Adenosine deaminase enzyme activity is increased and negatively correlates with catalase, superoxide dismutase and glutathione peroxidase in patients with Behçet's disease: original contributions/clinical and laboratory investigations.

AIM: Behçet's disease (BD) is an inflammatory vasculitis with immunologic, endothelial and neutrophil alterations. Adenosine deaminase (AD) is a marker of T-cell activation and is related to the production of reactive oxygen species by neutrophils with the production of NO(*), O(2)(*-), H(2)O(2) and OH(*). We reported increased tumour necrosis factor-alpha, soluble interleukin-2 receptor, interleukin-6, interleukin-8 and NO(*) in active BD. As there is a relation between cytokines, T cells and oxidative stress in inflammatory diseases, this study further evaluated: (1) plasma AD activity and its correlation with acute phase reactants; (2) thiobarbituric acid-reactive substances (TBARS) as an indicator for lipid peroxidation; and (3) antioxidant enzymes superoxide dismutase (SOD), glutathione peroxidase (GSHPx) and catalase in patients with BD. The effect of disease activity and correlations between the measured parameters were explored. METHODS: A total of 35 active (n=17) or inactive (n=18) patients with BD (16 men, 19 women) satisfying International Study Group criteria, and 20 age-matched and sex-matched controls (nine men, 11 women) were included in this cross-sectional case-control study. AD and TBARS were measured in plasma, catalase in red blood cells (RBC), and SOD and GSHPx in both plasma and RBC in both groups. Acute phase reactants (alpha(1)-antitrypsin, alpha(2)-macroglobulin, neutrophils, erythrocyte sedimentation rate) were used to classify patients as active or inactive. RESULTS: Plasma AD (mean+/-standard error of the mean, 36.1+/-0.7 U/l) and TBARS (4.2+/-0.1 nmol/ml) levels were significantly (for each, p<0.001) higher in BD than in controls (24.1+/-0.8 U/l and 1.6+/-0.1 nmol/ml, respectively). RBC catalase activity was significantly (p<0.001) lower in BD than in controls (120.9+/-3.8 versus 160.3+/-4.1 k/g haemoglobin). SOD and GSHPx activities were significantly lower in both plasma and erythrocytes of patients with BD than in controls (plasma SOD, 442.4+/-8.6 versus 636.4+/-9.2 U/ml, p<0.001; RBC SOD, 3719.2+/-66.0 versus 4849.7+/-49.0 U/g haemoglobin, p<0.001; plasma GSHPx, 73.1+/-1.5 versus 90.6+/-2.9 U/ml, p<0.001; RBC GSHPx, 600.7+/-8.0 versus 670.6+/-10.1 U/g haemoglobin, p<0.001). Active BD patients had significantly lower antioxidant enzymes (except RBC catalase) and higher AD and TBARS levels than inactive subjects (for each, p<0.01). When considering all BD patients, a significant positive correlation was present between AD and TBARS (p<0.001) whereas both AD and TBARS were negatively correlated with antioxidant enzymes (for each, p<0.05). CONCLUSIONS: AD and lipid peroxidation are increased and associated with defective antioxidants in BD, suggesting interactions between activated T cells and neutrophil hyperfunction. Measures of pro-oxidative stress and antioxidative defence with AD activity as an indicator of T-cell activation can be considered as significant supportive diagnostic indicators, especially in active disease. In addition, strengthening the antioxidant defence may contribute to treatment modalities

The role of anterior segment optical coherence tomography in the management of an intra-corneal foreign body

INTRODUCTION: Corneal foreign bodies are reported to be the second most common type of ocular injury. Anterior segment optical coherence tomography (AS-OCT) is a valuable tool for the early diagnosis and monitoring the progress of treatment in cases of ocular trauma. Herein we aimed to report on a patient with an intra-corneal foreign body and the role of AS-OCT in management. CASE PRESENTATION: A 34-year-old male presented with foreign body sensation in his left eye. Slit-lamp biomicroscopic examination revealed a peripherally located intrastromally embedded foreign body with a free anterior edge extending outwards from the cornea. It was not possible to visualize the foreign body’s entire route through the cornea because of localized corneal edema. AS-OCT showed shadowing of the corneal layers corresponding to the location of the corneal foreign body. A hyper-reflective lesion was observed close to the inside edge of the foreign body in the cornea, indicating that the foreign body had not completely penetrated the cornea. The foreign body was removed via the external route, as it had not completely penetrated the cornea. During the postoperative period the patient was asymptomatic, although the left eye’s cornea healed with scar tissue. DISCUSSION AND EVALUATION: AS-OCT facilitates non-invasive rapid imaging of ocular tissue at va rious depths, thereby providing accurate assessment of foreign body characteristics.The location of an intracorneal foreign body and the status of the surrounding ocular structure dictate the optimal surgical technique to be employed. CONCLUSIONS: AS-OCT in the present case facilitated localization and determination of the size of a corneal foreign body. In addition, AS-OCT findings assisted in selection of the appropriate surgical intervention

A Novel Surgical Technique to Prevent Postoperative Ahmed Valve (TM) Tube Exposure Through Conjunctiva: Tenon Advancement and Duplication

BACKGROUND AND OBJECTIVE: To present and evaluate a novel surgical technique to prevent exposure of the Ahmed valve implant tube (New World Medical, Rancho Cucamonga, CA) through conjunctiva in congenital glaucoma called "combined short scleral tunnel technique with Tenon advancement and duplication.

Avrupa Birliğine giriş sürecinde Türkiye’de özel sağlık sigortalarının durumu ve Avrupa ülkelerinin özel sağlık sigorta sisteminin karşılaştırılması

Sağlık kavramı, hizmetin arz ve talebinden, finansman araçlarına kadar son yıllarda popüler olan konular arasında ilk sıralarda bulunmaktadır. Sağlık sigortası sistemleriyle desteklenen ülkelerin finansman kaynakları seçimleri bakımından tartışmalara konu olmaktadır. Bu sebeple son yıllarda kamu ve özel sağlık sigortalarının önemi hızla artmakta olup, ekonominin büyümesinde sağlık sistemlerine yapılan harcamaların, üstlendiği rolün yeniden gözden geçirilmesine neden olmaktadır. Bu yükseklisans tezinde, sağlığın kavramı, sağlık arz-talep ilişkisi ve sağlık finasman modelleri ile ilgili genel bilgiler verilmiş olup, buna ek olarak, sigortanın yeri ve tarihsel gelişimi, sağlık sigortasının yeri ve tarihsel gelişimi de incelenmiştir. Avrupa Birliği üyesi dört ülke sırasıyla, Almanya, Hollanda, İngiltere ve Fransa’da sağlık sigortacılığı tarihsel gelişimi, sağlık harcamaları ve finansmanı, sağlık hizmetleri sunumu ve sağlık sistemlerinin örgütsel yapısı hakkında bilgi verilmiştir. Avrupa Birliği üyesi söz konusu dört ülkenin sağlık sigorta uygulamaları ile Türkiye arasında, işleyiş biçimleri bakımından karşılaştırma yapılmıştır. Yapılan değerlendirmede, Türkiye’de tamamlayıcı ve destekleyici sağlık sigortası uygulamasının geliştirilmesiyle ilgili noktalar tespit edilmiştir. Bunlardan biri, tamamlayıcı ve destekleyici özel sağlık sigortasının, kamu bütçesi üzerindeki baskıyı hafifleteceği düşünülmektedir. Tamamlayıcı sağlık sigortasının önemi kayıtlı ekonomiye geçiş sürecine sağladığı katkı açısından önemlidir. Tamamlayıcı sağlık sigortası kavramı, hem Türkiye hem de Avrupa ülkelerinde yapılan reformlar sonucunda kaynak alternatifini arttırmasının yanı sıra sağlık sisteminin yatırımlarında özel sigorta firmalarını da sistemin içine almaktadır. Sonuç olarak, Türkiye’de sağlık sigortacılığındaki sorunların temel sebepleri, ve sorunların çözüme kavuşma süreçlerine sunulan öneriler ile çalışma sonuçlandırılmıştır

Retinal tear: an unusual complication of ocular toxoplasmosis

Purpose: It is aimed to report on a 16-year-old patient with acquired ocular toxoplasmosis complicated by a retinal tear. Methods: Retrospective medical chart review Results: A 16-year-old Caucasian female presented with vision loss in her right eye. In addition to a white active lesion between the fovea and the optic nerve head, marked vitreous opacification was noted. She was diagnosed with ocular toxoplasmosis. The patient was treated with oral azithromycin, clindamycin, and trimethoprimsulfamethoxazole. One month later, retinochoroiditis resolved and vitreous cleared. Three months after onset, patient presented with floaters in the right eye and a retinal tear was located at the temporal region of the retina. Prophylactic argon laser treatment that encircled the retinal tear was performed. No other abnormalities were noted during 6 months of follow-up. Conclusions: Retinal tear associated with ocular toxoplasmosis is rare; however, a retinal tear can occur due to vitreoretinal traction following post-inflammatory structural alteration of the vitreous. Retinal tears may be seen during the healing phase, when the inflammation turns into tightening of vitreous substance. Careful retinal examination in cases of ocular toxoplasmosis is warranted, especially in patients with severe vitreous inflammation