Presumed Tuberculous uveitis: clinical features and management

AIM

To illustrate the various clinical features and management of presumed tuberculous uveitis in an endemic area in Tunisia.

METHODS

This is a retrospective study including 14 patients (26 eyes) diagnosed with presumed tuberculous uveitis at the Department of Ophthalmology Habib Bourguiba University Hospital of Sfax-Tunisia.

RESULTS

Mean age at onset was 31.7 years. Uveitis was bilateral in 86 % of cases (12 eyes). Panuveitis was the most common manifestation and represented 50% of cases (13 eyes). Ocular findings include mutton-fat keratic precipitates in 35% of cases (9 eyes), posterior synechiae in 31% of cases (8 eyes), vitritis in 81% of cases (21eyes), multifocal choroiditis in 23% of cases (6 eyes), periphlebitis in 27% of cases (7 eyes), and macular edema in 42% of cases (11eyes). Anti-tubercular treatment was prescribed in all patients and was associated with systemic corticosteroids in 71% of cases (10 patients). After a mean follow-up of 16.27 months (range, 6-36), inflammation was controlled with improvement in visual acuity. Recurrence developed in 7 % of cases (1 patient).

CONCLUSION

In the present study, posterior synechiae, vitritis, multifocal choroiditis, and retinal vasculitis are the most common manifestations of tuberculous uveitis in tuberculosis endemic area in Tunisia. These manifestations are suggestive of a tubercular cause of uveitis and merit specific treatment.

Gender differences in the association of ELMO1 genetic variants with type 2 diabetes in Tunisian Arabs

PURPOSE

Polymorphisms of the engulfment and cell motility 1 (ELMO1) gene were recently associated with type 2 diabetes (T2DM) and its complications. We investigated the association of rs10255208, rs7782979, and rs2041801 ELMO1 gene variants with T2DM in Tunisian Arabs.

METHODS

Subjects comprised 900 T2DM patients and 600 normoglycemic controls. ELMO1 genotyping was done by PCR-RFLP; the contribution of ELMO1 variants to T2DM was analyzed by Haploview and regression analysis.

RESULTS

Minor allele frequencies of rs7782979 and rs10255208 ELMO1 variants were significantly higher among unselected T2DM cases than controls, and significant differences in the distribution of rs7782979 genotypes were seen between T2DM cases and control subjects, which was seen in male but not female subjects. Three-locus ELMO1 haplotype analysis identified haplotype GAA to be positively associated, and haplotypes GCA, AAA, and GCG to be negatively associated with T2DM. The distribution of these haplotypes was gender-dependent for some (GCA, GCG, AAG), and gender-independent for others (GAA, AAA). This translated into altered risk of T2DM in male or female subjects, which persisted after adjusting for BMI, systolic and diastolic blood pressure, and serum lipid profile.

CONCLUSION

These results confirm role for ELMO1 as T2DM susceptibility locus, which appears to be gender-dependent.

[Incidence and causes of visual impairment in the district of Mahdia, in east Tunisia: Retrospective study of 1487 cases]

OBJECTIVE

To study socio-demographic characteristics and main causes related to visual impairment (VI) as a function of age bracket and to analyze their trends over time in the district of Mahdia.

METHOD

A retrospective review was performed on 1487 cases of visual impairment registered with the social authorities in Mahdia, between 1980 and 2013. The social, demographic, vision exam findings and causes were ascertained and analyzed in an SPSS database. Incidence rates of VI and blindness due to various causes were calculated based on the demographic data from the NSI to estimate the time trends using the general linear regression model and Spearman correlation.

RESULTS

Analyses included 1487 participants with a median age of 47 years, 40.6% of cases were aged under 45 years. Children accounted for 11.1% (165 patients), while age was between 16 and 45 years in 29.5% (439 patients), between 46 and 65 years in 31.5% (469 patients) and greater than 65 years in 27.8% (414 patients). The sex-ratio (M/F) was 1.78. Socially, 51% came from rural areas, 62% were illiterate, and 84% were unemployed. We observed blindness in 70% of participants and low vision in 30%. In children, the causes were dominated by congenital cataract and congenital glaucoma, each present in 31 children (18.8%). Between 16 and 45 years, glaucoma and hereditary dystrophies of the retina were found in 62 and 61 patients respectively (14% each). For age between 46 and 65 years, trachoma was responsible for 19.8% of cases of VI, glaucoma in 15.8% and cataract in 15.1%. Beyond 65 years, glaucoma accounted for 30.7% of the causes of VI and cataract 27.8% of cases. Trend analysis shows a significant increase in the incidence rate of visual impairment with an average of 12% per year (P=0.001). The mean age increased by 46% (P=0.003). Trachoma increased by 118% (P<0.0001) between 1980 and 1990, then declined by 42% (P=0.0013) between 1991 and 2013. Incidence of VI significantly increased by 4% for cataract (P=0.001), 23% (P=0.001) for glaucoma and 20% (P=0.02) for diabetic retinopathy, while VI related to refractive errors and AMD showed no significant change.

CONCLUSION

Advanced age, lower educational and socio-economic status were associated with bilateral VI. Age related eye problems are the main causes of VI, and their incidence is tending to increase. Public health policies and procedures should be targeted to risk related populations and age-related diseases in order to control the incidence of visual impairment and avoid its consequences.