PURPOSE: To report the clinical outcomes of implantation of a new Ferrara intrastromal corneal ring segment (ICRS) with a 210-degree arc length in eyes with keratoconus.
Dr. Guilherme Rocha, Dr. Paulo Ferrara, Dr. Leonardo Torquetti, Dra. Luciene Barbosa analisam os resultados dos implantes de Anel de Ferrara de Arco longo no pós operatório de 6 meses
PURPOSE: To evaluate the long-term safety and effica- cy of Ferrara intrastromal corneal ring segments (ICRS) (Ferrara Ring; AJL, Boecillo, Spain) in patients with kera- toconus.
A multicentric nonrandomized study was conducted in which a new 320-ICRS was placed in 138 eyes of 130 patients with keratoconus. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry, corneal volume, asphericity, lines of vision gain/loss, and vectorial analysis were assessed preoperatively and at the final follow-up visit after the procedure.
Purpose: To evaluate the corneal volume (CV) before and after Ferrara intrastromal corneal ring segments (ICRS) implantation and its influence in clinical outcomes in keratoconus patients.
PURPOSE: To report the clinical outcomes of implantation of a new Ferrara intrastromal corneal ring segment (ICRS) with a 210-degree arc length in eyes with keratoconus.
Dr. Guilherme Rocha, Dr. Paulo Ferrara, Dr. Leonardo Torquetti, Dra. Luciene Barbosa analisam os resultados dos implantes de Anel de Ferrara de Arco longo no pós operatório de 6 meses
PURPOSE: To evaluate the long-term safety and effica- cy of Ferrara intrastromal corneal ring segments (ICRS) (Ferrara Ring; AJL, Boecillo, Spain) in patients with kera- toconus.
A multicentric nonrandomized study was conducted in which a new 320-ICRS was placed in 138 eyes of 130 patients with keratoconus. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry, corneal volume, asphericity, lines of vision gain/loss, and vectorial analysis were assessed preoperatively and at the final follow-up visit after the procedure.
Purpose: To evaluate the corneal volume (CV) before and after Ferrara intrastromal corneal ring segments (ICRS) implantation and its influence in clinical outcomes in keratoconus patients.
Doktor Vedat Kaya, Canan Aslı Utine, Sezen Harmancı Karakuş, Işılay Kavadarlı ve Ömer Faruk Yılmaz tarafından hazırlanmış olan bu makaleyi ilginize sunarız.
Resultados preliminares do implante de um novo anel associado ao PRK para pre...Ferrara Ophthalmics
Dr. Sandro Coscarelli, Dr. Pablo Rodrigues, Dr. Guilherme Rocha e Dr. Leonardo Torquetti compilaram e compartilham seus resultados com o uso de Segmentos de Anel de Ferrara HM associado ao PRK para a correção da miopia de pacientes com corneas finas e contra indicados para as técnicas de Excimer Laser apenas.
Comparative Study of Visual Outcome between Femtosecond Lasik with Excimer La...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Excepcional artigo produzido pela Dra. Jordana Sandes do CEROF, GO mostra os efeitos dos arcos de 140º em Ceratocones com valores de astigmatismo elevados.
Purpose: To evaluate the influence of age and severity of keratoconus in the clinical outcomes of implantation of Ferrara intrastromal corneal ring segments (ICRS).
Title: Otoplasty: New Modification of the Mustardé technique
Author: Mohamed A.S.M. El-Rouby, MD,
Assistant Professor of Plastic surgery, Ain Shams University, Cairo, Egypt.
Abstract
Background: one of the most established techniques for management of protruding ears is the Mustardé technique (1). Many modifications had been published for this technique; however, all these modifications started by retro-auricular incision. We modify the Mustardé technique using three retroauricular microincisions to correct several deformities of the auricular cartilage in protruding ears.
Patients and Methods: 46 patients (7unilateral, 39 bilateral) (85 ears) who were candidates for this technique, their age (25 ± 2.8 years), 38 males, 8 females. The operation time, steps, follow up sessions (2 weeks, 3, 6 and 18 months) data was recorded. Preoperative and postoperative (1,18 months) photos were compared and analyzed by custom made computer program the evaluated the results.
Results: 42 patients achieve a natural appearance. extrusion of threads occurred in 8 ears. Asymmetrical ears were noticed in 4 patients and recurrence in 11 patients. These patients were revised by Mustardé technique with retro-auricular incisions. None of the patients developed retro-auricular scars.
Conclusion: this versatile modification allows for better asthenic results of otoplasty and minimizes complications of skin incision unless cartilage and/or skin resection is needed.
Avaliação das alterações na curvatura anterior e posterior da Córnea, sua paquimetria, resultados visuais e refrativos após o Implante de Anel de Ferrara com o auxilio do Galilei.
Background: Nowadays, ICRS are a step in the treatment of keratoconus. The purpose of this study was to evaluate the refractive effect and the tomographic and biomechanical parameters in keratoconus patients implanted with Ferrara ICRS, and their stability after 18 months.
Doktor Vedat Kaya, Canan Aslı Utine, Sezen Harmancı Karakuş, Işılay Kavadarlı ve Ömer Faruk Yılmaz tarafından hazırlanmış olan bu makaleyi ilginize sunarız.
Resultados preliminares do implante de um novo anel associado ao PRK para pre...Ferrara Ophthalmics
Dr. Sandro Coscarelli, Dr. Pablo Rodrigues, Dr. Guilherme Rocha e Dr. Leonardo Torquetti compilaram e compartilham seus resultados com o uso de Segmentos de Anel de Ferrara HM associado ao PRK para a correção da miopia de pacientes com corneas finas e contra indicados para as técnicas de Excimer Laser apenas.
Comparative Study of Visual Outcome between Femtosecond Lasik with Excimer La...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Excepcional artigo produzido pela Dra. Jordana Sandes do CEROF, GO mostra os efeitos dos arcos de 140º em Ceratocones com valores de astigmatismo elevados.
Purpose: To evaluate the influence of age and severity of keratoconus in the clinical outcomes of implantation of Ferrara intrastromal corneal ring segments (ICRS).
Title: Otoplasty: New Modification of the Mustardé technique
Author: Mohamed A.S.M. El-Rouby, MD,
Assistant Professor of Plastic surgery, Ain Shams University, Cairo, Egypt.
Abstract
Background: one of the most established techniques for management of protruding ears is the Mustardé technique (1). Many modifications had been published for this technique; however, all these modifications started by retro-auricular incision. We modify the Mustardé technique using three retroauricular microincisions to correct several deformities of the auricular cartilage in protruding ears.
Patients and Methods: 46 patients (7unilateral, 39 bilateral) (85 ears) who were candidates for this technique, their age (25 ± 2.8 years), 38 males, 8 females. The operation time, steps, follow up sessions (2 weeks, 3, 6 and 18 months) data was recorded. Preoperative and postoperative (1,18 months) photos were compared and analyzed by custom made computer program the evaluated the results.
Results: 42 patients achieve a natural appearance. extrusion of threads occurred in 8 ears. Asymmetrical ears were noticed in 4 patients and recurrence in 11 patients. These patients were revised by Mustardé technique with retro-auricular incisions. None of the patients developed retro-auricular scars.
Conclusion: this versatile modification allows for better asthenic results of otoplasty and minimizes complications of skin incision unless cartilage and/or skin resection is needed.
Avaliação das alterações na curvatura anterior e posterior da Córnea, sua paquimetria, resultados visuais e refrativos após o Implante de Anel de Ferrara com o auxilio do Galilei.
Background: Nowadays, ICRS are a step in the treatment of keratoconus. The purpose of this study was to evaluate the refractive effect and the tomographic and biomechanical parameters in keratoconus patients implanted with Ferrara ICRS, and their stability after 18 months.
Topical dorzolamide for macular edema in the early phase after vitrectomy and...Avaleks-Kiev
Background: The purpose of this study was to evaluate prospectively the efficacy of a topical carbonic anhydrase inhibitor in macular edema after vitrectomy.
Цель: оценка перспективы использования топического ингибитора карбоангидразы для профилактики развития макулярного отека после витрэктомии.
http://ophthalmolog.kiev.ua/
PURPOSE: To evaluate the clinical outcomes of implantation of Ferrara intrastromal corneal ring segments (ICRS) in patients with corneal ectasia after refractive surgery.
PURPOSE: To analyze the long-term corneal endothelial profile after Ferrara ring implan- tation in keratoconus, post-LASIK ectasia and pellucid degeneration eyes.
- An article describes what is the impact of refractive error on a layer of retina ( nerve fiber layer) in myopic subjects, Download its full text from Isra Medical Journal.
Objective: To evaluate myopic impact on thickness of nerve fiber layer of the retina in healthy myopic subjects.
Study Design: Prospective Observational study.
Place and Duration: Investigative Department of Ophthalmology of Al-Ibrahim Eye Hospital, Karachi from 1st May 2018 to 30th October 2018.
Methodology: In this study 80 eyes of myopic subjects (SE -0.5 to -11.0 DS) were enrolled. Each eye underwent through comprehensive ocular examination beginning with visual acuity, refraction, fundoscopy by slit lamp and ending up to optical coherence tomography of Nidek. Mean average peripapillary thickness of nerve fiber layer and thickness in superior, inferior, nasal and temporal quadrants was taken into consideration, calculated by Spectral Domain Optical Coherence Tomography (version 1.5.5.0).
Results: Forty subjects volunteered for study protocol among which 21 were male and 19 were female with a degree of refractive breakdown of 30% mild myopic, 50% moderately myopic and 20% highly myopic. The calculated average age was 25.0 ± 5.0 years (range 16-40 years). The average total nerve fiber layer thickness in myopic respondents was 90.85μm; superiorly 112.37μm; inferiorly 117.52μm; temporally 71.85μm and in nasal quadrant was 61.55μm. Retinal nerve fiber layer thickness was statistically significant in superior and temporal quadrant. In high myopes thickness was clinically significant in inferior quadrant in terms of quantity as compared to mild and moderate myopia
Conclusion: Average retinal nerve fiber layer thickness was significantly decreased in high myopia as compared to mild myopia while moderate group had slightly thicker thickness than high myopic group. Hence impact of dioptric power on nerve fiber layer thickness in myopic patients is significant.
Pterygium Excision with Free Conjunctival Limbal Autograftiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Macular Abnormality after Successful Surgery for Idiopathic Macular Hole Asse...CrimsonpublishersMSOR
Purpose: Macular changes following Internal Limiting Membrane peeling after successful Macular hole closure using optical coherence tomography.
Methods: 5 eyes of 5 patients were included in the study. The inclusion criteria were idiopathic full thickness macular hole and completed at least 6 months follow up. All patients underwent optical coherence tomography assessment before and after surgery until 6 months. Macular thickness and morphology map was analyzed before and after surgery.
Results: There were 3 males and 2 females. The age range from 45 to 59 years. Conspicuous irregular surface of the inner retina on Optical Coherence Tomography surface topography was evident in all eyes at 6 months. This was also associated with downward slope of the temporal macula seen on surface topography. There was trend towards decrease in subfield thickness especially in the T1, S1, I1 and N1 6 months after surgery. The average decrease was -60.4 microns in T1, -20.4 microns in S1, -13.0 microns in I1 and -23.4 microns in N1.
Conclusion: In this small case series brilliant blue assisted ILM peeling after successful macular whole closure showed evidence of decrease in macular thickness in all first subfield quadrant and downward slope of the temporal macula as well as conspicuous irregularity of the inner retina.
Double Rings - New approachs to fine tune clinical outcomes.pdfFerrara Ophthalmics
Inimaginável há poucos anos, a associação de segmentos concêntricos adjuvantes no tratamento da miopia e ceratocone tem trazido resultados praticamente refrativo no tratamento de pacientes com alta miopia e astigmatismo. A associação de segmentos de 5mm e 6mm se faz possível pela alta qualidade e precisão dos Tomógrafos e Laser de Femtosegundo que tornam a cirurgia extremamente precisa e os resultados reprodutíveis e passíveis de reintervenção e adequação do planejamento inicial.
Confira a apresentação competa com as indicações, citação do artigo científico, os resultados do estudo clinico inicial com 42 olhos, os resultados, a técnica cirúrgica e o nomograma do Ferrara HM para pacientes com miopia moderada a alta e contraindicação a cirurgia de PRK por limitação de espessura corneana.
Na edição 1991 do terceiro trimestre de 2021 a Revisa Oftalmologia em Foco destacou em sua capa o Surgimento de um Novo Anel intra corneano com foco nos pacientes com miopia moderada a alta com contra indicação ao PRK por limitação da espessura da córnea
Estudo de Casos Clínicos do Implante de Anel de Ferrara para o tratamento do Ceratocone disponibilizado pela Dra. Jordana Sandes para Drylab da Ferrara Ophthalmics no Curso refrativa RIO 2022
Estudos do comportamento da luz e de sua refração no prisma demonstram como o filtro amarelo atua minimizando a formação de halos e glare no corpo dos segmentos de Anel de Ferrara™.
O intuito do filtro é minimizar qualquer desconforto que a presença do ICRS - Intra Corneal Ring Segments - possam causar ao paciente.
Esta tecnologia é exclusiva da Ferrara Ophthalmics e utilizada em 87 países.
Desde sua patente em 1987, o Anel de Ferrara e a técnica de implante vêm se aprimorando. Hoje, com indicações seguras e reprodutíveis a técnica é realizada em 87 países e mais de 600.000 olhos já forma implantados.
Acompanhe este resumo do Implante de Anel de Ferrara para correção do Ceratocone. Característica, Mecanismo de Ação, técnica Cirúrgica, os diferentes arcos e efeitos são alguns dos tópicos abordados
A Aula apresenta os conceitos básicos sobre implantes intra corneanos, a evolução do nomograma da Ferrara Ophthalmics, a classificação morfologia do aspecto coreano e alguns casos clínicos.
Autor: Dr. Guilherme Rocha
Indicações de nomograma de utilização de segmentos de 320º de arco a partir de analise estatística de 26 casos operados e correlação com diferentes arcos existentes.
Using a diamond knife, set at 90% of corneal thickness at (90 degrees meridian), at 8 mm optic zone, a radial incision was done and corneal pockets were created. A 6.0 nylon preloaded spatula was then inserted into the corneal pocket and in a counterclockwise direction rotated in 3600 to create a deep stromal tunnel
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
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
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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.
NVBDCP.pptx Nation vector borne disease control program
Anel de Ferrara em Crianças
1. International Journal of Keratoconus and Ectatic Corneal Diseases, July-December 2017;6(2):1-4 1
IJKECD
Intrastromal Corneal Ring Segments in Children with Keratoconus
ABSTRACT
Purpose: To evaluate the long-term follow-up of Ferrara intra-
stromal corneal ring segments (ICRSs) (Ferrara Ophthalmics,
Belo Horizonte, Brazil) implantation for the management of
keratoconus in children.
Study design: Dr Paulo Ferrara Eye Clinic, Belo Horizonte,
MG, Brazil.
Materials and methods: A total of 58 eyes of 37 children with
keratoconus were included. One or two ring segments were
inserted into the cornea, embracing the keratoconus area.
Statistical analysis included preoperative and postoperative
uncorrected distance visual acuity (UDVA), corrected distance
visual acuity (CDVA), asphericity, pachymetry, and keratometry.
Results: Ferrara ICRS implantation significantly improved the
mean UDVA and CDVA. Corneal tomography (Pentacam®
)
showed corneal flattening in all eyes implanted with the Ferrara
ring. The mean K decreased, and the corneal asphericity and
pachymetry increased in all cases.
Conclusion: The Ferrara ICRS improved all parameters after
2 years of implantation in children with keratoconus. There
was significant corneal flattening after ring implantation with
improvement of the UDVA and the CDVA. All studied param-
eters remained stable over time.
Keywords: Children, Ferrara ring, Intrastromal corneal ring
segments, Keratoconus.
How to cite this article: Ferrara G, Ferrara P, Torquetti L.
Intrastromal Corneal Ring Segments in Children with Kerato-
conus. Int J Kerat Ect Cor Dis 2017;6(2):1-4.
Source of support: Nil
Conflict of interest: None
INTRODUCTION
Keratoconus is a corneal ectatic disease characterized
by noninflammatory progressive thinning of unknown
cause in which the cornea assumes a conical shape.
Intrastromal corneal ring segments have been used
to correct ectatic corneal diseases in order to reduce the
corneal steepening, reduce the irregular astigmatism, and
improve the visual acuity (VA).1-7
Besides, the segments
may be a surgical alternative to at least delay, if not elimi-
nate, the need of lamellar or penetrating keratoplasty.
The Ferrara ICRSs are made of PMMA Perspex CQ
acrylic. They vary in thickness, and are available in 0.15,
0.20, 0.25, 0.30, and 0.35 mm. The segment cross-section is
triangular, and the base for every thickness and diameter
is 0.60 mm. The segments have 90°, 120°, 160°, or 210° of arc.
Many studies have demonstrated the efficacy of intra-
stromal rings to treat many corneal conditions, such as
keratoconus,1-7
postlaser-assisted in situ keratomileusis
corneal ectasia,8
postradial keratotomy ectasia,9
astigma-
tism,10
and myopia.11-14
The changes in corneal structure
induced by additive technologies can be roughly pre-
dicted by Barraquer’s thickness law, i.e., when material is
added to the periphery of the cornea or an equal amount
of material is removed from the central area, a flattening
effect is achieved. The corrective result varies in direct
proportion to the thickness of the implant and in inverse
proportion to its diameter. The thicker and smaller the
diameter of the device, the higher the corrective result.15
In order to investigate the long-term VA and mechani-
cal stability after Ferrara ICRS implantation in children
with keratoconus, we conducted the current retrospec-
tive study.
MATERIALS AND METHODS
We retrospectively reviewed patient records of 58 eyes
of 37 children with keratoconus, which were followed
for a period of at least 6 months. The main indication for
ICRS implantation was contact lens intolerance and/or
progression of the ectasia. The progression of the disease
was defined by worsening of UDVA, CDVA (loss of at
least 1 line of VA), progressive intolerance to contact lens
wear, and progressive corneal steepening documented by
corneal topography. Patients were excluded if any of the
following criteria applied after preoperative examination:
Advanced keratoconus with significant apical opacity and
scarring, hydrops, thin corneas, with thickness below
300 µm in the ring track, intense atopia, and any ongoing
infectious process, local or systemic.
Patients were separated into two groups, initial and
advanced, according to Amsler–Krumeich classification.
Statistical analysis included preoperative and post-
operative UDVA, CDVA, keratometry, pachymetry at the
Intrastromal Corneal Ring Segments in Children
with Keratoconus
1
Guilherme Ferrara, 2
Paulo Ferrara, 3
Leonardo Torquetti
IJKECD
Original Paper
10.5005/jp-journals-10025-1140
1-3
Private Practitioner
1,2
Paulo Ferrara Eye Clinic, Belo Horizonte, Minas Gerais, Brazil
3
Centro de Excelência em Oftalmologia, Pará de Minas, Brazil
CorrespondingAuthor: Guilherme Ferrara,Av. Contorno, 4747
– Suite 601, Belo Horizonte-30110921, Minas Gerais, Brazil
2. 2
Guilherme Ferrara et al
thinnest point of the cornea, and corneal asphericity. The
anterior segment parameters were obtained from Penta-
cam (Oculus Pentacam®, Germany). Statistical analysis
was carried out using the MINITAB software (version
3.3.1). Student’s t-test for paired data was used to compare
preoperative and postoperative data.
All surgeries were performed by the same surgeon
(P.F.) using the manual technique for ICRS implanta-
tion, as previously described.1-5
The segments were
implanted according to a previously described Ferrara
nomogram.16,17
After surgery Ketorolac drops were used every
15 minutes for 3 hours, and a combination of 0.1% dexa-
methasone and 0.3% moxifloxacin or ciprofloxacin drops
was used every 4 hours for 7 days, as well as hypromellose
(Alcon) every 6 hours for 30 days.
RESULTS
Fifty-eight eyes of 37 patients were studied. Thirteen
eyes remained untreated and three eyes underwent
lamellar keratoplasty due to advanced keratoconus. The
mean age of patients was 13 ± 2.1 years (8–16 years). All
patients completed at least 6 months of follow-up (average
20 months, 6–81). No preoperative or postoperative com-
plications occurred.
Preoperative and postoperative UDVA, CDVA, asphe-
ricity, pachymetry, and keratometry data were collected
from all patients. The mean UDVA at the preoperative
period was 0.41 LogMAR, and the mean CDVA was
0.36LogMAR.Atthefirstmonth,themeanUDVAimproved
to 0.29 LogMAR and the mean CDVA improved to 0.20
LogMAR. At the first year follow-up, the mean UDVA was
0.30 LogMAR postoperatively. The mean CDVA, at the first
year follow-up, improved to 0.15 LogMAR, at the second
year follow-up, the mean UDVA increased slightly to 0.25
LogMAR, and the mean CDVA decreased slightly to 0.16
LogMAR postoperatively (Table 1).
Corneal topography showed corneal flattening in
all eyes. The mean Kminimum and the mean Kmaximum
decreased in all groups and there was an increase
of corneal asphericity and pachymetry. One patient
needed cross-linking and one patient needed a lamellar
keratoplasty due to progressive steepening despite ICRS
implantation.
Minimum Keratometry
Evaluating the results obtained between preoperative
and the first month postoperatively, the minimum kera-
tometry reduced, on average, four units (: 3–5), with 95%
confidence interval (CI).
Between the first month and the second year of follow-
up, there was no change in minimum keratometry values
(p-value = 0.412; Graph 1).
Maximum Keratometry
From the preoperative to the evaluation in the first month,
the maximum keratometry decreased, on average, 6 units
(: 4.7–7.3), with 95% CI.
From the first month and the second year of follow-up,
the maximum keratometry increased (p-value = 0.002).
At each year evaluated, the maximum keratometry
increased, on average, 0.7 units (95% CI: 0.2–0.5; Graph 2).
Asphericity
From the preoperative to the first month postoperative,
there was an increase in asphericity, which was, on
average, 0.61 units (p-value < 0.001).
Table 1: UDVA and CDVA variation
Pre- and postoperative data
Preoperative
Postoperative
1st month
p
-value 2nd year
p
-value
UDVA 0.41 0.29 0.004 0.25 0.262
CDVA 0.36 0.2 0.16 0.983
Graph 1: Variation in minimum keratometry over time Graph 2: Variation in maximum keratometry over time
3. International Journal of Keratoconus and Ectatic Corneal Diseases, July-December 2017;6(2):1-4 3
IJKECD
Intrastromal Corneal Ring Segments in Children with Keratoconus
From the first month and the second year of follow-up,
the asphericity values remained stable over time (p-value
= 0.275; Graph 3).
Corneal Thickness Variation
From the preoperative evaluation to the first month post-
operative, there was corneal thickening of, on average,
8.5 units (p-value = 0.05).
From the first month to the second year of follow-up,
the corneal thickness remained stable over time (p-value
= 0.112; Graph 4).
DISCUSSION
Preliminary investigations have demonstrated that intra-
corneal rings are effective in the treatment of astigma-
tism and myopia with astigmatism,15
with preservation
of CDVA and stable results over time.16,17
The objective
of the addictive technology is to reinforce the cornea,
decrease the corneal irregularity, and to improve the VA
in affected patients.
This is the first study to show the long-term follow-
up of children with keratoconus in which the Ferrara
ICRS was implanted for at least 6 months. This study is
in agreement with some other studies: Miranda et al18
obtained in their study a significant reduction in the
mean central corneal curvature postoperatively. The
results showed CDVA and UDVA improved in 87.1 and
80.6% of the eyes respectively. Siganos et al4
showed an
increase of the mean UDVA from 0.07 ± 0.08 preopera-
tively to 0.20 ± 0.13 and 0.30 ± 0.21 after 1 and 6 months
respectively, and the mean CDVA improved from 0.37 ±
0.25 preoperatively to 0.50 ± 0.43 and 0.60 ± 0.17 after 1
and 6 months respectively. Kwitko and Severo19
reported
that, after implantation of Ferrara ring in keratoconus eye,
the CDVA improved in 86.4% of eyes, was unchanged
in 1.9%, and worsened in 11.7%. The UDVA improved
in 86.4% of eyes, was unchanged in 7.8%, and worsened
in 5.8%. The mean corneal curvature was reduced from
48.76 ± 3.97 to 43.17 ± 4.79.
The minimum and maximum keratometry decreased
from the presurgical evaluation to the first month, while
the values of asphericity and pachymetry increased
during the same period. Between the first month of
follow-up to the second year, we observed that minimum
keratometry did not change over time, and maximum
keratometry had a slight increase over time. The value of
asphericity does not change over time; the pachymetry
did not change over time. Although there was a slight
increase in maximum keratometry over time (0.7 diop-
ters per year, on average), this increase was not clinically
significant.
Based on our personal (unpublished) data, about 5% of
patients go to penetrating or lamellar keratoplasty due to
progressive corneal scarring, despite proper ICRS implan-
tation. It is important to emphasize that these patients
usually had ring implantation in very advanced phases
of the disease and does not mean necessarily keratoconus
evolution but rather an unsatisfactory visual outcome. In
our study, two patients (5.4%) underwent keratoplasty
and one patient (2.7%) underwent corneal crosslinking
due to keratoconus progression.
Alió et al20
conducted a retrospective study to evaluate
the long-term (up to 48 months) results after implantation
of Intacs in patients with keratoconus. They found that
the mean CDVA increased significantly (p < 0.01) from
0.46 (20/50) preoperatively to 0.66 (20/30) 6 months after
implantation. Also, the mean average K-value decreased
significantly (p < 0.01) by 3.13D. The comparison of results
6 months and 36 months after implantation showed
refraction and topography stability.
Kymionis et al21
studied 17 eyes of patients with kera-
toconus that had Intacs implantation for corneal flatten-
ing. They found that the pre-Intacs UDVA was 20/50 or
Graph 3: Variation in asphericity over time Graph 4: Variation in pachymetry over time
4. 4
Guilherme Ferrara et al
worse in all eyes, whereas, at the last follow-up examina-
tion, 59% had UDVA of 20/50 or better. Most of the eyes
(59%) experienced a gain of one up to eight lines of VA.
Previous studies showed that the intrastromal ring
flattens the cornea and keeps this effect for a long period
of time. There is no significant resteepening of the cornea
over time in adults. We found that the preoperative kera-
tometry values were higher in our study when compared
with similar studies.20-22
Moreover, the preoperative
UDVA and CDVA were worse in our study. This can be
explained by the behavior of keratoconus in some chil-
dren, which can rapidly evolve, and when the surgery is
indicated the disease is more advanced.
There was improvement of all parameters in our
study. The pattern of reduction of keratometry parameters
was similar to other studies. Despite that, at 5 years of
follow-up we found corneal resteepening on maximum
keratometry, which was not found in other studies when
compared with our results. Regarding the VA, there was
improvement in UDVA and CDVA, but not as much as
in adults.
The present study showed that the Ferrara ring,
despite the small sample of patients, could be a valuable
tool to provide topographic and visual improvement in
children with keratoconus. Corneal re-steepening can
occur after ICRS implantation. It plays an important role
in delaying the progression of keratoconus and postpones
a corneal grafting surgery. Further studies with larger
samples and longer follow-up periods must be warranted
to confirm the presented results.
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