Fundus fluorescein angiography (FFA) is a technique that uses intravenous fluorescent dye and specialized camera to examine circulation in the retina and choroid. FFA provides vital information for diagnosing and monitoring treatment for various retinal diseases. It involves injecting fluorescein dye, which is absorbed by tissues and emits light when exposed to blue light during photography. FFA is analyzed in phases to evaluate blood flow and detect any leakage, pooling, or blockage that may indicate disease. While a useful diagnostic tool, FFA also carries risks of mild to severe allergic reactions in some patients.
-IOL formula
1st generation formula : SRK, Binkhost
2nd generation formula : SRK II
3rd generation formula: Hoffer Q, Holladay 1, SRK/T
4th generation formula: Haigis, Holladay 2, Olsen
-The Hoffer Q, Holladay I, and SRK/T formula are all commonly used.
-IOL formula
1st generation formula : SRK, Binkhost
2nd generation formula : SRK II
3rd generation formula: Hoffer Q, Holladay 1, SRK/T
4th generation formula: Haigis, Holladay 2, Olsen
-The Hoffer Q, Holladay I, and SRK/T formula are all commonly used.
Fundus Flourescein Angiography( FFA ) by optometry fans.pptxoptometry fans
Fundus flourescein angiography (FFA) by optometry fans.
Fundus flourescein angiography (FFA) is a valuable procedure in ophthalmic practice to the diagnosis and management of a large number of fundus disorders.
FFA provide information by allowing the examiner to study the changes, produced by various fundus disorders, in the flow of fluorescein dye along the vasculature of the retina and choroid
indication
Diabetic retinopathy
Vascular occlusions
Eales’ disease
Central serous retinopathy (CSR)
Cystoid macular oedema (CME)
Contraindication
Cardiac disease
Renal impairment
Uncontrolled hypertension
Pregnancy
Allergic reaction
Injecting 5 ml of 10 per cent solution of sterile sodium fluorescein dye in the antecubital vein
Taking serial photographs (with fundus camera) of the fundus of the patient with pupils fully dilated.
The first photograph is taken after 5 seconds, then every second for next 20 seconds and every 3-5 seconds for next one minute. The last pictures are taken after 10 minutes.
The fundus camera has a mechanism to use blue light (420-490 nm wavelength) for exciting the fluorescein present in blood vessels and to use yellow-green filter for receiving the fluorescent light (510-530 nm wavelength) back for photography.
Fluorescein angiography, fluorescent angiography, or fundus fluorescein angiography is a technique for examining the circulation of the retina and choroid using a fluorescent dye and a specialized angiographic camera.
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
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).
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
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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
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.
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
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
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.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
2. What is F.F.A?
fundus fluorescein angiography (FFA) is a
technique for examining the circulation of
the retina and choroid (parts of the fundus) by using a
iv fluorescent dye and a specialized angiographic
camera.
4. Dye used in FFA
Refers to fluorescein sodium (C20H10Na2O5).
First synthesized in 1871 in Germany by Von Bayer.
A brown or orange-red crystalline substance, alkaline in nature.
Stable, Highly Water Soluble & Pharmacologically inert.
Fluoresces at Blood Ph.
80% bound to plasma protein and also with RBC.
Absorbs blue light (490nm ) and emits yellow-green light
(530nm).
Metabolized by liver and exerted by kidney
5. Purpose of FFA
Studying the normal physiology of the retinal and
choroidal circulation,as well as disease process affecting
the macula
Evaluation of the vascular integrity of the retinal and
choroidal vessels
Check the integrity of the blood ocular barrier.
- outer blood retinal barrier breaks in CSR
- inner blood retinal barrier breaks in NVD,NVE
6. Therefore ,FFA helps
In clinical diagnosis of choroidal and retinal disease
To determine extent of damage.
To formulate treatment strategy.
To monitor result of treatment.
7. Indications of FFA
Indications
of FFA
Retinal vascular
malformation and
tumor
Retinal
vascular
disorders
Macular
disorders
Choroidal
disorders
Optic
nerve
disorders
8. Retinal vascular disorder, malformation
and tumors
1) Diabetic retinopathy.
2) Retinal vein occlusions.
3) Retinal artery occlusion.
4) Retinal vasculitis.
5) Coats disease.
6) Familial exudative vitreoretinopathy.
7) Capillary hemangioma of retina.
8) Cavernous hemangioma of retina.
9) Retinal AV malformation.
10) Congenital tortuosity of retinal vasculature.
11) Congenital hypertrophy of RPE.
12) Angioid streaks.
13) Astrocytic hamartoma.
12. Contraindications
ABSOLUTE
1) known allergy to iodine containing compounds.
2) H/O adverse reaction to FFA in the past.
RELATIVE
1) Asthma
2) Hay fever
3) Renal failure
4) Hepatic failure
5) Pregnancy ( especially 1st trimester)
13. PROCEDUREPatient is informed of the normal procedures, the side effects and the adverse
reactions.
Dilating the pupil of pt. and Made to sit comfortable
3-4 red free photographs taken. (control photographs)
5ml of 10% or 3ml of 25% NAF injected through the anticubital vein
wait for 10 – 12 seconds( normal arm-retina time)
Photos are taken at 1 second interval for 10 seconds
Then every 2 seconds interval for 30 seconds
Late photographs are usually taken after 3 ,5 and 10 minutes.
14. CIRCULATION OF DYE
Dye injected from peripheral vein
venous circulation
heart
arterial system
INTERNAL CAROTID ARTERY
Ophthalmic artery
Short posterior ciliary artery) Central retinal A.
(choroidal circulation.) ( retinal circulation)
15. Types of circulation in fundus
A.Choroidal
circulation
-choriocapillaries are
fenestrated
-so allows dye to
diffuse freely
BUT,
-outer blood-retinal
barrier in RPE don’t
let dye to reach
retina
B.Retinal circulation
-endothelial cells of
retinal blood vessels
joined by tight
junctions (inner
blood retinal barrier)
-prevents leakage of
dye from vessels
16. Phases of angiogram
A) Choroidal (pre-arterial) -
B) Arterial
C) Arteriovenous(capillary)
D) Venous and
E) Recirculation (elimination)-
Patchy filling
No leakage
No complication
17.
18. 1.Prearterial/choroidal phase
8-12 seconds after dye
injection
Initial patchy filling
followed by diffuse
filling
No dye has entered
retinal circulation
19. 2.Arterial phase
Shows arterial filling
Continuation of
choroidal filling
1 second after
choridal phase
24. 5.Late/elimination phase-
Elimination of dye
from choroidal and
retinal circulation
Staining of disc –
normal
In 5-10 minutes
fluorescein absent
from angiogram
25. FFA interpretation
FFA should be
Normal Abnormal Artifact
Hyperfluorescence Hypofluorescence
Leakage Pooling Staining Window Blocked Non
filling defect filling
d/t increased accumulation of dye
26. Window defect-
Defect in RPE – increased
transmission of choroidal
fluorescence.
Sharply defined
hyperfluorescence
area. Window defect- large
Macular hole
30. POOLING
1. In sub Retinal space
- As in CSR
2. In sub RPE space
- As in PED
31. STAINING -Accumulation of fluorescence within a tissue
-Due to prolonged dye retention
-Can be seen in normal as well as pathologically
altered tissue
RETINAL
a. Non-cystoid macular
oedema
b. Perivascular staining
SUB RETINAL
A. Drusens
B. Sclera
C. Lamina cribrosa
D. Scars
Examples are-
ARMD
32. Hypofluorescence
Reduction or absence of
fluorescein
Two causes-
1. BLOCKED
FLUORESCENCE
2. VASCULAR
FILLING DEFECTS
A. Optical obstruction (masking)
of normal density of fluorescein.
B. Caused by lesions anterior to
retina
A. Inadequate perfusion of tissue
with resultant low fluorescein
content
33. BLOCKED FLUORESCENCE EXAMPLES ARE
Pre-retinal lesions eg.vitreous
opacity,preretinal
haemorrhage block all
fluorescence
Deep retinal lesions
eg.intraretinal haemorrhage
and hard exudates block only
capillary fluorescence
Increased density of RPE
eg.congenital hypertrophy
Choroidal lesions eg.naevus
RPE hypertrophy
34. Examples of Filling defects-
Avascular occlusion of choroidal circulation or
retinal arteries,veins and capillaries
Loss of vascular bed eg.severe myopic degeneration –
choroideremia
Emboli
arteriosclerosis
36. Fovea in FFA(FAZ)
Appears dark
d/t
AVASCULARITY
in fovea
BLOCKAGE OF
CHOROIDAL
FLUORESCENCE
INCREASED
XANTHOPHYL
PIGMENTS
LARGER RPE
CELLS WITH
MORE
MELANIN
38. Complications of FFA
MILD
Staining of skin,
sclera and mucous
membrane
Stained secretion
Tear, saliva
Vision tinged with
yellow
Orange-yellow
urine
Skin flushing,
tingling lips
pruritis
MODERATE
Vasovagal response
Utricaria
Fainting
Periphlebitis
Nausea and
vomiting
SEVERE
Respiratory-
laryngeal edema
,bhroncospasm
Circulatory shock,
MI, cardiac arrest
Generalized
convulsion
Skin necrosis
39. Limitations of FFA
1) Does not permit study of choroidal circulation details due to
a) melanin in RPE
b) low mol wt of fluorescein
2) More adverse reaction
3) Inability to obtain angiogram in patient with excess hemoglobin
or serum protein.e.g.
- polycythemia
-weldenstrom macroglobulenaemia
bcz binding of fluorescein with excess Hb or protein so ,Lack
of freely circulating molecule
40. OPHTHALMIC ULTRASOUND
What is ultrasonography?
- Non-invasive imaging by
using ultrasonic wave
(Piezoelectric Effect)
- 1942 – Neurologist Karl
Dussik is credited with
being the first to
use sonography for
medical diagnoses
41. Frequency uses in ocular scan
Low frequency (3-5 MHz)
Use for orbital tissue pathology
Medium frequency (7- 10 MHz)
Retina , vitreous, and optic nerve pathology
High frequency (30-50 MHz)
For Ant. Chamber pathology
42. Type of scan
A-Scan (by using
single beam)
B-Scan (by using
multiple baem)
44. B-scan
Baum and Greenwood in 1950’s
developed B scan
Mainly 3 types of probe position-
A)Transverse section
B) Longitudinal section
C)Axial section