This is a seminar presentation conducted by 4th year medical student under supervision of a lecturer. This is for ophthalmology posting seminar. Source of information are from google, few textbooks and also based on previous ophthalmology posting group's seminar.
This is a seminar presentation conducted by 4th year medical student under supervision of a lecturer. This is for ophthalmology posting seminar. Source of information are from google, few textbooks and also based on previous ophthalmology posting group's seminar.
A group of eye disorders, glaucoma is characterized by high intraocular pressure (IOP) that damages the optic nerve.
Glaucoma is one of the leading causes of irreversible blindness in the world and is the leading cause of blindness among adults in the United States.
Glaucoma may occur as primary or congenital disease or secondary to other causes, such as injury, infection, surgery, or prolonged use of topical corticosteroids.
Primary glaucoma has mainly two forms :
1. Open angle glaucoma ( chronic, simple, or wide angle glaucoma)
2. Angle –closure glaucoma( Acute or narrow angle glaucoma)
Angle –closure glaucoma occurs suddenly and may cause permanent or irreversible vision loss in 48 to 72 hours.
complete information about the refractive errors due to the problem in the acomodation of eye lense , disturbed image formation in the retina, contains -types of disease condition .
Simple eye education for EHW, Ophthalmic eye student, school eye education & first - second year optometry students only .
common eye lid inflammatory conditions .
stye or hordeolum ( external / internal hordeolum ), lid abscess , chalazion or mebomian retention cyst, accessory lacrimal glands , lacrimal gland etc...
complete information about the retinal detachment , types, , symptoms , sign, etiology, causes, diagnosis, complications, medical management, nursing management, home care, patient teaching. nursing reserch.
Refractive error means that the shape of your eye does not bend light correctly, resulting in a blurred image. The main types of refractive errors are myopia (nearsightedness), hyperopia (farsightedness), presbyopia (loss of near vision with age), and astigmatism.
A group of eye disorders, glaucoma is characterized by high intraocular pressure (IOP) that damages the optic nerve.
Glaucoma is one of the leading causes of irreversible blindness in the world and is the leading cause of blindness among adults in the United States.
Glaucoma may occur as primary or congenital disease or secondary to other causes, such as injury, infection, surgery, or prolonged use of topical corticosteroids.
Primary glaucoma has mainly two forms :
1. Open angle glaucoma ( chronic, simple, or wide angle glaucoma)
2. Angle –closure glaucoma( Acute or narrow angle glaucoma)
Angle –closure glaucoma occurs suddenly and may cause permanent or irreversible vision loss in 48 to 72 hours.
complete information about the refractive errors due to the problem in the acomodation of eye lense , disturbed image formation in the retina, contains -types of disease condition .
Simple eye education for EHW, Ophthalmic eye student, school eye education & first - second year optometry students only .
common eye lid inflammatory conditions .
stye or hordeolum ( external / internal hordeolum ), lid abscess , chalazion or mebomian retention cyst, accessory lacrimal glands , lacrimal gland etc...
complete information about the retinal detachment , types, , symptoms , sign, etiology, causes, diagnosis, complications, medical management, nursing management, home care, patient teaching. nursing reserch.
Refractive error means that the shape of your eye does not bend light correctly, resulting in a blurred image. The main types of refractive errors are myopia (nearsightedness), hyperopia (farsightedness), presbyopia (loss of near vision with age), and astigmatism.
INTRODUCTION
ETIOLOGY
RISK FACTORS
PATHOPHYSIOLOGY
CLASSIFICATION
CLINICAL FEATURES
DIAGNOSTIC MEASURES
MANAGEMENT
Medical
Surgical
Nursing
CONCLUSION
BIBLIOGRAPHY
POST TEST
Glaucoma: the “silent thief of sight”
Glaucoma is a leading cause of preventable sight loss. Vision can often be preserved with early identification, good adherence to treatment and long-term monitoring.
MALARIA
It is an infectious disease of humans caused by parasitis protozoans belonging to the genus plasmodium.
It is endemic in most parts of India and other tropical countries.
As per WHO, malaria causes one death every minute globally and about 40,000 annual deaths in India.
The disease is transmitted by the bite of an infected female Anopheles mosquito.
Four species of protozoa plasmodium can cause malaria which are P. falciparum, P. vivax, P. ovale and P. malariae.
INTRODUCTION
These are the drugs which are used for the treatment, prophylaxis and prevention of relapses of malaria.
The treatment of malaria is available since 17 century. During those times, the bark of Cinchona tree was used in the crude form.
Later in 1820, quinine was isolated from the bark.
Since 1920, quinine and other drugs are commercially available in the market
OBJECTIVES IN USE OF ANTIMALARIAL DRUGS
The various objectives are:
To prevent clinical attack of malaria.
To treat clinical attack of malaria.
To completely eradicate the parasite from the patient’s body.
To cut down human to mosquito transmission.
THERAPEUTIC CLASSIFICATION
1. CAUSAL PROPHYLACTICS: (Destroy parasite in liver cells and prevent invasion of erythrocytes)
e.g. primaquine, pyrimethamine
2.BLOOD SCHIZONTOCIDES SUPPRESIVES (destroy parasites in the RBC and terminate clinical attacks of malaria): e.g. chloroquine, quinine, mefloquine, halofantrine, pyrimethamine
3. TISSUE SCHIZONTOCIDES used to prevent relapse: act vivax and P. ovale that produce replapses. E.g. primaquine
4. GAMETOCIDAL DRUGS: primaquine, chloroquine, quinine.
1. CHLOROQUINE
It acts as erythrocytic schizontocide against all species of plasmodia.
The parasite disappears from peripheral blood in 1-3 days. It control the clinical attacks of malaria within 1-2 days.
It doesn’t have any gametocidal activity.
It is bitter in taste, so patient should be advised ‘not to chew the tablet’ it is used for the treatment of malaria during pregnancy: no teratogenic effects have been reported.
MECHANISM OF ACTION
Its gets concentrated in the infected RBCs and then is actively taken up by the susceptible plasmodia.
The chloroquine binds to the heme and forms chloroquine heme complex.
Complex inhibits the formation of hemozoin and also damages the Plasmodium memberane
PHARMACOKINETICS
It is well absorbed orally.
50% of the drug is plasma protein bound, gets concentrated in liver, spleen, kidneys, lungs, skin and leukocytes.
The plasma half life is 3-10 days, whereas the terminal half life is 1-2 months. On prolonged use, it gets accumulated selectively in the retina and causes ocular toxicity.
It is partially metabolized in liver and slowly excreted in urine.
INDICATIONS ADVERSE EFFECTS
Clinical drug of choice for malaria.
Extraintestinal amoebiasis.
Rheumatoid arthritis
Infectious mononucleosis.
Mil
These are synthetic antimicrobial having a quinolones structure.
These are active against most of the gram negative bacteria.
In 1960s the first membered of this group, Nalidixic acid, was introduced .
Flouroquinolones have:
High potency
Expanded antimicrobial spectrum
Better tissue penetration
Good tolerability profile
Very low resistance development
1. NALIDIXIC ACID
It was the first member in quinolones. It was active against gram negative bacteria. It acts by inhibiting bacterial DNA gyrase. It is bacterial in nature.
It is given orally. It attains good concentration in gut, lumen, hence useful in diarrhea.
NALIDIXIC ACID CONTD…
It is most commonly seen in children. And causes neurological toxicity present as headache, drowsiness and vertigo and contraindicated in infants and G6PD deficient patients.
It is given in a dose of 0.5-1g TDS/QID
2. FLUOROQUINOLONES
Fluoroquinolones are quinolones antimicrobials having one or more fluorine substituitions.
The first generation fluoroquinolones have one fluoro substitution and were developed in 1980s.
The second generation fluoroquinolones have additional fluoroquinolones have additional fluoro substitution, which extended the antimicrobial activity and were developed in 1990s.
MECHANISM OF ACTION
The fluoroquinolones inhibits the enzyme DNA gyrase in Gram-negative micro-organism and topoisomerase IV in gram positive micro-organism. This lead to the bactericidal effects of fluoroquinolones.
RESISTANCE
The resistance to fluoroquinolones develops when the bacteria produce a DNA gyrase or topoisomerase IV which have reduced affinity for fluoroquinolones or the bacteria produce efflux pumps across bacterial memberane which shunt out the fluoroquinolones from the bacterial cells.
CLASSIFICATION
FIRST GENERATION FLOUROQUINOLONES :
Norfloxacin
Ofloxacin
Ciprofloxacin
Pefloxacin
SECOND GENERATION FLUOROQUINOLONES:
Levofloxacin
Moxifloxacin
Lomefloxacin
Gemifloxacin
Sparfloxacin
Prulifloxacin
PHARMACOKINETICS
These are given both by oral and intravenous route.
These have good absorption, when given empty stomach and food delays the absorption. These drugs have good tissue penetrability.
These are excreted in urine by glomerular filtration as well as tubular secretion.
INDICATIONS
Bacterial gastroenteritis
Typhoid fever
UTI
Gonorrhoea
Chancroid
Bone, Soft tissue and gynaecological infections
Respiratory infections
Tuberculosis
Gram negative septicemia and meningitis
Conjuctivitis
COMMON ADVERSE EFFECTS
GI SYSTEM: Nausea, vomiting, bad taste and anorexia
CNS: Headache, anxiety, insomnia, restlessness and impairment of concentrations.
Skin: Rash, photosensitivity
Contraindicated in pregnancy.
They should be used in caution in children as a few cases of joint pain and swelling have been reported and a risk of cartilage damage is suspended.
FIRST GENERATION FLUROQUINOLONES
SECOND GENERATION FLUROQUINOLONES
DRUG INTERACTIONS
Antacids decrease the absorption
INTRODUCTION
Sulfonamides were the first effective, synthetic antibacterial agents to be used systemically in man.
They were introduced by Domagk in 1935 and in the next few years several of them were synthesized and widely used. Currently their role in therapeutics is limited because of their toxicity, development of resistance availability of safer drugs.
CLASSIFICATION
Short acting: Sulfisoxazole, Sulfadiazine
Intermediate acting: Sulfamethoxazole
Long-acting: Sulfamethoxypyridazine, sulfadoxine
Poorly absorbed: Sulfasalazine
Topical: Sulfacetamide, mefedine
Silver sulfadiazine.
ANTIBACTERIAL SPECTRUM
It is wide spectrum antibiotic.
It inhibits many gram positive and some gram negative bacteria including streptococci, H. influenza, Norcardia, E. coli, proteus, V. cholerae, some stains of staphylococci, gonococci, memingococci and pneumococci.
They are also effective against Chlamydia, plasmodium falciparum and toxoplasma gondii.
MECHANISM OF ACTION
PABA (Para-aminobenzoic acid)
Folic acid synthesis
DIHYDROFOLIC ACID
Bacteria synthesize their own folic acid from PABA with the help of the enzyme folic acid synthetase. Sulfonamides are structurally similar to PABA and competitively inhibiting the enzymes folic acid synthetase.
They inhibit the enzyme folic acid synthase so folic acid is not synthesized (which is essential bacterial growth).
PHARMACOKINETICS
Sulfonamides are well absorbed, extensively bound to plasma proteins and are well distributed to all tissues.
They are metabolized in the liver and excreted in urine.
They can cross placental barriers.
COMMON USES
SYSTEMIC USES : sulfamethoxazole is used in combination with cotrimoxazolein many bacterial infections.
It is the drug of choice in pneumocystitis in AIDS patient.
Treatment of nocardiosis, toxoplasmosis, ulcerative colitis and rheumatoid arthritis.
TOPICAL USES: ocular sulfacetamide sodium is used in trachoma/inclusion conjuctivitis.
Topical silver sulfadiazine is used for preventing infection on burn surfaces.
Mefinide is active in the presence of pus and against pseudomonas, clostridia which are not inhibited by topical sulfonamides.
USES
Because of the development of resistance and availability of better antimicrobials, which are more effective and less toxic, these are not commonly used now except in a few cases:
UTI
NOCARDIOSIS
TOXOPLASMOSIS
TRACHOMA AND INCLUSION CONJUCTIVITIS
MALARIA
TOPICAL
ULCERATIVE COLLITIS
Contraindication & Precautions: Children younger than 2yrs, Pregnant and breast feeding mother, Renal and hepatic diseases, Hypersensitivity to sulphonamides drug.
Adverse effect: Fever, Rash, Nausea/vomiting, Aplastic Anemia.
DRUG INTERACTIONS
Sulphonamides can increasing the blood thinning effect of warfarin, possibly leading to abnormal bleeding.
Increases blood level of potassium may occur when Sulfamethoxazole trimethoprim is combined with ACE inhibitors.
Su
INTRODUCTION
Erythromycin is the first member of group, and was isolated from a strain of Streptomyces erythreus in 1952.
Rest drugs are semi-synthetic derivatives of erythromycin known as newer macrolides
Some other drugs are dirithromycin, oleandomycin and troleandomycin.
MECHANISM OF ACTION
Macrolide antibiotics are bacteriostatic agents and inhibit the protein synthesis by binding reversibly to 50s ribosomal subunit of sensitive microorganism and interfere with translocation step in the protein synthesis.
Gram positive bacteria's are 100 times more sensitive than gram negative bacteria's by these drugs.
MECHANISM OF ACTION
It is bacteriostatic at low concentration & bactericidal at high concentration
Bactericidal property depends on the concentration, organism concerned and its rate of multiplication
ANTI MICROBIAL SPECTRUM
It is narrow spectrum antibiotic. These antibiotics are more active against gram positive cocci and inactive against most of the aerobic and enteric gram negative bacilli.
In addition, Campylobacter, Legionella, Branhamella catarrhalis, G. vaginalis and Mycoplasma (which are not affected by pencillin are also highly susceptible to erythromycin)
ANTI MICROBIAL SPECTRUM
Moderately sensitive to H. influenza, B. pertussis, C. trachomatis, N. meningitidis and Rickettsiae
Ineffective against Enterobacteriaceae, other gram negative bacilli.
ERYTHROMYCIN
This drug is acid labile, given as enteric coated tablets. Poorly absorbed when given empty stomach and has poor tissue penetration.
DOSE: 250-500mg QID with half life of 1.5 hrs
Indications: a drug of choice in atypical pneumonia, whooping cough and cancroids and as an alternative to penicillin in streptococcal pharyngitis, tonsillitis, mastoiditis.
SIDE EFFECTS: Epigastric distress causing nausea, vomiting and diarrhea. Allergic reactions such as fever and skin eruption.
CLARITHROMYCIN
These drugs are acid stable, good absorption occurs when given empty stomach and has good tissue penetration.
Dose: 250-500mg BD with half life of 3-6 hrs at low dose and 3-9 hrs at high dose.
Indications: upper and lower RTI, sinusitis, otitis media, atypical pneumonia, skin infections. And H. pylori infection and first line drug in combination regimens in AIDS infection
Side effects: same as erythromycin but better gastric tolerance, reversible hearing loss at high doses.
AZYTHROMYCIN
These drugs are acid stable, good absorption occurs when given empty stomach and has good tissue penetration
Dose: 500mg OD with half life >50 hrs.
Indications: pharyngitis, tonsillitis, sinusitis, otitis media pneumonias, chronic bronchitis. In the prophylaxis and treatment of AIDS infections.
Side effects: nausea vomiting, diarrhea and abdominal pain.
ROXITHROMYCIN
These drugs are acid stable, good absorption occurs when given empty stomach and has good tissue penetration
DOSE: 150mg BD with half life of 12 hrs.
Indications: alternative to erythromycin for respiratory, skin
INTRODUCTION
Aminoglycosides are a class of antibiotics used mainly in the treatment of aerobic gram-negative bacilli infections, although they are also effective against other bacteria including Staphylococci and Mycobacterium tuberculosis.
They are often used in combination with other antibiotics.
Streptomycin – 1944
Actinomycetes – Streptomyces griseus
Bactericidal antibiotics which is interfere with protein synthesis
Used to treat aerobic Gram –ve bacteria
Exhibit ototoxicity and nephrotoxicity
MECHANISM OF ACTION
These drugs inhibit protein synthesis in the bacteria, there permeability is increased and cell contents leak out and death of cell occurs. These drugs leave bactericidal action.
CLINICAL USES
Gram –ve bacillary infection – Septicaemia, pelvic & abdominal sepsis
Bacterial endocarditis – enterococcal, streptococcal or staphylococcal infection of heart valves
Pneumonias, Tuberculosis
Tularemia
Plague, Brucellosis
Topical – Neomycin, Framycetin:- Infections of conjunctiva or external ear and also used it before surgery.
COMMON INDICATIONS OF AMINOGLYCOSIDES
Gram negative bacillary infections particularly septicemia, meningitis, UTI’s renal, pelvic and abdominal sepsis.
Bacterial endocarditis: usually gentamicin is preferred as a part of regimen.
Other infections such as tuberculosis, plague, brucellosis etc.
Topical uses: neomycin, framycetin and sisomicin are used for various topical infections.
NURSING IMPLICATIONS
The renal function should be regularly monitored.
Patients should be regularly enquired about any side effects.
Patients should be warned for not driving or operating the machinery.
Patient should be advised to take plenty of water during the course.
Monitor the sign and symptoms of hearing loss.
7-aminocephalosporanic acid has been modified by addition of different side chains to create a whole family of cephalosporin antibiotics.
these have been conventionally divided into 5 generations
Mechanism of action
All cephalosporins are bactericidal.
As penicillin it also inhibit the synthesis of bacterial cell wall and causing rapid cell lysis.
Inhibition of transpeptidation (Transpeptidase enzymes then cross-link the chains to provide strength to the cell wall and enable the bacterium to resist osmotic lysis)
Imperfect cell wall
Osmotic drive
Activation of autolysin enzymes
Lysis of bacteria
BACTERICIDAL
CLASSIFICATION
Based on
antimicrobial spectrum
Chronological sequence of development
Divided into generations.
First-generation agents
Cephalexin (O)
Cefadroxil (O)
Cefazolin (i.m, i.v)
Cefalothin (withdrawn)
Exhibit good activity against gram-positive bacteria but modest activity against gram negative organisms.
Most gram-positive cocci
Strepto,
Pneumo,
Methicillin sens. Staph. are susceptible to first-generation cephalosporins
Modest activity against E. coli, K. pneumoniae & Proteus mirabilis
Second-generation agents
Cefaclor (O)
Ceforanide
Cefuroxime (i.m , i.v)
Cefoprozil
Exhibit somewhat increased activity against gram negative organisms,
but much less active than third generation agents.
Less active against gram positive cocci & bacilli compared to first gen. drugs.
Use declined
Clinically replaced by 3rd & 4th generation drugs .
Third-generation agents
Cefotaxime
Ceftriaxone
Cefdinir
Cefibuten
Cefpodoxime
Ceftizoxime
Ceftazidime
Cefoperazone (withdrawn)
Highly augmented activity against gram-negative organisms
Less active than first generation agents against gram positive cocci & anaerobes.
All are highly resistant to β-lactamases from gram negative bacteria.
Some inhibit psuedomonas as well; ceftazidime, cefoperazone(withdrawn)
Some members of this group have enhanced ability to cross the blood-brain barrier eg. Ceftriaxone and are effective in treating meningitis caused by pneumococci, meningococci, H. influenzae and susceptible gram negative rods.
Fourth-generation agents
Cefpirome (im/iv)
Cefepime (iv)
Cefozopran (im)
Highly active against G –ve organisms
Similar to third gen drugs for g +ve bacteria
The fourth generation drugs comparable to third generation but more resistant to hydrolysis by β-lactamases.
Effective against bacterial infections resistant to earlier drugs
Fifth-generation agents
Ceftobiprole
Ceftaroline
Active against, g +ve cocci especially MRSA (Methicillin-resistant Staphylococcus aureus) It's tougher to treat than most strains of staphylococcus aureus -- or staph -- because it's resistant to some commonly used antibiotics.
penicillin resistant S. pneumoniae and enterococci
Adverse reactions
Pain after im injection
Thrombophlebitis of injected vein.
Diarrhoea more common with
oral Ceferadine
P/E Cefoperazone (Banned)
DEFINITION CHEMOTHERAPY & ANTIBIOTICS
CHEMOTHERAPY: Chemotherapy is the treatment of infections by substances which destroy or suppress bacteria and other microorganism. The substances / Agents used may natural synthetic or semi – synthetic in nature.
ANTIBIOTICS: An antibiotic is a chemical substance produced by microorganism which prevents the growth of other microorganism or kills the other microorganism. These are natural substances
CHEMOTHERAPY
It is a method of therapy of infectious disease and cancer with chemical agents – chemotherapeutic medicines
ANTIBIOTICS CLASSIFIED AS:
According to the mode of action on Bacteria:
According to the type of Bacteria:
According to the effectiveness against microorganism:
According to the mode of action on Bacteria:
Bacteriostatic: These antibiotics inhibit the growth & multiplication of Bacteria. Eg. Tetracycline, Chloramphenicol, Sulphonamides, Dapsone, Erythromycin, Clindamycin.
Bactericidal: These antibiotics destroy or kill all the Bacteria in the process of multiplication. Eg. Penicillin, Aminoglycosides, Cephalosporin, Fluoroquinolones, Rifampicin, Metronidazole etc.
According to the type of Bacteria:
Gram Positive: Some Antibiotics are effective mainly against Gram Positive Bacteria Eg. Penicillin.
Gram Negative: Some Antibiotics are effective mainly against Gram Negative Bacteria Eg. Streptomycin.
According to the effectiveness against microorganism:
Broad Spectrum: The Antibiotics which acts against wide range of microorganisms. Eg. Tetracycline.
Narrow Spectrum: These Antibiotics are useful against limited microorganisms. Eg. Erythromycin
Toxic Effects: Gastrointestinal irritation, Nausea, Vomiting and diarrhea may occur when given by mouth.
Skin sensitivity may develop with Penicillin or streptomycin causing rashes.
Serious toxic effect may occur due to streptomycin on the vestibular & auditory nerve causing vertigo & deafness
Drug Resistance: Many bacteria soon develops resistance to particular drug after a period of treatment, so that the bacteria will not respond to the same drug for example tubercle bacillus develops resistance to streptomycin quickly.
Super infection: The antibiotics given by mouth kill the normal bacteria inhibiting the alimentary canal and permits the over growth of other insensitive organisms which can cause serious complications. Eg. Fungus cause thrush which may go to the lungs with fatal results.
Hypersensitivity Reaction: Chemotherapeutic agents can cause Hypersensitivity reactions from mild rashes to serve anaphylactic shock. Eg. Penicillin & Sulphonamides.
Vitamin Deficiency: Alteration in vitamin formation and absorption from the bowel take place . So there is deficiency of Vitamin B complex and Vitamin K.
Anemia: In susceptible persons chloramphenicol may produce Aplastic anemia or agranulocytosis. (Action must be taken through proper history about previous drug reaction before administering penicillin sulphonamide and cephalosporin
definition of hydronephrosis,
causes and types of hydronephrosis
pathophysiology of hydronephrosis
clinical manifestation and diagnostic test for hydronephrosis
management
BIOGRAPHY OF FAYE GLENN ABDELLAH, AS AN EDUCATOR AND RESEARCHER, INFLUENCED FAYE ANDELLAH IN THE DEVELOPMENT HER OWN MODEL OF
NURSING, ABDELLAH’S TYPOLOGY OF 21 NURSING PROBLEMS, ASSUMPTION, CONCEPT, STEPS TO IDENTIFY THE CLIENT’S PROBLEM, 11 NURSING SKILLS, USE OF 21 PROBLEMS IN THE NURSING PROCESS AND LIMITATIONS
Nursing assessment and assessment of eyeNEHA BHARTI
examination of eye, Examination by ophthalmoscope,
assessment of the functions of eye, . PUPILLARY RESPONSE, FUNCTIONAL EXAMINATION, test for Focusing power, confrontation test, Colour sense test and visual acuity testing procedure etc
elimination, bowel elimination, physiology of elimination, process of bowel eliminaton factor impaired bowel, factors improve bowel elimination, alteration in bowel elimination, maintenance of bowel motility, assessment of bowel elimination, characteristics of feces, type of feces, methods for maintain the bowel elimination:- enemas, rectal suppositories and colostomies, types of colostomies, colostomy care
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
2. DEFINITION
• It is a group of disorders characterized by an
abnormally high intra ocular pressure (IOP), optic
nerve dystrophy (weakness) and peripheral visual
field loss (tunnel vision.)
• It is a symptomatic condition of the eye where
the IOP is more than normal (above 25mm Hg).
• Untreated of glaucoma leads to permanent
damage of the optic nerve and resultant visual
field loss, which can progress to blindness.
3. • Glaucoma is an eye disease where the eye’s
optic nerve is damaged. It is one of the
leading causes of blindness
4. www.opto.ca
EYE ANATOMY
• The optic nerve is a
bundle of nerve
fibers
• It carries visual
information from the
retina to the brain
7. www.opto.ca
Fluid Circulation
• The fluid exits the
eye at the angle
between the iris and
the cornea where it
drains through a
spongy meshwork
8. CAUSES AND RISK FACTORS
• Genetics:- Family history of glaucoma
• Ageing
• Ocular hypertension is a condition where the
pressure in your eyes, or IOP, is too high. Continually
high pressure within the eye can eventually damage
the optic nerve and lead to glaucoma or permanent
vision loss.
• Severe myopia:- It is associated with an increased
risk of pathological ocular complications and
may lead to blinding disorders like glaucoma
9. • Eye trauma:- It is most commonly caused by
blunt trauma, which is an injury that doesn't penetrate
the eye, such as a blow to the head or an injury directly
on the eye. This can lead to an increase
in eye pressure, which can damage the optic nerve.
• Ocular surgery:- can cause a change in the eye's
pressure. Sharp increases in eye pressure are called
“pressure spikes” and sometimes occur in patients
after cataract surgery. Often these pressure spikes are
short-term and can be treated with medicines.
10. • Migraine:- Prolonged increased pressure
can lead to visual loss if not corrected.
• Black ethnicity:- African Americans are also
more likely to develop glaucoma at a younger
age and suffer blindness from the disease. The
genetic causes underlying glaucoma remain
unclear, but these ethnic disparities in the risk
of developing glaucoma suggest a genetic
basis that is ethnicity-specific
11. • Prolonged use of local or systemic
corticosteroids:- Long-term use of topical and
systemic steroids produces secondary open-
angle glaucoma similar
to chronic simple glaucoma. The increased
intraocular pressure
[IOP] caused by prolonged steroid therapy is
reversible but the damage produced by it is
irreversible. (edema glucocorticoid receptors
on trabecular meshwork cells.)
12.
13. PATHOPHYSIOLOGY
•IOP is a function of production of liquid aqueous
humor by the ciliary processes of the eye and its
drainage through the trabecular meshwork.
•Aqueous humor is produced by the ciliary body
and flow into the posterior chamber behind the iris.
•The trabecular meshwork filters the aqueous
humor into Schlemm’s canal. Where is picked up by
the episcleral vessels and mixed with blood.
17. 1. CONGENITAL GLAUCOMA
• It is rare disease, occurs when a congenital defect in
the angle of the anterior chamber obstructs the out
flow of aqueous humor. If untreated, causes damage
to the optic nerve and blindness. In most cases,
surgery is required.
1.TRUE CONGENITAL GLAUCOMA
2. INFANTILE GLAUCOMA
3. JUVENILE GLAUCOMA
18. A.TRUE CONGENITAL GLAUCOMA
• It is labeled when IOP is raised during
intrauterine life and child is born with ocular
enlargement. It occurrence is about 40% of
cases.
B. INFANTILE GLAUCOMA:-
• It is labeled when the disease manifests prior
to the child’s third birthday. It occurs in about
50% of cases.
19. C. JUVENILE GLAUCOMA
• It is labeled in the rest 10% of cases who
develop pressure rise between 3-6 years of
life.
20. 2. ACQUIRED GLAUCOMA
A. PRIMARY GLAUCOMA
• 1. PRIMARY OPEN ANGLE GLAUCOMA
• 2. PRIMARY ANGLE CLOSURE GLAUCOMA
B. SECONDARY GLAUCOMA
21. A. PRIMARY GLAUCOMA
1. PRIMARY OPEN ANGLE GLAUCOMA
• POAG is the most common form of glaucoma
• It occurs when the fluid drainage is poor and
fluid builds up in the eye and the internal eye
pressure goes up
• This increased pressure can cause damage to
the optic nerve and vision loss
• The exact mechanism of damage is still
unknown
22. www.opto.ca
Symptoms of Primary Open
Angle Glaucoma
• POAG develops gradually and painlessly and has
no initial symptoms
Vision is normal in
the early stages
23. www.opto.ca
Symptoms of Primary Open
Angle Glaucoma
• If untreated, peripheral or side vision is slowly lost
Tunnel vision:-
Defective sight in
which objects cannot
be properly seen if
not close to the
centre of the field of
view.
25. B. SECONDARY GLAUCOMA
2. PRIMARY ANGLE CLOSURE GLAUCOMA
• This type of glaucoma is an emergency
situation
• It occurs when the iris itself blocks the
drainage angle and results in a sudden
increase in pressure
• Symptoms include severe eye pain, nausea,
eye redness and very blurred vision
• Immediate treatment is required
26. B. SECONDARY GLAUCOMA
• Glaucoma can develop as a complication from other
conditions including:
– Eye injuries
– Diabetes
– Steroid use
27. www.opto.ca
3. Low Tension Glaucoma
• Low Tension (or Normal Tension) Glaucoma is not
as common
• In these cases, the eye pressure is in the normal
range but the optic nerve still gets damaged
• The exact mechanism of damage is still unknown
28. DIAGNOSTIC EVALUATION
• Regular eye examinations by an optometrist
or ophthalmologist are vital to detecting
glaucoma
• A number of tests are performed
• A patient’s medical history, family history and
background are important to determine the
presence of risk factors
29. www.opto.ca
Glaucoma Tests:
Slit Lamp & Gonioscopy
• A special microscope called a slit lamp is used to
examine the structures of the eye
• A gonioscopy lens may be used to view the drainage
angle
30. SLIT- LAMP EXAM
• Once patient in the examination
chair, the doctor will place an
instrument in front of patient on
which to rest chin and forehead.
• This helps steady head for the
exam. Doctor may put drops in
eyes to make any abnormalities
on the surface of cornea more
visible.
• The drops contain a yellow dye
called fluorescein, which will
wash away the tears. Additional
drops may also be put in eyes to
allow pupils to dilate, or get
bigger.10/26/2018
31. • The doctor will use a low-powered microscope, along
with a slit lamp, which is a high-intensity light. They
will look closely at eyes. The slit lamp has different
filters to get different views of the eyes. Some
doctor’s offices may have devices that capture digital
images to track changes in the eyes over time.
• During the test, the doctor will examine all areas of
your eye, including the:- eyelids, conjunctiva, iris,
lens, sclera, cornea, retina and optic nerve.
10/26/2018
33. TONOMETERY
• Tonometry is the
procedure eye care
professionals perform
to determine the
intraocular pressure,
the fluid pressure inside
the eye. It is an
important test in the
evaluation of patients at
risk from glaucoma.
• (normal pressure range
is 12 to 22 mm Hg)
10/26/2018
34. www.opto.ca
Glaucoma Tests:
Ophthalmoscopy
• Eye drops may be placed in the eyes to dilate the pupils
• Special magnifying lenses are used to examine the
retina and optic nerve for damage
Normal Optic Nerve Suspicious Optic Nerve
36. COLOR FUNDUS PHOTOGRAPHY
• Fundus camera to record color images of the
condition of the interior surface of the eye, in order
to document the presence of disorders and monitor
their change over time.
• A fundus camera or retinal camera is a specialized
low power microscope with an attached camera
designed to photograph the interior surface of the
eye, including the retina, retinal vasculature, optic
disc, macula, and posterior pole (i.e. the fundus).
10/26/2018
37. MANAGEMENT
MEDICAL MANAGEMENT:-
• BETA ADRENERGIC BLOCKERS:- Timolol,
betaxolol are used to decreased aqueous
humor production.
• CHOLINERGIC (MIOTICS):- Pilocarpine,
carbacol are used to reduce IOP by facilitating
the outflow of aqueous humor
38. • CARBONIC ANHYDRASE INHIBITORS:-
Dorzolamide, methazolamide or
acetazolamide to decrease the formation and
secretion of aqueous humor.
• PROSTAGLANDIN ANALOGS:- Latanoprost to
reduce IOP by increasing uveoscleral outflow.
39.
40. SURGICAL MANAGEMENT
ARGON LASER TRABECULOPLASTY:-
• It may be used to treat open angle glaucoma.
In this, thermal argon laser burns are applied
to the inner surface of the trabecular
meshwork to open the intra trabecular spaces
and widen the canal of Schlemm, thereby
increasing the outflow of aqueous humor and
decreasing IOP.
41.
42. LASER IRIDOTOMY:-
• An opening is made by the laser bean in the
iris to eliminate the pupillary block. It relieves
pressure and preserves vision by promoting
outflow of the aqueous humor.
43.
44. CYCLOCRYOTHERAPY:-
• Application of a freezing probe to the sclera
over the Cilliary body that destroy some of the
Cilliary processes, results in the reduction of
the amount of aqueous humor produced.
45. CYCLODIALYSIS:-
• Through a small incision in the sclera, a
spatula type instrument is passed into the
anterior chamber, creating an opening in the
angle.
46. • FILTERING PROCEDURES:- for chronic
glaucoma filtering procedure are used to
create an opening or fistula in the trabecular
meshwork to drain aqueous humor.
47. • TRABECULOTOMY:- A partial thickness
incision is made in the sclera and further
section of sclera is removed to produce an
opening for aqueous humor outflow under
the conjunctiva, creating a filtering bleb.
48. • SCLERECTOMY:- A partial thickness incision is
made in the sclera and one or more openings
are made with a punch. The top flap of sclera
is closed over the punched holes.
49. NURSING MANAGEMENT
ASSESSMENT:-
• History or presence of risk factor:- positive
family history, tumour of eye, haemorrhage,
uveitis, trauma etc.
• Physical examination based on those in
general assessment of the eye may indicate:-
blurred vision, decreased light perception
redness cloudy appearance etc.
50. DIAGNOSIS:-
• Acute pain related to increased IOP and
surgical complications as evidenced by patient
verbalization or facial expression of the
patient
GOAL:- The pain of patient will be reduced.
51. INTERVENTIONS:-
• Monitor vital signs of the patient
• Monitor the degree of eye pain very 30 min
during the acute phase.
• Monitor visual acuity at any time before hatching
ophthalmic agent for glaucoma.
• Maintain the bed rest in semi- fowler position
• Give analgesic prescription and evaluation of its
effectiveness.