered to follow a monthly IM long acting penicillin injection regimen, with an estimated recurrence rate of 6.5%. Most of cases came from socioeconomically disadvantaged families as indicated by higher crowding index and lower income of cases. History of preceding upper respiratory tract infection [URT1] was reported by all cases within 4 weeks. Five cases received treatment during this URTI for a mean duration of 4 +/- 1 days. Carditis was diagnosed clinically and confirmed by echocardiography in 3 cases, while arthritis was diagnosed in 4 cases. Congestive heart failure complicated 2 of these cases. In conclusion ARF is still a serious public health problem in Alexandria. Encouraging doctors to search for cases among absentees and describe proper antibiotics for appropriate duration are important. Promoting the two weekly prophylaxis regimen and educating students to follow the prophylaxis schedule may reduce recurrences. Emphasis on importance of health education regarding good ventilation and nutrition is needed as a component of any prevention and control program