This document provides an overview of diabetic retinopathy and its management. It begins by defining diabetic retinopathy and diabetic macular edema as microvascular complications of diabetes that can cause vision loss. It then describes the signs and stages of diabetic retinopathy from mild nonproliferative to proliferative, and discusses evaluation and classification using techniques like OCT, FA and clinical examination. Management approaches covered include control of systemic risk factors, laser photocoagulation protocols for proliferative retinopathy and macular edema, and intravitreal injections of anti-VEGF agents or steroids. The document concludes by outlining treatment protocols from studies like ETDRS and DRCR.net.
Branched Retinal Vein Occlusion (BRVO) for undergraduate MBBS Students.
Covers the basics of Aetiology, pathophysiology, clinical features, types, associated conditions and management of BRVO.
Also encompasses salient points for PGMEE
Branched Retinal Vein Occlusion (BRVO) for undergraduate MBBS Students.
Covers the basics of Aetiology, pathophysiology, clinical features, types, associated conditions and management of BRVO.
Also encompasses salient points for PGMEE
Indication, contraindication, advantage, disadvantage, types of keratoplasty, complication of keratoplasty and management, corneal graft rejection and failure
M.S ophthalmology, sarojini devi eye hospital, regional institute of ophthalmology, osmania medical college, hyderabad, telangana
Title:
Choosing amongst current modalities to manage Diabetic Retinopathy
At Medical Retina Clinic, Eye Department WAPDA Teaching Hospital Complex Lahore
Objective:
1. To review the current management options for DR
2. To share author’s four years follow up from Jan 2008 to Nov 2011 at Medical Retina Clinic, Eye Department WAPDA Teaching Hospital Complex Lahore.
3. Discussion on future Trends in management of DR.
Synopsis:
Diabetic retinopathy is the leading cause of new blindness in the world,
Argon LASER treatment has established itself as a gold standard in the management of DR. Intravitreal therapies in the form anti VEGF agents and steroids are also being widely used nationally and internationally. These therapies do not replace but complement each other.
Author will share his four years experience at Medical Retina clinic WAPDA hospital complex Lahore. 125 patients with DR were enrolled during this period. Treatment modalities used, included Argon Green Laser, Intravitreal Anti VEGF (Bevacizumab), Intravitreal Triamcinolone and subtenon Triamcinolone. Staging and severity of the disease as well as response to the offered therapy were the parameters used to tailor the treatment options.
Dr. Zia ul Mazhry
FRCS (Edin), FRCS (Glasgow), FCPS, CICOphth (UK)
Asstt Professor Central Park Medical College Lahore.
Consultant Eye Surgeon and Head of Eye Department
Wapda Teaching Hospital Complex
210 Feroz Pur Road Lahore.
Website: www.EyeAcuity.com
mazhry@yahoo.com
03004401151
Indication, contraindication, advantage, disadvantage, types of keratoplasty, complication of keratoplasty and management, corneal graft rejection and failure
M.S ophthalmology, sarojini devi eye hospital, regional institute of ophthalmology, osmania medical college, hyderabad, telangana
Title:
Choosing amongst current modalities to manage Diabetic Retinopathy
At Medical Retina Clinic, Eye Department WAPDA Teaching Hospital Complex Lahore
Objective:
1. To review the current management options for DR
2. To share author’s four years follow up from Jan 2008 to Nov 2011 at Medical Retina Clinic, Eye Department WAPDA Teaching Hospital Complex Lahore.
3. Discussion on future Trends in management of DR.
Synopsis:
Diabetic retinopathy is the leading cause of new blindness in the world,
Argon LASER treatment has established itself as a gold standard in the management of DR. Intravitreal therapies in the form anti VEGF agents and steroids are also being widely used nationally and internationally. These therapies do not replace but complement each other.
Author will share his four years experience at Medical Retina clinic WAPDA hospital complex Lahore. 125 patients with DR were enrolled during this period. Treatment modalities used, included Argon Green Laser, Intravitreal Anti VEGF (Bevacizumab), Intravitreal Triamcinolone and subtenon Triamcinolone. Staging and severity of the disease as well as response to the offered therapy were the parameters used to tailor the treatment options.
Dr. Zia ul Mazhry
FRCS (Edin), FRCS (Glasgow), FCPS, CICOphth (UK)
Asstt Professor Central Park Medical College Lahore.
Consultant Eye Surgeon and Head of Eye Department
Wapda Teaching Hospital Complex
210 Feroz Pur Road Lahore.
Website: www.EyeAcuity.com
mazhry@yahoo.com
03004401151
Novel Development in treatment of Diabetic Macular Edema, by Dr. Fritz Allen, presented at VO, Lecture Series 11, Feb 20, 2011
COPE Course ID: 30657-PS
updating in diabetic macular edema including old and new approach era, including DRCR protocol
how to approach, how to treat, when to surgery
plus knownledge about anti-VEGF therapy up to date
In this case-based presentation, Dr. Lori Myers unscrambles the alphabet soup of Diabetic Retinopathy, providing clear explanations and outstanding images to describe the diagnosis, risk stratification, and treatment of diabetic retinopathy.
65 million (17%) of 387 million persons with diabetes mellitus (DM) globally reside in India.The prevalence of DR in urban areas is between 13–18% and in rural areas is 9–10%.In India, in 1970–1975 DR was the 20th cause of blindness, and today, it is the 6th cause of blindness.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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!
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.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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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
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.
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.
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
7. sharply demarcated extravascular
deposits of lipid material resultIng
from spillage and incomplete
resorption of lipoproteins .
often present at border between
edematous & non edematous
retina .
they may exist as circinate ring
pattern around the
Hard exudates
8. Progressive capillary closure and
resulting retinal ischaemia leads to
intraretinal microvascular
abnormalities ( IRMA )
intraretinal haemorrhages
and venous abnormalities
( eg venous beading )
10. retinal thickening of
the posterior pole
and detected by slit
lamp biomicroscopy or
optical coherence
tomography (OCT )
Diabetic macular odema
( DME )
11. 3 zone of thick retina one
disc area or larger any
part of which is with in
one disc diameter of
center of macula
ETDRS defines
CSME
1 thickening of retina at or with
in 500 µm of center of macula
2 hard exudates at or with
in 500 µm center macula
with thick adjacent retina
12. Proliferative diabetic retinopathy
( PDR )
PDR formation of new
vessels and fibrotic
tissue on retina and
optic disc
contraction of fibrous
tissue lead to
tractional retinal
detachment and
viterous haemorrhage .
13. PDR with HRC s
• NVD equal to or greater
than 1/ 4 to 1/3 disc area
• any amount of NVD with
fresh vitreous / pre
retinal haemorrhage
• NVE equal to or greater
than ½ disc area with
fresh viterous /pre
retinal haemorrhage .
14. Evaluation
• Previous history of diagnosis
or treatment if any should be
taken thoroughly.
• Comprehensive eye
examination including VISUAL
ACUITY , IOP measurement ,
• slit lamp examination of
anterior segment and dilated
funduscopic examination
15. Evaluation
• ophthalmoscopy in a dilated pupil
remains the standard for clinical
diagnosis and further
classification .
• posterior pole examination is
best done with slit lamp
biomicroscopy with accessory
lenses .
• imaging modalities commonly
used in the management are
fundus photography , FA & OCT
16. OCT and FA
are the most useful investigations in DME
• Confirm presence macular edema
• Know type of macular edema
• Assess macular thickness
• Know response to intravitreal
pharmacotherapy
• For follow up and documentation
OCT role in DME
17. FA role
• Type of leak focal
or diffuse
• Rule out macular
ischaemia
Increasingly OCT is being used for evaluation of macular edema .
Spectral domain ( SD OCT ) has replaced time domain OCT ( TD OCT ) .
18. Diabetic macular odema
• Slit lamp biomicroscopy , color fundus
photography or ophthalmoscopy may not be
able to detect mild DME . Here OCT is very
helpful in measuring central foveal thikness.
• OCT has become gold standard in
monitoring the progression and treatment
response in DME
• give micrometer sensitive measurements in
central retinal thickness.
19. classification
• Mild non proliferative
diabetic retinipathy
( NPDR )
Few microaneurysms
or haemorrhages may be
present .
21. classification
• Severe NPDR 4-2-1 rule
Any one of following three
features is considered
diagnostic of severe NPDR
all 4 quadrants contain severe
intra retinal haemorrhages/
microaneurysms
venous beading in 2 or more
quadrants .
IRMA in at least 1 quadrant .
22. PROLIFERATIVE DIABETIC
RETINOPATHY
Early PDR
New vessels and criterion not
met for high risk PDR
PDR with HRCs
• NVD ≥ than ¼ to 1/3 disc area.
• NVD any amount with vitreous
or pre retinal haemorrhage .
• NVE ≥ than ½ disc area with
fresh vitreous or pre retinal
haemorrhage
23. Management
• Modification of systemic
risk factors
• Intensive control of blood
sugar
• Control of blood pressure
• Lowering of lipid levels
• Exercise and food habbits
27. PRP protocol
•ETDRS ( early treatment
diabetic retinopathy
study ) protocol for full
scatter laser provides
useful guidelines
•Size of burn 500 µm
•Time .1 second
28. argon laser burn of moderate intensity
placed one half to one burn apart
divided between 2 or more sittings.
29. Management of macular odema
• If thickening
involves centre
of fovea then
treat other wise
wait .
• ETDRS
recommends
treatment if
CSME is there.
CSME
30. DRCR .net protocol I
treat centre involving DME with
intravitreal inj of anti vegf agents till the
macula is relatively dry followed by focal
laser .
RANIBIZUMAB ( LUCENTIS )
.3 mg in .05 ml
Or
BEVACIMIZUMAB ( AVASTIN)
1.25mg in .05 ml.
31. • to reduce the burden
and cost of injections
usually three
intravitreal anti vegf
injections are given and
then switched to as
required PRN dosing
.one can add intravitreal
injection Triamcinolone
1mg / .025 ml
32. DRCR .net protocol I
intravitreal anti vegf
agents
with early or
deferred laser
Superior
Over
laser alone
laser with steroids
steroids alone
or
or
33. DRCR .net protocol T
• all the three anti vegf
agents RANIBIZUMAB ,
BEVACIMIZUMAB &
AFLIBERCEPT are effective
in management of DME .
•RANIBIZUMAB is slightly
better than BEVACIMIZUMAB
but latter is more economical
34. Role of steroids in DME
• Retisert , illuven,
ozurdex
dexamethasone
implant &
triamcinolone
• ( 1mg and 4 mg )
are inferior to laser
or intravitreal anti
vegf agents
35. Role of steroids in DME
•Intravitreal steroids has
main complication of
cataract and glaucoma .
•In pseudophakic patients
IV TA plus laser benefit is
comparable to IV ANTI
VEGF agents and
superior to that seen in
laser group
36. Modified ETDRS focal / grid laser
protocol as used by DRCR .net
• Direct treatment
of leaking
microaneurysms in
area of retinal
thickening 500 to3000
µm centre of macula .
• Spot parameter 50
µm , barely visible
and .05 to .1 sec burn
duration .
37. Grid treatment
•500 to 3000 µm superiorly
, nasally and inferiorly
•500 to 3500 µm
temporally from macular
centre .
•No burn in 500 µm of
optic disc
•Burn parameter two
visible burns width apart
38. Pt. of PDR with HRCs with DME
involving centre or having CSME
focal or grid laser
followed by PRP .
Give intravitreal anti
VEGF agents
39. Pt. of PDR with HRCs with DME
involving centre or having CSME
GRID
PRP
injection