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anatomy of optic nerve and its blood supply and clinical corelation
Presentation Layout: optic nerve anatomy
Embryology of optic nerve
Introduction
Parts of optic nerve
Blood supply
Clinical significance
For Further Reading
Wolff’s Anatomy of the eye and orbit by Bron, Tripathi and Tripathi
Anatomy and Physiology of eye by A.K. Khurana 2nd edition
Comprehensive Ophthalmology by A.K. Khurana 5th edition
AAO- Fundamentals & Principles of Ophthalmology : sec 2
Walsh and Hoyt’s Clinical Ophthalmology
Internet
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
Disorders of amino acid metabolism
Disorders of renal amino acid transport
Disorders of carbohydrate metabolism and transport
Carbohydrate-deficient protein syndromes
carbohydrate metabolism and transport
Disorders of fatty acid oxidation
Disorders of purine and pyrimidine metabolism
Disorders of lipid and lipoprotein metabolism
Ceroid lipofuscinosis and other lipidoses.
Disorders of serum lipoproteins
Lysosomal disorders
Peroxisomal disorders
Disorders of metal metabolism
Porphyrias
Acute Transverse Myelitis
Blockage of the Spinal Cord’s Blood Supply
Cervical Spondylosis
Compression of the Spinal Cord
Hereditary Spastic Paraparesis
Subacute Combined Degeneration
Syrinx of the Spinal Cord and Brain Stem
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anatomy of optic nerve and its blood supply and clinical corelation
Presentation Layout: optic nerve anatomy
Embryology of optic nerve
Introduction
Parts of optic nerve
Blood supply
Clinical significance
For Further Reading
Wolff’s Anatomy of the eye and orbit by Bron, Tripathi and Tripathi
Anatomy and Physiology of eye by A.K. Khurana 2nd edition
Comprehensive Ophthalmology by A.K. Khurana 5th edition
AAO- Fundamentals & Principles of Ophthalmology : sec 2
Walsh and Hoyt’s Clinical Ophthalmology
Internet
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
Disorders of amino acid metabolism
Disorders of renal amino acid transport
Disorders of carbohydrate metabolism and transport
Carbohydrate-deficient protein syndromes
carbohydrate metabolism and transport
Disorders of fatty acid oxidation
Disorders of purine and pyrimidine metabolism
Disorders of lipid and lipoprotein metabolism
Ceroid lipofuscinosis and other lipidoses.
Disorders of serum lipoproteins
Lysosomal disorders
Peroxisomal disorders
Disorders of metal metabolism
Porphyrias
Acute Transverse Myelitis
Blockage of the Spinal Cord’s Blood Supply
Cervical Spondylosis
Compression of the Spinal Cord
Hereditary Spastic Paraparesis
Subacute Combined Degeneration
Syrinx of the Spinal Cord and Brain Stem
Multiple sclerosis (MS) is a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged.This damage disrupts the ability of parts of the nervous system to communicate, resulting in a range of signs and symptoms, including physical, mental, and sometimes psychiatric problems
Personal History.
Complaint.
Past History.
Family History.
Present History
General examination
Mentality
Speech
Cranial nerve examination
Motor system examination
Muscle status
Muscle tone
Muscle power
Coordination
Involuntary movements
Static
Kinetic
Reflexes
Superficial reflexes
Deep reflexes
Primitive reflexes
Sensations
Superficial sensations
Deep sensations
Cortical sensations
Examination of Back and skull
Examination of gait
this presentation discusses epileptic seizures
D.D. Of epilepsy
how to Identify type of seizure (seizure semiology) International classification of epileptic seizures.
Investigations aiming at confirmation of the diagnosis & searching for an aetiology of epilepsy
how to Identify epileptic syndrome
International classification of epilepsy & epileptic syndromes
I. Cerebrum
II. Brain Stem
III. Cerebellum.
The Cerebral Cortex
A. Frontal lobe
1) Motor area (area 4):
Frontal lobe
parietal lobe
temporal lobe
occipital lobe
I. The carotid system.
II. The vertebral system.
1) The ophthalmic artery.
2) The anterior choroidal artery.
3) The posterior communicating artery
II. The Vertebro-Basilar System VOS
brain stem syndromes
Hemiparesis is unilateral paresis, that is, weakness of the entire left or right side of the body (hemi- means "half"). Hemiplegia is, in its most severe form, complete paralysis of half of the body. Hemiparesis and hemiplegia can be caused by different medical conditions, including congenital causes, trauma, tumors, or stroke
Hypenension: Commonest cause of intracerebral haemorrhage.
Rupture of an intracranial aneurysm, angioma or A-V malformation: commonest cause of subarachnoid haemorrhage.
Haemorrhagic blood diseases: purpura, haemophilia.
Anticoagulants.
Trauma to the head: commonest of subdural haematoma.
II. Infective: ;
Encephalitis
Meningitis – Brain abscess.
III. Neoplastic: e.g. Meningioma.
IV. Demyelination: multiple sclerosis may present with hemiplegia.
V. Traumatic: e.g. Cerebral laceration and subdural haematoma.
VI. Hysterical: patient suffering from paralysis in the absence of organic lesion.
this presentation discusses pain pathways, definition and glossary of pain symptoms, classification of pain, pathogenesis, causes, diagnosis , types and treatment of neuropathic pain
illustrated with figures
normal fundus , the retina how it works & how it is visualised is described here.
the procedure of direct ophthalmoscopy how the image is seen.
Abnormalities of retina how are they seen.
Examination of cranial nerves /certified fixed orthodontic courses by Indian ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Parkinsonism is a clinical syndrome and, typically, when the condition
appears to be idiopathic and responsive to levodopa therapy, is referred
to as Parkinson’s disease1
• The four cardinal features of the parkinsonian syndrome are:2
– Bradykinesia
– Muscular rigidity
– Resting tremor
– Postural instability (and gait impairment)
• These features are not always observed in every patient, at any given
time
To make a diagnosis of PD, the physician must distinguish between
different forms of parkinsonism:1
– Parkinson’s disease
– Secondary parkinsonism
– Parkinsonism as part of another neurodegenerative disorder (e.g., multiple
system atrophy, progressive supranuclear palsy, corticobasal degeneration, or
Lewy body dementia)
SCALES COMMONLY USED IN
PARKINSON’S DISEASE
RESEARCH
SCALES COMMONLY USED IN
PARKINSON’S DISEASE
RESEARCH
Progressive multifocal leukoencephalopathy (PML) is a disease of the white matter of the brain, caused by a virus infection that targets cells that make myelin--the material that insulates nerve cells (neurons). Polyomavirus JC (often called JC virus) is carried by a majority of people and is harmless except among those with lowered immune defenses. The disease is rare and occurs in patients undergoing chronic corticosteroid or immunosuppressive therapy for organ transplant, or individuals with cancer (such as Hodgkin’s disease or lymphoma). Individuals with autoimmune conditions such as multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus -- some of whom are treated with biological therapies that allow JC virus reactivation -- are at risk for PML as well. PML is most common among individuals with HIV-1 infection / acquired immune deficiency syndrome (AIDS). Currently, the best available therapy is reversal of the immune-deficient state, since there are no effective drugs that block virus infection without toxicity. Reversal may be achieved by using plasma exchange to accelerate the removal of the therapeutic agents that put patients at risk for PML. In the case of HIV-associated PML, immediately beginning anti-retroviral therapy will benefit most individuals. Several new drugs that laboratory tests found effective against infection are being used in PML patients with special permission of the U.S. Food and Drug Administration. Hexadecyloxypropyl-Cidofovir (CMX001) is currently being studied as a treatment option for JVC because of its ability to suppress JVC by inhibiting viral DNA replication.
In general, PML has a mortality rate of 30-50 percent in the first few months following diagnosis but depends on the severity of the underlying disease and treatment received. Those who survive PML can be left with severe neurological disabilities.
Sequencing in management of Multiple sclerosisAmr Hassan
Sequencing of DMTs for individual multiple sclerosis patients should be designed in such a way to maximize disease control and minimize risk based on the mechanism of action, pharmacokinetic and pharmacodynamic properties of each therapy. This includes the DMT patients are being switched from to those they are being switched to. The reversibility of immune system effects should be a key consideration for DMT sequence selection. This feature varies across DMTs and should factor more prominently in decision making as newer treatments become available for the prevention of disability accumulation in patients with progressive MS. In this short review, we discuss the landscape of existing therapies with an eye to the future when planning for optimal DMT sequencing. While no cure exists for MS, efforts are being directed toward research in neuroregeneration with the hope for positive outcomes.
A neuromuscular disorder that leads to weakness of skeletal muscles.
Symptoms
Causes
Prevention
Complications
Common tests & procedures
Neurological examination:
Repetitive nerve stimulation test:
Antibody test:
Pulmonary function tests (PFTs): To check any breathing difficulty.
CT scan: To rule out a presence of tumor in thymus.
Magnetic resonance imaging (MRI): MRI of the chest is performed to rule out a presence of tumor in thymus.
Edrophonium (Tensilon) test:
Medication
Procedures
Nutrition
Prediction of outcome of Multiple sclerosisAmr Hassan
Prediction of outcome of Multiple sclerosis
An understanding of the natural history of multiple sclerosis(MS) in a patient is important to begin proper treatment at the correct time, especially when there is a high risk for poor prognosis. Factors that predict unfavorable prognosis are a primary or secondary progressive course, older age at disease onset, short interval between first and second attacks, initial cerebellar or pyramidal symptoms, a large number of functional systems involved at onset, moderate to severe disability within the first 2 years, and the presence of typical plaques or greater lesion volume shown by magnetic resonance imaging results during the first 5 years. However, there are no established laboratory tests able to predict long-term prognosis.
Lifestyle modification in epilepsy
Lifestyle Modifications
Lifestyle modifications can include:
Adequate sleep: Fatigue is one of the most common seizure triggers, and disrupted sleep can make the brain more vulnerable to misfiring.
Avoiding drugs and alcohol: These can be triggers for seizures in patients with epilepsy. Even one or two drinks can provoke seizures.
Minimizing emotional stress: Although there is not definitive proof that stress causes seizures, those who maintain healthy stress levels have reported that they believe it reduces their risk.
Frequency of exercise: In addition to a range of health benefits, regular exercise can help reduce risk of seizure. However, you should consult your physician before starting a new exercise routine, as some exercise can, rarely, cause seizures.
Childhood demyelinating syndromes
In the past decade, the number of studies related to demyelinating diseases in children has exponentially increased. Demyelinating disease in children may be monophasic or chronic. Typical monophasic disorders in children are acute disseminated encephalomyelitis and clinically isolated syndromes, including optic neuritis and transverse myelitis. However, some cases of acute disseminated encephalomyelitis or clinically isolated syndrome progress to become chronic disorders, including multiple sclerosis and neuromyelitis optica. This review summarizes the current knowledge on monophasic and chronic demyelinating disorders in children, focusing on an approach to diagnosis and management.
Diabetic polyneuropathy
Diabetic polyneuropathy (DPN) is defined as peripheral nerve dysfunction. There are three main alterations involved in the pathologic changes of DPN: inflammation, oxidative stress, and mitochondrial dysfunction.
Excessive daytime sleepiness
The most common causes of excessive daytime sleepiness are sleep deprivation, obstructive sleep apnea, and sedating medications. Other potential causes of excessive daytime sleepiness include certain medical and psychiatric conditions and sleep disorders, such as narcolepsy.
Vagal Nerve stimulation
Vagus nerve stimulation (VNS) is a medical treatment that involves delivering electrical impulses to the vagus nerve. It is used as an add-on treatment for certain types of intractable epilepsy and treatment-resistant depression. Frequent side effects include coughing and shortness of breath. Serious side effects may include trouble talking and cardiac arrest.
Dystonia
Dystonia is a movement disorder in which your muscles contract involuntarily, causing repetitive or twisting movements.
The condition can affect one part of your body (focal dystonia), two or more adjacent parts (segmental dystonia) or all parts of your body (general dystonia). The muscle spasms can range from mild to severe. They may be painful, and they can interfere with your performance of day-to-day tasks.
Dystonia: Causes, Types, Symptoms, and Treatments
Trigeminal neuralgia is sudden, severe facial pain. It's often described as a sharp shooting pain or like having an electric shock in the jaw, teeth or gums.
Trigeminal neuralgia
Contents
Overview
Symptoms
Causes
Diagnosis
Treatment
Nootropics and smart drugs are natural or synthetic substances that can be taken to improve mental performance in healthy people.
They have gained popularity in today’s highly competitive society and are most often used to boost memory, focus, creativity, intelligence and motivation.
Here’s a look at the ]best nootropics and how they enhance performance.
Nystagmus is a condition of involuntary (or voluntary, in some cases)eye movement, acquired in infancy or later in life, that in extremely rare cases may result in reduced or limited vision. Due to the involuntary movement of the eye, it has been called "dancing eyes"Contents
1 Causes
1.1 Early-onset nystagmus
1.2 Acquired nystagmus
1.3 Other causes
2 Diagnosis
2.1 Pathologic nystagmus
2.2 Physiological nystagmus
3 Treatment
4 Epidemiology
Basics of Neuroradiology
Neuroradiology is an essential tool in management of patients with neurological and neurosurgical disorders. The aim of this presentation will be to acquaint the reader to understand how images are formed on a computed tomography (CT) and magnetic resonance imaging (MRI) along with a review of the relevant neuroanatomy. This understanding will be helpful to the reader in interpretation of images and diagnosis of various neurological disorders.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
4. 4
Pathway extends from the
„front‟ to the „back‟ of the
brain.
The Visual Pathway
OT
ON
OC
VISUAL
CORTEX
RETINA
VISUAL
FIELD
LGN
OPTIC
RADIATIONS
ON = Optic Nerve
OC = Optic Chiasm
OT = Optic Tract
LGN = Lateral Geniculate Nucleus of Thalamus
8. • Macula: oval region
approximately 3-5
mm that surrounds
the fovea, also has
high visual acuity.
• Fovea: central
fixation point of
each eye// region
of the retina with
highest visual
acuity.
Eyes & Retina
9. Eyes & Retina
• Optic disc: region
where axons
leaving the retina
gather to form the
Optic nerve.
10. Eyes & Retina
• Blind spot located
15° lateral and
inferior to central
fixation point of
each eye.
11. 11
Object to be seen
Peripheral Retina
Central Retina (fovea
in the macula lutea)
19. 19
Pathway extends from the
„front‟ to the „back‟ of the
brain.
The Visual Pathway
OT
ON
OC
VISUAL
CORTEX
RETINA
VISUAL
FIELD
LGN
OPTIC
RADIATIONS
ON = Optic Nerve
OC = Optic Chiasm
OT = Optic Tract
LGN = Lateral Geniculate Nucleus of Thalamus
20. 20
Retinal Quadrants
nose
UTQ UTQ
LTQ LTQLNQLNQ
UNQ UNQ
Right retina Left retina
Papilla (optic
nerve head)
Macula with
fovea centralis
Retina as you would see it through the
ophthalmoscope & the patient‟s pupil
Temporal Hemiretina
UTQ = upper temporal quadrant
LTQ = lower temporal quadrant
Nasal Hemiretina
UNQ = upper nasal quadrant
LNQ = lower nasal quadrant
Horizontal Meridian
Vertical Meridian
The blind spot in the Visual Field corresponds to the location of
the optic nerve head on the NASAL side of the retina.
21. 21
Definition: The entire area that
can be “seen” by the patient
without movement of the head
and with the eyes fixed on a
single spot.
Monocular Visual Fields
Mapping of Visual Fields:
• Confrontational method
• Perimetry (Manual or
Automated)
Temporal Field of
Left Eye
Nasal Field of
Left Eye
F
Normal Monocular Visual
Field of Right Eye
Normal Monocular Visual
Field of Left Eye
F
Monocular Visual Fields:
• Each eye is tested separately.
• The monocular visual field is plotted with the Fovea (F) at the center.
• The monocular visual field (colored area -- blue for left; green for right in this example) is
not round.
• Horizontal and Vertical Meridians correspond to those of the retina and divide the visual
field into upper temporal, upper nasal, lower temporal and lower nasal quadrants.
Vertical
Meridian
Horizontal
Meridian
UpperFieldof
LeftEye
LowerFieldof
LeftEye
UTQ
LTQ
UNQ
LNQ
22. 22
Blind Spot
• 15° to the temporal side
of the visual field of each
eye
• On the horizontal
meridian
• Corresponds to the
location of the optic
nerve head 15° to the
nasal side of the retina of
each eye.
Demonstration of the Blind Spot:
• Draw the star and box on a piece of paper.
• Close your left eye; Look at the star with your right eye; Move paper back and forth
until the green box disappears.
• Open your left eye and the box can be seen because even though it was falling on the
blind spot of the right eye, it is not falling on the blind spot of your left eye.
• With both eyes open & binocular vision intact, you don‟t realize that there is a blind
spot since the corresponding spot on the contralateral retina will see the object.
Temporal Field of
Left Eye
Nasal Field of
Left Eye
Normal Monocular Visual
Field of Left Eye
F F
Normal Monocular Visual
Field of Right Eye
UpperFieldofLeft
Eye
LowerFieldofLeft
Eye
Monocular Visual Fields
23. 23
• Understand the difference
between the “monocular
visual field of the left eye”
vs. the “Left Visual Field”
• and vice versa for the right
counterparts.
Normal Binocular Visual Field
F
Right Visual FieldLeft Visual Field
Upper Fields
Lower Fields
Temporal Field of
Left Eye
Nasal Field of
Left Eye
Normal Monocular Visual
Field of Left Eye
F F
Normal Monocular Visual
Field of Right Eye
Binocular Visual
Fields
24. 24
• Binocular vision is dependent
upon the extraocular muscles
aligning the eyes so that an
image falls on
“corresponding points” on the
retina of each eye.
• This is essential for the brain
to perceive a single image.
• Diplopia occurs when the
images are not aligned to fall
on corresponding points of
each retina. Normal Binocular Visual Field
F
Right Visual FieldLeft Visual Field
Upper Fields
Lower Fields
Temporal Field of
Left Eye
Nasal Field of
Left Eye
Normal Monocular Visual
Field of Left Eye
F F
Normal Monocular Visual
Field of Right Eye
Binocular Visual
Fields
25. 25
Retina of Left Eye Retina of Right Eye
Binocular
Visual Field
Monocular Crescent of
Right Eye
Monocular Crescent of
Left Eye
The Visual Pathway
26. 26
Visual Pathway
• Optic Nerve (ON)
• = Axons of ganglion cells in the retina
of the corresponding eye
• Outgrowth of diencephalon, so is a
CNS tract & not a „true‟ cranial nerve.
• Myelinated by oligodendrocytes.
• Optic Chiasm (OC)
• Located just anterior to pituitary
• Partial crossing of optic nerve axons
in the OC is essential to binocular
vision
• Axons from temporal fields cross
• Axons from nasal fields do not
cross
• “Wilbrand‟s knee” may be artifact
Retinotopic representation
• Central (macular) vision
• Peripheral vision
Left visual field Right visual field
Right retinaLeft retina
Left LGN
Temporal Nasal TemporalNasal
lateral lateralmedial medial
LVFLVF UVFUVF
E.W.
Right visual
cortex
midbrain
Right LGN
Left visual cortex
Left
temporal
retina
Right
temporal
retina
Nasal
retina
Ciliary
ganglion
pretectal
nuclei
cuneus
lingual
gyrus
Calcarin
e sulcus
III
III
Upper field
Lower field
VISUAL FIELDS:
Hatched = binocular
Stippled = monocular
Central area = macula
ON
OC
OT
27. 27
• Optic Tract (OT)
• Optic nerve fibers from the optic chiasm
continue as the optic tract & terminate in
the lateral geniculate nucleus of thalamus.
• Each tract contains axons that carry input
from the contralateral visual field.
• Left OT receives from R. visual field
• Right OT receives from the L. visual
field
Retinotopic representation
• Central (macular) vision
• Peripheral vision
Left visual field Right visual field
Right retinaLeft retina
Left LGN
Tempora
l
Nasal Tempora
l
Nasal
lateral lateralmedial medial
LVFLVF UVFUVF
E.W.
Right visual
cortex
midbrain
Right LGN
Left visual cortex
Left
temporal
retina
Right
temporal
retina
Nasal
retina
Ciliary
ganglion
pretectal
nuclei
cuneus
lingual
gyrus
III
III
Visual Pathway
Post-Chiasmatic portion of the pathway:
From optic tract to visual cortex, each side of the brain
deals with the contralateral visual field.
Upper field
Lower field
VISUAL FIELDS:
Hatched = binocular
Stippled = monocular
Central area = macula
ON
OC
OT
• Lateral Geniculate Nucleus (LGN)
• Primary termination of OT fibers
• Each LGN receives input from the
contralateral visual field.
• OT Projections to pretectum for reflexes
28. 28
• Geniculocalcarine Tract (= optic
radiations)
• Axons of LGN neurons travel to primary
visual cortex (Area 17) via the
geniculocalcarine tract located in the
retrolenticular and sublenticular portions
of the internal capsule.
• Axons from upper visual fields take a
looping course into the temporal lobe on
the way to visual cortex. (=Meyer‟s loop)
• Axons from lower visual fields take a
more direct route to visual cortex.
• Macular fibers are in an intermediate
location in the optic radiation.
Left visual field Right visual field
Right retinaLeft retina
Left LGN
Tempora
l
Nasal Tempora
l
Nasal
lateral lateralmedial medial
LVFLVF UVFUVF
E.W.
Right visual
cortex
midbrain
Right LGN
Left visual cortex
Left
temporal
retina
Right
temporal
retina
Nasal
retina
Ciliary
ganglion
pretectal
nuclei
cuneus
lingual
gyrus
Calcarin
e sulcus
III
III
Meyer‟s
loop
Optic radiation or
geniculocalcarine
tract
Visual Pathway
Post-Chiasmatic portion of the pathway:
From optic tract to visual cortex, each side of the brain
deals with the contralateral visual field.
Upper field
Lower field
VISUAL FIELDS:
Hatched = binocular
Stippled = monocular
Central area = macula
ON
OC
OT
29. 29
Visual Pathway
Retinotopic representation
• Central (macular) vision
• Peripheral vision
Left visual field Right visual field
Right retinaLeft retina
Left LGN
Tempora
l
Nasal Tempora
l
Nasal
lateral lateralmedial medial
LVFLVF UVFUVF
E.W.
Right visual cortex
midbrain
Right LGN
Left visual cortex
Left
temporal
retina
Right
temporal
retina
Nasal
retina
Ciliary
ganglion
pretectal
nuclei
cuneus
lingual
gyrus
Calcarin
e sulcus
III
III
Meyer‟s
loop
Optic radiation or
geniculocalcarine
tract
Upper field
Lower field
VISUAL FIELDS:
Hatched = binocular
Stippled = monocular
Central area = macula
ON
OC
OT
• Primary Visual Cortex (Area 17)
• Located on either side of & within the
calcarine fissure.
• Upper fields project to the lingual gyrus.
• Lower fields project to the cuneus.
• Macular representation is most caudal in
Area 17.
• Peripheral field representation is in the
rostral 2/3rds of Area 17.
• Lesions of Area 17 result in blindness in
the contralateral visual field.
• Association Visual Cortex (Areas
18 & 19)
• Input from Area 17 & elsewhere
• Deals with complex aspects of vision
• Lesions of result in visual agnosia.
35. • Cells in area MT or V5
respond to movement
but not color
• For example, this
particular neuron in this
monkey’s V5 area
responds best when
stimulus moved down
and to the left
Visual Cortex: Area MT or V5
MOTION
45. Optic nerve-type field defects
• Retinal fibers
enter optic discs
in a specific
manner.
• Nerve fiber
bundle (NFB)
defects are of the
following:
1. Papillomacular
bundle.
2. Sup. & Inf.
Arcuate bundle.
3. Nasal bundle.
46. Papillomacular Bundle
• Macular fibers that enter the temporal
aspect of the disc.
• Defect, result in the following:
1. Central scotoma: defect covering central
fixation.
2. Centrocecal scotoma: a central scotoma
conneted to the blind spot.
3. Paracentral scotoma: defect of some of the
fibers of the papillomacular bundle lying
next to, but not involving central fixation.
48. 48
Lesions of the Visual Pathway
1. Normal visual fields
2. Blindness of the right eye
3. Blindness of right eye + contralateral left upper
quadrantanopia
4. Bitemporal heteronymous hemianopsia
5. Left homonymous hemianopsia
6. Left upper homonymous quadrantanopsia
7. Left homonymous hemianopsia with macular
sparing
RightLeft
Definitions
Strabismus
Diplopia
Amblyopia
Scotoma
Quadrantanopsia - # 3, 6
Hemianopsia - # 4, 5, 7
Heteronymous Defects - # 3, 4
Homonymous Defects - # 5, 6, 7
Congruous Defects - # 5, 6, 7
Incongruous Defects - # 3
Altitudinal Defects - # 6
Masked area = area
of visual loss
Aka
“field
cuts”
Fields, not
retinal
quadrants
49. 49
Lesions of the Visual Pathway
1. Normal visual fields
2. Blindness of the right eye
3. Blindness of right eye + contralateral left upper
quadrantanopia
4. Bitemporal heteronymous hemianopsia
5. Left homonymous hemianopsia
6. Left upper homonymous quadrantanopsia
7. Left homonymous hemianopsia with macular
sparing
RightLeft
50. • Hemianopia – loss of
pattern vision in either
the left or right visual
field
• Quadrantanopia –
blindness in one
quadrant of the visual
field – damage to the
optic tract, LGN or V1
Lesions of the Visual Pathway
54. Deficits in Color Perception -
Achromatopsia
• Congenital colorblindness (dichromats)
vs. acquired colorblindness
• Usually associated with damage to V4
• Object recognition OK
56. Deficits Following Damage to the
WHAT Pathway
• Visual agnosia – partial or total inability
to recognize visual stimuli,
unexplainable by a defect in elementary
sensation or reduced level of alertness
or memory
84. ~30 cortical visual
areas with distinct
functions
Each visual area
has a topographic
representation of
external space in
the contralateral
hemifield
(however, these
get ‘less’
topographic as we
get further up in
the system)