Purpose We aimed to describe the demographic and clinical features, ocular man ifestations, complications, visual prognosis, and treatment in a large populatio n of Turkish patients with Behcet uveitis. We also aimed ...Purpose We aimed to describe the demographic and clinical features, ocular man ifestations, complications, visual prognosis, and treatment in a large populatio n of Turkish patients with Behcet uveitis. We also aimed to compare visual progn osis between male and female sex and between patients who presented before and a fter 1990. Design Observational case series. Methods A retrospective study of 88 0 consecutive patients (1,567 eyes) with Behcet uveitis seen at the Uveitis Serv ice, Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul Univers ity, from 1980 to 1998. All patients met the classifi cation criteria of the Int ernational Study Group for Behcets Disease. Information on the patients sex, age at onset of uveitis, ocular features, ocular complications, visual acuity, and systemic treatment was collected. Results Five hundred ninetynine patients ( 68%)weremale and 281 (32%)were female. The mean age at onset of uveitiswas 28. 5 years inmale and 30 years in female patients. Ocular involvement was bilateral in 78.1%and unilateral in 21.9%of the patients. Panuveitiswas the most common form in both sexes. Fundus lesions as well as sightthreatening complications we re more common in males. At the beginning of the follow up, potential visual ac uity was 0.1 or less in 30.9%of eyes in males and 24.2%of eyes in females. Kap lan Meier survival analysis estimated the risks of losing useful vision (>0.1) at 5 and 10 years for males and females as 21%vs 10%and 30%vs 17%, respectiv ely. Male patients who presented in the 1990s had a significantly lower risk of losing vision compared with male patients who presented in the 1980s. Conclusion Behcet uveitis starts frequently around the end of the third decade and has a m ale predominance. The disease is more severe and the risk of losing useful visio n is higher in males than in females. However, this risk has been significantly reduced in the 1990s.展开更多
Thalidomide,an immunomodulatory drug,is widely recommended for the treatment of recurrent aphthous stomatitis(RAS).This review aimed to assess the reliability of thalidomide for managing RAS,oro-genital ulcers associa...Thalidomide,an immunomodulatory drug,is widely recommended for the treatment of recurrent aphthous stomatitis(RAS).This review aimed to assess the reliability of thalidomide for managing RAS,oro-genital ulcers associated with Behçet’s disease(BD),and RAS in individuals with HIV infection.A systematic review was conducted following PICOS(Patient,Intervention,Control,Outcome,Study design)principles.Given the heterogeneity across studies,a qualitative analysis was performed in place of a meta-analysis.Eight randomized controlled trials(RCTs)were deemed eligible for inclusion.In three RCTs focused on RAS,a dosage of thalidomide at 100 mg/d demonstrated efficacy,while a lower dose of 25 mg/d helped prolong the recurrence interval of RAS.For oro-genital ulcers of BD,two RCTs indicated that both 300 mg/d for 24 weeks and 200 mg/d for 28 d,preceded by an initial dose of 400 mg/d for 5 d,were effective.In three RCTs investigating RAS in HIV-infected patients,thalidomide at 200 mg/d for either 4 or 7 weeks,with an initial dose of 400 mg/d for the first week,proved effective.However,a regimen of 100 mg three times per week failed to prevent the recurrence of oral ulcers.Adverse reactions to thalidomide were generally tolerable within the dosage ranges used in these studies.Overall,thalidomide showed promising efficacy for treating RAS,oro-genital ulcers in BD,and RAS in HIV-infected individuals.However,the variability in trial designs,dosages,and treatment durations makes it challenging to recommend an optimal dose and course of therapy.Further high-quality RCTs are necessary to establish more definitive guidelines.展开更多
BACKGROUND Behcet’s disease(BD),a chronic vasculitic disorder affecting multiple organs,is characterized by recurrent oral and genital ulcers,arthritis,vasculitis,and intes-tinal ulcers.Although intestinal involvemen...BACKGROUND Behcet’s disease(BD),a chronic vasculitic disorder affecting multiple organs,is characterized by recurrent oral and genital ulcers,arthritis,vasculitis,and intes-tinal ulcers.Although intestinal involvement of BD is common in East Asia,the efficacy and long-term outcomes of surgical treatment of intestinal BD still remain to be established.AIM To evaluate the postoperative clinical course of intestinal BD and determine factors associated with its recurrence.METHODS Data from patients who underwent surgical treatment for intestinal BD between January 2010 and August 2021 were retrospectively reviewed.Patients’demo-graphics,clinical features,postoperative course,complications,and follow-up data were evaluated.RESULTS We analyzed 39 surgeries in 31 patients.The mean patient age was 45.1 years,and the mean interval between the diagnosis of intestinal BD and surgical treatment was 4.9 years(range 1.0-8.0 years).The most common indication for surgery was medical intractability(n=16,41.0%),followed by fistula or abscess(n=11,28.2%).Laparoscopic approaches were used in 19 patients(48.7%),and 5 patients(12.8%)underwent emergency surgeries.The most common surgical procedure was ileocecal resection(n=18,46.2%),followed by right colectomy(n=11,28.2%).A diverting stoma was created in only one patient(2.6%).During a mean follow-up period of 45(range 8-72)months,eight cases(20.5%)of recurrence in five patients required reoperation.The interval between operations was 12.1 months(range 6.3-17.8 mo).Four patients(10.3%)experienced recurrence within 1 year postoperatively,and all eight recurrences occurred within 2 years of the initial surgery.The reoperation rates at 1 and 3 years were 10.3%and 20.5%,respectively.A redo ileocolic anastomosis was performed in all recurrent cases.In multivariate Cox regression analysis,emergency surgery[hazard ratio(HR)9.357,95%confidence interval(CI):1.608-54.453,P=0.013]and elevated C-reactive protein(CRP)levels(HR 1.154,95%CI:1.002–1.328,P=0.047),but not medication use,were predictors of recurrence.CONCLUSION Surgical resection is a feasible treatment option for complicated BD.Reoperation is associated with severe inflam-matory conditions,reflected by increased CRP levels and the requirement for emergency surgery.展开更多
BACKGROUND Behcet's disease(BD)is an inflammatory disorder known for various symptoms,including oral and genital ulcers and ocular inflammation.Panuveitis,a severe eye condition,is rare as the first sign of BD.CAS...BACKGROUND Behcet's disease(BD)is an inflammatory disorder known for various symptoms,including oral and genital ulcers and ocular inflammation.Panuveitis,a severe eye condition,is rare as the first sign of BD.CASE SUMMARY We present an unusual case of a 30-year-old man who developed panuveitis after receiving the mRNA-based coronavirus disease 2019(COVID-19)vaccine(Moderna).Laboratory tests ruled out infections,but he had a positive HLA-B51 result and a history of genital ulcer and oral ulcers,leading to a BD diagnosis.Treatment with corticosteroids improved his condition.Interestingly,he had another episode of panuveitis after the second mRNA vaccine dose,which also responded to corticosteroids.CONCLUSION This case highlights the rare onset of BD following mRNA COVID-19 vaccination,suggesting a potential link between these vaccines and BD's eye symptoms,emphasizing the importance of quick treatment in similar cases.展开更多
文摘Purpose We aimed to describe the demographic and clinical features, ocular man ifestations, complications, visual prognosis, and treatment in a large populatio n of Turkish patients with Behcet uveitis. We also aimed to compare visual progn osis between male and female sex and between patients who presented before and a fter 1990. Design Observational case series. Methods A retrospective study of 88 0 consecutive patients (1,567 eyes) with Behcet uveitis seen at the Uveitis Serv ice, Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul Univers ity, from 1980 to 1998. All patients met the classifi cation criteria of the Int ernational Study Group for Behcets Disease. Information on the patients sex, age at onset of uveitis, ocular features, ocular complications, visual acuity, and systemic treatment was collected. Results Five hundred ninetynine patients ( 68%)weremale and 281 (32%)were female. The mean age at onset of uveitiswas 28. 5 years inmale and 30 years in female patients. Ocular involvement was bilateral in 78.1%and unilateral in 21.9%of the patients. Panuveitiswas the most common form in both sexes. Fundus lesions as well as sightthreatening complications we re more common in males. At the beginning of the follow up, potential visual ac uity was 0.1 or less in 30.9%of eyes in males and 24.2%of eyes in females. Kap lan Meier survival analysis estimated the risks of losing useful vision (>0.1) at 5 and 10 years for males and females as 21%vs 10%and 30%vs 17%, respectiv ely. Male patients who presented in the 1990s had a significantly lower risk of losing vision compared with male patients who presented in the 1980s. Conclusion Behcet uveitis starts frequently around the end of the third decade and has a m ale predominance. The disease is more severe and the risk of losing useful visio n is higher in males than in females. However, this risk has been significantly reduced in the 1990s.
文摘Thalidomide,an immunomodulatory drug,is widely recommended for the treatment of recurrent aphthous stomatitis(RAS).This review aimed to assess the reliability of thalidomide for managing RAS,oro-genital ulcers associated with Behçet’s disease(BD),and RAS in individuals with HIV infection.A systematic review was conducted following PICOS(Patient,Intervention,Control,Outcome,Study design)principles.Given the heterogeneity across studies,a qualitative analysis was performed in place of a meta-analysis.Eight randomized controlled trials(RCTs)were deemed eligible for inclusion.In three RCTs focused on RAS,a dosage of thalidomide at 100 mg/d demonstrated efficacy,while a lower dose of 25 mg/d helped prolong the recurrence interval of RAS.For oro-genital ulcers of BD,two RCTs indicated that both 300 mg/d for 24 weeks and 200 mg/d for 28 d,preceded by an initial dose of 400 mg/d for 5 d,were effective.In three RCTs investigating RAS in HIV-infected patients,thalidomide at 200 mg/d for either 4 or 7 weeks,with an initial dose of 400 mg/d for the first week,proved effective.However,a regimen of 100 mg three times per week failed to prevent the recurrence of oral ulcers.Adverse reactions to thalidomide were generally tolerable within the dosage ranges used in these studies.Overall,thalidomide showed promising efficacy for treating RAS,oro-genital ulcers in BD,and RAS in HIV-infected individuals.However,the variability in trial designs,dosages,and treatment durations makes it challenging to recommend an optimal dose and course of therapy.Further high-quality RCTs are necessary to establish more definitive guidelines.
文摘BACKGROUND Behcet’s disease(BD),a chronic vasculitic disorder affecting multiple organs,is characterized by recurrent oral and genital ulcers,arthritis,vasculitis,and intes-tinal ulcers.Although intestinal involvement of BD is common in East Asia,the efficacy and long-term outcomes of surgical treatment of intestinal BD still remain to be established.AIM To evaluate the postoperative clinical course of intestinal BD and determine factors associated with its recurrence.METHODS Data from patients who underwent surgical treatment for intestinal BD between January 2010 and August 2021 were retrospectively reviewed.Patients’demo-graphics,clinical features,postoperative course,complications,and follow-up data were evaluated.RESULTS We analyzed 39 surgeries in 31 patients.The mean patient age was 45.1 years,and the mean interval between the diagnosis of intestinal BD and surgical treatment was 4.9 years(range 1.0-8.0 years).The most common indication for surgery was medical intractability(n=16,41.0%),followed by fistula or abscess(n=11,28.2%).Laparoscopic approaches were used in 19 patients(48.7%),and 5 patients(12.8%)underwent emergency surgeries.The most common surgical procedure was ileocecal resection(n=18,46.2%),followed by right colectomy(n=11,28.2%).A diverting stoma was created in only one patient(2.6%).During a mean follow-up period of 45(range 8-72)months,eight cases(20.5%)of recurrence in five patients required reoperation.The interval between operations was 12.1 months(range 6.3-17.8 mo).Four patients(10.3%)experienced recurrence within 1 year postoperatively,and all eight recurrences occurred within 2 years of the initial surgery.The reoperation rates at 1 and 3 years were 10.3%and 20.5%,respectively.A redo ileocolic anastomosis was performed in all recurrent cases.In multivariate Cox regression analysis,emergency surgery[hazard ratio(HR)9.357,95%confidence interval(CI):1.608-54.453,P=0.013]and elevated C-reactive protein(CRP)levels(HR 1.154,95%CI:1.002–1.328,P=0.047),but not medication use,were predictors of recurrence.CONCLUSION Surgical resection is a feasible treatment option for complicated BD.Reoperation is associated with severe inflam-matory conditions,reflected by increased CRP levels and the requirement for emergency surgery.
文摘BACKGROUND Behcet's disease(BD)is an inflammatory disorder known for various symptoms,including oral and genital ulcers and ocular inflammation.Panuveitis,a severe eye condition,is rare as the first sign of BD.CASE SUMMARY We present an unusual case of a 30-year-old man who developed panuveitis after receiving the mRNA-based coronavirus disease 2019(COVID-19)vaccine(Moderna).Laboratory tests ruled out infections,but he had a positive HLA-B51 result and a history of genital ulcer and oral ulcers,leading to a BD diagnosis.Treatment with corticosteroids improved his condition.Interestingly,he had another episode of panuveitis after the second mRNA vaccine dose,which also responded to corticosteroids.CONCLUSION This case highlights the rare onset of BD following mRNA COVID-19 vaccination,suggesting a potential link between these vaccines and BD's eye symptoms,emphasizing the importance of quick treatment in similar cases.
