Search

Rym Maamouri, Molka Ferchichi, Yasmine Houmane, Zaineb Gharbi, Monia Cheour Department of Ophthalmology, Habib Thameur Hospital, Tunis, TunisiaCorrespondence: Rym Maamouri, Department of Ophthalmology, Habib Thameur Hospital, 3, Rue Ali Ben Ayed, Montfleury, Tunis, 1089, Tunisia, Tel +21698314970, Email ryma.maamouri@fmt.utm.tnAbstract: Horner’s syndrome (HS) is caused by a damage to the oculosympathetic pathway. HS may be congenital, but it is usually acquired and may reveal a life-threatening condition. According to the anatomic location of the underlying pathologic process, HS is classified as central, pre- or postganglionic, when the lesion affects the first, second or third-order neuron, respectively. Pharmacological testing, if available, can be used to differentiate HS from « pseudo-HS » in patients with mild symptoms. Given the financial burden that imaging of the entire oculosympathetic pathway represents, a targeted imaging approach is advised. Although in the majority of cases, clinical examination may predict etiology, in other cases pharmacological testing can help in the localization process. We searched PubMed data base for papers published before December 2022 that concerned Horner’s syndrome, its neuro-ophthalmological manifestations and diagnosis. In this article, we describe the main neuro-ophthalmological manifestations of the three types of HS, the most common etiologies, and a targeted diagnostic strategy in each type.Keywords: Horner’s syndrome, neuro-ophthalmology, pharmacological testing

Abstract Purpose To describe clinical features and the course of a case of non-necrotizing herpetic retinitis secondary to Varicella zoster virus (VZV). Materiel and methods A single case report documented with multimodal imaging. Results A 52-year-old female patient with a past medical history of diabetes mellitus who presented with painful red right eye (OD). Ophthalmic examination showed perilimbal conjunctival nodule, granulomatous anterior uveitis, sectoral iris atrophy and increased intraocular pressure. Fundus examination in OD revealed posterior multifocal retinitis. Left eye examination was unremarkable. Polymerase chain reaction (PCR) of aqueous humor sample confirmed the presence of VZV DNA. Systemic antiviral therapy allowed the improvement of intraocular inflammation and disappearance of the retinal non necrotizing retinitis after one year of regular follow-up. Conclusion Non-necrotizing retinitis is an underdiagnosed form of VZV ocular infection.

Introduction: Bipolar disorders (BD), either type 1 or type 2, are associated with high rates of suicide attempts (SA). Suicidal ideations and planification can lead to different methods of SA. Objectives: The aim of our study is to describe and evaluate the several methods of SA in our Tunisian community and to compare our results to those all over the world. Methods: It's a descriptive study of 40 bipolar disorder patients. All of the patients reported at least one suicidal behavior in their life. Sociodemographic data, family and personal history were collected directly from patients and their medical files. Semi structured interviews were conducted to investigate closely about the suicidal attempts. Results: our sample contained 40 BD patients. The mean age of our sample was 41,8+10,6 years. 57,5% were male, 55% were single. 82,5% attempted suicide at least once in their lifetime and 17,5% self-destructive behavior (suicidal equivalent). Drug overdose was the mostly reported method in 47,5% of cases, caustic products in 20%, hanging and wrist-cutting in 10% both, self-strangulation in 7,5%, immolation in 5%, drowning and jumping from height in 2,5% both. We see that we didn't find the use of firearms, a way mostly reported in the USA. Our results are different from countries in which we do not share the same culture and laws. Conclusions: the knowledge of these methods helps us prevent suicide even with the cultural differences. [ABSTRACT FROM AUTHOR]

Introduction: Anorexia Nervosa (AN) is a serious psychiatric disorder, it may affect up to 4.2% of women during their lifetime and carries the highest mortality rates of any mental health disorder. The latest data suggest that a quarter of all people withANfulfil diagnostic criteria for borderline personality disorder (BPD), and that a similar percentage of those with BPD have AN. Objectives: This case report aims to describe a case of anorexia nervosa in a girl with BPD and to determine the prevalence and mechanism of association between AN and BPD. Methods: A patient case is presented with associated literature review. Results: Ms. MA, aged 19, with no medical history, is a student in the secondary school. She was referred by the emergency unit for suicidal thoughts. The interview revealed, in addition to the depressive symptomatology, many criteria for BPD such as frantic efforts to avoid abandonment, interpersonal relationships instability, Impulsive and self-harming behaviour, substance abuse... Additionally, MA is on a restrictive diet with a target weight of 44 kg (previous target weight was 50 last year). The diagnosis of anorexia nervosa was retained according to DSM-5 criteria. MA was put on antidepressant treatment combined with dialectical behavior therapy (DBT) with progressive improvement noted. Psychopathological, neurobiological and endocrine models are incriminated in the association between AN and BPD Conclusions: It is important that clinicians are aware of the frequency with which AN occurs in association with BPD because of the severity of this combination and the need for a specific and careful management. [ABSTRACT FROM AUTHOR]

Introduction: Impulsivity is a prominent aspect in bipolar disorders (BD), it contributes to many of its complications including suicidal behavior. Objectives: The aim of our study was to evaluate the impulsivity rates in BD patients and to search for a correlation between this trait and the emergence of suicidal acts. Methods: It's a cross sectional, descriptive study including 100 bipolar patients type 1 or 2 divided into two groups: 40 BD with suicidal behaviors and 60 BD without suicidal behaviors. Sociodemographic data, family and personal history were collected directly from patients and from their medical files. Patients responded to BIS-11: Barrat impulsivity scale traduced and validated in our dialectal Tunisian language. The analysis was made by IBM SPSS statistics 25. For the analysis of correlations and statistical links, we used linear regression. Results: The mean age of our sample was 42,9+11,5 years. 77% were male, 50% were single. The average BIS-11 score for our sample was 69,2±10,7. It was 73,7±10,9 for suicidal patients and 66,2±9,6 for non-suicidal patients. We found a statistical link between high rates of impulsivity BIS-11>75 and suicidal behavior in BD patients (p<0,001 OR 3,6) Conclusions: High rates of impulsivity are statistically associated with suicidal behavior in BD patients. Screening for impulsivity traits in BD patients using objective measures is mandatory in order to predict and prevent suicide in this risky population. [ABSTRACT FROM AUTHOR]

Introduction: Child sexual abuse is associated with some clinical phenomena that represents a more severe form of bipolar disorder(BD). In fact, it can lead to a higher risk of suicidal attempts. Objectives: The aim of our study was to evaluate the correlation between early sexual abuse and the likehood of suicidal behavior in bipolar disorder patients. Methods: It's a cross sectional, descriptive study containing 100 bipolar patients type 1 or 2 divided into two groups: 40 BD with suicidal behaviors and 60 BD without suicidal behaviors. Sociodemographic data, family and personal history were collected directly from patients and from their medical files. Patients responded to Childhood trauma questionnaire (CTQ). The analysis was made by IBM SPSS statistics 25. For the analysis of correlations and statistical links, we used linear regression. Results: The mean age of our sample was 42,9+11,5 years. 77% were male, 50% were single. The average CTQ total score was 41,6+10,7. It was 43,5+11,5 for the suicidal patients and 40,3+9,7 for the nonsuicidal patients. The average scores for emotional neglect, physical neglect, emotional abuse, physical abuse and sexual abuse were respectively: 10,2/7,9/8,6/8,4 and 6,5 for the suicidal group. we noticed a significant correlation between early sexual abuse and the emergence of suicidal behavior in BD adult patients (p=0,009<0,05), but there was no statistical link between emotional and physical neglect, emotional and physical abuse and the likehood of suicidal behaviors. Conclusions: Childhood traumas, especially sexual abuse seem to be a predictor factor of suicidality in BD. we need to asses these childhood adversities to prevent self-destructive behaviors. [ABSTRACT FROM AUTHOR]

Introduction: Patients with borderline personnality disorder (BPD) occupy an important place among patients admitted for suicidal attempt. Preventing recurrence of suicide attempts in this specific population, by controlling its risk factors, is an important public health issue. Objectives: The purpose of this study was to determine the risk factors of the recurrence of suicidal attempt in BPD patients consulting the emergency unit. Methods: It's a retrospective study about 30 cases. All subjects included in the study had been diagnosed with BPD according to DSM V criteria. Moreover, they all consulted the emergency psychiatric unit after, at least, one suicide attempt. The exclusion criteria were the presence of cognitive, bipolar or psychotic disorders. Patients were divided into two groups: with and without recurrence of suicide attempt. Socio-demographic informations was collected. The gravity of depressive disorders was assessed with the Hamilton Depression Rating Scale (HDRS). Results: Among the thirty patients included in the study, 66% patients were re-admitted to the emergency unit for one or several suicide attempt. The recurrence of the suicide attempt was significantly higher in unemployed patients, in patients with family history of suicide and in patients who consume cannabis. Interestingly, living with parents who are not separated seems to be a protective factor (OR = 0.3). Furthermore, recurrence and intensity (HDRS) of the major depressive episode did not differ statistically in patients with or without SB recurrence. Conclusions: Identifying patients at risk of recurrence of suicidal act, represents an essential step in secondary prevention. [ABSTRACT FROM AUTHOR]

Introduction: Recent studies suggest a close relationship between childhood trauma and major depressive disorder. The effect of childhood trauma on the recurrence of depressive episodes is still controversial. Objectives: The aim of our study was to analyze the relationship between childhood trauma and the recurrence of depression in patients suffering from major depressive disorder. Methods: We proceeded to a cross-sectional and retrospective study. We recruited 50 patients followed for major depressive disorder. Patients responded to the short form of Childhood Trauma Questionnaire Scale. Depressive symptoms were evaluated by the Hamilton Depression Rating Scale. Information about the recurrence of depression during the two first years following the first depressive episode were collected from the medical file. Results: Patients with recurrent depressive episodes had a significantly higher physical abuse score (p=0.04) than those who did not have depression relapse during the first two years of follow-up. There was no significant difference in the frequencies of exposure to the different dimensions of childhood trauma between patients with depressive recurrence in the first two years of follow-up and those who did not. Conclusions: This study emphasizes the existence of a significant association between physical abuse and the recurrence of depressive episode. Moreover, the retrospective design means that no causeto-effect relationship can be attested. [ABSTRACT FROM AUTHOR]

Purpose: To describe a case of bilateral retinitis in a patient with endocarditis and a serologically confirmed Q fever., Methods: A single case report documented with multimodal imaging., Results: A 55-year-old patient with culture-negative endocarditis was referred to our department for an ocular examination. His visual acuity was 20/20 in both eyes. Fundus examination showed white retinal infiltrates with few superficial retinal hemorrhages scattered in the posterior pole. There was no staining on fluorescein angiography. Swept-source optical coherence tomography (SS-OCT) revealed increased inner retinal reflectivity with a focal area of retinal thickening. Laboratory tests showed a high titer of antibodies against Coxiella burnetii . The patient was treated with doxycycline. Two weeks later, fundus examination showed partial resolution of retinitis with inner retinal thinning in SS-OCT., Conclusions: Multifocal retinitis is an uncommon presentation of Q fever. The diagnosis should be considered, especially when associated with culture-negative infective endocarditis, highlighting the importance of routine ocular examination., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Current Ophthalmology.)

Background: Ectrodactyly is a rare congenital limb malformation characterized by a deep median cleft of the hand and/or foot due to the absence of central rays. It could be isolated or depicts a part of diverse syndromic forms. Heterozygous pathogenic variants in the TP63 gene are responsible for at least four rare syndromic human disorders associated with ectrodactyly. Among them, ADULT (Acro-Dermato-Ungual-Lacrimal-Tooth) syndrome is characterized by ectodermal dysplasia, excessive freckling, nail dysplasia, and lacrimal duct obstruction, in addition to ectrodactyly and/or syndactyly. Ophthalmic findings are very common in TP63 -related disorders, consisting mainly of lacrimal duct hypoplasia. Absent meibomian glands have also been well documented in EEC3 (Ectrodactyly Ectodermal dysplasia Cleft lip/palate) syndrome but not in ADULT syndrome., Methods: We report a case of syndromic ectrodactyly consistent with ADULT syndrome, with an additional ophthalmic manifestation of agenesis of meibomian glands. The proband, as well as her elder sister, presented with congenital cone dystrophy.The molecular investigation was performed in the proband using Whole Exome Sequencing. Family segregation of the identified variants was confirmed by Sanger sequencing., Results: Two clinically relevant variants were found in the proband: the novel de novo heterozygous missense c.931A > G (p.Ser311Gly) in the TP63 gene classified as pathogenic, and the homozygous nonsense pathogenic c.1810C > T (p.Arg604Ter) in the CNGB3 gene. The same homozygous CNGB3 variation was also found in the sister, explaining the cone dystrophy in both cases., Conclusions: Whole Exome Sequencing allowed dual molecular diagnoses: de novo TP63 -related syndromic ectrodactyly and familial CNGB3 -related congenital cone dystrophy.

Introduction: The interaction between physicians and pharmaceutical industry highlighted many issues lately concerning their influence on physician's attitude and their prescribing behavior., Aim: To evaluate the attitudes of Tunisian ophthalmologist towards pharmaceutical promotion., Methods: Data was collected through an auto-administered anonymous questionnaire elaborated in French that was distributed to 160 ophthalmologists (residents and specialists) working in hospitals or private practices in four Tunisian governorates (Tunis, Sousse, Monastir and Sfax)., Results: One hundred and two valid responses were received. Twenty-nine respondents (28.43%) estimated the number of visits by pharmaceutical representatives (PR) at 11 to 20 times during the last year. Most physicians considered guides (94%), drug samples (88%), articles (86%), stationery (81%), sponsorship of overseas conferences (72%) and international trips to symposia organized by pharmaceutical industries (58%), as appropriate gifts. Over 80% of doctors agreed that promotional activities by drug companies were appropriate. Accepting sponsorship from a pharmaceutical company for a partner to attend a meeting was considered inappropriate by 79% of ophthalmologists. Eighty-eight percent of the respondents agreed that receiving gifts will increase their prescription of the company's drug. However, they perceived themselves to be less influenced than their colleagues (p=0.011). Eighty-six percent of ophthalmologists reported training about how to interact with PR to be insufficient., Conclusions: Despite the role of PR in supporting research, ethical issues may arise through their interactions with healthcare professionals. Training about pharmaceutical promotion and appropriate ways to deal with it are lacking in Tunisian medical schools' curricula, leaving future doctors unprepared to deal with pharmaceutical influences.

Introduction: There are three types of primary hyperoxaluria, with type 1 considered the most severe., Aim: To analyze the clinical, genetic, and evolutionary characteristics of type 1 primary hyperoxaluria with pediatric onset., Methods: This was a retrospective, descriptive study that included Tunisian children under the age of 18 at the time of diagnosis over a period of 25 years (January 1, 1996, to December 31, 2022)., Results: Thirty-five patients were included, with a mean age of 4.1 years. The most common presenting circumstances of the disease were nephrolithiasis and end-stage renal failure. The average serum creatinine level was 225.42 µmol/l. Five mutations were identified, with the p.Ile244Thr mutation being the most prevalent. Nephrocalcinosis, surgical intervention, and a creatinine level ≥57 µmol/l were predictive of progression to end-stage renal failure. The infantile form was predictive of mortality., Conclusions: Screening for the disease would improve the prognosis of this condition.

Background: Wolfram syndrome type 1 is a rare neurodegenerative disorder including diabetes insipidus, diabetes mellitus, optic atrophy, and deafness, with variable additional findings. The phenotypic spectrum is very heterogeneous, with non-autoimmune juvenile-onset diabetes and optic atrophy as minimal criteria for the diagnosis. Biallelic mutations in the WFS1 gene are the causative genetic anomaly for the syndrome, with, however, no evident genotype-phenotype correlation. Among the clinical features of the disease, diabetic retinopathy depicts a rarely reported microvascular complication. In this report, we describe the clinical and genetic findings in a 26-year-old patient presenting with Wolfram syndrome and severe diabetic retinopathy., Methods: The mutation screening was performed by polymerase chain reaction followed by Sanger sequencing of the entire coding sequence of the WFS1 gene., Results: A novel homozygous missense variant c.1901A>T (p.Lys634Met) was found in the proband and classified as probably pathogenic according to the American College of Medical Genetics and Genomics., Conclusions: The molecular study of the WFS1 gene is essential for the diagnostic confirmation, to provide appropriate genetic counseling and a mutational screening in the at-risk relatives. The c.1901A>T (p.Lys634 Met) is a novel variant that could be responsible for a severe form of Wolfram syndrome with early and proliferative diabetic retinopathy.

Lifebuoy cataract is a rare form of congenital cataract with anatomical characteristics. Herein, we present a case of an otherwise healthy 42-year-old female with a long-standing history of blurred vision. Examination showed the presence of esotropia and bilateral horizontal nystagmus. Visual acuity was limited to light perception in both eyes. Slit-lamp examination showed a calcified lens capsule with the absence of lens material in the right eye and the presence of an annular cataract in the left eye, corresponding to a unilateral lifebuoy cataract. She underwent cataract surgery with intraocular lens implantation. We report the clinical findings, anterior segment optical coherence tomography (AS-OCT), and surgical management tips. We noticed that during surgery, both anterior capsulorhexis and central membrane removal were the most challenging steps due to the absence of central nucleus and the strong adherence of central membrane to the anterior hyaloid., Competing Interests: None