Central retinal vein thrombosis can cause sudden vision loss in elderly patients. On examination, there are typically extensive hemorrhages extending from the optic disc to the retinal periphery, along with edema of the disc and retina. Risk factors include older age, hypertension, cardiovascular disease, and diabetes. Treatment options include anti-VEGF drugs which have been shown to reduce macular edema, as well as corticosteroid implants. Laser treatment is only beneficial for neovascularization complications.
Congenital Glaucoma is one of the most common causes of irreversible childhood blindness. This presentation covers this topic in detail that can aid physicians in effective patient care.
PS: The slides in the preview look skewed, download the presentation to view the font used in Office 2012 and upwards.
Systemic Diseases and the Eye
Various systemic diseases affect the eye and it's functioning. Here we present those common systemic diseases that are responsible to cause effects in the eye.
What are the diseases that affect eye?
Eye is affected by the following diseases:
Systemic Hypertension (Increased blood pressure of the body)
Diabetes Melitus (Increased blood sugar level)
Systemic Lupus Erythromatosus (SLE)
AIDS and other Venereal Diseases like Syphilis
Sickle Cell Anemia,
Eales Disease and many more.
Look at the slides.
Vitelliform dystrophy, or Best disease,
is a hereditary retinal dystrophy involving the retinal pigment epithelium (RPE), and leads to a characteristic bilateral yellow “egg-yolk” appearance of the macula
Congenital Glaucoma is one of the most common causes of irreversible childhood blindness. This presentation covers this topic in detail that can aid physicians in effective patient care.
PS: The slides in the preview look skewed, download the presentation to view the font used in Office 2012 and upwards.
Systemic Diseases and the Eye
Various systemic diseases affect the eye and it's functioning. Here we present those common systemic diseases that are responsible to cause effects in the eye.
What are the diseases that affect eye?
Eye is affected by the following diseases:
Systemic Hypertension (Increased blood pressure of the body)
Diabetes Melitus (Increased blood sugar level)
Systemic Lupus Erythromatosus (SLE)
AIDS and other Venereal Diseases like Syphilis
Sickle Cell Anemia,
Eales Disease and many more.
Look at the slides.
Vitelliform dystrophy, or Best disease,
is a hereditary retinal dystrophy involving the retinal pigment epithelium (RPE), and leads to a characteristic bilateral yellow “egg-yolk” appearance of the macula
this ppt explains PG level vascular occlusion retinopathies in OPTHALMOLOGY
SOURCE- PARSON DISEASES OF EYE
CONTAINS FUNDOSCOPY AND FFA IMAGES WITH LATEST TREATMENTS
Fluorescein angiography, fluorescent angiography, or fundus fluorescein angiography is a technique for examining the circulation of the retina and choroid using a fluorescent dye and a specialized angiographic camera.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
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
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.
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.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Central retinal vein thrombosis
1. Central retinal vein thrombosis
Dr. K. Vasantha M.S., F.R.C.S.
Director RIO Chennai (Rtd)
2. • Retinal venous occlusions can be
• Central – CRVO
• Branch retinal – BRVO
• Hemicentral vein occlusion – rare. Usually
upper or lower part of the retina is affected.
Very rarely nasal or temporal part can be
affected. This depends on the type of
anatomical variation.
3. Signs and symptoms
• Commonest cause of sudden loss of vision in
the elderly.
• In typical CRVO extensive superficial and
deep hemorrhages are seen. Hemorrhages
extend from to the disc to the periphery.
• Edema of the disc and retina
• Dilated and tortuous retinal veins.
4. • In mild cases only few hemorrhages, mild
disc edema and slight dilatation of veins are
seen.
• If associated with ischemia cotton wool
spots, severe macular edema and capillary
non perfusion areas will be seen.
• Ischemia – severe loss of vision along with
RAPD
5. • In CRVO the thrombus formation is at the
retro laminar level.
• There is narrowing of vessels
• And the artery and vein are closely placed at
this location.
• There is turbulent blood flow – endothelial
damage – thrombus called Virchow’s triad
6. Predisposing factors
• Old age group – POAG, hypertention, cardio
vascular and collagen vascular dis., diabetes,
smoking and more common in males
• Thrombus – due to alterations in blood flow
• Abnormal cellular products- leukemia, sickle cell
disease
• Abnormal plasma – Lupus, factor V Leiden
mutation, low plasminogen (birth control pill)
• Excess cells – polycythemia, thrombocytosis
7. • Abnormal plasma- hyper proteinemia and
homocyteinemia
• Alterations in blood vessel – atherosclerosis,
compression due to tumors, vessel wall
derangement in diabetes
• Abnormal blood flow currents – low flow in
cavernous sinus thrombosis, dural cavernous
fistula
• Compression of blood vessels
• Endothelitis – syphilis, multiple sclerosis, Eales’,
sarcoidosis, parsplanitis, autoimmune, TB
8. • Risk of CRVO decreases with postmenopausal
estrogen
• Increases with increased ESR
• In polycythemia and Waldenstrom’s
macroglobulinemia bilateral CRVO may be
seen.
• Presence of anti cardiolipin and
antiphospolipid antibodies.
9. • Protein C and protein S (anticoagulant)
deficiency. History of abortions and
involvement of other arteries and veins will
be present.
• Activated protein C resistance – AD trait
• In younger age group phlebitis must be
suspected.
12. Ischemic CRVO
• Visual acuity very low. Often less than 6/60.
• Afferent pupillary defect
• Slightly lower IOP
• More severe field loss
• Fundus: Presence of cotton wool spots
• More hemorrhages
• More than ten disc areas of non perfusion
13. Late Fundus Picture
• Hemorrhages disappear slowly. Some
peripheral hemorrhages may persist even for
years.
• Dilatation and tortuosity of veins reduce.
• Fibrous sheathing of vessels may develop.
• Disc edema will reduce.
• Collaterals may develop near the disc.
14. Late CRVO
• Micro aneurysms may be seen
• Persistent macular edema
• Changes in the macular pigmentation
• Neovascularization of the disc and retina.
15. F.F.A.
• Prolonged arterio venous transit time. If it is
more than 20 sec – ischemia
• Staining of the walls of the vein – ischemia
• Presence of capillary non perfusion areas
may not be seen due to the hemorrhages.
• If non perfusion is seen close to the fovea –
poor prognosis
16. • Ischemia causes increase in permeability of
vessels – edema – diffuse or petalloid pattern
of macular edema.
• Decrease in perifoveal blood flow,
enlargement of capillary avascular zone.
• Increase in peri foveal inter capillary area.
17. O.C.T.A
• Abnormalities are seen both in superficial
and deep retinal capillary network. This is
more in deep vessels
• Decrease in vascular perfusion
• Mean foveal avascular zone will be larger.
• Inter capillary areas are larger in the
perifoveal capillaries
18. E.R.G.
• Reduced B wave amplitude
• Reduced b/a wave ratio
• Prolonged b wave implicit time.
19. Complications
• Major cause of visual loss is macular edema
• Can be mild or severe
• Due to hydrostatic stress and ischemia
• May be transient or persistent
20. Hemorrhage
• Will definitely be present but number will
vary
• If present in the fovea – severe loss of vision
• If lots of hemorrhagic spots are seen it is
called “tomato ketchup” appearance
• Very rarely vitreous hemorrhage may be
present in acute case. If it occurs in late stage
it will be due to neovascularization.
21. Ischemia
• If large number of (more than 10 disc
diopters) capillary avascular zones are
present ischemia should be suspected.
• If ischemia is close to the fovea – severe loss
of vision
• Will lead on to neovascularization
22. Neovascularization
• Seen on the disc, elsewhere in the retina, iris
or in the angle of anterior chamber.
• Neovascularization of the iris is more
common than that of the retina.
• Once neovascularization of iris occurs it will
progress fast. Hence this must be watched
diligently.
• Rarely can occur in non-ischemic cases also
23. Other complications
• Rhegmatogenous and exudative retinal
detachment can occur
• Micro aneurysms
• Large aneurysms which appear similar to
macroaneurysms arise from the capillaries
• Collaterals seen as tortuous vessels near the
disc
24. • Choroidal arteries may be affected
• If cilio retinal artery is present it may get
occluded as this artery has a lower perfusion
pressure compared to retinal artery. This will
gross loss of vision.
• Cotton wool spots
• Rarely hard exudates may be seen. This
indicates severe ischemia and increased
triglyceride levels.
25. D.D
• Early CRVO – AION – no haemorrhage,
altitudinal defect
• Papilledema – no loss of vision
• Hypertension – younger age, bilateral
• Hyper viscosity – bilateral
• Anemia – bilateral
• Diabetes – bilateral, hard exudates, micro
aneurysms
26. D.D
• Early CRVO – AION – no haemorrhage,
altitudinal defect
• Papilledema – no loss of vision
• Hypertension – younger age, bilateral
• Hyper viscosity – bilateral
• Anemia – bilateral
• Diabetes – bilateral, hard exudates, micro
aneurysms
28. Treatment
• Various studies have been done to find out
the best treatment for CRVO
• Cruise study found that Ranibizumab is
better than sham
• Bevacizumab also was found to be better
than sham
• COPERNICUS study found aflibercept was
better than shams
29. • GALILEO study found aflibercept was better
than sham
• SCORE study compared 1 g and 4 mg intra
vitreal triamcinolone versus standard care
(just observation). Adverse events like
cataract and glaucoma were more in 4 mg
group. Results showed that IVTA is not
favourable.
30. • In GENEVA study micronized dexamethasone
implant (ozurdex) with either 0.3, 0.7 mg or
sham was used
• Decrease in foveal thickness was seen with
ozurdex.
• Cataract and glaucoma were more in 0.7 mg
group
• Ozurdex helps in refractory cases also
31. • TANZANITE study :- here aflibercept alone or
along with supra choroidal injection of
triamcinolone was used.
• It was found that combination resulted in
better visual acuity, more reduction in
edema, and for more than 9 months
additional injections were not needed.
32. • Newer anti VEGF drugs are being tried like
conbercept, brolucizumab.
• Nano particles and liposomes are tried to
deliver the drugs in a better manner.
• Special devices are being tried to deliver the
drugs like tPA in to the vein itself.
33. Laser treatment
• CVO study showed that there is no role for
grid laser in macular edema due to CRVO
• Pan retinal photocoagulation was shown to
be beneficial in eyes which already have 2
clock hours of NVI or NVA.
• Photocoagulation before the appearance of
new vessels is not useful. Hence the need for
frequent follow up to look for iris and angle
new vessels.
34. • In RELATE trial ranibizumab was used for 6
months and the either ranibizumab alone or
along with laser was tried.
• It was found that addition of laser was of no
use.
• Recurrence of edema was more in old age, if
central 1 mm was involved or when initial
edema was >570, late treatment, larger areas of
non perfusion (75 – 150 seen with wide angle
ffa)
36. Branch retinal vein occlusion
• In this lesion also hemorrhages will be seen
but restricted to the area drained by that
vein.
• Usually the upper temporal branch is
involved as there are more arterio venous
crossings.
• If the vein is occluded very close to the disc
affected area will naturally be large with
more complications.
37. • Infero temporal branch is the next commonly
affected
• Nasal branches are rarely affected
• When nasal branches are affected visual
deprivation is less. Hence not reported by
affected individuals immediately.
38. • The occluded vein will be tortuous and
dilated due to banking of blood.
• Superficial and deep hemorrhages will be
seen along the affected vessel.
• Cotton wool spots may be seen.
• Retinal edema
• Arterio venous crossing changes must be
looked for in the other eye also
39. • Common in males
• Hypertensives
• Hyperops
• Diabetics
• Open angle glaucoma should be looked for
40. Eye Disease Case Control study
• Predisposing factors are similar to CRVO.
• Cardio vascular diseases more in BRVO
• Obesity and higher serum levels of alpha 2
globulin
• Alcohol consumption and normal levels of
high density proteins reduces BRVO.
41. • Vision will often be affected due to
involvement of the macula by hemorrhages,
edema and ischemia.
• Vitreous hemorrhage and retinal detachment
also can rarely occur affecting vision.
43. Fundus picture
• The previous slide shows the typical fundus
picture
• Hemorrhages along the involved vein.
• Cotton wool spots may be present
• In late cases intra retinal collateral going
across the median raphe
• If ischemia was there sheathing may be seen
44. F.F.A.
• As expected delay in venous filling in the
involved vein will be seen.
• Retinal edema along the involved vein.
• Macular edema and ischemia may be seen –
this will cause decrease in vision.
• Retinal and disc neovascularisation is rare
and if present will be at the junction of
perfused and non perfused area.
45. • In BRVO study new vessel formation was
seen in 22% of eyes.
• If more than 5 disc diameters of capillary non
perfusion was seen neovascularisation is
likely to occur.
• Neovascularisation can lead on to vitreous
hemorrhage.
• Micro aneurysms and hard exudates may
develop later.
46. Complications
• Rhegmatogenous Retinal detachment can
rarely occur posterior to the equator.
• Fibro vascular proliferations can cause
traction and tears in the retina.
• Ischemia also can cause retinal hole and lead
on to detachment.
• Exudative detachment can occur in the region
of the involved vein if ischemia is present.
47. • Epiretinal membrane
• Irregularities in the retinal pigment
epithelium
• Sub retinal scar
• Macular hole
• Are other complications
• Prognosis will be poor if the occlusion is very
close to the disc.
49. Treatment
• SCORE study :- intra vitreal steroids are
helpful
• VIBRANT study:- Aflibercept is better than
laser.
• GENEVA study found ozurdex to be useful
• Bevazizumab was found to be better than
laser
• MARVEL - Ranibizumab was seen to be better
than Bevazizumab
50. Laser
• Branch vein occlusion study – laser covering
the entire area of involved retina except
within 2 dd of the fovea reduced the risk of
neovascularisation in eyes with >5 dd of non
perfused retina. When new vessels were
already present incidence of vitreous
hemorrhage was also less.
• After the use of anti VEGF laser is used less.