Anatomy and an important paper presentation on the topic 'VITREOUS HUMOUR ' it's very useful for an optometrist/ophthalmologist and also for optometry students .
vitreous humour have it's own important function. But here only anatomy of vitreous humour/body.
Anatomy and an important paper presentation on the topic 'VITREOUS HUMOUR ' it's very useful for an optometrist/ophthalmologist and also for optometry students .
vitreous humour have it's own important function. But here only anatomy of vitreous humour/body.
LIMBUS… • The limbus forms the border between the transparent cornea and opaque sclera, contains the pathways of aqueous humour outflow, and is the site of surgical incisions for cataract and glaucoma
2. Anatomical Limbus: Circumcorneal transitional zone of the conjunctivocorneal & corneoscleral junction Conjunctivo-corneal junction: • Bulbar conjunctiva is firmly adherent to underlying structures • Substantia propria of the conjunctiva stops here but its epithelium continues with that of the cornea. Sclero-corneal junction: • Transparent corneal lamellae become continuous • With the oblique, circular and opaque fibres of sclera
3. CONTINUE…. • In the area near limbus, the conjunctiva, tenon’s capsule & the episcleral tissue are fused into a dense tissue which is strongly adherent to corneo scleral junction.It is preferred site for obtaining a firm hold of the eyeball during ocular surgery. • The limbus is a common site for the occurrence of corneal epithelial neoplasm. • The Limbus contains radially oriented fibrovascular ridge known as the palisades of Vogt that may harbour a stem cell population. The palisades of Vogt are more common in the superior and inferior quadrants around the eye
UVEA constitutes- middle vascular coat
• 3 parts- a)iris
b)ciliary body
c)choroid
• Developmentally,structurally and functionallyindivisible
• color varies from light blue to dark brown
EMBRYOLOGY
IRIS-
• Both layers of epithelium derived from
marginal region of optic cup (neuroectoderm)
• Sphincter and dilator pupillae- anterior
epithelium (neuroectoderm)
• Stroma and vessels- vascular mesoderm
LIMBUS… • The limbus forms the border between the transparent cornea and opaque sclera, contains the pathways of aqueous humour outflow, and is the site of surgical incisions for cataract and glaucoma
2. Anatomical Limbus: Circumcorneal transitional zone of the conjunctivocorneal & corneoscleral junction Conjunctivo-corneal junction: • Bulbar conjunctiva is firmly adherent to underlying structures • Substantia propria of the conjunctiva stops here but its epithelium continues with that of the cornea. Sclero-corneal junction: • Transparent corneal lamellae become continuous • With the oblique, circular and opaque fibres of sclera
3. CONTINUE…. • In the area near limbus, the conjunctiva, tenon’s capsule & the episcleral tissue are fused into a dense tissue which is strongly adherent to corneo scleral junction.It is preferred site for obtaining a firm hold of the eyeball during ocular surgery. • The limbus is a common site for the occurrence of corneal epithelial neoplasm. • The Limbus contains radially oriented fibrovascular ridge known as the palisades of Vogt that may harbour a stem cell population. The palisades of Vogt are more common in the superior and inferior quadrants around the eye
UVEA constitutes- middle vascular coat
• 3 parts- a)iris
b)ciliary body
c)choroid
• Developmentally,structurally and functionallyindivisible
• color varies from light blue to dark brown
EMBRYOLOGY
IRIS-
• Both layers of epithelium derived from
marginal region of optic cup (neuroectoderm)
• Sphincter and dilator pupillae- anterior
epithelium (neuroectoderm)
• Stroma and vessels- vascular mesoderm
The corneal diseases are one of the leading causes of blindness in the world. in most cases, these infections are preventable or treatable.
This seminar provides an overview of the anatomy and physiology of the cornea, as well as an overview of common conditions.
Concussions, TBI, Reading, Balance, Car-Sickness, Attention, Visual Fatigue Problems Vision Therapy 101 for the Primary Care Practitioner By Stan Appelbaum, OD
Current Thoughts on Nutrition With Emphasis on Treating the Cause of Degenera...Visionary Ophthamology
Current Thoughts on Nutrition
With Emphasis on Treating the Cause of Degenerative Eye Disease, Safety Issues, B Vitamins and Essential Fatty Acids and Dry Eyes
Ellen Troyer, MT MA
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
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
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.
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!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Cornea and Lens Histopathology Refractive Surgery Cataracts High Myopia
1. Cornea and Lens
Histopathology
Refractive Surgery
Cataracts
High Myopia
Chi-Chao Chan, M.D.
Immunopathology Section
Laboratory of Immunology
National Eye Institute
National Institutes of Health
2. Classification
Ocular Tissue (a
z)
cornea
Trabecular meshwork
Conjunctiva
conjunctiva
Cornea
sclera
Lens
Optic Nerve
retina
Orbit/Extraocular Muscles
Retina
vitreous
Sclera
Trabecular meshwork
Uvea (Iris, Ciliary body, Choroid)
Vitreous
iris
Ciliary body
lens
retina
choroid
sclera
optic nerve
The average size of a normal adult eye: 25 mm (h) x 24.5 mm (v) x 24 mm (AP)
3. Conjunctiva
Gross (Macroscopic structure):
» Palpebral (Tarsal) Conjunctiva
» Fornical Conjunctiva
» Bulbar Conjunctiva
epithelium
Microscopic Structure:
» Epithelium (two or more layers)
– Stratified epithelia, goblet cells
» Substantia propria (fibrovascular tissue including
nerves and lymphatics)
Substantia propria
6. Refractive Surgery
An eye surgery used to improve the refractive
state of the eye and decrease or eliminate
dependency on glasses or contact lenses
Remodeling of the cornea
The most common methods today use excimer
lasers to reshape curvature of the cornea
Successful refractive eye surgery can reduce or
cure common vision disorders such as myopia
(near sight), hyperopia (far sight) and astigmatism
(non-perfected spherical cornea).
8. LASIK
Photorefractive Keratectomy (PRK)
LASIK
LASIK: Laser Assisted In Situ Keratomileusis
A type of refractive surgery
Wound healing only at the periphery of micotome incision
Stromal reaction less after LASIK than PRK
Requires a long time for wound healing
Perz-Santonja, et al. Refract Surg 1998;14:601-9.
Park, et al. Cataract Refract Surg 1999;25:842-50.
Wachtlin, et al. Refract Surg 1999;15:451-8.
Kato. Br J Ophthalmol 1999;83:1302-5.
16. INTACS
• A 47-yr-old man with a
history of keratoconus
and failure of using a
Rigid Gas Permeable
(RGP) contact lens, O.S.
• Implantation of Intacs,
O.U.
• 10 mons later: Multiple,
whitish, small crystalline
deposits around the
edges and the border of
the superior Intacs
segment nasally
• Penetrating keratoplasty,
O.S.
Cao, et al. J Med Case Rep 2011, 5:398.
17. INTACS
A. A space containing residue
plastic (Intacs) material is
surrounded by a dense
acellular/ hypocellular
collagen scar. The channel
haze is observed at the inner
edge of Intacs.
B. The severely attenuated
corneal endothelial cells.
C. The acidophilic densification
and mild inflammatory cell
infiltration at the inner edge of
Intacs.
D. Immunochemistry of CD68
shows macrophage (CD68+)
infiltration at the inner edge of
Intacs.
Cao, et al. J Med Case Rep 2011, 5:398.
18. Neovascularization
• Corneal neovascularization is an unwanted
vascular growth into the avascular cornea.
Contact lens causing
»
Soft contact lens wearers - micropannus
Inflammation
»
»
Vascularized pannus
Stromal keratitis – e.g., Cogan syndrome
Stem cell deficiency
Poor wound healing
»
Corneal transplantation under 2 yr.
29. Lens: Adult Cataracts
Aging
–
Nuclear, Cortical, Posterior Subcapsular
–
In theory, everyone would get cataract if one lives long enough
Drug-induced
–
Corticosteroids, Phenothiazines, Miotics, Aminodarone, etc.
Trauma
–
Contusion, Injury: mechanical, chemical, radiation, etc.
Metabolic
–
Diabetes Mellitus, Galactosemia, Wilson Disease, etc.
Nutritional
38. Cataract: Exfoliation
•
•
•
•
Age related disease
Accumulation of abnormal fibrillar extracellular material
Anterior segment involvement
Cause cataract and glaucoma
SEM
a. SEM: lens capsule
b. TEM: lens capsule
c. TEM: lens epithelium
Z: zonular fiber/lamella
Ritch, Schlotzer-Schrehardt.
Surv Ophthalmol 2001;45:265315.
41. Tilted Optic Nerve Head
•
•
•
Because of the elongated eye, the nerve inserts obliquely
Most commonly, the nerve head is tilted toward the temporal side
This can make the assessment of the cup:disc ratio difficult and OCT nerve may be unreliable
42. Peripapillary
Chorioretinal Atrophy
• Due to tangential tractional forces of the elongating globe, the RPE, Bruch’s
membrane, and choroid fall short of reaching the entrance of the nerve into
the eye, and bare sclera is seen
46. Posterior Staphyloma
• Abnormal elongation of the globe and the attenuation of
the sclera are accompanied by a localized ectasia
involving the sclera, choroid, and RPE (outward bowing)
• Histologically, staphylomas contain decreased amounts of
scleral collagen bundles and decrease in caliber
• Axial length elongation and/or posterior staphyloma may
generate inward tractional force which is opposed by the
residual posterior vitreous cortex, ILM, and/or retinal
vessels
• Detected in 9-35% of highly myopic eyes with posterior
staphylomas
• Majority remain stable
• Can lead to foveal detachment and/or macular hole
47. Posterior Staphyloma
• The prevalence and severity of staphylomas are found to increase with greater age, eye
length, and myopic refraction
• Most commonly involves the posterior pole, extending from 2 to 5 disc diameters nasal to the
optic nerve to an area involving the macula
• Best seen on B-scan ultrasound
48. Macular Foveoschisis
Detected in 9-35% of highly myopic eyes with posterior
staphylomas
• Majority remain stable
• Can lead to foveal detachment and/or macular hole
•
49. Macular Foveoschisis
Tnag, et al. J Ophthalmol 2010, 2010:1-4.
• interbridging strands in the outer plexiform layer of the
macular region
• located mainly in the outer plexiform layer
50. Atrophic Changes in the
RPE and Choroid
Early degenerative changes affect the
choriocapillaris and RPE
– Loss of choroidal melanocytes and RPE atrophy
'tessellated/tigroid' fundus
51. Atrophic Changes in the
RPE and Choroid
In later stages, the neuroretina also
becomes atrophic leading to generalized
and/or patchy atrophy
– Vision may begin to be affected at this stage
52. Lacquer Cracks
• Yellow-white linear or stellate lesions that are typically horizontal oriented and branched
• Represent mechanical breaks of the RPE, Bruch’s membrane, and choriocapillaris from
elongation of the globe
• Usually occur in eyes >26.5 mm in length and more common in males
• Macular hemorrhages can sometime occur in the crack in the absence of CNV
• Number usually increase over time and can be associated with the development of atrophy
• Important prognostic factor for the development of CNV
The cornea is the transparent anterior part of the eye’s tough fibrous outer coat and is the eye’s principal refractive element. The bulk of the cornea is comprised of interweaving lamellae of type I collagen fibers, which are spaced in an exquisitely regular fashion. Artifactitious clefts separate the stromal lamella in routine histologic sections. Cornea is composed of a nonkeratinized epithelium which usually five cells in thickness corvers the anterior surface of the cornea, , Bowman layer is a hyaline band of modified stroma, stroma Descemet’s membrane and a delicate monolayer of flattened endothelium. The stroma contains flattened dendritiform fibroblastlike cells called keratocytes.
Molecular analyses revealed 10 fold lower IP-10/CXCL10 mRNA and two fold higher CCL5 mRNA in the fibrous tissue surrounding the Intacs channels, as compared to the central corneal stroma. IP-10/CXCL10 is a fibrotic and angiostatic chemokine produced by macrophages, endothelial cells and fibroblasts. IP-10/CXCL10, a CXC chemokine, which promotes chemoattraction but inhibits angiogenesis, is secreted by monocytes, endothelial cells, fibroblasts and keratinocytes. IP-10/CXCL10 regulates wound healing and inhibits fibrosis in the lung. IP-10/CXCL10 also induces apoptosis in several cell types. Therefore, it is not surprising that only occasional apoptotic cells are detected in the collagen scar tissue.
Patient: Thomas McDonough
Left: Thomas McDonough
Right: Jacqueline Tran
Lattice degeneration: occurs more frequently in myopic than non-myopic eyes, however its incidence is greater in moderate than severe myopia
Lattice degeneration: occurs more frequently in myopic than non-myopic eyes, however its incidence is greater in moderate than severe myopia
Lattice degeneration: occurs more frequently in myopic than non-myopic eyes, however its incidence is greater in moderate than severe myopia
Margaret Bon
Study by Benhamou and colleagues and Fujimotoe et al.structure of macular retinoschisis inner and outer schisis, need for ILM detachment (21 eyes, 10 had foveal detachment, 9/10 had ILM detachment)
ILM detachment
ELM to OPL detachment
Margaret Bon
Study by Benhamou and colleagues and Fujimotoe et al.structure of macular retinoschisis inner and outer schisis, need for ILM detachment (21 eyes, 10 had foveal detachment, 9/10 had ILM detachment)
ILM detachment
ELM to OPL detachment
30-50% of eyes will go on to develop CNV over the next 10 years