Epiphora is caused by impairment of lacrimal drainage leading to excess tearing. It can be due to anatomical issues obstructing tear drainage pathways or functional issues with the lacrimal pump. Common anatomical causes include punctal, canalicular, lacrimal sac, or nasolacrimal duct obstructions from congenital abnormalities, infections, trauma, tumors, or other conditions. A thorough clinical evaluation includes examining the eyelids, puncta, and ocular surface as well as diagnostic tests like dye disappearance tests, probing, and imaging when needed to localize the obstruction.
A surgical procedure featuring a partial thickness scleral flap that creates a fistula between AC and subconjunctival space for filtration of aqueous and creation of conjunctival bleb in an effort to lower IOP
A surgical procedure featuring a partial thickness scleral flap that creates a fistula between AC and subconjunctival space for filtration of aqueous and creation of conjunctival bleb in an effort to lower IOP
Ophthalmology Eye care Presentation, nasolacrimal duct obstruction, congenital nasolacrimal duct obstruction, acquired nasolacrimal duct obstruction, medical residency training presentation, ear nose and throat approach to nasolacrimal surgeries, federal medical centre lokoja, kogi state, Nigeria, ophthalmology surgery
A Radiographic Examination of the Nasolacrimal Duct following administration of Iodine Based Contrast Media to define the anatomy of Lacrimal Gland and Nasolacrimal Ducts in search of stenosis and Obstruction
Glaucoma is not a single disease process but a group of disorders characterized by a progressive optic neuropathy resulting in a irreversible visual field defects that are associated frequently raised intraocular pressure (IOP).
IOP is the most common risk factor but not the only risk factor for development of glaucoma.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
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.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
2. • Epiphora implies overflowing of tears due to
impairment lacrimal drainage.
• due to a disruption in the balance between tear
production and tear loss.
4. • Anatomical complete or partial punctal
canalicular or NLD obstruction
• Functional Lacrimal pump failure due to
Anatomical deformity (Laxity, orbicularis weakness)
5. Eyelids
• Horizontal laxity and floppy lids
• Lower lid entropion with orb.oculi overriding
• Lower lid ectropion with ineffective orb.oculi
• Loss of skin / orbicularis
7. Canalicular
• Congenital absence/fistula
• Acquired
Intrinsic
• Canaliculitis
• Trauma/ Post radiation Trauma/ Post radiation
• Tumours
Extrinsic
• Compression by adjacent tumours
8. Lacrimal Sac Abnormality
o Sac inflammation
o Perilacrimal fibrosis
o Dacryolith
o Sac tumors (rare in pediatric age group)
o Adnexal tumors pressing on lacrimal sac or drainage
pathway
9. NASOLACRIMAL DUCT OCCLUSION
Congenital:
• NLD obstruction
• Delayed opening of Hasner’s valve,
• Cranio facial anomalies
• Agenesis.
Acquired:
• Primary obstruction
• Secondary obstruction: tumour, trauma
NASAL CONDITIONS
o Severe Deviated Nasal Septum or Turbinate Hypertrophy
10. Excessive tears production
Reflex lacrimation in response to various factors
Trichiatic cilia severe entropion,
raised IOP allergic conjunctivitis,
corneal exposure, drug irritation
environmental irritants like pollution
11. OTHERS
• Ocular surface disorders like chronic KCS,
conjunctivochalasis, cicatricial ocular surface
pemphigoid, symblephron.
• Neurogenic hypersecretory disorders like
compressive irritation of parasympathetic lacrimal
fibres, Aberrant regeneration of facial nerve
following trauma.
• Facial palsy
13. • Careful history
• External examination
• Slit lamp biomicroscopy
• Syringing and probing
• Imaging
14. HISTORY
• constant versus intermittent tearing
• periods of remission versus no remission
• unilateral or bilateral condition
• subjective ocular surface discomfort
• history of allergies
• use of topical medications
• history of probing during childhood
• prior ocular surface infections
• prior sinus disease or surgery, midfacial trauma, or nasal fracture
• previous episodes of lacrimal sac inflammation
• clear tears versus tears with discharge or blood
15. EXTERNAL EXAMINATION
The eyelids : malpositions, entropion, ectropion,or
lid laxity
The puncta : malpositions, stenosis, agenesis,atresia
or accessory puncta.
16. SLIT LAMP BIOMICROSCOPY:
• abnormalities of eyelids,
• position of punctas,size and patency,discharge,
• size of caruncle,
• eyelid laxity, blinking mechanism,
• marginal tear strip,
• Tearfilm debris,
• papillae or follicles
• pinguecula,pterygium, conjunctival chelosis.
• Ocular cicatricial pemphigoid.
19. Anatomical tests
These tests helps in localization of
obstruction
● Syringing / irrigation
● Diagnostic probing
● Dacryocystography
● CT/MRI
20. Functional tests
● To access functioning of lacrimal apparatus
under physiologic conditions
● Performed only when there is no evidence
of obstruction in anatomical tests
Flourescein dye disappearance test
Scintigraphy
Jones dye test I
21. DYE DISAPPERANCE TEST
• heavily relied upon in children, in whom lacrimal
irrigation is impossible without deep sedation
• Instillation of fluorescein drops 2% into the
conjunctiva of both eyes then examine after 5
minutes .
• Normally, very little or no dye present
• significant residual dye or prolonged retention is an
indication of inadequate drainage of the dye
23. Dye test grading
• 0=No fluorescein in the conjunctival sac
• 1=Thin flurescing marginal tear drop persists
• 2=More fluorescein persists somewhere between 1
and 3 grades
• 3=Wide brightly fluorescein tear strip
• Grades 0 and 1 are considered normal
24. JONES DYE TESTING
Jones I test, or primary dye test:
• Differentiates partial obstruction from
hypersecretion of tears.
• Fluorescein 2% drops instilled into the conjunctiva.
• After about 5 minutes, cotton tipped applicator
inserted under the inferior turbinate.
• Positive: Detection of fluorescein from the nose
means patency of the system.
• Negative: No dye detected, means either a partial or
absolute obstruction or failure of the lacrimal pump.
25.
26. Jones II test, or secondary dye test:
• the residual fluoresce in is flushed from the
conjunctival sac following an negative jones 1 test.
• clear saline is placed in to the inferior canaliculus
using syringe/cannula
• irrigant is retreived from nasal cavity
• Positive: Recovery of dye stained saline from the
nose meaning a partial obstruction of the NLD.
• Negative: Recovery of unstained saline through the
nose means total obstruction of the upper drainage
system or a defective lacrimal pump mechanism.
27.
28.
29. Probing
• After topical anaesthesia, curved lacrimal cannula
on a saline filled syringe is gently inserted into lower
punctum & advanced
• Canula comes to either hard or soft stop
30. • Hard stop:it comes to stop at medial wall of sac
through which rigid lacrimal bone is felt…this
indicates obstruction of nasolacrimal duct
• Soft stop:it comes to stop at junction of common
canaliculus & lacrimal sac(lateral wall)….
it indicates common canalicular block
31.
32. Lacrimal Sac Syringing
• most frequently performed immediately after a DDT
to determine the level of lacrimal drainage system
occlusion
• After instillation of topical anesthesia, the lower
eyelid punctum is dilated
• The irrigating cannula is placed in the canalicular
system.
• To prevent canalicular kinking and difficulty in
advancing the irrigating cannula ,lateral traction of
the lower eye lid
• clear saline is injected and the results noted
34. Complete common canalicular obstruction. A "soft stop" is encountered at the
level of the lacrimal sac, and irrigated fluid ref luxes through the opposite
punctum.
Soft stop is a spongy feeling due to canalicular obstruction
35. Complete nasolacrimal duct obstruction. The cannula is easily advanced to the
medial wall of the lacrimal sac, then a "hard stop" is felt, and irrigation fluid ref
luxes through the opposite punctum.
If the probe touches the medial orbital wall, this means Hard Stop.
36. Partial nasolacrimal duct obstruction. The cannula is easily placed, and
irrigation fluid passes into the nose as well as refluxing through the opposite
punctum.
37. Patent la crimal drainage system. The cannula is placed with ease, and
most of the irrigation fluid passes into the nose .
39. Contrast Dacryocystography (DCG)
• Technique: Plastic catheters are placed into one
canaliculus in both eyes, 1ml lipidol is
simultaneously injected through both catheters
• Water's view radiographs are taken, 5 minutes later,
an erect oblique film is taken.
• Results: The site of obstruction is usually evident.
Diverticula, filling defects due to stones and
strictures can be diagnosed.
40.
41. Lacrimal scintillography
• Scintillography is used to assess the lacrimal
drainage system under physiological conditions.
• Technique: Tchnetium-99 is delivered by a
micropipette to the inferior conjunctival sac. The
tracer is imaged using a gamma camera.
42.
43. CT/MRI
● Epiphora foll. Trauma with NLD obst.
R/o orb. Rim/ max. #
● Infant with cystic mass at med. Can.
Amniocele v/s meningocele
● Suspected malignancy
44. Lacrimal Endoscopy
• 1.0 mm diameter rigid endoscope or fibroptic
flexible endoscopes was inserted through the puncti
and canaliculi to inspect the lining mucosa of
lacrimal system, its contents and investigating DCR
fistulae.