RESUMEN
OBJECTIVE: The study used machine learning models to predict the clinical outcome with various attributes or when the models chose features based on their algorithms. METHODS: Patients who presented to an orthopedic outpatient department with joint swelling or myalgia were included in the study. A proforma collected clinical information on age, gender, uric acid, C-reactive protein, and complete blood count/liver function test/renal function test parameters. Machine learning decision models (Random Forest and Gradient Boosted) were evaluated with the selected features/attributes. To categorize input data into outputs of indications of joint discomfort, multilayer perceptron and radial basis function-neural networks were used. RESULTS: The random forest decision model outperformed with 97% accuracy and minimum errors to anticipate joint pain from input attributes. For predicted classifications, the multilayer perceptron fared better with an accuracy of 98% as compared to the radial basis function. Multilayer perceptron achieved the following normalized relevance: 100% (uric acid), 10.3% (creatinine), 9.8% (AST), 5.4% (lymphocytes), and 5% (C-reactive protein) for having joint pain. Uric acid has the highest normalized relevance for predicting joint pain. CONCLUSION: The earliest artificial intelligence-based detection of joint pain will aid in the prevention of more serious orthopedic complications.
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Artralgia , Inteligencia Artificial , Proteína C-Reactiva , Aprendizaje Automático , Ácido Úrico , Humanos , Femenino , Masculino , Ácido Úrico/sangre , Adulto , Persona de Mediana Edad , Artralgia/sangre , Artralgia/diagnóstico , Artralgia/etiología , Proteína C-Reactiva/análisis , Algoritmos , Valor Predictivo de las Pruebas , Adulto Joven , Anciano , Redes Neurales de la Computación , Reproducibilidad de los Resultados , Creatinina/sangre , Biomarcadores/sangre , AdolescenteRESUMEN
The immunopathogenesis of chikungunya virus (CHIKV) infection and the role of acute-phase immune response on joint pain persistence is not fully understood. We investigated the profile of serum chemokine and cytokine in CHIKV-infected patients with acute disease, compared the levels of these biomarkers to those of patients with other acute febrile diseases (OAFD) and healthy controls (HC), and evaluated their role as predictors of chronic arthralgia development. Chemokines and cytokines were measured by flow Cytometric Bead Array. Patients with CHIKV infection were further categorized according to duration of arthralgia (≤ 3 months vs >3 months), presence of anti-CHIKV IgM at acute-phase sample, and number of days of symptoms at sample collection (1 vs 2-3 vs ≥4). Patients with acute CHIKV infection had significantly higher levels of CXCL8, CCL2, CXCL9, CCL5, CXCL10, IL-1ß, IL-6, IL-12, and IL-10 as compared to HC. CCL2, CCL5, and CXCL10 levels were also significantly higher in patients with CHIKV infection compared to patients with OAFD. Patients whose arthralgia lasted > 3 months had increased CXCL8 levels compared to patients whose arthralgia did not (p<0.05). Multivariable analyses further indicated that high levels of CXCL8 and female sex were associated with arthralgia lasting >3 months. Patients with chikungunya and OAFD had similar cytokine kinetics for IL-1ß, IL-12, TNF, IFN-γ, IL-2, and IL-4, although the levels were lower for CHIKV patients. This study suggests that chemokines may have an important role in the immunopathogenesis of chronic chikungunya-related arthralgia.
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Artralgia/inmunología , Fiebre Chikungunya/inmunología , Interleucina-8/sangre , Reacción de Fase Aguda/sangre , Reacción de Fase Aguda/inmunología , Adolescente , Adulto , Artralgia/sangre , Fiebre Chikungunya/sangre , Fiebre Chikungunya/complicaciones , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Adulto JovenRESUMEN
OBJECTIVES: To evaluate the performance of the European League Against Rheumatism (EULAR) definition of arthralgias suspicious for progression to RA in patients with hand arthralgias and to estimate the added value of both auto-antibodies and ultrasound (US) with power Doppler (PD). METHODS: Consecutive patients admitted for hand arthralgias to "Reuma-check" ® program were included. This program includes the following at baseline: clinical assessment, laboratory tests, US with PD of both hands, and radiography of both hands and feet. All patients were followed-up after baseline evaluation by their treating rheumatologists, and a definitive diagnosis of RA (ACR/EULAR 2010 criteria) was established or not. RESULTS: A total of 465 consecutive patients were included. During follow-up, 44 (9.4%) were diagnosed with RA. Mean of baseline EULAR features describing arthralgia suspicious for progression to RA was 4.1 in patients with final diagnosis of RA vs 2.3 in non-RA patients (p < 0.0001). The AUC for the EULAR defined features describing arthralgia suspicious for progression to RA for the final diagnosis of RA was 0.7827, while adding US with PD, rheumatoid factor (RF), and anti-cyclic citrullinated peptide antibodies (ACPA) data, the AUC was 0.9172 (p < 0.0001). In the multivariate regression logistic analysis, baseline features associated with a final diagnosis of RA were difficulty with making a fist, RF, ACPA, and US with PD. CONCLUSIONS: EULAR definition of arthralgia suspicious for progression to RA had an acceptable performance to predict the future development of RA and improves adding information of both RF, ACPA and US with PD data.Key Points⢠Clinically suspect arthralgia may trigger rheumatologists to monitor patients closely for an early diagnosis.⢠EULAR definition of arthralgia suspicious for progression to RA predicts future development of arthritis.⢠Auto-antibodies and ultrasound improve EULAR definition of arthralgia suspicious for progression to RA.
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Anticuerpos Antiproteína Citrulinada/sangre , Artritis Reumatoide/diagnóstico , Factor Reumatoide/sangre , Ultrasonografía Doppler , Adulto , Anciano , Área Bajo la Curva , Artralgia/sangre , Artralgia/diagnóstico por imagen , Artritis Reumatoide/sangre , Artritis Reumatoide/diagnóstico por imagen , Progresión de la Enfermedad , Diagnóstico Precoz , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estudios Prospectivos , Reumatología/métodos , Reumatología/normas , Sinovitis/sangre , Sinovitis/diagnóstico por imagenRESUMEN
Hip pain is a common complaint in a pediatric emergency department. The causes of hip pain are diverse and generally include traumatic and infectious causes. We report a case of hip pain caused by deep soft tissue infection associated with hypercalcemia and primary hyperparathyroidism. Atypical presentation of primary hyperparathyroidism may result in a delay in diagnosis.
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Artralgia/etiología , Articulación de la Cadera , Hipercalcemia/complicaciones , Hiperparatiroidismo Primario/complicaciones , Artralgia/sangre , Artralgia/diagnóstico , Calcio/sangre , Niño , Diagnóstico Tardío , Diagnóstico Diferencial , Humanos , Hipercalcemia/sangre , Imagen por Resonancia Magnética , MasculinoRESUMEN
In chronic dialysis patients, ectopic, extraosseous calcifications can cause significant morbidity. Uremic tumoral calcinosis is an uncommon and severe complication of dialysis therapy. It is defined as deposition of dense nodular calcium-containing masses surrounding the large joints of the body, generally associated with the presence of high serum calcium-and-phosphorus product. We describe a 69-year-old woman submitted to long-term chronic hemodialysis that developed painful, bilateral hip tumors. Radiographic investigation showed extensive periarticular calcifications, and a bone biopsy was suggestive of adynamic bone disease and contained substantial amounts of aluminum. The lesions were surgically excised, and the histological analysis demonstrated amorphous, calcified material associated with densely collagenized connective tissue.
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Artralgia/cirugía , Calcinosis/cirugía , Fallo Renal Crónico/terapia , Neoplasias de Tejido Conjuntivo/cirugía , Diálisis Renal , Anciano , Artralgia/sangre , Artralgia/diagnóstico por imagen , Artralgia/etiología , Calcinosis/sangre , Calcinosis/diagnóstico por imagen , Calcinosis/etiología , Calcio/sangre , Femenino , Humanos , Fallo Renal Crónico/sangre , Neoplasias de Tejido Conjuntivo/sangre , Neoplasias de Tejido Conjuntivo/diagnóstico por imagen , Fósforo/sangre , RadiografíaRESUMEN
Objetivo Determinar las concentraciones de aluminio en suero de pacientes con terapia de reemplazo renal crónico con hemodiálisis y las concentraciones en agua de redes de distribución y diálisis en dos unidades renales en Bogotá. Material y Métodos Estudio descriptivo en 63 pacientes en hemodiálisis y 20 individuos sanos. Las concentraciones de aluminio se determinaron por espectrofotometría de absorción atómica horno de grafito con corrección de lámpara de deuterio. Resultados El promedio de las concentraciones de aluminio en suero de los pacientes fue de 26,5 µg/L (11,2 a 49,2 µg/L, DE=8,03), en individuos sanos de 8,05 µg/L (menor al Límite de Detección a 17,2 µg/L, DE=4,31), en agua de diálisis fue menor a 2 µg/L y en agua de las redes de distribución menor a 200 µg/L. Conclusiones Las concentraciones de aluminio en el agua de la red de distribución y diálisis estudiadas se encontraron por debajo de los valores establecidos internacionalmente indicando un adecuado tratamiento de las mismas. Igualmente las concentraciones de aluminio pre-HD y post-HD observadas en los pacientes se encontraron por debajo de las reportadas en la literatura. El consumo de hidróxido de aluminio aumenta significativamente la concentración de aluminio en suero. Variables como edad, género, estado civil y situación laboral no son factores de riesgo que alteren significativamente las concentraciones de aluminio en suero.
Objective Determining aluminium concentrations in the serum of patients undergoing chronic renal replacement therapy with haemodialysis and concentration in distribution network water and dialysis in two renal units in Bogotá. Material and Methods This was a descriptive study of 63 haemodialysed patients and 20 healthy subjects. Aluminium concentration was determined in water and serum using graphite furnace atomic absorption spectrometry with deuterium lamp background corrector. Results Average aluminium concentration was 26.5 µg/L in patients (ranging from 11.2 to 49.2 µg/L; 8.03 standard deviation) and 8.05 µg/L in healthy individuals (ranging from undetectable to 17.2 µg/L; 4.31 standard deviation). Aluminium concentration in dialysis water and distribution network water was below 2 µg/L and 200 µg/L, respectively. Conclusions Aluminium concentration in water and serum in this study was below international standard values, thereby indicating appropriate treatment. Additionally, aluminium concentration in pre-HD and post-HD sera was below that reported previously. Aluminium hydroxide uptake increases aluminium concentration in serum. Personal situation regarding age, gender, civil and work status were not risk factors determining aluminium concentrations in serum.
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Aluminio/sangre , Soluciones para Hemodiálisis/análisis , Fallo Renal Crónico/terapia , Diálisis Renal , Hidróxido de Aluminio/farmacocinética , Artralgia/sangre , Artralgia/complicaciones , Colombia , Utensilios de Comida y Culinaria/estadística & datos numéricos , Estudios Transversales , Hábitos , Fallo Renal Crónico/sangre , Fallo Renal Crónico/complicaciones , Concentración Máxima Admisible , Trastornos de la Memoria/sangre , Trastornos de la Memoria/complicaciones , Trastornos del Movimiento/sangre , Trastornos del Movimiento/complicaciones , Muestreo , Espectrofotometría Atómica , Trastornos del Habla/sangre , Trastornos del Habla/complicaciones , Agua/análisisRESUMEN
OBJECTIVE: Determining aluminium concentrations in the serum of patients undergoing chronic renal replacement therapy with haemodialysis and concentration in distribution network water and dialysis in two renal units in Bogotá. MATERIAL AND METHODS: This was a descriptive study of 63 haemodialysed patients and 20 healthy subjects. Aluminium concentration was determined in water and serum using graphite furnace atomic absorption spectrometry with deuterium lamp background corrector. RESULTS: Average aluminium concentration was 26.5 µg/L in patients (ranging from 11.2 to 49.2 µg/L; 8.03 standard deviation) and 8.05 µg/L in healthy individuals (ranging from undetectable to 17.2 µg/L; 4.31 standard deviation). Aluminium concentration in dialysis water and distribution network water was below 2 µg/L and 200 µg/L, respectively. CONCLUSIONS: Aluminium concentration in water and serum in this study was below international standard values, thereby indicating appropriate treatment. Additionally, aluminium concentration in pre-HD and post-HD sera was below that reported previously. Aluminium hydroxide uptake increases aluminium concentration in serum. Personal situation regarding age, gender, civil and work status were not risk factors determining aluminium concentrations in serum.
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Aluminio/sangre , Soluciones para Hemodiálisis/análisis , Fallo Renal Crónico/terapia , Diálisis Renal , Adulto , Anciano , Hidróxido de Aluminio/farmacocinética , Artralgia/sangre , Artralgia/complicaciones , Colombia , Utensilios de Comida y Culinaria/estadística & datos numéricos , Estudios Transversales , Femenino , Hábitos , Humanos , Fallo Renal Crónico/sangre , Fallo Renal Crónico/complicaciones , Masculino , Concentración Máxima Admisible , Trastornos de la Memoria/sangre , Trastornos de la Memoria/complicaciones , Persona de Mediana Edad , Trastornos del Movimiento/sangre , Trastornos del Movimiento/complicaciones , Muestreo , Espectrofotometría Atómica , Trastornos del Habla/sangre , Trastornos del Habla/complicaciones , Agua/análisis , Adulto JovenRESUMEN
A medical occupational study was performed in 40 workers belonging to productive units in telecommunication works, 22 to car radiator mechanics and 11 to battery repairs. A practical medical and occupational study was applied to the group and also were determined their blood lead and air lead exposure levels. Seventy-three individuals, without risk of laboral exposure to lead, without familiar, pathological and occupational antecedents, and healthy at the time of the test, to whom the blood lead levels were determined served as control group. The mean values of plumbemia in exposure workers to inorganic lead exceed the level threshold of the COVENIN 2277-85 norm (30 micrograms/dl) (Telecommunication work, 40.10 micrograms/dl, radiators mechanics, 37.40 micrograms/dl and battery repairs, 45.77 micrograms/dl), values that were significantly higher (p < 0.0001) compared with the ones obtained in the non-exposed population. The factors that can influence the variability of the results were analyzed and it was established a correlation between the plumbemia of the radiator mechanics and battery repairmen and the length of occupational period and air lead levels (p < 0.0001). The inherent factors to the climatic, occupational and personal conditions of technicians in telecommunications, are presented as elements able to explain the lack of correlation between blood lead levels and length of occupational period and air lead. The clinical findings in exposed workers were unspecific. The workers do not practice or follow the basic sanitary regulations, personal protection and industrial security. This work will contribute to establish a basic description, to further and more complex observational prospective studies in order to determine the occurrence of alterations that are derived from occupational lead exposure.