Complicaciones de los pacientes con uveítis en un estudio poblacional español: proyecto UveCAM / Complications of uveitis in a Spanish population, UveCAM study

Objetivo Estimar la frecuencia poblacional de complicaciones de uveítis y evaluar sus principales factores de riesgo en los pacientes con uveítis del estudio UveCAM. Pacientes y método Desarrollo de complicaciones de los 386 pacientes con uveítis de toda el área sanitaria de la provincia de Toledo (estudio UveCAM) durante el periodo de un año. Descripción de complicaciones y estudio de los posibles determinantes mediante modelos de regresión multivariante. Resultados Se dispuso de información sobre el desarrollo de complicaciones en 371 de los 386 pacientes del estudio. El 45,8% de los pacientes presentó al menos una complicación, siendo las más frecuentes las sinequias posteriores (19,0%), la hipertensión ocular (14,0%), el edema macular (7,5%), la membrana epirretiniana (6,9%), el glaucoma (6,6%), la atrofia iridiana (5,6%) y las cataratas (5,5%). El riesgo de complicaciones aumenta con la edad, las formas intermedias y panuveítis, y las de evolución crónica o recurrente. Conclusión Las uveítis se asocian con una elevada frecuencia de complicaciones, especialmente en pacientes de edad avanzada, con localización intermedia o posterior del proceso inflamatorio y con evolución crónica o recurrente (AU)

Objective To estimate the population frequency of uveitis complications and to evaluate their main risk factors in the patients with uveitis from the UveCAM study. Patients and methods Development of complications in 386 patients with uveitis in the whole health area of the province of Toledo (UveCAM study) during a period of one year. Description of complications and study of their possible determinants by means of multivariate regression models. Results Information on the development of complications was available in 371 of the 386 patients of the UveCAM study. 45.8% of patients had at least one complication, the most frequent were posterior synechiae (19.0%), ocular hypertension (14.0%), macular oedema (7.5%), epiretinal membrane (6.9%), glaucoma (6.6%), iridian atrophy (5.6%), and atrophy (5.6%) and cataracts (5.5%). The risk of complications increases with age, intermediate and panuveitis locations, and those of chronic or recurrent evolution. Conclusion Uveitis is associated with a high frequency of complications, especially in older patients, with intermediate or posterior localization of the inflammatory process, and chronic or recurrent evolution (AU)

Complications of uveitis in a Spanish population, UveCAM study.

OBJECTIVE: To estimate the population frequency of uveitis complications and to evaluate their main risk factors in the patients with uveitis from the UVECAM study. PATIENTS AND METHODS: Development of complications in 386 patients with uveitis in the whole health area of the province of Toledo (UVECAM study) during a period of 1 year. Description of complications and study of their possible determinants by means of multivariate regression models. RESULTS: Information on the development of complications was available in 371 of the 386 patients of the UVECAM study. The most frequent complications were posterior synechiae (19.0%), ocular hypertension (14.0%), macular edema (7.5%), epirretinal membrane (6.9%), glaucoma (6.6%), iridian atrophy (5.6%) and cataract (5.5%). The risk of complications increases with age, intermediate and panuveitis locations, and those of chronic or recurrent evolution. CONCLUSION: Uveitis is associated with a high frequency of complications, especially in older patients, with intermediate or posterior localization of the inflammatory process and chronic or recurrent evolution.

Epidemiology of Uveitis in a Spanish Region: Prevalence and Etiology.

OBJECTIVE: To estimate the prevalence of uveitis and to describe its etiologic and anatomical patterns based on a population study carried out in a Spanish region. MATERIAL AND METHODS: A cross-sectional, descriptive, population-based multicenter study was conducted. The selection criteria consisted of having a diagnosis of uveitis. All data were collected from existing information in medical records.Clinical information was collected in all cases that had a diagnosis of uveitis, regardless of its etiology, in participating centers from the date of the study to the end of the following year. All patients underwent a complete ophthalmological examination, which included assessment of their visual acuity, biomicroscopy, applanation tonometry, and indirect ophthalmoscopy. RESULTS: During the study, 389 cases of uveitis were registered. The prevalence was 58.7 (95% confidence interval [CI] 53.0-64.9). The mean age was 47.0 ± 20.6 years and 57.8% were women. The most prevalent anatomical pattern was anterior uveitis (54.2; 95% CI 48.1-60.8). For adults, the idiopathic group constituted the highest prevalence (31.7; 95% CI: 27.1-36.9), while autoimmune etiology was most frequent for children (10.6; 95% CI: 5.8-17.7). CONCLUSION: The results of this population-based study offer a representative estimate of the magnitude of uveitis in this area of Spain.

Development and validation of a Bayesian network for the differential diagnosis of anterior uveitis.

PurposeTo develop and validate a Bayesian belief network algorithm for the differential diagnosis of anterior uveitis.Patients and methodsThe 11 most common etiologies were included (idiopathic, ankylosing spondylitis, psoriasic arthritis, reactive arthritis, inflammatory bowel diseases, sarcoidosis, tuberculosis, Behçet, Posner-Schlossman syndrome, juvenile idiopathic arthritis (JIA), and Fuchs' heterochromic cyclitis). Frequencies of association between factors and etiologies were retrieved from a systematic review of the literature. Prevalences were calculated using a random sample of 200 patients receiving a diagnosis of anterior uveitis in Moorfields Eye Hospital in 2012. The network was validated in a random sample of 200 patients receiving a diagnosis of anterior uveitis in the same hospital in 2013 plus 10 extra cases of the most rare etiologies (JIA, Behçet, and psoriasic arthritis).ResultsIn 63.8% of patients the most probable etiology by the algorithm matched the senior clinician diagnosis. In 80.5% of patients the clinician diagnosis matched the first or second most probable results by the algorithm. Taking into account only the most probable diagnosis by the algorithm, sensitivities for each etiology ranged from 100% (7 of 7 patients with reactive arthritis and 5 of 5 with Behçet correctly classified) to 46.7% (7 of 15 patients with tuberculosis-related uveitis). Specificities ranged from 88.8% for sarcoidosis to 99.5% in Posner.ConclusionsThis algorithm could help clinicians with the differential diagnosis of anterior uveitis. In addition, it could help with the selection of the diagnostic tests performed.

Actividad física y ocio y su relación con el Índice de Ruffier en adolescentes / Physical activity and leisure habits and relation with Ruffier Index in adolescents

El objetivo del estudio fue medir y correlacionar la práctica de actividad física y con el Índice de Ruffier (IR) en adolescentes. A un total de 884 alumnos (edad=16,4±0,8 años) se les midió la actividad física con la Versión modificada del Assessment of Physical Activity Level Questionnaire (APALQ) y se evaluó la capacidad de adaptación al esfuerzo mediante el Test Ruffier. La media del Índice de Ruffier fue 11,1±4,6 y el Índice de actividad física (IAF) 13,8±4,4. Las relaciones entre IAF y el IR, y entre horas de ocio sedentario e IR resultaron ser significativas aunque débiles (r=-0,31; p=0,000). En el IR los chicos presentaron valores superiores (t= -8,78; p= 0,000) a las chicas. También destinan más tiempo a la práctica de AF y estas diferencias fueron significativas en AF reglada y no reglada y en participación en competición (p=0,000), mientras que las chicas destinan más tiempo a actividades sedentarias como leer y estudiar (p=0,000). Es necesario promover la práctica de actividades físico-deportivas, especialmente entre las chicas (AU)

The aim of the study was to assess and correlate physical activity practice and fitness level in adolescents. A total of 884 students (age=16,4±0,8 years) answered the modified version of the 'Assessment of Physical Activity Level Questionnaire (APALQ)' and aerobic capacity was assessed through the Ruffier Test. The mean Ruffier Index (IR) was 11,1±4,6 and the mean Physical Activity Index (IAF) was 13,8±4,4. The relationship between IAF and IR, and between sedentary activities in leisure time and IR, was significant (r=-0,31; p=0,000). although weak. Boys showed higher physical fitness values (t= -8,78; p= 0,000) and spent more time practicing physical activity. These differences were significant for both regulated and not regulated physical activity and for participation in competition (p=0.000). Girls spent more time in sedentary activities like reading and studying (p=0.000). It is necessary to promote physical activity and sport practice, especially among girls (AU)

Calidad de la dieta y su relación con el IMC y el sexo en adolescentes / Diet quality and its relation to sex and BMI in adolescents

El sobrepeso afecta de manera creciente a los adolescentes de los países occidentales. Analizar su incidencia y la relación con los hábitos nutricionales puede convertirse en el primer paso para diseñar estrategias de actuación. Se analizó la calidad de la dieta de 1057adolescentes de la ciudad de Leganés (Madrid, España) a través del índice KIDMED. Se calculó su IMC y se categorizó en normo peso, sobrepeso u obesidad. Existen diferencias significativas entre sexos en los hábitos nutricionales, donde los chicos presentan una nutrición más saludable, así como en la prevalencia de obesidad, siendo ésta mayor en el caso de los chicos. No se ha mostrado relación entre el índice de calidad de la dieta y la composición corporal. Deben diseñarse estrategias de actuación para mejorar la calidad de la dieta en los adolescentes, especialmente en las chicas (AU)

Overweight is an increasing affection among the adolescents in western countries. Analyzing its incidence and the relationship with nutritional habits can become the first step to design action strategies. The quality of the diet of 1057 adolescents from Leganés city (Madrid, Spain) was analyzed through index KIDMED. BMI was calculated and compared with the categorization according to normal weight, overweight or obesity. Significant differences exist between gender in the nutritional habits, where boys display a healthier nutrition, as well as in the obesity prevalence, being major in the case of boys. Relationship between diet quality index and body composition has not been found. Action strategies must be designed to improve the quality of the diet in adolescents, especially in girls (AU)

Methotrexate: an option for preventing the recurrence of acute anterior uveitis.

AIMS: To evaluate the efficacy of methotrexate (MTX) in preventing the recurrence of acute anterior uveitis (AAU). METHODS: This prospective, open, longitudinal study included patients from June 2002 to March 2005 who had either three or more episodes of AAU in the previous year, or a recurrence of AAU within 3 months before starting the trial. We excluded uveitis of infectious origin, masquerade syndromes, and patients with contraindications to MTX. The response criteria were defined as an absence of symptoms and the presence of a normal ophthalmologic examination. The study outcome compared the number of flare-ups of uveitis over an MTX-treated for 1 year to the number of flare-ups of the same group during the previous year without MTX. RESULTS: A total of 571 patients with uveitis were evaluated during the period of the study, and 10 fulfilled the inclusion criteria. One patient refused the treatment, and nine completed the study. The mean number of recurrences in the pre-MTX year was 3.4 (SD: 0.52), which was significantly reduced to 0.89 (SD: 1.17) in the year of treatment (P=0.011). CONCLUSION: MTX treatment seems to reduce the number of flare-ups in patients with recurrent AAU.

Réplica: «Neuro-Behçet y neurotoxicidad por ciclosporina» / Reply to: «Neuro-Behçet and neurotoxicity due to cyclosporine»

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Enfermedad de Behçet en tratamiento con ciclosporina y crisis comiciales: el dilema diagnóstico / Behçet’s disease in treatment with cyclosporine and seizures: diagnostic dilemma

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[Fuchs' heterochromic cyclitis without heterochromia: a diagnostic approach]. / Aproximación diagnóstica a la ciclitis heterocrómica de Fuchs en ausencia de heterocromía.

OBJECTIVE: To obtain diagnostic guidelines of Fuchs' heterochromic cyclitis (FHC) in the absence of heterochromia using Bayesian methods. METHODS: The pre-test and post-test likelihood that a certain patient without heterochromia (but with other characteristic symptoms of the disease such as iris nodules, cataracts, glaucoma or vitritis) has FCH, was assessed by the Bayes' theorem for conditioned likelihood. The prevalence values of FCH and the presentation rate of symptoms in FCH and in other forms of anterior uveitis were obtained from published literature data. RESULTS: In the absence of heterochromia, the combination of iris nodules together with cataracts, vitritis or glaucoma, and the association of the last three symptoms in the absence of nodules, resulted in an accumulated likelihood of more than 50% of subjects having the disease. CONCLUSIONS: The coincidence in one patient of several indicative symptoms, even in the absence of heterochromia, may make FCH a likely diagnostic option.

Meningoencefalitis recurrente como inicio de enfermedad de Behçet / Relapsing meningoencephalitis as onset of Behçet's disease

Introducción. La enfermedad de Behçet es una enfermedad inflamatoria, multisistémica, crónica y recidivante de etiopatogenia desconocida. Se caracteriza por úlceras aftosas orales recidivantes, úlceras genitales y uveítis. El sustrato patológico principal es una vasculitis leucocitoclástica. Caso clínico. Presentamos a una paciente con enfermedad de Behçet que se inició como una meningoencefalitis recurrente, con pleocitosis linfocitaria y proteinorraquia en el líquido cefalorraquídeo. La resonancia magnética cerebral mostró una lesión predominante del tronco del encéfalo. Conclusiones. Entre un 5-20% de los pacientes con enfermedad de Behçet tienen afectación neurológica, siendo la manifestación inicial en el 3% de los casos. Puede presentarse como: un único ataque con remisión completa o incompleta, como una forma remitente-recidivante, una forma progresiva o presentar únicamente afectación neurológica silente. La afectación neurológica más frecuente es una meningoencefalitis recurrente, a menudo con curso progresivo, que afecta más frecuentemente al troncoencéfalo. El pronóstico de la enfermedad va a depender de su forma de presentación, con peor porvenir en las formas parenquimatosas, sobre todo con afectación de tronco y medular, de las anomalías encontradas en el líquido cefalorraquídeo y del número de episodios o de las recaídas tras la disminución del tratamiento con esteroides. Tiene una mortalidad alta, llegando a comunicarse hasta un 20% de mortalidad a los 7 años en casos con afectación neurológica

Introduction. Behçet's disease is a systemic, chronic, relapsing inflammatory disease of unknown etiology characterized by recurrent oral aphthae, genital ulcerations and uveitis. The main pathological mechanism is leukocytoclastic vasculitis. Clinical case. We present the case of a patient with Behçet's disease that presented as a relapsing meningoencephalitis with lymphocytic pleocytosis and high protein levels in cerebrospinal fluid. The MRI revealed a lesion in the brain stem and part of diencephalon. Conclusions. The central nervous system is involved in up to 5%-20% of patients with Behçet's disease, this being the first manifestation in 3% of the cases. Clinical course includes: patients with an isolated episode with complete or incomplete recovery, relapsing and remitting forms, progressive forms or asymptomatic neurological involvement. The most frequent presentation is relapsing meningoencephalitis, with progressive course localized in the brain stem. Prognosis varies according to the type of neurologic process. The worse outcome is in the parenchymal forms with brain stem and spinal cord involvement. It also depends on the pathological findings in the cerebrospinal fluid, and the number of total events or recurrences after tapering the glucocorticoids. Mortality rate is high, up to 20 % of cases after 7 years in patients with neurological involvement

Aproximación diagnóstica a la ciclitis heterocrómica de Fuchs en ausencia de heterocromía / Fuchs´heterochronic cyclits without heterochromia: a diagnostic approach

Objetivo: Obtener pautas de diagnóstico de la ciclitis heterocrómica de Fuchs (CHF) en ausencia de heterocromía utilizando metodología bayesiana. Métodos: Se obtienen las probabilidades pre-test y post-test de que un determinado paciente sin heterocromía pero con otros síntomas característicos de la enfermedad, tales como nódulos iridianos, cataratas, glaucoma o vitritis anterior, tenga CHF. Para ello se utiliza el teorema de Bayes para la probabilidad condicionada. Los valores de la prevalencia de la CHF y de la frecuencia de presentación de los síntomas en la CHF y en el total de las uveitis anteriores se obtienen de los datos de la literatura publicada. Resultados: En ausencia de heterocromía, la combinación de nódulos iridianos junto con cataratas, vitritis o glaucoma, así como la asociación de estos tres últimos síntomas aún sin nódulos supone una probabilidad acumulada de más del 50% de tener la enfermedad. Conclusiones: La coincidencia en un paciente de varios síntomas indicativos aún en ausencia de heterocromía puede hacer que la CHF sea una opción diagnóstica probable

Objective: To obtain diagnostic guidelines of Fuchs’ heterochromic cyclitis (FHC) in the absence of heterochromia using Bayesian methods. Methods: The pre-test and post-test likelihood that a certain patient without heterochromia (but with other characteristic symptoms of the disease such as iris nodules, cataracts, glaucoma or vitritis) has FCH, was assessed by the Bayes’ theorem for conditioned likelihood. The prevalence values of FCH and the presentation rate of symptoms in FCH and in other forms of anterior uveitis were obtained from published literature data. Results: In the absence of heterochromia, the combination of iris nodules together with cataracts, vitritis or glaucoma, and the association of the last three symptoms in the absence of nodules, resulted in an accumulated likelihood of more than 50% of subjects having the disease. Conclusions: The coincidence in one patient of several indicative symptoms, even in the absence of heterochromia, may make FCH a likely diagnostic option

[Relapsing meningoencephalitis as onset of Behçet's disease]. / Meningoencefalitis recurrente como inicio de enfermedad de Behçet.

INTRODUCTION: Behçet's disease is a systemic, chronic, relapsing inflammatory disease of unknown etiology characterized by recurrent oral aphthae, genital ulcerations and uveitis. The main pathological mechanism is leukocytoclastic vasculitis. CLINICAL CASE: We present the case of a patient with Behçet's disease that presented as a relapsing meningoencephalitis with lymphocytic pleocytosis and high protein levels in cerebrospinal fluid. The MRI revealed a lesion in the brain stem and part of diencephalon. CONCLUSIONS: The central nervous system is involved in up to 5%-20% of patients with Behçet's disease, this being the first manifestation in 3% of the cases. Clinical course includes: patients with an isolated episode with complete or incomplete recovery, relapsing and remitting forms, progressive forms or asymptomatic neurological involvement. The most frequent presentation is relapsing meningoencephalitis, with progressive course localized in the brain stem. Prognosis varies according to the type of neurologic process. The worse outcome is in the parenchymal forms with brain stem and spinal cord involvement. It also depends on the pathological findings in the cerebrospinal fluid, and the number of total events or recurrences after tapering the glucocorticoids. Mortality rate is high, up to 20% of cases after 7 years in patients with neurological involvement.

Abnormalities in the bone mineral metabolism in HIV-infected patients.

OBJECTIVE: To evaluate bone mineral metabolism in HIV infected and asymptomatic patients receiving highly active antiretroviral therapy (HAART) containing protease inhibitors (PI) and naïve patients. METHODS: We studied 30 asymptomatic HIV infected male patients, 13 in the naive group and 17 in the IP group, both without differences in demographics characteristics. We excluded women and patients with any known factor associated to osteopenia. We did a nutritional questionnaire, a DEXA scan in lumbar spine and femur, a study of CD4 lymphocytes, viral load and an analysis of bone formation and resorption markers in all patients. We compared vitamin D and PTH levels with a control group of healthy male volunteers age-pareated. For the statistical analysis we used the SPSS program. RESULTS: Osteopenia was present in 17/30 (57%), 8/13 (61.5%) in the naïve group and 9/17 (53%) in the PI group (not significant differences). We found a vitamin D deficiency in 86% of patients, with mean serum levels that was found to be significantly lower than those from a healthy control group (p=0.04). Testosterone level was significantly related to bone mineral density in lumbar spine (p