This case report discusses a 20-year-old male with right-sided ptosis, hypotropia, and poor elevation in all gazes of the right eye (monocular elevation deficit) who was also found to have pellucid marginal degeneration. Examination found severe right-sided congenital ptosis with Marcus-Gunn jaw winking phenomenon and poor Bell's phenomenon. The patient underwent right eye inferior rectus recession and Knapp's procedure with Foster augmentation to address the monocular elevation deficit. Topography was performed pre and post-operatively. The association between monocular elevation deficit and pellucid marginal degeneration has not been previously reported. Further follow up is needed to evaluate the potential association and et
Simple report in ophthalmology
Squint Esotropia
by dr. Ali kareem
fifth year medical student in Al Mustansiriyah University College of Medicine\ Baghdad \ IRAQ 2018
Simple report in ophthalmology
Squint Esotropia
by dr. Ali kareem
fifth year medical student in Al Mustansiriyah University College of Medicine\ Baghdad \ IRAQ 2018
Introduction to general ophthalmic evaluation and management principles. Lecture taken at Central Park Medical College Lahore Pakistan. The guidelines will be useful for General Practitioners as well.
Rare Case Of Right Eye Persistent Fetal Vasculature With Left Eye Optic Nerve...Dr. Jagannath Boramani
Sayli Gavaskar - Jr.Resident, V H Karambelkar - Professor, D K Sindal - Professor, and HOD , Department of Ophthalmology KRISHNA INSTITUTE OF MEDICAL SCIENCES AND DEEMED UNIVERSITY, KARAD, MAHARASHTRA.
Oct : Noninvasive Method To Monitor Effectivity Of Chemotherapy In Lung Car...Dr. Jagannath Boramani
Dr. Prajakta Patil(Fellow), Dr. Sarvesh Tiwari(Consultant), Dr. Gaurav Shah(Honorary Consultant), Dr. Anand Subramanyam (Head Of The Department), K. B. H. Bachooali Ophthalmic And Ent Hospital,Parel,Mumbai
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...
Monocular Elevation Deficit With Pellucid Marginal Degeneration: A Case Report
1. Monocular elevation deficit with Pellucid Marginal
Degeneration: A case report
Authors:
− Dr Jayesh Suresh Patil
− Dr Mangesh Dhobekar
− Dr Prasanna Aradhye
− Dr Amrita Ajani
Token No. 0414
2. Introduction
Monocular elevation deficiency
inability to elevate eye in all
fields of gaze
presents with hypotropia of
affected eye which is equal
in all gazes
pseudoptosis with or without
true ptosis
Aetiology includes
supranuclear defects or
primary superior rectus
paresis or primary inferior
rectus restriction or
combination
Pellucid marginal degeneration
Peripheral corneal ectatic
disorder
Band of thinning 1–2 mm in
width, typically in the
inferior cornea,
high irregular astigmatism
Corneal topography shows
characteristic and typical
appearances.
3. Purpose:
To report and discuss a case of association between
monocular elevation deficiency(MED) and pellucid
marginal degeneration(PMD) and its management.
Association of monocular elevation deficit with
pellucid marginal degeneration is not reported before
4. History and examination
A 20 year old male came to OPD with drooping of
right upper eyelid since birth with poor vision.
Examination:
Right sided severe congenital ptosis with Marcus-
Gunn jaw winking and poor Bell's phenomenon was
noted. Right hypotropia was present which was equal
in all horizontal gazes.
5. Anterior segment and Fundus
Right Eye Left Eye
BCVA
6/45 6/6
Refraction
-1.00DS/-8.50DCX60 Plano
Lid
Severe Ptosis Normal
Conjuctiva
Clear Clear
Cornea
Clear Clear
Anterior
chamber
Quiet, well formed Quiet, well formed
Iris Pattern Normal Normal
Pupil Round regular,
brisk reaction
Round regular,
brisk reaction
Lens Clear Clear
IOP 16 mm Hg 16 mm Hg
Fundus WNL WNL
6. Squint Examination and plan
APCT/EOM
FDT Positive for Inferior rectus
FGT negative for Superior Rectus
Plan :
Stage I Inferior
rectus recession
Stage II Knapp's
procedure with
Foster
augmentation
9. Topography and pachymetry was performed pre-
operative and after 6 weeks
07-09-
2016
20-07-
2016
17-06-
2016
10. Further plan
For Ptosis with Marcus-Gunn Jaw winking
Planned for OD LPS muscle resection + Frontalis sling
procedure
For Pellucid Marginal degeneration :
To wait and watch for now. If corneal topography is
stable, Nil intervention
If Progression noted, may plan for Collagen cross-
linking or surgical inetervention
11. Discussion & Conclusion
Monocular elevation deficiency is commonly
associated with congenital ptosis, Marcus-Gunn jaw
winking phenomenon. Other ocular associations of
MED were not much reported. Here we are
presented a case of association between monocular
elevation deficit with pellucid marginal
degeneration. Further evaluation and follow up will
be required to confirm association and aetiological
correlation