BackgroundDiabetic retinopathy is the leading cause of blindness in economically active populations. The aims of this study were to estimate the prevalence and to identify risk factors for diabetic retinopathy in patients with type 1 diabetes in Brazil.MethodsThis was a nationwide, cross-sectional study conducted between August 2010 and August 2014. The study included 1760 patients with type 1 diabetes. Patients underwent a standard questionnaire, clinical and laboratory analyses and were screened for diabetic retinopathy. To analyze the risk factors related to diabetic retinopathy, two models of logistic regression models were performed, one considering vision-threatening cases and the other with any diabetic retinopathy cases as dependent variables. The group with vision-threatening included patients with severe non-proliferative diabetic retinopathy, proliferative diabetic retinopathy and macular edema.ResultsIn total, 1644 patients (mean age, 30.1± 12.0 years; duration of diabetes, 15.3 ± 9.3 years; female, 55.8%) were studied. 35.7% presented diabetic retinopathy and 12% presented vision-threatening diabetic retinopathy. Three risk factors associated with diabetic retinopathy were in common to both groups: longer diabetes duration (OR 1.07; 95% CI, 1.05–1.09), higher levels of HbA1c (OR 1.24; CI, 1.17–1.32) and higher levels of serum uric acid (OR 1.22; CI, 1.13–1.31) (p < 0.001 for all comparisons).ConclusionThe higher rate of vision-threatening retinopathy found in our study highlights the need to improve access to eye care and screening programs for diabetic retinopathy in Brazil. In addition to traditional risk factors, we found an association between serum uric acid levels and diabetic retinopathy. Further studies are needed to address this association.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5859-x) contains supplementary material, which is available to authorized users.
BackgroundDiabetic retinopathy is the main cause of preventable blindness in the economically active population in western countries. Diabetic retinopathy screening is effective in preventing blindness and can be performed through various diagnostic methods. Our objective is to compare binocular indirect ophthalmoscopy (BIO) to telemedicine protocols of digital retinography for diabetic retinopathy screening in a large and heterogenous type 1 diabetes population in a developing country.MethodsData from 1266 Type 1 Diabetes Mellitus patients from a Brazilian multicenter study were analyzed. Patients underwent BIO and digital retinography, non-mydriatic and mydriatic. Images were sent to a reading center in a telemedicine protocol. Agreement between the different methods was calculated with kappa statistic for diabetic retinopathy and maculopathy classification. Clinical outcome was either observation or referral to specialist.ResultsAgreement between BIO and mydriatic retinography was substantial (kappa 0.67–0.74) for diabetic retinopathy observation vs referral classification. Agreement was fair to moderate (kappa 0.24–0.45) between retinography and BIO for maculopathy. Poor mydriasis was the main obstacle to image reading and classification, especially on the non-mydriatic strategy, occurring in 11.9 % of right eyes and 16.9 % of left eyes.ConclusionMydriatic retinography showed a substantial agreement to BIO for diabetic retinopathy observation vs referral classification. A significant amount of information was lost on the non-mydriatic technique because of poor mydriasis. We recommend a telemedicine-based diabetic retinopathy screening strategy with digital mydriatic retinography, preferably with 2 fields, and advise against non-mydriatic retinography in developing countries.
In diabetes BM thickening develops in retinal and glomerular capillaries in a correlated manner. Tight glycemic control may be beneficial in preventing the pathologic development of capillary BM thickening and FN overexpression in retinal and renal tissues, two target tissues of diabetic microangiopathy.
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Development of a mechanical maintenance training simulator inOpenSimulator for F-16 aircraft engines
AbstractMechanical maintenance of F-16 engines is carried out as a team effort involving 3 to 4 skilled engine technicians, but the details of its procedures and requisites change constantly, to improve safety, optimize resources, and respond to knowledge learned from field outcomes. This provides a challenge for development of training simulators, since simulated actions risk becoming obsolete rapidly and require costly reimplementation. This paper presents the development of a 3D mechanical maintenance training simulator for this context, using a low-cost simulation platform and a software architecture that separates simulation control from simulation visualization, in view of enabling more agile adaptation of simulators. This specific simulator aims to enable technician training to be enhanced with cooperation and context prior to the training phase with actual physical engines. We provide data in support of the feasibility of this approach, describing the requirements that were identified with the Portuguese Air Force, the overall software architecture of the system, the current stage of the prototype, and the outcomes of the first field tests with users.
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