This document discusses intermediate uveitis (IU), which involves inflammation in the anterior vitreous, pars plana, and peripheral retina. IU accounts for 8-22% of uveitis cases. Clinically, it is characterized by "snowballs" or yellow-white exudates in the peripheral vitreous. Treatment involves topical/periocular steroids initially, with cryotherapy, vitrectomy or immunosuppressants for non-responsive cases. Complications include cystoid macular edema, cataracts, glaucoma, and retinal detachment. Proper diagnosis requires excluding other causes like syphilis, Lyme disease, multiple sclerosis and sarcoidosis.
This presentation describes the background of the cornea and the corneal diseases in general, also it describes in detailed manner how to manage the corneal ulcer with its different causes
This presentation describes the background of the cornea and the corneal diseases in general, also it describes in detailed manner how to manage the corneal ulcer with its different causes
Pars Planitis is a disease of the eye that is characterized by inflammation of the narrowed area (pars plana) between the colored part of the eye (iris) and the choroid. This may lead to blurred vision; dark, floating spots in the vision; and progressive vision loss.
A detailed description of sarcoidosis, pulmonary in specific but also covering the other systems. a rare entity in india or a better way to say, often an overlooked disease.
“An ENT disease with an ophthalmic manifestation”
Orbital cellulitis (OC) is an inflammatory process that involves the tissues located posterior to the orbital septum within the bony orbit, but the term generally is used to describe infectious inflammation.
It manifests with erythema and edema of the eyelids, vision loss, fever, headache, proptosis, chemosis, and diplopia.
OC usually originates from sinus infection, infection of the eyelids or face, and even hematogenous spread from distant locations.
OC is an uncommon condition that can affect all age groups but is more frequent in the pediatric population.
This seminar is for medical graduates..it describes inflammation of posterior part of uvea i.e choroid along with retina.it describes symptoms, signs and how to diagnose such patient and treatment.
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
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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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.
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
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
3. • Pars plana is a flat extension from posterior
aspect of ciliary processes to ora serrata
• 3.5 to 4 mm in length
• Around 3 mm from limbus- ciliary processes
6. International Uveitis Study Group (IUSG)
Anatomic Classification of Uveitis*
Anterior uveitis
Primary site of inflammation: anterior chamber
Intermediate uveitis
Primary site of inflammation: vitreous
Posterior uveitis
Primary site of inflammation: retina or choroid
Panuveitis
Primary site of inflammation: anterior chamber, vitreous, retina or
choroid
7. INTERMEDIATE UVEITIS
• Intermediate uveitis (IU) is described as inflammation in
the anterior vitreous, pars plana and the peripheral retina
• The diagnostic term pars planitis should be used only for
that subset of IU where there is snow bank or snowball
formation occurring in the absence of an associated
infection or systemic disease
8. DEMOGRAPHY OF INTERMEDIATE
UVEITIS
• Incidence in population – 1 in 15000
• % of IU in cases of uveitis- 8 to 22%
• Incidence in indian referral eye hospital-
19.8%
• Male: female- 54:46
• Average age in various studies- 23 to 28 years
• Bilateral- 70 to 90% at presentation
9. • The IUSG (International Uveitis Study Group)
suggested the term IU to denote an idiopathic
inflammatory syndrome, mainly involving the
anterior vitreous, peripheral retina and the
ciliary body with minimal or no anterior
segment or chorioretinal sign
10. • IU is not hereditary though it has been
observed in families.
• patients who are HLA-DR15-positive and have
IU may have systemic findings of another HLA-
DR15-related disorder- multiple sclerosis,
optic neuritis, and narcolepsy
11. ETIOPATHOGENESIS
• Exact theory yet to be known
• may be initiated by an unknown antigen, leading
to a clinical picture of vasculitis and vitreous cells.
• antigen may be infectious(Lyme's, syphilis and
cat-scratch fever) , autoimmune-(multiple
sclerosis and sarcoidosis)
• Type II collagen in the vitreous may be an
autoantigen in some patients
contd...
12. • Intermediate uveitis seems to be a T-cell-
mediated disease
• Lymphocytic infiltration of the retinal venules
leads to the clinical picture of vasculitis.
• T-cells are the predominant cell type in the
vitreous up to 95% of all cells, of which CD4+ cells
are 35-90%.
• Macrophages -second most important cells
• In active inflammation epitheloid cells and
multinucleated giant cells are seen
• HLA associations include HLA-DR, B8, and B51,
the most significant being HLA-DR which occurs in
67-72% of patients
13. HISTO-PATHOLOGY
• Histological studies of the peripheral retina
and ciliary body demonstrate – condensed
vitreous, fibroblasts, spindle cells,
lymphocytes and blood vessels and prominent
lymphocyte cuffing of retinal veins.
• Pars plana exudates appear to consist of loose
fibrovascular layer containing scattered
mononuclear inflammatory cells and a few
fibrocyte-like cells adjacent to the hyperplastic
nonpigmented epithelium of the pars plana.
14. CLINICAL FEATURES
One of the most under diagnosed uveitic
disease- lack of routine examination of pars
plana, lack of awareness
SYMPTOMS-(initially)
• floaters
• Mild blurring of vision
• Mild photophobia
• Uncommon- pain, redness
15. SIGNS-
• Conjunctiva- mild congestion
• Anterior chamber- no or minimal findings
• Cells and flare, KPs, posterior synechiae
( usually inferiorly)
• Vitritis is a characteristic feature of IU, and it is
typically described as vitreous haze ranging
from trace to 4+
16.
17. FUNDOSCOPY-
• Characteristic mobile, globular, yellow-white
"snowballs" ("ants' eggs") seen in the inferior
peripheral vitreous.
• They lie close to the retina, but are not in
contact with it.
• Inflammatory exudates accumulate over pars
plana to form SNOWBANK
• Periphlebitis of peripheral veins in vicinity of
exudates
18.
19. CONTD....
• Later the vitreous shows degenerative changes
with fibre-like cylindrical condensations of
coarse vitreous strands.
• Posterior vitreous detachment (PVD) is
common
• Retinal changes in IU include tortuosity in
arterioles and venules, sheathing of peripheral
veins, neovascularizations and retinal
detachments
• Cystoid macular edema
20.
21. The hallmark of pars planitis are
• the white or yellowish-white pars plana
exudates ("posterior hypopyon") and
• collagen band (snowbank) over the pars plana.
• These exudates are preretinal, peripheral,
typically inferior but may also be superior or
divided into multiple foci or extend 360
degrees over the entire pars plana
26. Multiple sclerosis: About 3-27% of patients
develop pars planitis and 7.8-14.8% of
patients with IU/pars planitis develop MS.
• characterized by pars plana snowbanks, retinal
periphlebitis (in 5-20%) and panuveitis are the
commonest manifestations of MS and up to
95% are bilateral
Intraocular lymphoma:10-20% the disease
commences as vitreous or retinal infiltrates
mimicking uveitis and 95% are non-Hodgkins
B-cell lymphomas
27. Sarcoidosis: About 23-26% of patients with sarcoidosis
develop IU
• typical ocular findings-CME, optic disc swelling,
periphlebitis, and retrobulbar optic neuritis were
seen in patients with IU, both with or without
sarcoidosis
• It is commonly bilateral, and presents as IU and
granulomatous anterior uveitis
28. Syphilis: uveitis is the commonest presentation of syphilis.
• Anterior uveitis( granulomatous and
nongranulomatous), posterior uveitis, panuveitis, vitritis,
vasculitis, retinitis, placoid choroiretinitis and optic
nerve involvement are also seen in eyes with syphilitic
uveitis.
• IU has been described to occur in Lyme's disease caused
by another spirocheate- Borrelia burgdorferi, both in
adults and in children
29. DIAGNOSIS
• Diagnosis is based on clinical findings
• patient's history should focus-duration of
symptoms, the number of recurrences, and
findings that might be associated with
systemic disorders
30. Ancillary test-
FFA- detection of CME
- capillary and disc hyperflourescence,
staining of vessel wall, fern pattern radial
hyperflourescence
31. • USG- exudates over pars plana
• ERG- abnormal b wave implicit time
• UBM- exudates and vitritis
34. CATARACTS-
• Either due to inflammation or steroids
• Most often type – PSC
• 15-50% of eyes
• GLAUCOMA
35. • Optic disc edema- due to intraocular
inflammation
20% patients
• optic neuritis – may or may not be associated
with multiple sclerosis
• NVD/NVE
36. • Venous sheathing- most often benign
• VASCULITIS- associated with ischaemia
Sheathing +/-
• Retinal detachment
A) Serous RD
B) Rhegmatogenous RD- associated with dialysis at
snow bank
37. TREATMENT
Four step approach by Kaplan
Step 1-
• Posterior sub tenon injection of steroids- methyl prednisolone
40mg or triamcinolone 40 mg (0.75 to 1 ml)
• Preferably in upper temporal quadrant
• 2 to 3 injections at interval of 3-4 weeks- resolution
• Topical 1% prednisolone acetate
• Systemic steroids 1mg/kg can be added (mantoux test to be done)
• Improvement in vision 67% cases
• Appropriate antibiotics for infections causes
Compliactions- rise in iop, ptosis, globe perforation, necrotising
scleritis
38.
39. Step 2-
• Not responded to peri ocular/ systemic steroids
• Cryopexy can be done
• Mechanism- destruction of hyperemic vascular
component of diseases by eliminating neovasclar
and ischaemic tissue
• Double freeze and thaw technique
• Impovement in vision- 32 to 67 percent
• Complications- RD, PVR
• Doesnt prevent recurrence
• Indirect laser also used
40. Step 3-
• Not responding to cryopexy also
• Pars plana vitrectomy is done
• Helps in early resolution of CME
Step 4-
• If step 1 fails- immunosuppresive agents can be
used
• Cyclophosphamide, azathioprine, chlorambucil
• Azathioprine- 50 mg thrice daily for four
months(tapered)
• Platelet counts, WBC regularly monitored
42. • Some advocate use of a combination of
betamethasone and depot methylprednisolone(sub
tenon) in an effort to achieve early onset and
prolonged duration of action.
• Intravitreal triamcinolone acetonide injections have
been used to treat CME
• use of somatostatin analogues (Octreotide) IM and
intravitreal bevacizumab (Avastin) in patients with
refractory uveitic CME.
• the surgical implantation of a fluocinolone acetonide
(Retisert) or dexamethasone (Ozurdex) implant can be
considered
43. STEROID REFRACTORY UVEITIS
• Cyclosporine, tacrolimus, azathioprine, and methotrexate are the
most commonly used agents with documented efficacy in many
uveitic conditions
• Chlorambucil can be considered for intractable cases
NEWER DRUGS USED-
• infliximab, (anti-TNF) monoclonal antibody, has been shown to be
effective in improving macular thickness and visual acuity in
patients with uveitic refractory CME due to intermediate uveitis or
other noninfectious uveitis.
• Daclizumab, an interleukin-2 receptor blocking antibody, has been
shown to be effective in noninfectious uveitis in a multicenter
nonrandomized interventional case series
• interferon-beta (INF-beta), which has an established value in the
treatment of MS, appears to have a positive effect in terms of visual
acuity, CME
44. • MANAGEMENT OF GLAUCOMA
• Rx OF CATARACT
• Anti VEGF for neovascularisation
• Supportive rx
