Effect of orbital decompression surgery on the choroidal profile in patients with thyroid eye disease.

This study aimed to investigate the effect of orbital wall decompression surgery and reduction of proptosis on the choroidal vascularity index (CVI) and subfoveal choroidal thickness (SFCT) in patients with thyroid eye disease (TED). Fifty-one eyes from 38 patients with controlled TED and proptosis were enrolled in this study. The majority of the patients (50.9%) had a clinical activity score (CAS) of zero, and none had a CAS greater than 2. The patients underwent a complete baseline ophthalmologic examination, and their choroidal profile alterations were monitored using enhanced depth imaging optical coherence tomography (EDI-OCT) before and during the three months after surgery. Changes in SFCT, luminance area (LA), total choroidal area (TCA), and the choroidal vascularity index (CVI) were measured as the ratio of LA to TCA in EDI-OCT images. The participants had an average age of 46.47 years, and 22 were female (57.9%). The SFCT of the patients exhibited a significant reduction over the follow-up period, decreasing from 388 ± 103 to 355 ± 95 µm in the first month (p < 0.001) and further decreasing to 342 ± 109 µm by the third month compared to baseline (p < 0.001). The CVI exhibited a drop from 0.685 ± 0.037 at baseline to 0.682 ± 0.035 and 0.675 ± 0.030 at 1 and 3 months post-surgery, respectively. However, these changes were not statistically significant, indicating comparable decreases in both LA and TCA. There was a significant correlation between improved proptosis and reduction in SFCT (p < 0.001) but not with CVI (p = 0.171). In conclusion, during the three months of follow-up following orbital wall decompression, CVI did not change, while SFCT reduced significantly. Additionally, SFCT was significantly correlated with proptosis reduction, whereas CVI was not.

Backpropagation-free training of deep physical neural networks.

Recent successes in deep learning for vision and natural language processing are attributed to larger models but come with energy consumption and scalability issues. Current training of digital deep-learning models primarily relies on backpropagation that is unsuitable for physical implementation. In this work, we propose a simple deep neural network architecture augmented by a physical local learning (PhyLL) algorithm, which enables supervised and unsupervised training of deep physical neural networks without detailed knowledge of the nonlinear physical layer's properties. We trained diverse wave-based physical neural networks in vowel and image classification experiments, showcasing the universality of our approach. Our method shows advantages over other hardware-aware training schemes by improving training speed, enhancing robustness, and reducing power consumption by eliminating the need for system modeling and thus decreasing digital computation.

Parallel temporal signal processing enabled by polarization-multiplexed programmable THz metasurfaces.

Under the trends of multifunctionality, tunability, and compactness in modern wave-based signal processors, in this paper, we propose a polarization-multiplexed graphene-based metasurface to realize distinct mathematical operators on the parallel time-domain channels enabled by vertical and horizontal polarizations. The designed metasurface is composed of two perpendicularly-oriented graphene strips for each of which the chemical potential can be dynamically tuned through a DC biasing circuit. The programmable metasurface exhibits two orthogonal channels through which the time-domain input signals are elaborately processed by separate mathematical functions. Several illustrative examples are presented demonstrating that the proposed device can operate on different time-domain analog computing modes such as fractional-order differentiator and phaser at the same time. The strategy introduced in this paper will enable real-time parallel temporal analog computing and has potentially essential applications in terahertz spectroscopy architectures, communication systems, and computing technologies.

Parallel wave-based analog computing using metagratings.

Wave-based signal processing has witnessed a significant expansion of interest in a variety of science and engineering disciplines, as it provides new opportunities for achieving high-speed and low-power operations. Although flat optics desires integrable components to perform multiple missions, yet, the current wave-based computational metasurfaces can engineer only the spatial content of the input signal where the processed signal obeys the traditional version of Snell's law. In this paper, we propose a multi-functional metagrating to modulate both spatial and angular properties of the input signal whereby both symmetric and asymmetric optical transfer functions are realized using high-order space harmonics. The performance of the designed compound metallic grating is validated through several investigations where closed-form expressions are suggested to extract the phase and amplitude information of the diffractive modes. Several illustrative examples are demonstrated to show that the proposed metagrating allows for simultaneous parallel analog computing tasks such as first- and second-order spatial differentiation through a single multichannel structured surface. It is anticipated that the designed platform brings a new twist to the field of optical signal processing and opens up large perspectives for simple integrated image processing systems.

Electromagnetic wave-based extreme deep learning with nonlinear time-Floquet entanglement.

Wave-based analog signal processing holds the promise of extremely fast, on-the-fly, power-efficient data processing, occurring as a wave propagates through an artificially engineered medium. Yet, due to the fundamentally weak non-linearities of traditional electromagnetic materials, such analog processors have been so far largely confined to simple linear projections such as image edge detection or matrix multiplications. Complex neuromorphic computing tasks, which inherently require strong non-linearities, have so far remained out-of-reach of wave-based solutions, with a few attempts that implemented non-linearities on the digital front, or used weak and inflexible non-linear sensors, restraining the learning performance. Here, we tackle this issue by demonstrating the relevance of time-Floquet physics to induce a strong non-linear entanglement between signal inputs at different frequencies, enabling a power-efficient and versatile wave platform for analog extreme deep learning involving a single, uniformly modulated dielectric layer and a scattering medium. We prove the efficiency of the method for extreme learning machines and reservoir computing to solve a range of challenging learning tasks, from forecasting chaotic time series to the simultaneous classification of distinct datasets. Our results open the way for optical wave-based machine learning with high energy efficiency, speed and scalability.

Management of Malignant Glaucoma.

Purpose: To compare the outcomes of various invasive and noninvasive approaches to the treatment of malignant glaucoma. Methods: Glaucoma-related keywords were looked up in PubMed and Google Scholar, and related articles up to 2022 were used to put together this review article. Results: Numerous surgical methods and techniques have been introduced in the past few years. This review outlined current knowledge regarding the nonsurgical and surgical management of malignant glaucoma. In this regard, we first briefly outlined the clinical presentation, pathophysiology, and diagnosis of this disorder. Then, the current evidence on the management of malignant glaucoma was reviewed. Finally, we discuss the need for treatment of the other eye and the factors that might affect the outcome of surgical intervention. Conclusions: Fluid misdirection syndrome, or malignant glaucoma, is a severe disorder that can occur spontaneously due to surgical intervention. The pathophysiology of malignant glaucoma is complicated, and numerous theories exist about the underlying mechanisms that may contribute to the disease. Malignant glaucoma can be treated conservatively using medications, laser therapy, or surgery. Laser treatments and medical treatments have been adequate for the treatment of glaucoma, but the effects have generally been short-lived, and surgical treatment has proved to be the most effective. There have been a variety of surgical methods and techniques introduced. Still, none have been studied in a large proportion of patients as a control case to compare effectiveness, outcomes, and recurrence. Pars plana vitrectomy with irido-zonulo-capsulectomy still seems to have the best results.

Spatial wave control using a self-biased nonlinear metasurface at microwave frequencies.

Recently, investigation of metasurfaces has been extended to wave control through exploiting nonlinearity. Among all of the ways to achieve tunable metasurfaces with multiplexed performances, nonlinearity is one of the promising choices. Although several proposals have been reported to obtain nonlinear architectures at visible frequencies, the area of incorporating nonlinearity in form of passive-designing at microwave metasurfaces is open for investigation. In this paper, a passive wideband nonlinear metasurface is manifested, which is composed of embedded L-shape and Γ -shape meta-atoms with PIN-diode elements. The proposed self-biased nonlinear metasurface has two operational states: at low power intensities, it acts as a Quarter Wave Plate (QWP) in the frequency range from 13.24 GHz to 16.38 GHz with an Axial Ratio (AR) of over 21.2%. In contrast, at high power intensities, by using the polarization conversion property of the proposed PIN-diode based meta-atoms, the metasurface can act as a digital metasurface. It means that by arranging the meta-atoms with a certain coding pattern, the metasurface can manipulate the scattered beams and synthesize well-known patterns such as diffusion-like and chessboard patterns at an ultra-wide frequency range from 8.12 GHz to 19.27 GHz (BW=81.4%). Full-wave and nonlinear simulations are carried out to justify the performance of the wideband nonlinear metasurface. We expect the proposed self-biased nonlinear metasurface at microwave frequencies reveals excellent opportunities to design limiter metasurfaces and compact reconfigurable imaging systems.

Self-biased tri-state power-multiplexed digital metasurface operating at microwave frequencies.

Exploiting of nonlinearity has opened doors into undiscovered areas to achieve multiplexed performances in recent years. Although efforts have been made to obtain diverse nonlinear architectures at visible frequencies, the room is still free for incorporating non-linearity into the design of microwave metasurfaces. In this paper, a passive dual-band power intensity-dependent metasurface is presented, which is composed of two different linear and nonlinear meta-atoms accommodating a capacitor and a PIN-diode, respectively. The proposed digital metasurface has three operational states: 1) it acts as a normal reflector at low power intensities while providing a dual-band nonlinear response upon illuminating by high-power incidences where 2) it perfectly absorbs the radiations at f1=6.7 GHz and 3) re-distributes the scattered beams by arranging the meta-atoms with a certain coding pattern at f2=9.4 GHz. The performance of the designed coding elements has been characterized by using the scattering parameters captured in the full-wave simulations and the nonlinear analysis performed in ADS software where the accurate model of diodes is involved. The emergence of microwave self-biased metasurfaces with smart re-actions against incident waves with different power levels reveals great opportunities for designing smart windows, smart camouflage coating surfaces, and so on.

Association of PON1-L55M Genetic Variation and Breast Cancer Risk: A Case-Control Trial.

BACKGROUND: Paraoxonase 1 (PON1), a multifactorial antioxidant enzyme, has a defensive role against oxidative stress, which is believed to contribute to cancer development. This study aimed to investigate the association of PON1-L55M functional polymorphism with breast cancer risk. MATERIAL AND METHODS: In the experimental study, blood samples were collected from 150 healthy women controls and 150 breast cancer subjects. The L55M genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism. RESULTS: Our analysis showed that the genotypes distribution is in Hardy-Weinberg equilibrium for both case and control groups. Our data revealed that there are significant associations between PON1-L55M polymorphism and breast cancer risk in homozygote (OR= 2.13, 95%CI= 1.14-4.00, p= 0.018), dominant (OR= 1.72, 95%CI= 1.07-2.76, p= 0.024), and allelic (OR= 1.55, 95%CI= 1.12-2.15, p= 0.008) models. CONCLUSIONS: Our results suggest that the PON1-L55M genetic variation could be a genetic risk factor for breast cancer risk and it could be considered as a molecular biomarker for screening of susceptible women.
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Common gene polymorphism in ATP-binding cassette transporter A1 and coronary artery disease: A genetic association study and a structural analysis.

ATP-binding cassette transporter A1 (ABCA1) has a crucial role in removing intracellular cholesterol and plays a protective role against atherosclerosis. Therefore, genetic polymorphisms in this gene may alter the susceptibility to coronary artery disease (CAD). This study was aimed to examine the association of rs2230806 (c.1051 G > A; p.R219K) variation in the ABCA1 gene with CAD in a case-control design which was followed by a meta-analysis and in silico approach. In the case-control study, 300 subjects including 150 individuals with CAD and 150 healthy controls were recruited. The c.1051 G > A genotyping was done by polymerase chain reaction-restriction fragment length polymorphism method. In the meta-analysis, eligible studies were collected from PubMed, Google Scholar, and ScienceDirect databases and pooled odds ratio, heterogeneity, publication bias, and sensitivity analyses were carried. Finally, some bioinformatics tools were employed to assess the impacts of p.R219K variation on ABCA1 protein structure. Our case-control examination showed a statistically significant association between c.1051 G > A genetic polymorphism and CAD risk. In addition, the meta-analysis showed reliable significant associations between c.1051 G > A transition and risk of CAD in the Caucasian population. In silico analysis showed that the p.R219K substitution could alter the secondary structure, hydrophobicity pattern, and Ramachandran plot of ABCA1. These findings elucidate that the c.1051 G > A variation could be a genetic risk factor for CAD and it could be considered as a prognostic and predictive biomarker for susceptible individuals.

Fingolimod and changes in hematocrit, hemoglobin and red blood cells of patients with multiple sclerosis.

INTRODUCTION: Fingolimod is the first oral drug approved by Food and Drug Administration (FDA) of United States for treating patients with relapsing-remitting multiple sclerosis (RRMS). Fingolimod acts by immunomodulation but there are still much remained about its different effects. OBJECTIVES: The aim of this study was to evaluate the changes in hematocrit (Hct), hemoglobin (Hb), and red blood cells (RBC) of patients with MS under treatments with fingolimod. METHODS: A total number of 66 MS patients were included to our study based on certain exclusion criteria and eligibility for fingolimod oral treatment. Hct, Hb, and RBC were measured for each patient before drug administrations. Patients were treated with Fingolimod. 5 mg daily and after three months of treatments, measurements of Hct, Hb, and RBC were performed. Data were analyzed using SPSS software version 24. RESULTS: Amounts of Hct, Hb, and RBC were significantly decreased in this patient cohort. Hematocrit was decreased in all patients. Hemoglobin levels were significantly decreased in the female cohorts. Such decreases for male patients were insignificant. Red blood cell counts were also significantly decreased in patients. CONCLUSION: Accumulating line of evidence had surveys on different side effects of fngolimod but here we indicated that fingolimod will also decrease amounts of Hct, Hb, and RBC which could result further problems in patients susceptible to other diseases.

Asymmetric Spatial Power Dividers Using Phase-Amplitude Metasurfaces Driven by Huygens Principle.

Recent years have witnessed an extraordinary spurt in attention toward the wave-manipulating strategies revealed by phase-amplitude metasurfaces. Recently, it has been shown that, when two different phase-encoded metasurfaces responsible for doing separate missions are added together based on the superposition theorem, the mixed digital phase distribution will realize both missions at the same time. In this paper, via a semi-analytical procedure, we demonstrate that such a theorem is not necessarily valid when using phase-only metasurfaces or ignoring the element pattern functions. We introduce the concept of asymmetric spatial power divider (ASPD) with arbitrary power ratio levels in which modulating both amplitude and phase of the meta-atoms is inevitable to fully control the power intensity pattern of a reflective metasurface. Numerical simulations illustrate that the proposed ASPD designed by proper phase and amplitude distribution over the surface can directly generate a desired number of beams with predetermined orientations and power budgets. The C-shaped Pancharatnam-Berry meta-atoms locally realize the optimal phase and amplitude distribution in each case, and the good conformity between simulations and theoretical predictions verifies the presented formalism. A prototype of our ASPD designs is also fabricated and measured, and the experimental results corroborate well our numerical and semi-analytical predictions. Our findings not only offer possibilities to realize arbitrary spatial power dividers over subwavelength scale but also reveal an economical and simple alternative for a beamforming array antenna.

Effect of pioglitazone on decreasing of proteinuria in type 2 diabetic patients with nephropathy.

INTRODUCTION: Diabetic nephropathy that means albuminuria greater than 30 mg/day, affects about one third of diabetic patients. There are many studies about the effect of different medications for diabetic nephropathy with controversy in their results. So, the aim of the study was to investigate the effect of pioglitazone on decreasing of proteinuria in type II diabetic patients and nephropathy. METHODS AND MATERIALS: It is a double blind clinical trial. At first, 2356 medical carts of the patients were evaluated and 76 patients with type 2 diabetes mellitus with proteinuria greater than 250 mg / day were enrolled in 2 equal groups. In the case group, pioglitazone 15 mg/day was prescribed and patients in the control group received placebo for two months. At the beginning of the study and after 2 months, urinary protein during 24 h was measured in all of the patients and data were entered to SPSS (version23) and evaluated by using Chi- square, Mc Nemar, paired t-test and logistic regression model. RESULTS: At the beginning of the study, urine protein during 24 h in the case and control groups were 957.7 ±â€¯385.1 and 972.1 ±â€¯378.6 respectively (P = .872). So, after 2 months the mean proteinuria in the case and control groups were 647.3 ±â€¯367.2 and 896 ±â€¯372.4 respectively that is valuable (P = 0.005). Pioglitazone had the considerable effect on FBS,HbA1c and blood triglyceride too. CONCLUSION: The study showed that low dose of pioglitazone is an effective, safe and inexpensive method in reducing of proteinuria in type2 diabetic patients with nephropathy.

Association of carotid intima-media thickness with exercise tolerance test in type 2 diabetic patients.

AIMS: Atherosclerosis and ischemic heart disease are more common in diabetic patients. Atherosclerosis process can disturb the normal functioning of the vascular endothelium and increase vessel wall thickness. The aim of this study was the comparison of Carotid intima-media thickness (CIMT) with Exercise tolerance test as an alternative way to evaluate cardiac ischemia in diabetic patients. METHODS: In a cross-sectional study, 30 diabetic patients with positive exercise test and 30 diabetic patients with negative exercise test were enrolled. CIMT of the carotid artery in both groups of patients was measured. RESULT: CIMT in the patients with positive and negative exercise test were 1.04 ±â€¯0.21 mm and 0.61 ±â€¯0.11 mm, respectively (P < 0.001). CIMT in positive exercise test group was positively associated with age and negatively associated with gender, FBS, HDL and LDL cholesterol and in negative exercise group was negatively associated with gender, age, FBS, HDL and LDL cholesterol. CONCLUSION: Considering observed significant positive association between CIMT with result of exercise tolerance test (ETT) in type 2 diabetic patients, it may possible to use CIMT as an inexpensive and non-invasive method for evaluation of ischemic heart disease in diabetic patients.

An Information Theory-Inspired Strategy for Design of Re-programmable Encrypted Graphene-based Coding Metasurfaces at Terahertz Frequencies.

Inspired by the information theory, a new concept of re-programmable encrypted graphene-based coding metasurfaces was investigated at terahertz frequencies. A channel-coding function was proposed to convolutionally record an arbitrary information message onto unrecognizable but recoverable parity beams generated by a phase-encrypted coding metasurface. A single graphene-based reflective cell with dual-mode biasing voltages was designed to act as "0" and "1" meta-atoms, providing broadband opposite reflection phases. By exploiting graphene tunability, the proposed scheme enabled an unprecedented degree of freedom in the real-time mapping of information messages onto multiple parity beams which could not be damaged, altered, and reverse-engineered. Various encryption types such as mirroring, anomalous reflection, multi-beam generation, and scattering diffusion can be dynamically attained via our multifunctional metasurface. Besides, contrary to conventional time-consuming and optimization-based methods, this paper convincingly offers a fast, straightforward, and efficient design of diffusion metasurfaces of arbitrarily large size. Rigorous full-wave simulations corroborated the results where the phase-encrypted metasurfaces exhibited a polarization-insensitive reflectivity less than -10 dB over a broadband frequency range from 1 THz to 1.7 THz. This work reveals new opportunities for the extension of re-programmable THz-coding metasurfaces and may be of interest for reflection-type security systems, computational imaging, and camouflage technology.

Comparison of Complications of Arteriovenous Fistula with Permanent Catheter in Hemodialysis Patients: A Six-month Follow-up.

BACKGROUND: Arteriovenous fistula (AVF), permanent catheter (PC), and vascular graft are three vascular access types used for hemodialysis procedure. Due to insufficient reliable information on the comparison between AVF and PC, this study was conducted to compare AVF and PC regarding dialysis adequacy. MATERIALS AND METHODS: This prospective study was carried out from March, 2013 to September, 2013. In this study, 76 hemodialysis patients were enrolled and assigned to two unequal groups of AVF and PC. Before and after the dialysis session, blood samples were taken for laboratory examinations and measurement of urea reduction ratio (URR) and Kt/V. The patients were followed up for six months, and then laboratory examinations were repeated. RESULTS: Of the 76 hemodialysis patients, 30 had AVF and others PC. During the 6-month follow-up, 24 patients in PC group but only one patient in AVF group showed infection (P = 0.006), while in each group, three cases of thrombosis were seen (P = 0.58); however, catheter dysfunction was seen in 13 patients of PC group but no patients of AVF group (P = 0.004). There was no difference between the two groups in Kt/V and URR at the beginning of the study; however, after six months, Kt/V and URR were greater in AVF group (P < 0.05). CONCLUSIONS: In addition to some advantages of AVF over PC, such as lower rate of infection and thrombosis, we also found better dialysis adequacy in AVF group. We recommend that AVF be created in all of patients with chronic kidney disease who are candidates for hemodialysis.

Impact of Kelussia odoratissima Mozaffarian lipid profile and fasting blood sugar in hyperlipidemia patients.

Introduction: Hyperlipidemia is associated with increased risk of cardiovascular disease. Each type of medication works differently and has different types of side effects. Flavonoids are a group of polyphenolic compounds with antioxidant properties that help reducing the cardiovascular risk factors. Kelussia odoratissima is a flavonoid containing plant. Objectives: The aim of this study was investigating the effect of this herb on lipid and glucose profile in hyperlipidemia patients. PATIENTS AND METHODS: This study performed on 61 hyperlipidemia patients. They assigned in control and intervention groups. The control group received 40 mg/day of lovastatin and intervention group received 40 mg/day of Lovastatin plus 2 g/day powder of Kelussia odoratissima. Before, two weeks and 1 month after the beginning of the study, cholesterol, triglyceride (TG), low density lipoprotein cholesterol (LDL-C), very low density lipoprotein cholesterol (VLDL-C), high density lipoprotein cholesterol (HDL-C), and fasting blood sugar (FBS) were measured. Data were analyzed by variance analysis with repeated measures, chi-square and t tests. Results: The reduction rate of cholesterol, TG, VLDL-C and LDL-C was similar in the control and intervention groups. The HDL-C rate was higher in intervention group compared to control group (P < 0.05). The mean LDL/HDL ratio decreased during the study (P < 0.001); however, there was not any significant difference between the two groups (P > 0.05). The mean of FBS did not change between and within groups (P > 0.05). Conclusion:Kelussia odoratissima did not have a desirable effect on serum lipid profile and FBS in hyperlipidemic patients that use lovastatin, but is able to increase HDL-C significantly.

Effect of vitamin D on proteinuria in type 2 diabetic patients.

BACKGROUND: Vitamin D (Vit D) deficiency is a common disorder in diabetic patients and may be a risk factor for ischemic heart disease and exacerbation of diabetic nephropathy(DN). OBJECTIVES: The aim of this study was to evaluate the effect of Vit D3 therapy on protein uriain type 2 diabetic patients with deficient or insufficient serum Vit D. PATIENTS AND METHODS: In a double blind clinical trial, 60 type 2 diabetic patients with proteinuria greater than 150 mg/day who had Vit D deficiency or insufficiency were randomly enrolled in two equal groups. Pearl of Vit D as 50 000 IU/week and placebo (1 tablet per week) were prescribed in patients of case and control groups respectively for 8 weeks. At the beginning and 2 months later, 24 hours urine protein was checked in all patients. RESULTS: There is no difference between serums Vit D level in case and control group at the beginning of the study, however at the end of the study serum Vit D level was significantly higher in the case group. There is no difference in proteinuria between case and control group at the beginning and the end of the study, while a significant difference between the changes of proteinuria before and after the study was seen in two groups (P = 0.028). CONCLUSIONS: Vit D deficiency may exacerbate protein uric and DN, hence correction of Vit D deficiency may decrease proteinuria in diabetic patients with nephropathy.

A study on the association of diabetic dermopathy with nephropathy and retinopathy in patients with type 2 diabetes mellitus.

BACKGROUND: Diabetic dermopathy is one of the most prevalent skin complications in diabetes patients. Some studies have pointed to association of diabetic dermopathy with retinopathy and nephropathy in patients with type 2 diabetes as microangiopathy presentations, but no rigorous study has been conducted to confirm this association. OBJECTIVES: This study investigated association of diabetic dermopathy with nephropathy and retinopathy in patients with type 2 diabetes referring specialty clinic of Shahrekord. PATIENTS AND METHODS: This descriptive, cross-sectional study was conducted on 102 type 2 diabetes patients with dermopathy referring clinic constantly or as outpatient. Dermatological and ophthalmological examinations and examination for nephropathy were done for all patients. Demographic data and results of examinations and patients history, and biochemical tests were gathered and recorded by researcher developed checklists. RESULTS: Mean age of patients was 83.8 2.60 years, of whom 64 (63.7%) were female and 37.3% were male. Prevalence of retinopathy in patients was 4.31% and nephropathy 3.33%. In this study, significant associations of diabetic dermopathy with diabetic nephropathy (P = 0.001), with retinopathy (P < 0.001), age (P < 0.001), duration of diabetes (P = 0.001), and also with glycosylated hemoglobin (P < 0.01) was detected. No significant association between diabetic dermopathy and other studied variables was seen (P > 0.05). CONCLUSIONS: Results of this study confirm the association of diabetic dermopathy with retinopathy and nephropathy in patients with type 2 diabetes. Since dermopathy is usually developed before retinopathy and nephropathy, dermopathy could be used as a clinical finding in early diagnosis and prevention of retinopathy and nephropathy in diabetes patients.