The document provides information on electrooculogram (EOG) testing guidelines from the International Society for Clinical Electrophysiology of Vision (ISCEV). It describes the standard EOG testing method which involves recording the electrical potential between the cornea and retina during dark and light adaptation over 15 minutes each. Abnormal EOG results can indicate diseases affecting the outer retina and retinal pigment epithelium. Specific conditions that cause EOG abnormalities and the diagnostic significance of EOG testing are discussed. Case examples demonstrate how EOG may be useful in evaluating and monitoring certain retinal diseases.
Electrooculography is a technique for measuring the corneo-retinal standing potential that exists between the front and the back of the human eye. The resulting signal is called the electrooculogram. Primary applications are in the ophthalmological diagnosis and in recording eye movements
The clinical electro-oculogram is an electrophysiological test of function of the outer retina and retinal pigment epithelium in which the change in the electrical potential between the cornea and the fundus is recorded during successive periods of dark and light adaptation.
Electrooculography is a technique for measuring the corneo-retinal standing potential that exists between the front and the back of the human eye. The resulting signal is called the electrooculogram. Primary applications are in the ophthalmological diagnosis and in recording eye movements
The clinical electro-oculogram is an electrophysiological test of function of the outer retina and retinal pigment epithelium in which the change in the electrical potential between the cornea and the fundus is recorded during successive periods of dark and light adaptation.
Describes the basic of applanation tonometry, the factors affecting it and also how to perform the ideal tonometry. The slide are borrowed but it gives complete idea of mastering Applanation tonometry.
If the original owner of the slides has an objection i shall take down the ppt with due apologies.
These lectures has prepared for postgraduate student (Ophthalmology) according to the curriculum of Bangladesh College of Physician and Surgeons (BCPS) and Bangabondhu Sheikh Mujib Medical University (BSMMU) Bangladesh
Describes the basic of applanation tonometry, the factors affecting it and also how to perform the ideal tonometry. The slide are borrowed but it gives complete idea of mastering Applanation tonometry.
If the original owner of the slides has an objection i shall take down the ppt with due apologies.
These lectures has prepared for postgraduate student (Ophthalmology) according to the curriculum of Bangladesh College of Physician and Surgeons (BCPS) and Bangabondhu Sheikh Mujib Medical University (BSMMU) Bangladesh
Electrophysiological techniques allow clinical investigations to include a ‘dissection’ of the visual system. Using suitable electrophysiological techniques, the ‘dissection’ allows function to be ascribed to the different photoreceptors (rod and cone photoreceptors), retinal layers, retinal location or the visual pathway up to the visual cortex. Combined with advances in genetics, retinal biochemistry, visual fields and ocular imaging, it is now possible to obtain a better understanding of diseases affecting the retina and visual pathways.
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.
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
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Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
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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.
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
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
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.
2. Source of information
• The Journal of Korean Medicine
Ophthalmology and Otolaryngology and
Dermatology
• international Society for Clinical
Electrophysiology of Vision (ISCEV)
• Case, Description, and Review of Revised AAO
Recommendations
• Birmingham & Midland Eye Centre … UK
• Clinical and Experimental Optometry March 2014
3. • Emil du Bois-Reymond (1848) observed that the
cornea of the eye is electrically positive relative to
the back of the eye.
• Elwin Marg named the electrooculogram in 1951
• Geoffrey Arden (Arden et al. 1962) developed the
first clinical application.
Geoffrey ArdenElwin MargEmil -Reymond
4. EOG
is an electrophysiological test of
function of the outer retina and
retinal pigment epithelium in which
the change in the electrical potential
between the cornea and the ocular
fundus is recorded during successive
periods of dark and light adaptation.
5. • The EOG is concerned with the slower changes
in the standing potential of the eye rather than
the rapid activity of the retinal neurones which
produces the ERG.
• In the clinical test, there is an initial drop in the
standing potential during a period of dark
adaption, followed by an increase in potential
occurring over several minutes when the eye is
subsequently exposed to light. This is the basis
of the EOG
6. • The changes in the potential which occur when
the retinal illumination is altered appear to be
related to the metabolism of the pigment
epithelium , Any disease therefore which affects
the rods or the pigment epithelium will give an
abnormal EOG result
• Disturbances of vision due to diseases of the
optic nerve, however , will not cause any electro -
diagnostic abnormality.
8. The Standard Method
• Pupils Apply dilating drops before any other
action to allow pupil dilation to be relatively
complete by the start of the test (see notes
below). Their size should be checked at the
start and end of the test and recorded at the
end of the test.
• Electrodes After suitable skin preparation,
place small recording electrodes, close to the
canthi of each eye
9. The Standard Method
Connect the electrodes from each eye to
separate channels of a differential amplifier.
The ‘ground’ electrode can be placed on the
forehead.
The electrodes, amplifier (to provide recordings
of the saccades which appear as square
waves) and impedance meter must be
approved for medical use.
10.
11. • Full field (Ganzfeld) stimulator This should
have a comfortable head/chin rest, and two
red fixation lights 15 degrees left and right of
centre
12. • Pre-adaptation The test subject should be in
stable indoor lighting for as long as possible
before the test, and should not be exposed to
any large changes in lighting (lighter/darker)
during this period, such as indirect
ophthalmoscopy. As near as is practical, the
pre-test light exposure should be the same
for all test subjects.
13. • Preparing the test subject Explain the
procedure including, ‘chin/head on
rest/restraint in stimulator, 15 min dark, 15 min
light, fixation lights alternate in simple
rhythmic manner, for 10 s each minute, when
lights change, move eyes in single sweep to
next one, do not turn head, do not anticipate
the changes’.
14. • Dark phase In total darkness for 15 min,
except for the dim fixation lights, alternate
the fixation lights every 1 s for 10 s every
1 min, and record the resulting EOG
potentials. The test subject should remain
looking into the stimulator the whole time if
possible, and should be warned of the start
of each measurement sequence to ensure
attention.
15. • Light phase Bring on the ganzfeld
background light of 100 photopic cd/m2 .
If necessary, bring this on gradually over a
short period (e.g. 20 s) for patient
comfort, especially in cases of
photophobia. Continue recording every
1 min as above. Keep the test subject
forward in the stimulator bowl for the
whole time and with eyes open.
16. while moving the eyes back and forth
alternating between the two red lights.
The movement of the eyes produces a voltage
swing of approximately 5 mill volts between
the electrodes on each side of the eye, which
is charted on graph paper or stored in the
memory of a computer.
17. Potentials decrease progressively lowest value
called ‘dark trough’ in 8-12 min
• Light insensitive part of EOG
• Switch on record in light adapted state
• Progressive increase in potential, peak is
called ‘light peak’ in 10 min
• Potentials decrease progressively reaching
Light sensitive part of EOG
18. • Light sensitive – [ Light peak ]
- Contributed by rods and cones
• Light insensitive – [ Dark trough ]
• - Contributed by RPE ,
Photoreceptors ,inner nuclear layer
20. ARDEN’S RATIO :
• It is the ratio of ‘largest EOG amplitude during light
adaptation’(light peak) to ‘least amplitude during
dark adaptation’ (dark trough).
• Clinically normal value of this ratio is 1.85 or higher
.
21. value of Arden ratio
• Light peak / dark trough X 100
• >180% Normal
• 165—180% Borderline
• <165% Subnormal
• Difference of >10% in BE is significant
22. The standard method
• As validity of results depends upon
consistent tracking of fixation target
over 30 min., this test is not suitable in
uncooperative patients & children.
• Also EOG depends up on a minimum
degree of light adaptation so it is not
reliable in patients with dense cataracts.
23. The standard method
• Good pt cooperation is required For EOG to
be normal,
• it requires as little as 20-25 % of normal
functioning retina. Thus abnormal EOG
indicates a dense pathology involving
entire retina.
• Thus abnormal EOG indicates a dense
pathology involving entire retina.
24.
25. Reporting
• According to the 2017 ISCEV standards,[2] the report of
EOG should include
• Light peak: dark trough ratio (this terminology is
preferred over conventional Arden ratio)
• Amplitude of dark trough (mv)
• Time from the start of light phase to light peak (when
present)
• type of adapting light source
• pupil size
• Difficulties/deviation from protocol including patient
compliance, inconsistent eye movements
26. Standing potentials
• This Standard recommends the reporting of
the minimum standing potential (minimum
dark trough), taken from the underlying
response curve.
• This value is not often used in diagnosis , but
if the value is abnormally low (less than
150 μV) it may indicate an inactive retina (e.
g. total retinal detachment), and the
calculated Arden ratio may be unreliable
27.
28. Potential Indications
• Inherited retinal dystrophies
• Toxic and nutritional eye disease
VISUAL ELECTRODIAGNOSTICS
A Guide according to ISCEv
29. • Similar to ERG,EOG is amass response
phenomenon and not effected by localized
disorder.
• All condition effecting the B wave amplitude
effects EOG , hence EOG is at best complementary
test to ERG
• Only in certain condition like Best vitelliform
dystrophy of the retina , gain special diagnostic
importance as, its effected early even when the
ERG was normal.
30. • Other examples of ERG to EOG
dissociation :
Diffuse fundus flavimaculatous dystrophy
(Stargardt’s dystrophy)
Pattern dystrophy of RPE
( Butterfly Macular Dystrophy)
Chloroquine retinopathy
Metallosis bulbi
32. • In retinal detachment the EOG immediately
becomes grossly abnormal and there is no
corresponding rise in potential when the
illumination is increased.
• Electro diagnostic tests are of importance
when a detachment is suspected and the
fundus cannot be viewed directly due to the
presence of cataract or corneal opacities.
33. The EOG is more sensitive, however, and is
pathological even before ERG or fundus
changes becomes manifest , These tests
thus provide a method of early diagnosis.
especially useful in hereditary diseases
of this kind.
34. • In an occlusion of the central retinal vein or one
of its branches, the EOG in most cases shows a
reduced light rise
• Electro diagnostic tests are found to be of
prognostic value here; a normal EOG and an ERG
in which the b-wave is not diminished indicating
a good prognosis as far as recovery of visual
function is concerned
35. Myopia
• A low EOG result is obtained in certain cases of
degenerative myopia, probably because the
earliest degenerative changes occur in the pigment
epithelium. Later on the ERG is also affected and
the typical fundus picture is seen. Electro -
diagnostic tests are of assistance here in
diagnosing progressive myopia in early cases or in
childhood.
36. Choroidal Lesions
• In conditions such as acute choroiditis
which affect the outer layers of the
retina only, an abnormal EOG will be
obtained, although in most cases the
ERG remains unaffected.
37. Vitamin A Deficiency
• Vitamin A deficiency may induce ocular
changes including night blindness. The
waveform of the ERG is affected and an
abnormal EOG is also recorded.
This usually returns to normal when the
metabolic error is corrected, provided the
deficiency is not prolonged, in which case
permanent damage may occur.
38. The EOG is abnormal in:
• Best vitelliform macular dystrophy (early stage) and in carriers
• Stargart macular dystrophy (advanced stage)
• Pattern dystrophies (normal or modestly subnormal)
• Retinitis pigmentosa and rod-cone dystrophies
• Acquired cone and cone-rod dystrophies
• Fundus Albipunctatus (no notable light rise with dark adaptation of
15 minutes)
• Choroideremia
• Gyrate atrophy
• Diffuse choroidal atrophy
• Diffuse chronic chorioretinal inflammation
• Hypertensive retinopathy
39. • Retinal detachment
• Silicone oil exposure during retinal detachment repair
surgery, even 4 mo after removal
• Chloroquine and hydroxychloroquine toxicity
• Didanosine use (can be reversible after stopping therapy)
• Desferrioxamine
• Diabetes, worsening with the duration of diabetes
• Retained intraocular iron particles (siderosis bulbi)
• Progressive high myopia
• Choroidal malignant melanoma
40. The EOG is normal in:
• Dominantly inherited drusen of Bruch's
membrane
• Congenital achromatopisa
• Progressive diffuse cone dystrophy
• Autosomal recessive and X-linked recessive
congenital stationary nyctylopia
• Carotid occlusive disease
• Optic nerve disease
41. • Drugs that reduce systemic
standing potential :
• IV 20% mannitol (reduced by
43%) hyperosmolarity-induced response
• IV 500 mg acetazolamide
• Timolol
42. • Conditions that increased
systemic standing potential :
• Retinal hypoxia
• Silicone oil exposure and removal
43. AN AUTOSOMAL DOMINANT DISORDER,
THE EOG IS ABNORMAL EVEN IN A
CARRIER PATIENT WHO HAS NO FUNDUS
CHANGES AND IS CLINICALLY
ASYMPTOMATIC.
Best vitelliform dystrophy
45. • A Case of Adult-Onset Vitelliform
Dystrophy Treated with Intravitreal
Injection of Bevacizumab
• Journal of the Korean
Ophthalmology
46. A Case of Adult-Onset Vitelliform Dystrophy
Treated with Intravitreal Injection of
Bevacizumab
((EOG) showed
decrease in the
Arden ratio
(light-dark
ratio), 1.16 in
the right eye
and 1.25 in the
left eye.
49. Fundus photographs, right
and left, respectively,
revealing the foveal light
reflex was dismissed with
hard exudates and white
refractive deposits in
peripheral retina
50.
51. CONFLICTING EVIDENCE AS TO UTILITY AND ABNORMALITY
IN TOXICITY
TESTS NO LONGER RECOMMENDED ACCORDING TO
REVISED AAO RECOMMENDATIONS
Bull's eye maculopathy;
Hydroxychloroquine;
Rheumatoid arthritis
52. • Potentially blinding Progressive loss of RPE
and photoreceptors in a parafoveal pattern,
producing a
• “Bull’s-eye” maculopathy and paracentral
scotoma
• Associated with many years of CQ/HCQ use
55. Spectral domain OCT
demonstrate loss of
outer retinal layers with
disruption in IS/OS jxn.
Fundus exam and
autofluorescence reveal
classic bull’s-eye
maculopathy
56. Multifocal ERG trace array shows
decreased amplitudes in parafoveal area.
Recent studies show detection earlier than VA,
Amsler, and color testing
58. A Case of Hydroxychloroquine
Retinopathy
Electrooculogram shows decreased Arden ratio.
59. Fundus photograph shows
diffuse RPE atrophy of
macula with foveal sparing in
both eyes. (A) Right eye. (B)
Left eye.
Humphrey Automated
Visual Field shows
central scotoma in both
eyes.
60. ACUTE ZONAL OCCULT OUTER
RETINOPATHY, RESPONSIVE TO AN
IMMUNOSUPPRESSIVE AGENT:
61. Acute zonal occult outer retinopathy
Fundus photographs of both
eyes show normal appearance
of the optic disc and retina.
Humphrey static
perimetry reveals
marked visual field
defect in the left eye,
and normal in the
right eye.
62. Electroretinographic
findings show normal in
the right eye, abnormal
in the left eye;
subnormal rod specific
ERG, both a-wave and b-
wave amplitude
reduction in maximal
response, subnormal
photopic single flash b-
wave amplitude, and
markedly delayed and
subnormal 30-Hz flicker
ERG.
63. Electro-oculogram of both
eyes. The EOG light rise of the
left eye is markedly reduced
compared with that of the right
eye. Accordingly, arden ratio of
the left eye is markedly
reduced.
65. • The use of the term Stargardt’s disease
should be ideally restricted to atrophic
macular dystrophy associated with flecks.
Perifoveal flecks
Hyper fluorescence
in the macula with
‘silent choroid
66. OCT-reduction in macular function and
reduction in foveal thickness.
• SD-OCT-selective loss of foveal
photoreceptors
67. • EOG- tends to be subnormal
• ERG-The photopic and scotopic ERG is
generally normal, although in advanced
stages slight reduction in amplitudes of ERG
are noted.
68. The most consistent electrophysiological
abnormality in STGD/ FFM is the
reduction of the PERG. ERG and EOG
abnormalities occur more often in the
presence of flecks.
69. Electrophysiological findings in STGD/FFM.
Incidance of abnormality
• With flecks (n = 52 eyes
Without flecks (n = 42 eyes
Scotopic
ERG
ampllwde
Scotopic
ERG
latency
EOGPERG
(PSO)
amplitude
30 Hz
ERG
latency
30 Hz
ERG
ampli
tude
Photopic
ERG
ampllwd
e
71. • reflecting the function of the retinal
pigment epithelium (RPE). Therefore, is a
useful test to evaluate and monitor RPE
function in retinitis pigmentosa
• Clinical and Experimental Optometry ,
2013, Optometrists Association Australia
72. a 53-year-old man, who reported
having difficulty seeing at night,
first noticed a few years ago.
Static perimetry showed markedly
constricted visual fields and visual
acuities were 6/7.5+ right eye and
6/9.5 left eye
73. (i), Typical EOG traces from a healthy subject
the mildly reduced dark phase and
considerably reduced light phase
response exhibited by the RP individual.
74. • ERG and EOG abnormalities in carriers
of X-linked retinitis pigmentosa
• The results of this study suggest that the
use of both tests, including measurement of
the scotopic b wave latency, may increase
the carrier detection rate
• Birmingham & Midland Eye Centre … UK