- Evisceration and enucleation are surgical procedures to remove an eye. Evisceration removes the intraocular contents while leaving the outer shell intact, while enucleation removes the entire eye. Enucleation is preferred if there is suspicion of intraocular malignancy to allow for histological examination.
- Orbital implants are used to replace the lost volume after eye removal and allow for prosthesis motility. Implant options include porous or solid materials. Porous implants have better integration but higher risk of extrusion, while solid implants have less movement but lower extrusion risk.
- Complications after anophthalmic socket surgery can include infection, implant exposure or migration, conj
Update knowledge about Muntifocal IOL made by Asaduzzaman
Working as Associate Optometrist in Ispahani Islamia Eye Institute &Hospita, Dhaka 1215
Email:asad.optom92@yaho. com
Update knowledge about Muntifocal IOL made by Asaduzzaman
Working as Associate Optometrist in Ispahani Islamia Eye Institute &Hospita, Dhaka 1215
Email:asad.optom92@yaho. com
Basic overview of phaco dynamics along with all the Newer phacoemulsification techniques available in current practice - a video-assisted the presentation
Basic overview of phaco dynamics along with all the Newer phacoemulsification techniques available in current practice - a video-assisted the presentation
Maxillectomy and craniofacial resection Mamoon Ameen
all maxillectomy types in detail and maxillofacial resection ,indications ,contraindications ,preoperative asssessment and detail techniques and rehabilitations
Goals of anophthalmic socket surgery are-
-Maximizing orbital implant volume with good centration within the orbit
- Achieving optimal eyelid contour, volume, and tone
- Establishing a socket lining with deep fornices to retain the prosthesis
- Transmitting motility from the implant to the overlying prosthesis
- Achieving comfort and symmetry
Presentation revealing several main concepts regarding management of anophthalmic socket. It includes orbital implants during amputation surgery (evisceration or enucleation), managing the socket immediately after the removal of the eye; fitting the artificial eye and taking care of it during rest of the time. What the ophthalmic nurse and general ophthalmologist should know about artificial eye?
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.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
5. Anophthalmic socket
• Psychologically distressing
• However, single eyed patient often live a
normal life (With exceptions to those who
need stereopsis and wide VF)
• Need to safeguard the other eye using
polycarbonate glasses.
6. Before jumping to anophthalmic socket!
• Consider scleral shell for cosmesis for those with:
• Non-painful blind eyes with no malignancy
• Perfect for phthisis bulbi
• If no phthisis, consider colored contact lens
7. Types of anophthalmic surgery
• Evisceartion: Removal of the intraocular contents including cornea.
• Enucleation: Removal of the globe
• Exentration: Removal of the globe as well as some or all the orbital
contents.
8. Evisceration
• Evisceration involves the removal of the contents of the globe, leaving
the sclera, extraocular muscles, and optic nerve intact.
• NOTE: MUST RULE OUT INTROCUOCULAR MALIGNANCY
• This is the procedure of choice in:
• Perforated corneal ulcers
• Endophthalmitis
• Blind painful eye
• Evisceration can be done without keratectomy in case of a healthy
cornea:
10. The 4-petal technique of evisceration
• Blind eyes after trauma are often
reduced in size, thereby making it
difficult to accommodate a large-
sized implant.
• 4 petal technique or posterior
sclera relaxing incisions can
accommodate larger inmplants.
11. Evisceration without keratectomy
Evisceration can be done without keratectomy in case of a healthy
cornea. Steps:
• The superior rectus is cut off the eye and an incision through the
sclera is made posterior to the superior rectus insertion.
• After the intraocular contents are removed, an implant is placed into
the eye and the scleral wound is closed.
• The superior rectus is reattached.
12. Evisceration
Advantages Disadvantages
Simple procedure Cannot be performed for ocular
malignancy
Less disruption to the orbital anatomy Higher risk for sympathetic
endophthalmitis as compared to
enucleation
Good motility of the ocular prosthesis Less specimen for histological analysis
Lower rate of implant migration,
extrusion
13. Enucleation
• If the nature of the eye disease is unknown or if suspecting tumor,
enucleation is the treatment of choice (beware of the phthysical eye).
• If performed for tumor, to avoid globe penetration and should take a
long optic nerve segment for histological examination.
15. Enucleation
Advantages Disadvantages
Avoiding sympathetic ophthalmia Technically difficult
Usedful in confined neoplasms to the
globe
Motility less than evisceration
Allows complete histological examination
of the ocular tissue
Significant loss of the orbital volume
which may need expanders in children
16. Case
• 40 year old man with right eye
pain, redness, photophobia and
floaters.
17. Sympathetic ophthalmia
• Enucleation must be done within 10 days of ocular trauma to
eliminate the risk of sympathetic ophthalmia.
• The incidence of sympathetic ophthalmia is estimated to be 0.03 in
100,000 per year.
• The condition has been reported to occur from 9 days to 50 years
after corneoscleral perforation.
• The infrequency of sympathetic ophthalmia, coupled with improved
medical therapy for uveitis, has made early enucleation strictly for
prophylaxis a debatable practice.
18. Extentration
Types of extentration
• Subtotal. The eye and adjacent intraorbital tissues are removed such
that the lesion is locally excised (leaving the periorbita and part or all
of the eyelids). This technique is used for some locally invasive
tumors, for debulking of disseminated tumors, or for partial
treatment in selected patients.
• Total. All intraorbital soft tissues, including periorbita, are removed,
with or without the skin of the eyelids.
• Extended. All intraorbital soft tissues are removed, together with
adjacent structures (usually bony walls and sinuses).
19. Indication
• Destructive tumors extending into the orbit from the sinuses, face,
eyelids, conjunctiva, or intracranial space.
• Intraocular melanomas or retinoblastomas that have extended
outside the globe
• Malignant epithelial tumors of the lacrimal gland.
• Orbital zygomycosis
20.
21. Ideal anophthalmis socket
• Central, buried, bioinert implant replacing the volume of the orbit
• Healthy conjunctiva and tenon with good motility of the implant.
• Comfortable ocular prosthesis which looks similar to the other eye.
• Healthy eyelids with normal position and appearance to the other
eye.
23. Orbital implants
• Used to replace the lost volume of the orbit and for motility
• In children, very important for bony growth of the orbit.
• Size consideration:
• The volume of the orbit is approximately 30 ml. The volume of the eye is 7.5
ml. The volume of the eye must be replaced with volume provided by the
combination of the implant and the prosthesis.
• A 16 mm sphere replaces 2 ml of volume. A 20 mm sphere replaces 4–5 ml of
volume. An average-sized prosthesis can make up for the additional 2.5 ml of
volume lost during enucleation.
• In general, patients receive implants that are 20 mm in diameter. Occasionally,
a 22 mm implant can be placed without undue tension on the closure.
24. Orbital implants
• Types of implants:
• Porous or solid
• Biological vs synthetic
• Buried or exposed
• Muscles attached or unattached
25. Comparison
Porous Non-porous (Solid)
E.g. Hydroxyapetite (HA), bioceramic and Medpor E.g. Silicone, PMMA, Acrylic
Advantages Advantages
• Integration with the blood vessels (vascular
ingrowth; takes about 6 months) therefore
lower rate of migration.
• Allows good motility
• Can be pegged
• Lower rate of exposure
• Cheap
Disadvantages:
• Higher rate of exposure and extrusion
• Higher rate of infection
• Expensive
Disadvantages
• Can migrate within orbit
• Less movement
• Cannot be pegged
29. Superior sulcus syndrome
• Cause: Small or no
implant
• Management:
• Replace the larger orbital
implant. (better outcome)
OR
• Replace with large ocular
prosthesis
30. Exposed implant
• Cause: excessive rubbing of
the conjunctiva over the
porous implants.
• Management:
• Cover with scleral patch
graft
• Removal of the implant
31. Giant papillary conjunctivitis (GPC)
• Cause: Mechanical Rubbing
of the ocular prosthesis
over the tarsal conjunctiva
or immunological reaction
to the prosthesis
• Management:
• Replace the old prosthesis
especially if rought surface
or if too large.
• Steroids, mast cell
stabalizers and lubrications.
32. Contracted socket
• Cause: Short fornices due to not
fitting conformer/prosthesis,
radiotherapy, cicatricial causes such
as chemical injury or poor surgical
technique
• Management:
• Reconstruction using mucous
membrane grafting from buccal
mucosa or lips.
33. Entropion
• Cause: Poor fitting of the prosthesis
leading to shortening of the
posterior lamella.
• Management:
• Custom fit prosthesis
• Grafting of the posterior lamella
• Entropion surgery
34. Ectropion
• Cause: Heavy large prosthesisor
frequent removal of the prosthesis
accelerating the lower eyelid laxity.
• Management:
• Lateral tarsal strip or tightening of the
medial canthal tendon.
35. Ptosis
• Cause: small or non-custom
fitted prosthesis or due to
GPC.
• Management:
• Custom fit prosthesis to
modify the superior lift.
• Treat GPC
Posterior scleral relaxing incisions allows placement of a large implant.
Prosthesis is fitted 4-6 weeks later
A buried implant implies that the entire implant is covered with
a closure of conjunctiva. Exposed implants were used primarily
in the 1940s when a portion of the implant was allowed to
project through an opening in the conjunctiva. This exposed
portion of the implant was physically linked or “integrated”
to the prosthesis. These implants failed because of chronic
infection and eventual extrusion. Almost all implants in use
today are covered with conjunctiva or buried.
Medpor smoother surface than HA and thus lower rate of migration.