Treatment challenges in an atypical presentation of tubulointerstitial nephritis and uveitis (TINU)

Purpose: To describe an atypical presentation of Tubulointerstitial Nephritis and Uveitis (TINU), with challenges in treatment course. Observations: A 12-year-old Hispanic female presented to the National Eye Institute\u27s Uveitis clinic with bilateral blurred vision, red eyes and photophobia, not responsive to topical steroids. On exam, she had bilateral severe panuveitis with areas of subretinal fluid. During her evaluation, she was noted to have elevated serum creatinine. A kidney biopsy confirmed the presence of severe tubulointerstitial nephritis and interstitial fibrosis. She was treated with oral steroids with excellent resolution of symptoms and subretinal fluid. She continued to have anterior segment flares with attempts to taper oral prednisone which lead to treatment with multiple immunomodulatory agents. Associated hypertension and kidney damage complicated the choice of a secondary immunosuppressive agent. Conclusions and Importance: Although rare, TINU can present as panuveitis with choroidal involvement which may or may not be preceded by tubulointerstitial nephritis. A renal biopsy is required for definitive diagnosis, but abnormal urinalysis or renal function should raise suspicion for TINU. © 201

Surveying uveitis specialists—a call for consensus

Thomas Brennan became disillusioned with popular law school rankings and so decided to survey 100 academics, judges, and lawyers on his own, asking them to rank a list of ten schools he provided. He used a composite index similar in structure, but different in content, to those used by main-stream surveyors, such as U.S. News & World Report. As expected, many of the big name schools—Harvard, Yale, Stanford—made it to the top of the list. Penn State, as Brennan recalled, “[Was] about in the middle of the pack. Maybe fifth among the 10 schools listed. ” There was one small problem, however. Penn State had no law school at the time. Brennan had included it to make a point: surveys are limited by both the quality of the questions asked and by how familiar respondents are with the subject being surveyed [1, 2]

Overall and cancer related mortality among patients with ocular inflammation treated with immunosuppressive drugs: retrospective cohort study

Context Whether immunosuppressive treatment adversely affects survival is unclear

Diagnostic techniques for inflammatory eye disease: past, present and future: a review

Investigations used to aid diagnosis and prognosticate outcomes in ocular inflammatory disorders are based on techniques that have evolved over the last two centuries have dramatically evolved with the advances in molecular biological and imaging technology. Our improved understanding of basic biological processes of infective drives of innate immunity bridging the engagement of adaptive immunity have formed techniques to tailor and develop assays, and deliver targeted treatment options. Diagnostic techniques are paramount to distinguish infective from non-infective intraocular inflammatory disease, particularly in atypical cases. The advances have enabled our ability to multiplex assay small amount of specimen quantities of intraocular samples including aqueous, vitreous or small tissue samples. Nevertheless to achieve diagnosis, techniques often require a range of assays from traditional hypersensitivity reactions and microbe specific immunoglobulin analysis to modern molecular techniques and cytokine analysis. Such approaches capitalise on the advantages of each technique, thereby improving the sensitivity and specificity of diagnoses. This review article highlights the development of laboratory diagnostic techniques for intraocular inflammatory disorders now readily available to assist in accurate identification of infective agents and appropriation of appropriate therapies as well as formulating patient stratification alongside clinical diagnoses into disease groups for clinical trials

Outcomes of non-infectious Paediatric uveitis in the era of biologic therapy

Abstract Background There is a paucity of data on the ocular outcomes in paediatric non-infectious uveitis since the introduction of the biologic agents. The purpose of this study was to outline the clinical characteristics of children with non-infectious uveitis and determine the visual outcomes and ocular complication rates in the modern era. Methods Children with non-infectious uveitis from January 2011 to December 2015 were identified. Data was collected at baseline, 1, 3, 5, and 10 years post diagnosis. The incidence rates of visual impairment, structural ocular complications and surgical intervention were calculated. Using logistic regression the association between various baseline characteristics and later visual impairment was investigated. Results Of the 166 children, 60.2% (n = 100) had a systemic disease association. 72.9% (n = 121) children received methotrexate, 58 children progressed to a biologic. The incidence rates of visual acuity loss to > 0.3 LogMAR (6/12) and to ≥1.0 LogMAR (6/60) were 0.05/Eye Year (EY) and 0.01/EY, respectively. Visual outcomes in the Juvenile Idiopathic Arthritis associated Uveitis (JIA-U) and Idiopathic Uveitis cohorts were not statistically significant. Of the 293 affected eyes, posterior synechiae was the predominant complication on presentation, while cataract had the highest incidence rate (0.05/EY). On direct comparison, children with JIA-U were statistically significantly more likely to develop glaucoma while children with Idiopathic Uveitis were statistically significantly more likely to develop macular oedema. Conclusion One third of children received a biological therapy, reflecting increasing utilisation and importance of biological agents in the management of inflammatory conditions. Rates of visual impairment and ocular complications are an improvement on previously published data

Error Minimization in Phoneme based Automated Speech Recognition for Similar Sounding Phonemes

AbstractThe technology of ASR (Automated Speech Recognition) has been quite successful with the use of Hidden Markov Model (HHM) with the aid of probabilistic and the best path methods. The words with limited vocabulary content can easily be modeled and trained. The modules with a large dictionary has to be modeled with context independent phones joining together to form a word. The major problem lies in recognizing the word with similar sounding phonemes. This paper aims in minimizing the error with similar sounding phonemes by using the viterbi algorithm for each similar syllable in the backward direction

D.: Self-normalized linear tests

Making decisions based on a linear combination L of features is of course very common in pattern recognition. For distinguishing between two hypotheses or classes, the test is of the form sign(L − τ) for some threshold τ. Due mainly to fixing τ, such tests are sensitive to changes in illumination and other variations in imaging conditions. We propose a special case, a “self-normalized linear test” (SNLT), hard-wired to be of the form sign(L1 − L2) with unit weights. The basic idea is to “normalize ” L1, which involves the usual discriminating features, by L2, which is composed of non-discriminating features. For a rich variety of features (e.g., based directly on intensity differences), SNLTs are largely invariant to illumination and robust to unexpected background variations. Experiments in face detection are promising: they confirm the expected invariances and out-perform some previous results in a hierarchical framework. 1

The trace model for object detection and tracking

Abstract. We introduce a stochastic model to characterize the online computational process of an object recognition system based on a hierarchy of classifiers. The model is a graphical network for the conditional distribution, under both object and background hypotheses, of the classifiers which are executed during a coarse-to-fine search. A likelihood is then assigned to each history or “trace ” of processing. In this way, likelihood ratios provide a measure of confidence for each candidate detection, which markedly improves the selectivity of hierarchical search, as illustrated by pruning many false positives in a face detection experiment. This also leads to a united framework for object detection and tracking. Experiments in tracking faces in image sequences demonstrate invariance to large face movements, partial occlusions, changes in illumination and varying numbers of faces.