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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.
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Algoritmos , Teorema de Bayes , Uveíte Anterior/diagnóstico , Diagnóstico Diferencial , Humanos , Prevalência , Sensibilidade e EspecificidadeRESUMO
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.
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Inibidores Enzimáticos/uso terapêutico , Imunossupressores/uso terapêutico , Metotrexato/uso terapêutico , Uveíte Anterior/prevenção & controle , Adolescente , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Prevenção Secundária , Adulto JovemRESUMO
No disponible
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Humanos , Síndrome de Behçet/diagnóstico , /diagnóstico , Ciclosporina/toxicidade , Neurotoxinas , Espectroscopia de Ressonância MagnéticaRESUMO
No disponible
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Feminino , Adulto , Humanos , Imunossupressores/efeitos adversos , Ciclosporinas/efeitos adversos , Síndrome de Behçet/tratamento farmacológico , Convulsões/induzido quimicamente , Ácido Valproico/uso terapêutico , Fatores de Tempo , Metotrexato/administração & dosagem , Metotrexato/uso terapêutico , Pressão Intraocular , Imunossupressores/uso terapêutico , Seguimentos , Ciclosporinas/uso terapêutico , Anticonvulsivantes/uso terapêutico , Síndrome de Behçet/complicações , Síndrome de Behçet/diagnóstico , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Convulsões/diagnóstico , Convulsões/tratamento farmacológicoAssuntos
Síndrome de Behçet/tratamento farmacológico , Ciclosporinas/efeitos adversos , Imunossupressores/efeitos adversos , Convulsões/induzido quimicamente , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Adulto , Anticonvulsivantes/uso terapêutico , Síndrome de Behçet/complicações , Síndrome de Behçet/diagnóstico , Ciclosporinas/administração & dosagem , Ciclosporinas/uso terapêutico , Eletrorretinografia , Emergências , Feminino , Seguimentos , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/uso terapêutico , Pressão Intraocular , Metotrexato/administração & dosagem , Metotrexato/uso terapêutico , Convulsões/diagnóstico , Convulsões/tratamento farmacológico , Fatores de Tempo , Ácido Valproico/uso terapêuticoRESUMO
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=0.05). CONCLUSIONS: HIV may be an individual risk factor in bone disorders, requiring calcium and vitamin D supplementation.