This document discusses giant retinal tears (GRTs), which are full thickness circumferential retinal tears of more than 900 of the retina. GRTs are often associated with vitreous detachment and can occur spontaneously or due to conditions like high myopia. The main management approaches are vitrectomy using perfluorocarbon liquids, sometimes combined with laser photocoagulation or scleral buckling. Vitrectomy involves removing the vitreous gel, unfolding the retina using perfluorocarbon liquids, applying laser to the tear edges, and exchanging the liquids for gas or silicone oil. The reattachment rate after surgery is 80-90% with a final rate of 94-100%, though visual outcomes are often poor if prolif
Corneal graft failure and rejection are the nightmares for an Ophthalmologist. Here is an overview on Rejection vs Failure, identification of risk factors, prevention and Mx of a failure
Update knowledge about Muntifocal IOL made by Asaduzzaman
Working as Associate Optometrist in Ispahani Islamia Eye Institute &Hospita, Dhaka 1215
Email:asad.optom92@yaho. com
Corneal graft failure and rejection are the nightmares for an Ophthalmologist. Here is an overview on Rejection vs Failure, identification of risk factors, prevention and Mx of a failure
Update knowledge about Muntifocal IOL made by Asaduzzaman
Working as Associate Optometrist in Ispahani Islamia Eye Institute &Hospita, Dhaka 1215
Email:asad.optom92@yaho. com
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
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
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.
Follow us on: Pinterest
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
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
2. INTRODUCTION
• Full thickness, circumferential tears of more than
90⁰ of retina
• Associated with vitreous detachment
• Can occur spontaneously, but often associated with
number of conditions
3.
4. INCIDENCE / AEITIOLOGY
• 1.5% of RRDs
• Average age – 42 years
• Males 72%
• Causes
• Idiopathic - 54%
• High myopia – 25%
• Hereditary conditions – 14%
• Mafans’s, Stickler-Wagner, Ehrler Danlos Xd
• Trauma – 12.3%
• Bilateral in 12.8%
• Incidence – 0.05/100,000 per year
5. PATHOGENESIS
• Liquefaction of central vitreous
• Peripheral vitreous condensation
• Concomitant traction at the vitreous base
• The neurosensory retina tears circumferentially in
the area of the posterior vitreous base
• Vitreous gel attached to the anterior flap
• Posterior flap moves freely and can fold upon itself
[In retinal dialyses the vitreous is adherent to the
posterior aspect of the retinal tear, therefore the
retina is not very mobile – laser/ scleral buckle]
6. MANAGEMENT
• Perfluorcarbon liquids were described by Stanely
Chang in 1987
• Increased the primary attachment rate from 58% to
over 94% (inverted surgical beds/ retinal tracks/
sutures..)
• Options…
• Laser photocoagulation
• Scleral buckle
• Primary vitrectomy with PFCL
• Vitrectomy + buckle
• Combined phaco/ vitrectomy
7. • Laser
• When the retina is attached
• Edge of the tear is treated with 2-4 rows of
photocoagulation
• Particularly the radial edges of the tear, treat anteriorly
up to the ora serrata
• Scleral buckle
• If the edge is not inverted
• Good option in children (lens protection/ positioning)
• Support of the edges + cryo/laser
• PPV + PFCL + gas/SiO tamponade
• To unroll and reposition a folded retina
• PPV + buckle
• In PVR
8. 25-gauge vitrectomy…
• ADVANTAGES
• Less trauma
• Smaller incisions
• Reduced sclerotomy complications
• Shortened surgical times
• CHALLENGES
• Slower removal of vitreous
• Some difficulty reaching the anterior retina and vitreous
near the ora serrata
• Flexible instruments
• More prolonged aspiration time during the air/ fluid
exchange (crucial to prevent retinal slippage)
10. 1. Removal of all the
vitreous posteriorly
and injection of
perfluoro-octane
liquid over the optic
nerve
• Done slowly with a
dual bore cannula
(to prevent trauma
and IOP elevation)
• PFCL as a single
bubble (prevent fish
eggs)
11. 2. Once the retina is
stabilized posteriorly,
the anterior vitreous
and the anterior
retinal flap are
removed
• Chandelier illumination
and scleral depression
aid in the visualization
• Paramount to remove all
the vitreous, esp. the
corners (to prevent
redetachment)
12.
13. 3. More PFCL is
added to further
flatten the retina over
the level of the edge
of the tear
• Keep the PFCL level
below the infusion to
avoid the formation of
fish eggs
• Retina can be unfolded
with forceps, with a
soft-tip cannula or with
a vitreous rake loop
14. 4. All of the anterior flap and vitreous need to be
thoroughly removed
• Especially all possible vitreous traction on the corners
since this is the area where any residual vitreous
traction can cause proliferation, traction and
redetachment
15. 5. If epiretinal
membranes, star
folds, or macular
holes are present,
membranes and
the ILM can be
peeled through
the PFCL
• Staining can be
done prior to
injecting PFCL
16. 6. Laser is applied
to the corners and
edge of the tear
• Two to three rows
up to the ora serrata
• Using a curved laser
probe
• Rest of the retina
should be checked
for small breaks etc..
17. 7. Fluid – Air Exchange
• Aspiration of all fluid
anterior to the PFCL
meniscus with a soft tip
cannula
• To prevent retinal
slippage
• Residual PFCL aspirated
over the optic nerve
• Eye filed with minimally
expanding conc. of gas
• If SiO used direct
PFCL/SiO exchange
preferred to prevent
retinal slippage
18. PHAKIC EYES
1. PRESERVE THE LENS
• Chandelier illumination – scleral depression can be used
to remove the anterior flap without causing trauma to
the lens
• Advantage- accurate lens calculations/ risk of losing
pupillary dilatation from lens removal is avoided
• Disadvantage – technically difficult to clear the anterior
vitreous and retinal flap
2. PHACOEMULSIFICATION / PARS PLANA
LENSECTOMY
• Concomitant / secondary IOL
• Advantage – easier access to anterior vitreous
• Disadvantage – extra procedures / imprecise lens
calculation / poor visibility due to pupillary miosis
19. PROLIFERATIVE VITREORETINOPATHY
• Not uncommon in GRT
• RPE dispersion + VH
• Occur in 45%
• More in trauma / chronic
• Pre-placing an encircling silicone scleral buckle
(#41/#42)
• Removal of all fibrous proliferation on both surfaces of
the retina
• Subretinal before and on the surface after PFCL injection
• Scleral buckle is placed and vitrectomy done as
described above
• Scleral buckle NOT ROUTINELY RECOMMENDED in eyes
without PVR
• Creation of retina redundancy > guttering > retinal slippage
20. COMPLICATIONS
• Retinal slippage during PFCL removal
• Retinal folds associated with slippage, SB or high
myopia
• Residual PFCL
• Cataract progression
• Recurrent RD with PVR
• Re-detachment Causes :
• Anterior traction and re-proliferation at the corners
• Missed breaks away from the tear
• Concomitant macular holes
• PVR (old/ blood/ pre-existing membranes/ pre-existing
PVR)
21. RESULTS
• Rate of reattachment following single procedure is
80 - 90%
• Final reattachment rate 94-100%
• In PVR – visual prognosis poor (despite
reattachment and anatomical success)
22. OTHER EYE
• 12.8% develop bilateral GRTs
• High risk in:
• High myopes
• White without pressure
• Vitreous condensation
• Peripheral pathology should be treated with laser
• Prophylactic buckle – controversial
Editor's Notes
Pseudophakic + no PVR
Injection of PFCL with a dual‑bore cannula to unfold retina
Removal of the anterior vitreous in the corners of
the tear
Scleral depression with chandelier illumination in a phakic eye to trim the anterior retinal flap
Laser applied to the edges of the GRT
Removal of ERMs with forceps through the PFCL
bubble
Rows of laser photocoagulation around the 360° GRT
Direct silicone oil/PFCL exchange with remaining
PFCL bubbles on the surface of the retina.