Scleritis,is considered a chronic inflammatory response that involves the superficial and deep episcleral plexus. The exact mechanism of inflammation in scleritis remains unclear, as some report a variety of immunopathological findings, while others point to granulomatous inflammation and collagen disruption, which can lead to loss of tissue and subsequent thinning.
Scleritis has a proposed incidence of 4.1 cases per 100,000 person-years and can be idiopathic, associated with a systemic autoimmune disease, surgically induced or infectious, although only 4% to 10% of all cases are deemed infectious.Potential pathogens include bacteria, fungi, parasites and viruses.
AUTHOR DR RUPALI TYAGI, CO-AUTHOR 1 DR SHUBHA NAGPAL, CO-AUTHOR 2 DR NEELAM PUTHRAN, CO-AUTHOR 3 DR VARSHA KULKARNI MS OPHTHALMOLOGY BHARATI HOSPITAL BHARATI VIDYAPEETH UNIVERSITY PUNE
Discussion of clinical approach to typical (demyelnating) and atypical optic neuritis (immune/inflammatory/infectious) optic neuritis with evidence-based review.
Target: Ophthalmologists/Neurologists
Scleritis,is considered a chronic inflammatory response that involves the superficial and deep episcleral plexus. The exact mechanism of inflammation in scleritis remains unclear, as some report a variety of immunopathological findings, while others point to granulomatous inflammation and collagen disruption, which can lead to loss of tissue and subsequent thinning.
Scleritis has a proposed incidence of 4.1 cases per 100,000 person-years and can be idiopathic, associated with a systemic autoimmune disease, surgically induced or infectious, although only 4% to 10% of all cases are deemed infectious.Potential pathogens include bacteria, fungi, parasites and viruses.
AUTHOR DR RUPALI TYAGI, CO-AUTHOR 1 DR SHUBHA NAGPAL, CO-AUTHOR 2 DR NEELAM PUTHRAN, CO-AUTHOR 3 DR VARSHA KULKARNI MS OPHTHALMOLOGY BHARATI HOSPITAL BHARATI VIDYAPEETH UNIVERSITY PUNE
Discussion of clinical approach to typical (demyelnating) and atypical optic neuritis (immune/inflammatory/infectious) optic neuritis with evidence-based review.
Target: Ophthalmologists/Neurologists
Optic Neuritis and OCT in Multiple Sclerosis neurophq8
An overview of the update in optic neuritis and the utility of OCT in multiple sclerosis presented at the MS perceptorship in Dasman Institute in April 13 , 2017
Slides include
Basic anatomy of optic nerves
Background & epidemiology of optic neuritis
Classification of optic neuritis
Clinical features
Investigations
Diagnosis
Differential diagnosis
Managements
Prognosis
Shape is Endophthalmitis , it is prevalent in Nepal (more or less it is seen more commonly in Kaski District ). This diseases is associated with exposure to Moth.
Electrophysiological assessment of optic neuritis: is there still a roleClare Fraser
Visual evoked potentials were once in the diagnostic criteria for Multiple Sclerosis, but have been left off the most recent criteria. However, there are newer techniques available which are still invaluable in the diagnosis of optic neuritis and its common mimics.
Systemic Lupus-erythmatosus a detailed review.pdfUsamaSaleem91
Systemic lupus erythmatosus is an autoimmune disease affecting multiple organ systems. This presentation almost describes everything you need to know about this disease. A proper knowledge of this disease is necessary for healthcare professionals specially those related to medicine and rheumatology.
updating in diabetic macular edema including old and new approach era, including DRCR protocol
how to approach, how to treat, when to surgery
plus knownledge about anti-VEGF therapy up to date
slide presentation about ptosis in ophthalmology department
including mechanical,myogenic,aponeurotic,traumatic,neurogenic cause
plus dermatochalasis
in general appraoch and surgery choice
Epiretinal membrane and vitreomacula traction in updates by Panit Cherdchu, MD.Panit Cherdchu
Epiretinal membrane + Vitreomacula traction in focus of PPP from AAO guidelines includes definition, classification, investigation, treatment (Ocriplasmin,vitrectomy,observation)
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
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CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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 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.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
4. present illness
1 yr PTA : She was admitted to PMK hospital
(10-16 Aug 2016) with acute visual loss RE (RE
VA FC'2), no clinical eye pain/pain on eye
movement, no floater, no flashing, no Hx of
head/eye trauma, No Hx ocular Sx , she had
paresthesia both legs, no
respiratory/bowel/bladder symptoms
5. OD OS
VA FC'2 PH not improved 20/80-1 PH 20/40-1
EOM full, no pain on eye movement full, no pain on eye movement
IOP 12 16
Lid Not swelling Not swelling
Conjunctiva No injected, No discharge Not injected, no discharge
Cornea Clear Clear
A/C Deep/Quiet Deep/Quiet
Iris and Pupil Round, 3 mm RTL Round, 3 mm RTL
RAPD Positive RE
Lens Clear Clear
Vitreos No AV cell /scatter vitreous
clumping
No AV cell / scatter vitreous
clumping
Fundus C:D 0.3, blurred disc margin, A:V
2:3, macular normal foveal reflex,
scatter whitish retinal infiltration,
sheathing vessels
C:D 0.3, A:V 2:3, macular normal
foveal reflex, scatter whitish retinal
infiltration, sheathing vessels
10 Aug 2016
Ocular examination
15. CSF protein sugar WBC RBC PMN Mono
CBC 38 64 6 - - -
NMO igG (CSF,serum) :negative
Oligoclonal band in CSF : positive
Quantiferon-TB : Negative
VEP : Slightly abnormal RE
Lab10 Aug 2016
16. Diagnosis
• Optic neuritis RE (Ddx NMO or MS)
• Intermediate uveitis BE (phlebitis R/O pars
planitis)
• R/O Autoimmune disease
17. Treatment
•Methylprednisolone 750 mg IV OD * 3
days(11-13 Aug 20/6)
-clinical improved 3 days(VA RE20/125) and
color vision normal
•pred (5) 7*1 oral(11days)
18. Progress note
Date VA RAPD
24 Aug 2016 RE : Fc' CC 20/200
LE : 20/40 PH not
positive RE
-Pred(5) 7*1
CTVF 24-2 : normal BE
26 Aug 2016 RE : 20/125 PH20/40 positive RE
23 Sep 2016 RE : 20/200 PH20/50 positive RE
28 Sep 2016 RE : 20/200 PH20/40 Negative
27/10/2016 -MRI brain c orbit c spine : slightly
enhancing of optic nerve RE
-MRI spine : No significant change of
lesion
1 Feb 2017 RE 20/125 PH not Negative
CTVF 24-2 : normal BE
color vision : normal BE
14 June 2017 RE 20/125 PH 20/63 Negative
19. MRI spine
• No significant change of lesion
27 Oct 2016
27 Oct201627 Oct2016
20. Present illness
1 day PTA : She had left eye pain and pain on eye
movement and suddenly blurred vision, no floater, no
flashing, no history of head/eye trauma, no history of
ocular surgery, no paresthesia/paralysis, no respiratory
symptom, no bowel/bladder symptom
21. Systemic review
• No fever
• No headache / severe dizziness / seizure /
unconsciousness / depression or mental illness
• No tinnitus
• No oral ulcer/severe sore
throat/tonsilitis/sinusitis/running nose/ abscessed teeth
• No UTI/proteinurea/hematurea/genital herpes
• No muscular pain/arthritis/stiffness/severe back pain
• No alopecia/poliosis/vitilligo/rash
22. Personal History
• No Smoking
• No ever eaten raw meat / unpasteurized milk / dirty
fruit or veggies
• No contact cat / dog / soil
• No insect bite
• No Hx of contact TB/chronic cough
23. Ocular examination
OD OS
VA 20/160 PH 20/100 20/160 PH 20/50
EOM full, no pain on eye movement full, pain on eye movement
IOP 19 17
Lid Not swelling Not swelling
Conjunctiva Mild injected, no discharge Not injected, no discharge
Cornea Clear Clear
A/C Deep/Quiet Deep/Quiet
Iris and Pupil Round, 3 mm RTL Round, 3 mm RTL
RAPD Positive LE
Lens Clear Clear
Vitreos AV cell trace/scatter snowball AV cell trace / scatter snowball
Fundus C:D 0.3 pale disc (temporal), A:V 2:3,
macular dull reflex, no cws , no
hemorrhage, no sheathing vessles
C: C:D 0.3 hyperemia,blurred discA:V
2:3, macular dull reflex, no cws , no
hemorrhage, no sheathing vessles
1 Sep 2017
36. Progress note
Date BCVA EOM
Eye pain/ Pain
on eye
movement
RAPD Tx
4 Sep 2017 RE : 20/63
LE : 20/32
full No positive LE -Pred(5) 7*1
- Disc Photo : No change
-CTVF 24-2 : Left
Superotemporal VF
defect( Compare
1/9/2017)
- OCT disc : poor signal
strength
13 Sep 2017 RE : 20/50
LE : 20/25
full No positive RE -Pred(5) 7*1
-Disc Photo and
-OCT disc : No change
43. Female
Young
History of optic neuritis RE
History of limb weakness
VF defect
Positive RAPD in each attack of effected eye
Color vision defect
Rapid VA gain after an attack
Positive finding on MRI
Positive result of oligoclonal band test
Negative result of NMO IgG
Presence of intermediate uveitis BE
Positive finding
44. Is it just an ordinary Optic neuritis?
Or Is it NMO!?
or Is it Optic neuritis with MS!?
45. OPTICNEURITIS
Optic Neuritis is a clinical diagnosis that is made when
a patient presents with
CLINICAL PRESENTATION PRESENC
E
pain with eye movement and/or periorbital discomfort
RAPD
visual field defect
optic nerve swelling (35% anterior disc edema, 65%
retrobulbar)
unilateral decreased visual acuity
46. OPTICNEURITIS
1.optic neuritis is a clinical diagnosis,
2.typical (unilateral vision decrease, pain with eye movement) optic neuritis will
recover with good visual prognosis by 6-12 months,
3.the final amount of vision recovery is independent of treatment with or without IV
IV steroids
4.oral prednisone alone is CONTRAINDICATED
5.MRI of the brain is a must after an initial episode of optic neuritis
47. OPTICNEURITIS
Up to 75% of MS patients have at least 1 episode of optic neuritis
The ONTT showed that even without any lesions present
on MRI, there still was a 16% chance of developing MS in
5 years, 22% in 10 years and 25% in 15 years.
At 10 years, the overall risk of MS was 38% after an initial episode of
optic neuritis. That risk is 56% if the MRI had 1 or more lesions.
48. OPTICNEURITIS
At 15 years, the overall risk of MS was 50% after an initial episode of
optic neuritis and strongly related to presence of lesions on a
baseline non-contrast-enhanced MRI of the brain.
No lesion on MRI brain = 25% chance of
developing MS
1 or more lesions on MRI brain = 72% chance of
developing MS
49. Talking about first attack
NMO
NMOSD without AQP4-IgG or NMOSD with unknown AQP4-IgG
status
1. At least 2 core clinical characteristics : Optic neuritis +LETM
acute myelitis (disseminated in space)
2. Negative test for AQP4-IgG from best detection method
3. Exclusion of alternative diagnosis
50. NMO Talking about first attack
Red flags (clinical/laboratory)
• Presence of CSF oligoclonal bands (occur in
<20% of NMO vs >80% of MS)
53. MS Talking about first attack
SPACE TIME
She had negative MRI finding after follow up
approximately 30 days from attack
54. Talking about second attack
• This time she only has left optic nerve enhancement on
MRI
• No spine lesion on MRI
• Negative NMO IgG in serum and CSF
• Positive oligoclonal band
NMO
56. • Uveitis is 10 times more common in MS patients
than in general population
• 30% of MS patients have uveitis
• Intermediate uveitis is the most common
manifestation of MS-associated uveitis
• 95% are bilateral
• Most patients develop mild vitritis with
periphlebitis
Chen L, GordonLK. Ocularn manifestations of multiple sclerosis. Curr Opin Ophthalmol.2005;16(5):315-320.
Zein G, Berta A, Foster CS. Multiplesclerosis-associated uveitis. OculImmunol Inflamm. 2004;12(2):137-142.
Evidence supporting MS theory
57. • Immunological abnormalities in the CSF are common in patients with
optic neuritis
• Frederiksen et al : abnormal CSF were present in 79% of 45 patients
with isolated optic neuritis which 69% were oligoclonal bands
• Soderstrom : oligoclonal bands were present in 69% of patients with
optic neuritis
• Predictive value of CSF oligoclonal bands for the development of CDMS
within 5 years after optic neuritis event : the presence of
oligoclonal bands was associated with the development of
CDMS (P=0.02) which was useful when MRI brain was
normal
Optic neuritis + oligoclonal bands from
ONTT
58. • CDMS developed in 42% of patients with optic neuritis+positive
oligoclonal bands test
• CDMS developed in 16% of patients with optic neuritis+negative test
result
• (Odds ratio 3.88 CI= 1.18,13.86 P=0.02)
Optic neuritis + oligoclonal bands from
ONTT
59. • Among 39 patients with normal MRI brain, CDMS developed in 3 of 11
(27%) patients with oligoclonal bands present but in only 1 of 28% (4%)
without oligoclonal bands
• Among 37 patients with abnormal MRI brain, CDMS developed in 13 of
27 (48%) with oligoclonal bands and in 5 of 10 (50%) without oligoclonal
bands
Optic neuritis + oligoclonal bands from
ONTT
thus MRI of the orbit with gadolinium looking for optic nerve enhancement, blood testing for inflammatory or infectious etiologies, and lumbar puncture are not needed for the diagnosis,
(IV STEROIDS DO NOT IMPROVE VISUAL OUTCOME, THE NATURAL HISTORY AND PROGNOSIS OF TYPICAL OPTIC NEURITIS IS VERY FAVORABLE WITH OR WITHOUT IV STEROID TREATMENT),
because it has been shown to cause more recurrences to the affected eye or new episodes in the contralateral eye compared to placebo or IV steroids followed by oral prednisone
because the number of lesions will stratify patients’ risk for developing clinically definite multiple sclerosis (CDMS) after a clinically isolated syndrome (CIS),
Since optic neuritis is common among patients who have MS, (up to 75% have at least one episode of optic neuritis in their life time), these patients are at risk for developing CDMS.
In patients with CDMS, the median time to diagnosis was 3 years and 34% of the diagnoses were made in the first 2 years whereas 72% were made within 5 years.
25% of patients with no lesions on baseline brain MRI developed MS during follow-up compared with 72% of patients with 1 or more lesions. Baseline factors associated with a lower risk for MS included male sex, optic disc swelling, and atypical features of optic neuritis.
NMOSD without AQP4-IgG or NMOSD with unknown AQP4-IgG status
At least 2 core clinical characteristics : Optic neuritis +LETM acute myelitis (disseminated in space)
Negative test for AQP4-IgG from best detection method
NMOSD without AQP4-IgG or NMOSD with unknown AQP4-IgG status
At least 2 core clinical characteristics : Optic neuritis +LETM acute myelitis (disseminated in space)
Negative test for AQP4-IgG from best detection method