|Year : 2016 | Volume
| Issue : 4 | Page : 153-160
Retrospective study of ocular trauma in Mansoura Ophthalmic Center
Mansoura Ophthalmic Center, Mansoura University, Mansoura, Egypt
|Date of Submission||07-Dec-2016|
|Date of Acceptance||07-Dec-2016|
|Date of Web Publication||19-Apr-2017|
Ophthalmology Center, Faculty of Medicine, Mansoura University, Mansoura, P.O. 35516
Source of Support: None, Conflict of Interest: None
The aim of the study was to conduct an epidemiological study of ocular trauma cases presented to the Mansoura Ophthalmic Center, Mansoura College, regarding patient age, sex, and job, the reason for trauma, and kind of ocular injuries.
Patients and methods
This research is dependent on hospital discharge sheets, studies from the emergency room setting or population-based interviews. It is a retrospective epidemiological study that includes all patients presenting with ocular injuries to the Mansoura Ophthalmic Center (Mansoura College) throughout the period from January 2012 to June 2015. Within this study, we examined retrospectively 1134 patients presenting with eye injuries. Patient’s collected data included age, sex, address, occupation, duration of presentation, reason for trauma, site to trauma, and kind of injuries. The reason for injuries was differentiated into blunt or sharp. Based on the site of eye injuries, the data were classified into three groups: work-related injuries, home-related injuries, and street-related injuries. The examination sheet for the hurt eye was acquired, and information was recorded based on the standardized classification of ocular trauma.
The study incorporated 1134 patients presenting with eye injuries within a period of 3.5 years (from January 2012 to June 2015). Most instances (80.4%) of ocular trauma occurred in male patients, who had an average chronological age of 25 years (varying from 1 to 80 years). Factory employees represent 36.2% of the total injury cases. Farmers represented 2.5% of hurt individuals. Students represented 18.5% of hurt individuals. Motorists constituted 1.4%. Housewives constituted 7.2% of injury cases. Individuals without any jobs constituted 34.2% of cases. Within this study, there was no delay in presentation to the hospital in 788 (69.5%) cases. However, 268 (23.6%) patients demonstrated delay greater than 24 h to 1 week, and 78 (6.9%) patients demonstrated delay in excess of 7 days. Workplace injuries constituted 36.7% of cases, road-related injuries 31.9% of cases, and home injuries 31.4% of cases. Blunt objects represented 36.3% of eye injury cases. Sharp objects represented 63.7% of eye injury cases. There have been 852 (75.1%) closed-globe injuries and 282 (24.9%) open-globe injuries.
In Egypt, ocular trauma is an issue, as it is a significant reason for blindness. This research was targeted at determining factors that are characteristics of ocular trauma, so that they can aid in reducing its prevalence in Egypt.
Keywords: blunt, injuries, trauma
|How to cite this article:|
Elhesy AE. Retrospective study of ocular trauma in Mansoura Ophthalmic Center. J Egypt Ophthalmol Soc 2016;109:153-60
| Introduction|| |
Ocular trauma is a leading cause for visual loss. Worldwide interest in the area of ocular trauma is quickly growing as effective approaches for prevention and treatment are developed. Ocular trauma is definitely disabling and produces enormous costs to both victim and society. Worldwide, little is known about its epidemiology and connected visual impairment in developing nations .
Regardless of eyes representing only 0.1% of the total body surface, their significance is disproportionally greater.
Cruciani et al.  reported that eyes are the third, after hands and feet, most affected parts of the body. Although the socioeconomic effect of ocular trauma could be overestimated, individuals affected by it frequently are afflicted with lack of career possibilities, changes in lifestyle, and often permanent physical problem .
Data collection is the primary step in almost any epidemiological study. Once an adequate amount of details has been obtained on how the injuries have occurred (with whom, how, where, when, etc.), prophylactic measures could be planned. The ongoing collection of epidemiological information in a standardized fashion helps you to see whether a particular safety measure was effective or not . Ocular trauma is really a global health condition. It is characterized by mechanical or nonmechanical injuries to the eyes .
In the event of blunt trauma, the pressure, mechanism, and direction of trauma are incorporated in the resolution of the extent of injuries. Past ocular injuries by high-speed projectiles should alert the examiner to the potential of presence of an intra ocular foreign body (IOFB) . For penetrating injuries, one should determine the character of the potentially maintained foreign body (FB). Certain foreign objects can elicit severe inflammatory reaction or result in infection inside the globe, whereas some could be well tolerated .
Visual skill may be the vital manifestation of the attention, and its measurement is the primary step in most ophthalmologic examinations. Visual skill should be investigated in most responsive cases with ocular trauma, because it is key to diagnosis, guiding treatment, and predicting visual outcome in these instances .
The eye lids and periocular region ought to be examined regarding asymmetry, lacerations, edema, ecchymosis, foreign objects, or abnormal eye lid position. Medial eye lid lacerations should boost the suspicion of canalicular injuries. The existence of fat inside a lid laceration signifies injuries to the orbital septum, raising the suspicion of a FB in the orbital septum. The existence of proptosis might be suggestive of retrobulbar hemorrhage .
Limited extraocular motility might be suggestive of orbital fractures, cranial nerve injuries, extraocular muscle entrapment or injuries, or restriction of globe motility from intraorbital bloodstream or edema. One should distinguish whether a patient is experiencing monocular or binocular diplopia. Diplopia that continues when only one eye is open (i.e. monocular diplopia) indicates an abnormality within the ocular media, for example, corneal irregularity, iridodialysis, or lens abnormality. Diplopia that resolves through occlusion of either eye (i.e. binocular diplopia) is suggestive of an abnormality in matched eye movement .
Gross inspection and slit-light examination can identify injuries to the anterior segment such as the conjunctiva, cornea, iris, sclera, and lens. The conjunctiva and also the sclera ought to be examined for injection, bleeding, lacerations, uncovered tissue, and foreign objects. The existence of hemorrhagic chemosis is suggestive of open-globe injuries. The cornea ought to be examined for lack of clearness, problems, and foreign objects .
An afferent pupillary defect should alert the examiner toward the existence of optic nerve or severe retinal injuries .
The vitreous, optic disc, and retina could be visualized through a careful fundoscopic examination. The fundus examination must start by observing the status from the red reflex. An abnormal red reflex indicates corneal edema, cataract, vitreous hemorrhage, or perhaps a large retinal detachment .
Intraocular pressure (IOP) could be measured using an applanation tonometer or Schiotz tonometer. Topical anesthesia is essential in conscious patients. Normal IOP ranges between 10 and 21 mmHg. Elevated IOP might result from many distressing conditions, for example, hyphema, position closure, retrobulbar hemorrhage, or carotid–cavernous fistula. Decreased IOP can occur because of open-globe injuries, uveitis, cyclodialysis, or retinal detachment .
Visual field can identify disorders from the retina, optic nerve, anterior and posterior visual pathways, and visual cortex. Confrontational visual fields are measured with one eye alone and could be measured by evaluating the patient’s reactions toward the examiner’s field using the opposite eye closed (presuming the examiner has normal visual fields) .
Distressing ocular emergencies can occur alone or co-occur in polytrauma. It is not easy to complete a test on a seriously hurt patient. The attention might be inflamed or there might be intraocular bleeding making fundoscopic examination very difficult. The individual might be not able to reply, which makes it hard to assess the visual skill and ocular motility. As these lesions can result in severe visual loss, prompt and cautious utilization of imaging methods to obtain an accurate diagnosis should be initiated and begin appropriate management in the initial phase .
| Patients and methods|| |
This research relies on hospital discharge sheets, studies from the emergency room setting, and population-based interviews. It is a retrospective epidemiological study which includes all patients presenting with ocular injuries to the Mansoura Ophthalmic Center (Mansoura College) from January 2012 to June 2015. Within this study, the information from 1134 patients presenting with eye injuries was examined retrospectively. Patient’s collected data included age, sex, address, occupation, duration of presentation, reason for trauma, site of trauma, and kind of injuries. The reason for injuries ended up being differentiated into blunt or sharp. Based on the site of eye injuries, data were classified into three groups: work injuries, home injuries, and street injuries. The examination sheet of the hurt eye was acquired, and information was recorded based on the standardized classification of ocular trauma.
Each patient’s sheet was examined, and also the ocular trauma epidemiological data were collected. Demographic data included age, sex, and occupation. Trauma was examined to incorporate duration of injuries, site of trauma, and reason for trauma. Examination finding of injuries was split into closed and open-globe injuries.
Ocular trauma epidemiological data:
- Demographics: age, sex, and occupation.
- Time of injuries: date of presentation: no delay (under 24 h), postponed for 24 h to 1 week, or postponed to even more than 1 week.
- Place: street, home, or work.
- Reason for injuries: by sharp or blunt object.
- Bone fracture.
- Eye lid edema, laceration: site and extent (lid margin and canaliculi).
- Closed-globe injuries: conjunctival injuries, corneal intrastromal foreign body, distressing hyphema, lens injuries, choroidal rupture, vitreous hemorrhage, retinal damage, and optic nerve damage.
- Open-globe injuries: corneal wound without or with iris prolapse, limbal wound, and scleral wound without or with uveal prolapse, and IOFB.
| Results|| |
The research incorporated 1134 patients presenting with eye injuries in a 3-year period (from January 2012 to June 2015).
Age and sex
The mean age of patient with ocular trauma was 25±17 years (range: 1–80 years). The youthful age bracket (<18 years) constituted 38.8% of cases, whereas the adult age bracket (>18 years) constituted 61.2% of cases ([Table 1],[Table 2],[Table 3]).
Regarding sex, 912 (80.4%) patients were male and 222 (19.6%) patients were female, with a male to female ratio of 4 : 1 ([Table 4]).
Within this study, factory employees represent 36.2% of the total injury cases. Factory employees refer to individuals whose work is associated with rough-work machines and instruments and harmful surroundings.
Farmers represented 2.5% of hurt individuals. Students represented 18.5% of hurt individuals; however, most of these injuries do not occur in school but on roads. Motorists constituted 1.4% and symbolized because of the serious hazards of visual affection on their own career. Although not a genuine occupation, housewives still represent a sizable proportion of the Egyptian community and were also recorded, with 7.2% of injuries. Individuals without any jobs, including preschool age children, idle individuals, and individuals whose occupation was well recorded, constituted 34.2% ([Table 5]).
Duration of presentation
Within this study, there was no delay in presentation to the hospital in 788 (69.5%) cases. However, 286 (23.6%) patients demonstrated delay in excess of 24 h to 1 week, and 78 (6.9%) patients demonstrated delay in excess of 7 days ([Table 6]).
Site of trauma
Workplace injuries accounted for 36.7% of cases, road injuries for 31.9%, and home injuries for 31.4% ([Table 7]).
Reason for injuries
For men and women, blunt objects represent 36.3% of eye injuries. Gemstones tend to be more frequent reason for eye injuries adopted by wood sticks, hands fist, metal sticks and balls. Sharp objects represented 63.7% of eye injuries; metallic FBs, such as metal wire, gun shots, glass scissors, knives, and pens, were a far more frequent reason for eye injuries ([Table 8]).
The incidence of eye injuries differs based on kind of injuries: open-globe injuries (282 eyes), closed-globe injuries (782 eyes), lid injuries (64 eyes), and orbital fractures (six eyes):
- Open-globe injuries: open-globe injuries were reported in 282 cases, which represented 24.9% of total injuries. In [Table 9]
, the various diagnosis of open-globe injuries are presented. Some individuals might have several diagnoses. It is proven that 13.9% had corneal wounds, 5% had limbal wounds, 11.5% had sclera wounds, 12.8% had corneoscleral wounds, 8.8% had iris prolapse, 2.8% had distressing cataract, 2.6% had vitreous prolapsed, 5% had endophthalmitis, and 4.4% had IOFBs. Foreign objects varied between iron, glass, wood, and lead.
- Closed-globe injuries: closed-globe injuries were recorded in 852 cases, which represented 68.9% of total injuries. In [Table 10]
, the various proper diagnosis of closed-globe injuries are presented. It is proven that 31.1% of patients had corneal ulcer, 26.5% of patients had corneal FB, 2% had corneal intrastromal FB, 4.9% of patients had distressing hyphema, 1.3% had conjunctival tears, 2.6% had subconjunctival hemorrhage, 9% had vitreous hemorrhage, 5% had chemical stomach problems, 3% had commotio retinae, 3% had avulsed optic nerve mind, and 1.1% had distressing retinal detachment.
- Lid injuries: lid wounds and hematomas were recorded in 64 cases, which represent 5.7% of total injuries.
- Orbital fractures: orbital wall fracture was recorded in three cases, which represents 0.5% of total injuries.
| Discussion|| |
An injury that might be minor elsewhere in the body is really a serious one in the eyes, if it is not paid attention to, because of the delicacy and also the peculiarities of ocular tissue. Trauma may lead to severe damage, and owing to lack of attention, and ocular traumas are an essential reason for visual loss around the world .
The epidemiological data are different from one place to another. Within this epidemiological study, the goal would be to evaluate, whenever possible, many facets of the trauma cases presented to the Mansoura Ophthalmic Center. This can help to uncover factors that could be controlled for lowering the danger from such injuries. In this study, data have been collected over 3 years.
Any age group was discovered to be prone to ocular trauma. There are lots of studies concerning epidemiological pattern of ocular trauma. These studies also show many suggest be in comparison with this particular study in Mansoura Ophthalmic Center. Within this study, the mean age of patients presenting with ocular trauma is 25±17 years (range: 1–80 years).
Regarding the sex of the cases, male represented ∼80.4% and women represent ∼19.6%, with a male to female ratio of 4 : 1. The youthful age bracket (<18 years) constituted 38.8% of cases, whereas adult age bracket (>18 years) constituted 61.2% of cases.
Soliman and Macky  carried out an epidemiological study of ocular trauma. Similar to this research, they discovered that 80% of ocular trauma happened in men and 20% in women, with the average chronological age being 23 years. The youthful age bracket of younger than 16 years constituted 49.6% of cases. The adult age bracket of older than 16 years constituted 50.4% of cases, with a male to female ratio of 4 : 1.
Moreover, Brown and Thomas  study demonstrated that patients’ age ranged from 9 weeks to 68 years. The mean age was 25 years, and the male to female ratio was 3.4 : 1.
On the contrary, Salvatore and Francesco  reported a retrospective study to look for the epidemiology of ocular trauma cases in Southern Italy. Nearly all injuries were in male individuals (83.6%; male to female ratio=5.5 : 1; P<0.0005, Pearson’s χ2-test). The average age was 35.6±20.0 years.
Another retrospective study was held in New York within 1-year period by Bruce . This study included 529 eye injuries; 370 (70%) were male individuals and 159 (30%) were female individuals. The mean age was 30 years. Overall, 470 (79%) patients were adults (>18 years), and 110 (21%) were categorized as pediatric cases (<18 years).
As previously shown, most studies that were held in developing countries agreed with this study that most cases (75%) occur in individuals younger than 30 years. This distribution pattern, with most cases involving young and working groups, reflects the socioeconomic burden of ocular injury on our communities. However, other studies that were conducted in developed countries like Italy and USA showed that most cases were found in individuals older than 30 years.
Adult supervision has been found to be an important factor in preventing such accidents among children. Trauma was also found to affect male individuals more than female individuals, because Egyptian men and boys are more exposed to work that causes injuries than women.
In this study, factory workers represent 36.2% of the total injured patients. Students represented 18.5%; however, these injuries did not occur at school but mostly in streets. Farmers represented 2.5%.
Drivers constituted 1.4%. Although not a real occupation, housewives still represent a large portion of the Egyptian community and were also separately recorded to constitute 7.2% of injuries.
Nonoccupation individuals include those who are in the preschool age, those who are idle, and those whose occupation was not properly recorded, and they constituted 34.2% of cases.
The main hazards of ocular injury have been found to be falls among workers and students. This finding is supported by a study that was conducted by Soliman and Macky . It showed that students and workers form a large portion of patients sustaining ocular trauma, at 37 and 35%, respectively.
Salvatore and Francesco  agreed with the result of this study as they reported that children and students (first and second decades of life) represented 30.2% of the injuries. Factory workers represent 31% of the injuries.
Similarly to the present study, Amoaku  in Ghana recorded that 48.5% of the patients were either school-age children or students at higher levels, 19.5% were farmers, and 8.3% artisans. The remaining 23.7% belonged to a category made up of the unemployed, office workers, and housewives.
On the contrary, one study in Nepal, which was conducted by Khatry et al. , reported that the most common occupations were farmers (52%), domestic work (26%), and student (22%).
Finally, it is obvious that factory worker and students are more prone to ocular injuries than others in the developing countries.
In this study, 69.5% of patients presented to the hospital within the first 24 h, 23.6% of patients showed a delay of more than 24 h to 1 week at presentation, and 6.9% of patients showed a delay of more than 1 week. This is a large proportion.
This finding is nearly similar to what Soliman and Macky  had reported in their study. They reported that most patients (120 cases, 81.6%) came to the hospital within 24 h of their trauma, 12 (12%) patients showed a delay of more than 24 h, and nine (6%) patients showed a delay of more than 1 week.
Similarly, Amoaku  reported a retrospective study in Ghana, which recorded that ∼57.3% of the patients presented between 24 and 48 h after injury, whereas the rest came within 1 week or thereafter. These intervals between injury and presentation were not related to the distance needed to travel to the hospital.
However, Karaman et al.  conducted a retrospective study in Croatia, which reported that the median time from injury to admission to the hospital was 3 h (range: 0.25–194 h).
Another study was conducted by Alberto  in 273 patients. The interval between injury and the admission to the hospital was up to 6 h in 101 (37.0%) patients, from 7 to 23 h in 40 (14.7%), from 24 h to 5 days in 106 (38.8%), from 6 to 10 days in 12 (4.4%), and more than 10 days in 14 (5.1%) patients.
In this study, workplace injuries accounted for 36.7% of injuries, which were higher among male individuals. Street injuries accounted for 31.9% of injuries and also occur more in male individuals. Home injuries accounted for 31.4% of injuries in which females were mostly affected. Streets injuries in this study included car accidents and sidewalk injuries (may be by stone, gunshot, or fight).
In this study, there were more frequent injuries by sharp objects. Sharp objects represent 63.7% of eye injuries, whereas blunt objects represent 36.3% of eye injury. Work-related FBs are more frequent causes of eye injury followed by knives, scissors, stones, wood sticks, metal wires, glass, pencils, and metal sticks. Blunt objects such as stones, wood sticks, metal sticks, balls, hand, and fist remain the major cause of blunt trauma. A total of 40 children with gunshot trauma were included in this study, and hyphema was the most common injury. The parents were unfamiliar with guns and gun safety rules. This study demonstrates that most injuries among patients through childhood toys gunshot were related to child abuse, or negligence, and the availability of toys handguns in the home.
Soliman and Macky  agreed with result of this study as there was an increase of injuries caused by sharp instruments. Sharp object trauma (59%) occurred mostly because of injuries by knives, scissors, glass, and pens. Blunt trauma represented 41% of total eye injuries. This type of trauma was mostly caused by stones .
In contrast to the present study, Serrano et al.  conducted a retrospective study in Colombia (2003) and concluded that blunt (40.1%) and sharp (27.6%) objects represent the most frequent causes of eye injury, followed by fireworks (16.7%), sand, dust, and wood particles (10.6%), and chemicals (5%).
Also, Vats et al.  conducted a retrospective study in India, which concluded that blunt objects were implicated in 44.4% of eyes injuries, firecracker injury and sharp objects in 22.2% of eye injuries, FB in 17% of eye injuries, and fist in 5.6% of eye injuries.
It is not unusual for occurrence of such injuries among young children to play with hazardous objects such as gunshots, needles, knives, glasses, and pencils left within their reach by parents and supervising adults or among older children who are not instructed about the dangers of these objects.
Also, children are often exposed to adult activities that may pose a risk to them. This suggests a general lack of awareness and, in many cases, negligence regarding the dangers that certain objects and activities present to children. Projectile injuries constitute a significant portion of ocular trauma in Egypt.
The main cause was during hammering, where a small piece of metal separates from an old hammer to penetrate the globe at a very high speed. Represent a greater proportion of ocular injuries among workers. Although gun shots were not a major cause, they still represent a serious problem owing to the very high incidence of bilateral ocular injuries and severe visual loss.
In this study, open-globe injuries were reported in 282 cases, which represent 24.9% of total injuries. It is shown that 13.9% had corneal wounds, 0.5% had limbal wounds, 11.5% had scleral wounds, 12.8% had corneoscleral wounds, 8.8% had iris prolapse, 2.8% had traumatic cataract, 2.6% had vitreous prolapse, 0.5% had endophthalmitis, and 4.4% had IOFBs.
FB materials vary between iron, glass, wood, and lead.
Closed-globe injuries were recorded in 852 cases, which represented 68.9% of total injuries. It is shown that 31.1% of patients had corneal ulcer, 26.5% of patients had corneal FB, 0.2% had corneal intrastromal FB, 4.9% had traumatic hyphema, 1.3% had conjunctival tears, 2.6% had subconjunctival hemorrhage, 0.9% had vitreous hemorrhage, 0.5% had chemical ulcers, 0.3% had commotio retinae, 0.3% had avulsed optic nerve head, and 1.1% had traumatic retinal detachment. Lid wounds and hematomas were recorded in 64 cases, which represented 5.7% of total injuries. Orbital wall fracture was recorded in three cases, which represented 0.5% of total injuries.
Similarly, Yang  conducted a retrospective study in Taiwan, which reported that 228 patients were involved in this study. The most common ocular injury was closed-globe injury (178 patients, 78.1%) followed by burns (35 patients, 15.4%), open-globe injuries (eight patients, 3.5%), and orbital injuries (seven patients, 3.1%).
Another study was reported by Serrano et al.  who concluded that closed-globe injuries were far more frequent than open-globe injuries for male patients (82.4 vs. 17.6%) and female patients (83.8 vs. 16.2%). The most common types of closed-globe injuries were lamellar laceration (43.3%), contusions (32.3%), and superficial FBs (19.8%).
The most frequent types of open-globe injuries were penetrating injuries (78.9%), followed by intraocular FBs (14.1%) and rupture of the eyeball (4.2%) .
On the contrary, a previous study conducted by Soliman and Macky  in Egypt reported that open-globe injuries were more common than closed-globe injuries. Open-globe injuries occurred in 123 (80.4%) patients, and 30 (19.6%) patients had closed-globe injuries. Of the open-globe injuries, 48 eyes (31.4% of all eyes) had ruptured globes and 75 eyes (49% of all eyes) were lacerated globe, 37 (24%) eyes had intraocular FBs, 35 (23%) eyes had penetrating injuries, and three (2%) eyes had perforating injuries. Of the closed-globe injuries, 8.9% had hyphema, 4.2% had lamellar lacerations, and 3.5% had vitreous hemorrhage with retinal detachment, 2% had commotio retinae, and 1% had optic nerve avulsion .
On the contrary, Salvatore and Francesco  reported that open-globe injuries had a similar frequency to closed-globe injuries .
| Conclusion|| |
- Ocular trauma in Egypt is a major problem, resulting in most cases of blindness. These studies aimed at distinguishing factors participate in ocular trauma in a trial to reduce its prevalence in Egypt.
- People at a higher risk of trauma had been identified as those involved in work and street activities. Workers and students were the most affected population.
- The risk factors can be concluded, in that, we have relatively violent behavior in our streets throwing stones, fist fights, knives, sticks and guns, in addition to the workers using hammers or rough instruments without protection.
- Trauma is mostly not a random event, and the groups in which trauma occurs need to be targeted with preventive strategies. All children should be made aware of ocular trauma starting from preschool age. They should be taught about objects, events, and risks that can cause eye injuries, and what to do in case of an injury.
- Awareness regarding eye injuries among the general public can be achieved through appropriate mass media such as print (e.g. newspapers), electronic media (e.g. radio and TV), and nonelectronic media (e.g. street theatre); preventing the use of firecrackers at home; and teaching children to be careful how are they play with balls.
- Government has a very important role in developing the relevant capacities at the facility level and implementing protective eye health policies.
- Most cases of eye traumas in this study occurred in male individuals who are at an increased risk of work-related injuries. Because distance was not a reason for the patients in seeking care, recommendation of a campaign to urge people to seek medical advice immediately if an injury to the eye has occurred.
- Educational programs are essential if we wish to prevent eye injuries. Workers should be informed about the risk of eye injuries within their workplaces, and all eye-care providers should recommend appropriate safety spectacles.
- Patients with ocular trauma should receive good primary care; owing to poor compliance with follow-up examinations and secondary rehabilitation, there is a real need for urgent ophthalmic services in general hospitals.
- Good management by general physicians before ophthalmologic consultations is considered another key factor in improving the visual prognosis, providing a chance for secondary prevention.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]