Ocular Manifestations of Brucellosis

Brucellosis is considered a zoonotic disease which is still an important health problem in endemic areas such as the Middle East, the Mediterranean, and Asia. Brucellosis is a systemic infection that might affect any organ or system in the body. Ocular involvement has been reported in 21% of brucellosis patients. The most common ocular manifestations of brucellosis were considered as anterior uveitis and choroiditis. The patients with anterior uveitis were reported to be usually in the acute stage and the patients with choroiditis, papilledema, and posterior uveitis were reported to be usually in the chronic stage of the disease. Ocular manifestations of brucellosis might also involve dacryoadenitis, conjunctivitis, episcleritis, scleritis, nummular keratitis, cataract, glaucoma, exudative retinal detachment, maculopathy, and neuro-ophthalmic defects including papilledema, papillitis, and cranial nerve paresis. Optic nerve involvement in brucellosis is considered secondary to meningeal inflammation, and it usually involves both optic nerves. Premacular hemorrhage related to Brucella endocarditis was reported as a rare ocular manifestation. Since ocular brucellosis has a wide spectrum of clinical manifestations, the diagnosis is considered to be mainly dependent on positive bacteriological and serological tests. Agglutinations and/or culture has been widely used for diagnosis of brucellosis. Brucella agglutination test over 1/160 titer and positive blood culture are considered as diagnostic factors for brucellosis. Early diagnosis and prompt treatment are considered to be effective for preventing blindness from severe ocular damage. Systemic antibiotics including streptomycine, rifampicin, doxycycline along with topical or systemic corticosteroid treatment have been recommended for at least 2 months. The purpose of this chapter is to describe the ocular manifestations of brucellosis, early diagnostic procedures, and treatment with reviewing the literature

Cat-Scratch Disease: Unusual Perivascular Chorioretinal Lesions

This study is a case report of bilateral perivascular chorioretinal lesions associated with Bartonella henselae. A 37-year-old woman presented with headache and blurred vision in both eyes aggravating occasionally during five years. She was otherwise healthy, with best-corrected visual acuities were 20/20 in both eyes. History of close contact with cats was more than merely eye-catching upon examination of her fundus. In both eyes, fundi were coated with yellow-brown pigmented perivenous chorioretinal lesions along the superotemporal and inferotemporal vascular arcades and their branches. The perivenous lesions were associated with vascular fibrous bands and corresponding changes in vascular calibers. There were no associated intraocular inflammatory signs in both eyes. The serologic tests confirmed the diagnosis of cat-scratch disease. The patient received no treatment, and she was followed for three years without any signs of ocular inflammatio

The Effect of Infliximab Therapy on Maculopathy in Behcet's Panuveitis: A Case Report

Aim: To report a case of Behcet’s panuveitis and unilateral inflammatory maculopathy which was refractory to conventional immunosuppressive therapy but responded well to long-term treatment with the tumor necrosis factor-alpha inhibitor infliximab. Methods: Reporting the effect of intravenous infliximab infusion therapy for 54 weeks in a case of Behcet’s panuveitis and unilateral inflammatory maculopathy. The patient’s best corrected visual acuity was monitored, and biomicroscopic and fundus examinations as well as macular thickness map analysis by stratus optical coherence tomography were performed. Results: The best corrected visual acuity in his right eye improved after the resolution of inflammatory signs on biomicroscopic and fundus examinations as well as on stratus optical coherence tomography macular thickness analysis reports. No significant systemic side effects were noted. Conclusions: Long-term therapy with infliximab is effective and safe for refractory inflammatory maculopathy in Behcet’s disease. We report this case to contribute to the few previously reported cases showing the beneficial effect of long-term infliximab therapy for Behcet’s panuveitis. In conclusion, early initiation of infliximab therapy for inflammatory maculopathy in Behcet’s disease preserves and improves visual acuity

Long-Term Cyclophosphamide Treatment in a Case with Serpiginous Choroiditis

Purpose: To report the effect of long-term therapy with the alkylating agent cyclophosphamide in a case with serpiginous choroiditis and thus to contribute to the previously reported few cases showing the beneficial effect of long-term cyclophosphamide therapy for serpiginous choroiditis. Procedures: Oral cyclophosphamide therapy for 12 months in a case with unilateral active serpiginous choroiditis. Results: The active lesion responded well to long-term therapy with cyclophosphamide without recurrences and significant systemic side-effects. Conclusions: Long-term therapy with cyclophosphamide for serpiginous choroiditis is effective for improving vision and preventing recurrences

The Role of Renin-Angiotensin System in Ocular Inflammation and Uveitis

The renin-angiotensin system (RAS) plays an important role in the pathogenesis of inflammation and autoimmune dysfunction. Uveitis is a sight-threatening intraocular inflammatory disorder caused by infectious agents, autoimmune mechanisms, exposure to toxins and many other unknown factors. Most components of RAS have been identified in every organ including the eye. The tissue-specific RAS is believed to exert diverse physiological effects locally independent of circulating angiotensin II (AT II) which functions as the effector arm of RAS causing potent proinflammatory responses via Angiotensin type 1 receptor (AT1R). AT II mediated stimulation of tissue factor (TF), the principal initiator of the clotting cascade and a major regulator of haemostasis and thrombosis rapidly inducible by inflammatory agents in several cell lines including monocytes. Activation of NFκB, a key redox-sensitive transcription factor encoding for the TF gene, plays a key role in that mechanism amplified by locally synthesized angiotensin I. (AT I) The second arm of RAS establishes systemic and local protective axis against inflammation and autoimmune dysfunction via angiotensin-converting enzyme 2 (ACE2) which is a zinc-metallopeptidase able to cleave AT II to form angiotensin-(1–7) [AT-(1–7)]. AT-(1–7), a biologically active peptide, binds to a G-protein coupled receptor Mas, and activates signaling pathways that counteract the effects of AT II by negatively effecting inflammatory responses and negatively modulating leukocyte migration, cytokine expression and release, and fibrogenic pathways. The purpose of this chapter is to analyze both pro-inflammatory and protective role of RAS in ocular inflammation and uveitis both in humans and experimental models

Adult Attention Deficit Hyperactivity Disorder: Neurobiology, Diagnostic Problems and Clinical Features

Attention-deficit/hyperactivity disorder (ADHD) is a chronic, lifelong neurobeha-vioral disorder with childhood-onset, which seriously impairs the affected adults in a variety of daily living functions like academic, social and occupational functioning. Prevalence of ADHD declines with age in the general population. The approximate prevalence rates of ADHD is 8% in childhood, 6% in adolescence and 4% in adulthood. The unclear validity of DSM-IV diagnostic criteria for this condition can lead to reduced prevalence rates by underestimation of the prevalence of adult ADHD. The disorder is characterized by behavioral symptoms of inattention, hyperactivity, and impulsivity across the life cycle and is associated with considerable morbidity and disability. Although its etiology remains unclear, considerable evidence documents its strong neurobiological and genetic underpinnings. ADHD is associated with a high percentage of comorbid psychiatric disorders in every lifespan. In adulthood between 65-89% of all patients with ADHD suffer from one or more additional psychiatric disorders, above all mood and anxiety disorders, substance use disorders and personality disorders, which complicate the clinical picture in terms of diagnostics, treatment and outcome issues. The high comorbidity with other psychiatric disorders, the resulting deficits in social competences and risky health behavior that often go along with a diminished life quality must be stressed in these patients. Preventive and therapeutic interventions should be taken at an early stage to counteract the possible negative influences of ADHD on functioning and relationships. In this paper, we reviewed the historical aspects, epidemiology, neurobiology, comorbidity, diagnostic difficulties and clinical features of adult ADHD

LOCAL CULTURE EXPERIENCE AND NOVELTY SEEKING: A COMPARISON ON ISTANBUL AND ANTALYA TOURISM DESTINATIONS

Distinguishing the society from others, cultural assets create a unique local culture experience for tourists and lead to satisfaction by influencing the novelty seeking motivation. Based on this hypothesis, the aims of this research are as follows; a) to examine the effect of the local cultural experience on novelty seeking behavior, b) to examine the influence of the local culture experience on tourist satisfaction, and c) to assess the mediating role of novelty seeking between local cultural experience and satisfaction. Using structural equation modeling, a comparative study was carried out on Turkey's most-tourist attracting destinations which have distinctive DNA's in accordance with their specific positioning strategies. Findings revealed that local culture experience, novelty seeking and tourist satisfaction variables are associated with each other in both destinations. The SEM suggests that the novelty seeking variable have the mediating role between local culture experience and satisfaction.&nbsp