The document discusses the abducens nerve (CN VI), which innervates the lateral rectus muscle. It has three key points:
1. CN VI has only a motor component, originating from the abducens nucleus in the pons and innervating the ipsilateral lateral rectus muscle. It also sends interneurons through the medial longitudinal fasciculus to innervate the contralateral medial rectus.
2. CN VI passes through the subarachnoid space, pierces the dura at the dorsum sellae, traverses the cavernous sinus, and enters the orbit through the superior orbital fissure to reach the lateral rectus.
3. Les
Pupillary light reflex (PLR) : that controls the diameter of the pupil, in
response to the intensity of light that falls on the retinal ganglion cells of
the retina in the back of the eye.
- Light reflex
- Corneal reflex.
-Accommodation reflex:
Argyll Robertson pupils
Horner's syndrome:
Holmes–Adie syndrome
Pupillary light reflex (PLR) : that controls the diameter of the pupil, in
response to the intensity of light that falls on the retinal ganglion cells of
the retina in the back of the eye.
- Light reflex
- Corneal reflex.
-Accommodation reflex:
Argyll Robertson pupils
Horner's syndrome:
Holmes–Adie syndrome
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
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4. CRANIAL NERVE VI OR ABDUCENS
NERVE.
• abducens nucleus → only a somatic motor (general somatic
efferent) component
• Motor neurones supplying the ipsilateral lateral rectus, and
interneurones that pass through the medial longitudinal
fasciculus to the contralateral medial rectus.
• The abducens nucleus is located in the between the pons
and medulla oblongata.
• The sixth cranial nerve has a long subarachnoid course
• Innervates only one extra ocular muscle → Lateral rectus
muscle.
5.
6. Embryology:
• The human abducens nerve is derived
from the basal plate of
the embryonic pons.
7. COURSE
• Passes upwards & anterolaterally in
subarachnoid space of posterior cranial
fossa
• Pierces the arachnoid & dura lateral to
the dorsum sellae(part of the sphenoid
bone)
8. • Arises between the layers of dura on the
posterior surface of the petrous bone
near its apex.
• Turns anteriorly to traverse the cavernous
sinus
9. • Enters the orbit through the superior
orbital fissure within the annular tendon
to supply the lateral rectus muscle
10.
11.
12. NUCLEUS
• Situated near the
midline in the
tegmentum of the
pons ventral to the
colliculus facialis
• Colliculus facialis is
an elevation in the
floor of the 4th
ventricle , produced
by the genu of facial
nerve.
13.
14.
15. INTERNUCLEAR NEURON
• About 40% of its neurons project into the
ipsilateral MLF only to cross over to the
contralateral side and ascend to innervate
that contralateral medial rectus
subnucleus to participate in contralateral
eye adduction.
17. SUPERFICIAL EMERGENCE
• Emerges between
lower border of the
pons & lateral part of
the pyramid
• Emerge as seven or
eight rootlets
18. • abducens nerves are
about 1 cm apart
• Between them is the
Basilary Artery at its
formation from the two
vertebral Artery
• Lateral to each
abducens is the
emergence of the facial
Nerve at the lateral
side of the olive
19. 2.POSTERIOR CRANIAL FOSSA
Just after its emergence , the nerve is
crossed by the ANTERIOR INFERIOR
CEREBELLAR Artery
• Usually the artery is ventral , but it may
be dorsal or pass between the abducens
rootlets.
20. • Sleeved by the
piamater , it ascends
anterolaterally in the
cisterna pontis of the
subarachnoid space
between pons &
occipital bone
21. • At the upper border of the bone, it turns forward
at a right – angle under the Petro sphenoidal
ligament ( Gruber’s ligament )
• Thus passing through a canal called the Dorello’s
canal, to enter the cavernous sinus with the
inferior petrosal sinus
• Often the nerve pierces the inferior sinus,
entering the cavernous sinus within the inferior
petrosal sinus
26. Nerve is inferolateral to the horizontal
portion of the internal carotid artery with
its sympathetic plexus , which may
communicate with the nerve
27. • In the lateral wall of the
sinus , in descending
order are
• Oculomotor Nerve
• Trochlear Nerve
• Ophthalmic Nerve
• Maxillary Nerve
abducens nerve is
usually in the sinus,
with a separate sheath
28. 4.SUPERIOR ORBITAL FISSURE
• Traverses the fissure
within the annulus of
Zinn
• At 1st below the
division of
oculomotor Nerve
• Then between them
& lateral to
nasociliary nerve
29.
30. 5.IN THE ORBIT
• Nerve divides into 3
or 4 filaments which
enter the ocular
surface of lateral
rectus muscle behind
its midpoint
31.
32. Coordination of Lateral Rectus and
Medial Rectus Muscles
• For eye movements in the horizontal plane, the lateral rectus muscle of
one eye and the medial rectus muscle of the other eye must work
precisely together.
• The actions of these muscles is coordinated by the lateral gaze center
located in the pontine reticular formation.
• Inputs from higher centers of the brain synapse in the lateral gaze center,
which then sends simultaneous signals to the ipsilateral abducens nucleus
and to the contralateral occulomotor nucleus via the medial longitudinal
fasciculus.
• The abducens nucleus sends signals via CN VI to the lateral rectus muscle
of the ipsilateral orbit to command that eye to be abducted.
• Simultaneously, the occulomotor nucleus generates a command via CN III
to contract the medial rectus muscle of the contralateral orbit resulting in
adduction of that eye.
33. BLOOD SUPPLY:
• Anterior inferior cerebellar artery, the
posterior inferior cerebellar artery, the
internal auditory artery, the anterolateral
artery, the pontomedullary artery, the
inferolateral pontine artery, the
anterolateral artery
• The majority of the of the abducens
nerves were supplied by the anterolateral
arteries, and only some of them by the
AICA, or the pontomedullary artery.
35. 1. At the level of nucleus
• Ipsilateral weakness of
abduction
• Failure of horizontal
gaze towards the side of
lesion.
• Ipsilateral facial nerve
palsy (lower motor
neurone)→involvement of
facial fasciculus.
36. AN ISOLATED 6TH NERVE PALSY IS
THEREFORE NEVER NUCLEAR IN ORIGIN.
In adults, the most likely etiology of
isolated sixth nerve palsy is ischemic
mononeuropathy that may be due to
diabetes mellitus, arteriosclerosis,
hypertension, temporal arteritis or
anemia
37. 2.PONTINE SYNDROMES – AT THE LEVEL OF FASCICULUS
• MILLARD GUBLER
SYNDROMEM
• RAYMOND CESTON
SYNDROMER
• FOVILLE SYNDROME
F
38. A. Foville syndrome
Involves fasciculus as it
passes through PPRF
5th nerve – facial
anaesthesia
6th nerve + gaze palsy
7th nerve – facial
weakness
8th nerve – deafness
Central horner
syndrome
39.
40.
41. B. Millard – Gubler syndrome
Involves fasciculus as
it passes through the
pyramidal tract
Ipsilateral 6th nerve
palsy
Contralateral
hemiplegia (paralysis)
42. C. Raymond – Ceston syndrome
Due to tumor of cerebral peduncles
Red nucleus – speech & gait disorder
Paralysis of lateral conjugate gaze
Ipsilateral 6th Nerve palsy
5th nerve – facial anaesthesia
Contralateral hemiparesis
43.
44. 3. At the pontomedullary junction:
ACOUSTIC NEUROMA:
• May damage the 6th
nerve → pontomedullary
junction.
• 1ST symptom –
hearing loss
• 1st sign - ↓ corneal
sensitivity
45. It is very important to test
hearing & corneal sensation in all
patients with 6th nerve palsy
46. 4. In the basilar course
A. Raised intracranial
tension:
• Downward displacement
of brainstem
• Stretching of 6th nerve
over petrous tip
• Bilateral 6th nerve palsy –
false localizing sign
48. D. GRADENIGO’S SYNDROME:
• Mastoiditis/acute
Petrositis
• - damage to 6th nerve at
the petrous tip.
• Facial weakness
• Pain
• Hearing difficulties
49. 5. INTRACAVERNOUS PART
• Situated close to the
internal carotid Artery
• More likely to
damage than other
cranial nerves
Intra cavernous 6th
nerve palsy is
accompanied by a
postganglionic
Horner’s syndrome
50. CLINICAL PRESENTATION
• HISTORY:
– Esotropia
– Head-turn
– Binocular diplopia (worse at distance)
– Vision loss
– Pain
– Hearing loss
– Symptoms of vasculitis, particularly giant cell
arteritis
– Trauma
53. BCQ’S:
1. True statements of the abducens nerve
except:
a) Arises from the medulla
b) Passes under the petrosphenoidal ligament
c) May cross two venous sinuses in its course
d) Enters the orbit between the two divisions of III
e) May be damaged by raised intracranial pressure
54. • The abducens nerve nucleus:
a) Lies ventral to the genu of VII
b) Communicates indirectly with the nucleus of III
c) Sends fibres through Dorello's canal
d) Innervates lateral rectus on its extraconal surface