Prognostic relations between inflammatory markers and mortality in diabetic patients with non-ST elevation acute coronary syndrome.

OBJECTIVE: To determine the differences in the inflammatory status between diabetic and non-diabetic patients and to evaluate the usefulness of C reactive protein, fibrinogen, and leucocyte count as predictors of death in diabetic patients with unstable coronary disease. DESIGN: Nested case-control comparisons of the inflammatory status between diabetic and non-diabetic patients. Prospective cohort analysis of C reactive protein concentration, fibrinogen concentration, and leucocyte count as predictors of cardiovascular death in diabetic patients. SETTING: Coronary care unit in Spain. PARTICIPANTS: 83 diabetic patients with non-ST elevation acute coronary syndrome and 83 sex and aged matched patients selected from 361 non-diabetic patients with non-ST elevation acute coronary syndrome. MAIN OUTCOME MEASURES: Plasma concentrations of C reactive protein and fibrinogen, and leucocyte count. Investigators contacted patients to assess clinical events. RESULTS: Concentrations of C reactive protein and fibrinogen, and leucocyte count on admission were higher in diabetic than in non-diabetic patients (7 mg/l v 5 mg/l, p = 0.020; 3.34 g/l v 2.90 g/l, p = 0.013; and 8.8 x 10(9)/l v 7.8 x 10(9)/l, p = 0.040). Among diabetic patients, these values were also higher in those who died during the 22 month follow up (13 mg/l v 6 mg/l, p = 0.001; 3.95 g/l v 3.05 g/l, p < 0.001; and 11.4 x 10(9)/l v 8.4 x 10(9)/l, p = 0.005). After adjustment for confounding factors, diabetic patients in the highest tertile of C reactive protein had a hazard ratio for cardiovascular death of 4.51 (95% confidence interval (CI) 1.62 to 12.55). Similar hazard ratios were for fibrinogen 3.74 (95% CI 1.32 to 10.62) and for leucocyte count 3.64 (95% CI 1.37 to 9.68). CONCLUSIONS: Inflammation appears more evident in diabetic than in non-diabetic patients with acute coronary syndrome. C reactive protein concentration, fibrinogen concentration, and leucocyte count constitute independent predictors of cardiovascular death in diabetics with unstable coronary disease.

The Levandoski Panoramic Analysis in the diagnosis of facial and dental asymmetries.

Facial and dental asymmetries in 41 children from 8 to 12 year old were evaluated using the Levandoski Panographic Analysis. A high correlation between the standard facial photograph and linear measurement from panoramic radiograph were found. Varying degrees of facial and mandibular asymmetry were common in 100% of the sample. Significant association between the level of the glenoid fossa and the level of the eye from a frontal point of view were found; eleven patients (36.5%) showed left eye higher accompanied by a higher left fossa. Twenty patients (48.78%) presented with mandibular midline deviation toward the left side. The side with the longer condyle was usually accompanied by a longer coronoid in the ipsilateral side. The results of this study support the usefulness of the Levandoski Panographic analysis in diagnosis of facial and dental asymmetries, and its relation to the findings on the facial photographs.