ABSTRACT
Diabetes mellitus is a global health problem affecting 366 million people worldwide and its prevalence is growing rapidly. Diabetic eye disease is present in up to 25% of diabetic subjects. Diabetic retinopathy is a chronic complication of diabetes that can result in blindness. Generally, there are two stages of diabetic retinopathy, non-proliferative and proliferative. The longer a person has diabetes and the poorer metabolic control, the higher the chance of developing diabetic retinopathy. The majority of people with type 2 diabetes will ultimately develop diabetic retinopathy. Multifactorial therapy targeted to lifestyle modification and optional glycemic control reduces the risk. However, diabetic retinopathy develops or progresses with time. Primary [preventive] strategies include glycemic, lipid, and blood pressure control. Glycemic control effectively reduces the incidence of diabetic retinopathy. In additional, its effect on progression of diabetic retinopathy has been demonstrated in randomized clinical trials. Furthermore, tight control of blood pressure significantly reduces the progression of retinopathy and visual loss. However, the Action to Control Cardiovascular Risk in Diabetes [ACCORD] Eye Study Group has shown that intensive blood pressure control has no beneficial effect on reducing the rate of diabetic retinopathy in subjects with type 2 diabetes. Elevated serum lipids and dyslipidemias are associated with a higher risk of diabetic retinopathy. The beneficial effects of lipid-lowering agents on the progression of retinopathy have been reported. Intensive combination therapy for dyslipidemia has been shown to effectively reduce the rate of progression of diabetic retinopathy in type 2 diabetes. Secondary strategies are focused on various pathophysiologic approaches such as blockade of the renin angiotensin system [RAS], anti-vascular endothelial growth factor agents, somatostatin analogues, protein kinase inhibitors, and anti-inflammatory agents. The purpose of the current overview is to look into the medical management of diabetic retinopathy, and to explore the primary [preventive] measures as well as secondary strategies proposed to be effective in its medical management
Subject(s)
Humans , Disease Management , Diabetes MellitusABSTRACT
Bolton analysis is a good indicator to evaluate tooth size discrepancies but the ethnic variation of these values should be considered. Thus, the aim of this study was to determine the tooth ratios in different sexes and malocclusion groups in Iranian population and to compare these ratios with the data from the Bolton study. Also the best predictors of anterior and overall Bolton discrepancies were determined in this study. In this cross-sectional study, a total of 715 dental casts [526 female. 189 male] were recruited from department of orthodontics of Shiraz dental school and private offices of orthodontists. The samples were divided into three groups based on Angles Malocclusion groups. Then the greatest mesiodistal widths of all teeth were measured with digital caliper with accuracy of 0.01 mm and the anterior and overall ratios were calculated. Finally, the data were analyzed by Pearson Correlation, independent t-test and Kruskal-Wallis test, through SPSS software. The anterior ratio [78.74%] and the overall ratio [91.94%] showed no statistically significant differences according to sex and malocclusion groups in south Iranian population. The results revealed that the correlation coefficient of lateral ratio with anterior Bolton discrepancy was 0.544 and central ratio with anterior Bolton discrepancy was 0.536. Also the correlation coefficient of first premolar ratio with overall Bolton discrepancy was 0.440 and the second premolar ratio with overall Bolton discrepancy was 0.407. The anterior ratio for the whole population was statistically different from Bolton's, but no statistically significant difference was found for the overall ratio. In Iranian population, the best predictor of anterior Bolton discrepancy was lateral tooth and the best predictor of overall Bolton discrepancy was first premolar