This presentation gives a brief idea about angle of anterior chamber along with its structures and diagnostic methods to grade and visualize the structures.
This presentation gives a brief idea about angle of anterior chamber along with its structures and diagnostic methods to grade and visualize the structures.
miotics and mydriatics presentation m&mmparthsaraf55
Optometrists are well-acquainted with the two opposing muscles in the iris, the sphincter and the dilator, as we witness their effects daily in clinical practice. Pupil constriction (miosis) can either be stimulated by contraction of the iris sphincter or by relaxation of the iris dilator. On the other hand, pupil dilation (mydriasis) can either be stimulated by contraction of the iris dilator or by relaxation of the iris sphincter.
Miotic and mydriatic drops work by acting on these different muscles of the iris. The drops are able to control pupil size by targeting two parts of the autonomic nervous system: the sympathetic and parasympathetic systems. Let’s review their function and clinical role to better understand their present uses and why some of these agents are undergoing re-evaulation for potential new ones.
Behind the Scenes
The sympathetic pathway, mainly responsible for pupil mydriasis, involves a three-neuron pathway.1,2 The first neuron begins in the hypothalamus and descends through the midbrain to synapse onto a specific area of the spinal cord, known as the ciliospinal center of Budge. This synapse is located between the C8 and T2 vertebrae. The second neuron, which is the preganglionic neuron, exits the spinal cord, ascends through the thorax and synapses near the apex of the lung into the superior cervical ganglion. The third postganglionic neuron travels to the cavernous sinus and enters the orbit through the short and long ciliary nerves, synapsing to the iris dilator.1,2
Contrarily, the parasympathetic pathway is mainly responsible for pupil miosis.1,3 Pupil constriction starts when light enters the retina and activates the retinal ganglion cells—the beginning of the afferent arm—which then transmit their impulses into the optic nerve. This stimulus travels to the optic chiasm, through the optic tract and eventually reaches the pretectal nucleus. The impulses from the pretectal nucleus begin the efferent arm, which projects to the Edinger-Westphal nucleus. The Edinger-Westphal nucleus gives rise to preganglionic fibers, which then synapse with postganglionic neurons in the ciliary ganglion. Postganglionic neurons leave the ciliary ganglion to innervate the iris sphincter.1,3
Tropicamide has a strong mydriatic effect.
Tropicamide has a strong mydriatic effect. Click image to enlarge.
Behind the Scenes
The sympathetic pathway, mainly responsible for pupil mydriasis, involves a three-neuron pathway.1,2 The first neuron begins in the hypothalamus and descends through the midbrain to synapse onto a specific area of the spinal cord, known as the ciliospinal center of Budge. This synapse is located between the C8 and T2 vertebrae. The second neuron, which is the preganglionic neuron, exits the spinal cord, ascends through the thorax and synapses near the apex of the lung into the superior cervical ganglion. The third postganglionic neuron travels to the cavernous sinus and enters the orbit through the short and long ciliary n
This is a topic of sensory organ and this is detailed topic and can be refered by all nursing students bsc, msc and gnm which give you overall idea and things related to cataractwhich include definition, anat and physio, risk factor, pathophysiology, clinical menifestation, diagnostic evaluation, and management
AMBLYOPIA
Presenter : Dr Nikhil Agrawal (1st year resident)
Moderator : Dr Ekta Gupta
DHIR HOSPITAL POST GRADUATE INSTITUTE OF OPHTHALMOLOGY
BHIWANI-127021
Email: education@dhirhospital.com
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.
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.
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
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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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.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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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.
2. What is Cycloplegia?
• It is the paralysis of the ciliary muscle
of the eye, resulting in the loss of
visual accommodation.
• Accommodation is the ability of the
lens to change its refractive power to
view the near objects clearly.
• It is brought about by the contraction
of the ciliary muscles.
3. What are Cycloplegics?
• Agents causing cycloplegia.
• Cycloplegics inhibit the action of the acetylcholine on the
effectors sites innervated by the autonomic nerves.
• They block the muscarinic receptor sites.
• They are also called as anti- muscarinics, cholinergic
antagonists.
• acetylcholine - the acetic acid ester of choline, which is a neurotransmitter
at cholinergic synapses in the central, sympathetic, and parasympathetic
nervous systems; used in the form of the chloride salt as a miotic
cholinergic antagonists - An agent that is antagonistic to the action of
parasympathetic or other cholinergic nerve fibers
4. Cholinergic innervations to eye
• Originate within the Edinger – Westphal nucles located within the
mesencephalon.
• The preganglionic parasympathetic fibers emerge from the
EWN, exit the CNS , through the third cranial nerve and proceed
to ciliary ganglion.
• Synapses takes place with post ganglionic fibers at the ganglion.
The post ganglionic fibers enter the globe through the short
ciliary nerve and terminate on the iris sphincter muscle and the
ciliary body.
• Neurotransmitter in the effectors site is acetylcholine
5.
6. Parasympathetic action in eye
• The pupil size is determined predominantly by the varying degree
of the parasympathetic innervations to the sphincter muscles.
• The contraction of the sphincter muscle cause the constriction of
the pupil.
• The innervation to ciliary body cause contraction of the ciliary
muscle to induce accommodation.
7. Cholinergic receptors
• The cholinergic receptors in human eye have been found in the iris
sphincter and the ciliary body.
• It is of the muscarinic type. Other is nicotinic receptor mainly
found in the skeletal muscles.
• Five sub types of muscarinic receptors(M1-M5)have been
identified.
• The muscarinic agonist action at the receptor constricts the
pupil, contracts the ciliary muscles and in general lower IOP.
• The inhibition of these receptors by the cholinergic antagonist
induce the
pupillary dilatation
paralysis of accommodation
8.
9. Cycloplegic refraction
• It is the procedure to objectively determine the refractive
status of the eye when the accommodative action of the eye
is totally paralyzed.
• Commonly called as cyclorefraction or wet retinoscopy.
10. History...
• Cycloplegic refraction was put in scientific basis by Donders
• It was universally accepted after the publication of the
Donders -
“ Anomalies of accommodation and refraction of the eye” in
1864.
11. Cycloplegic agents
Cholinergic antagonists
Currently five Mydriatic- Cycloplegic cholinergic antagonist are available
for topical use.
Atropine sulphate
Homatropine eye drop
Scopolamine hydrobromide
Cyclopentolate hydrochloride
Tropicamide
12. Atropine
• Naturally occurring alkaloid
• First isolated from the belladonna plant(atropa belladona).
• Non selective muscarinic antagonist.
• Most potent mydriatic and cycloplegic agent presently available.
• Depending on concentration mydriatic may last up to 10 days and
cycloplegia for 7 to 12 days.
• Commercially available as the sulphate derivative in 1% solution
or 1% ointment.
13. Mode of action
•Reduce pain from ciliary spasm and to prevent the
formation of posterior synechia from secondary
iridocyclitis
•Increases the blood supply to anterior uvea
•Brings more antibodies in the aqueous humour
•Reduce exudation by decreasing hyperaemia and vascular
permeability
14. Action parameters of atropine
• Cycloplegia begin within 12 to 18 minutes
• Reach to maximum in 106 minutes.
• Accommodation began to retain in 42 hours
• Full accommodation ability usually attained within 8 days.
• Mydriatic effect began in 12 minutes, reach maximum in 26
minutes and reach initial stage in 10 days.
15. Clinical use
Cyclorefraction
• Often used for cycloplegic refraction in young , actively
accommodating children with suspected latent hyperopia or
accommodative esotropia.
• It is not typically used for the routine cycloplegic refraction in
school aged children or adults due to the prolonged paralysis of
accommodation that cause patient handicapped in near vision.
• The use is warranted in the case of esotropia with suspected
accommodative component. This may lead to the permanent
deviation.
16. Other uses
Treatment of myopia
use of atropine may prevent or slow
down the progression of myopia by
avoiding the tension due to
accommodation.
Treatment of amblyopia
used for mild and moderate
amblyopia as and alternative to occlusion.
It is called penalization.
17. Side effects
Ocular side effects
• Direct irritation from the drug itself.
• Allergic contact dermatitis.
• Risk of angle closure glaucoma .
• Elevation of IOP in patients with open angles.
18. Systemic side effects
• Diffuse cutaneous flush.
• Depressed salivation causing dry mouth and increase thirst.
• Fever
• Urinary retention
• Tachycardia
• Excitements, restlessness
• Speech disturbances.
• Ataxia - loss of coordination of the muscles
• Convulsion.
20. Homatropine
•One tenth as potent as atropine.
•Shorter duration of mydriasis and cycloplegia.
•It is not the drug of choice for the cycloplegic refraction
because of its prolonged mydriatic and cycloplegic action.
22. Cyclopentolate
• Introduced in clinical practice in 1951
• Commercially available as 0.5%,1%,and 2% solution.
Clinical use
drug of choice for the routine in nearly all age group, especially
infants and young children.
Faster onset of action and shorter duration of effect.
Equally effective as atropine in the case of older children's.
Full recovery of mydriasis and cycloplegia occur within 24 hours.
Cycloplegia occurs in 30-45 minutes of instillation.
For children under the age of 6 one or two drops of 1% is used
and for children above 6, 0.5% is used.
23. Side effects of cyclopentolate
Ocular side effects
Transient stinging on initial instillation.
Allergic reaction to cyclopentolate are rare and may be unrecognized by
practitioner.
Symptoms of irritation and diffuse redness, facial rash that develop within
minutes to hour of instillation.
Lacrimation , blurred vision are prominent.
Systemic effects
Drowsiness
Ataxia
Disorientation
Disturbance in speech
Restlessness
24. Tropicamide
• Short duration cycloplegic available in 0.5 and 1% solution.
• Cycloplegia in about 30 minutes.
• Recovery occurs within 2-6 hours.
• It is considered inadequate for children cycloplegia.
• Widely used as mydriatic agent.
25. Choice of cycloplegic agents
The choice of drug depends on its
strength
duration of action
duration of effect
side effects.
Which drug do you choose for cycloplegia?
26. When is cycloplegia ready for refraction?
The completeness of the cycloplegia is determined by assessing
the residual accommodation by push up test.
The mydriasis and cycloplegia do not complete at the same
time.
Unlike homatropine and tropiamide in the case of
cyclopentolate the cycloplegia is completed prior to mydriasis, so
often when there is complete mydriasis the cycloplegia is
considered to be complete for the refraction.
27. Old patients- the need of cyclorefraction decrease
markedly with age
The patient beyond 40 is not expected to have latent
hyperopia.
Young adults- only if latent hyperopia is a problem.
Suspected if asthenopia is complained for near work, but
do not have uncorrected hyperopia and other refractive
and binocular abnormalities.
28. Children
If a child often preschool is seen with convergent
strabismus, to find if it is associated with
accommodative component.
Child having the significant esophoria , should also
be undergone cyclorefraction, to find uncorrected
hyperopia.
29. Other indications
• The child uncooperative for the dry retinoscopy.
• If the difference in the refractive error of the eyes is unusually
greater.
• In the case of oblique astigmatism to determine the exact
orientation of power axis.
• If the unusually high astigmatism detected during dry
retinoscopy.
• If the retinoscopy finding is much greater than excepted in the
case of hyperopic patient.
30. Indications for cycloplegic refraction
• Symptom of ‘turning eye’
• Other suspicious symptom (e.g. young child closing or covering one
eye)
• Esotropia
• Significant esophoria
• Low accommodation
• Unstable objective or subjective refraction
• Large discrepancy between objective and subjective results
• Significant anisometropia in young child
• Spasm of the near triad [pickwell]
31. Post mydriatic treatment (PMT)
•Assessment of the finding of cyclorefraction by subjective
means after the effect of cycloplegia is eliminated.
•If atropine is used ciliary tonus should be subtracted.
•Not necessary in the case of cyclopentolate.