This document provides an overview of rhegmatogenous retinal detachment (RRD). It begins with definitions of the three types of retinal detachment - RRD, exudative retinal detachment (ERD), and traction retinal detachment (TRD). For RRD, it describes the pathophysiology involving a break or tear in the retina that allows fluid from the vitreous cavity to separate the sensory and retinal pigment epithelium layers. Risk factors, clinical features in both early and long-standing cases, the Lincoff rule for locating retinal breaks, and various management approaches including pneumatic retinopexy, scleral buckling, and vitrectomy are summarized.
A surgical procedure featuring a partial thickness scleral flap that creates a fistula between AC and subconjunctival space for filtration of aqueous and creation of conjunctival bleb in an effort to lower IOP
A surgical procedure featuring a partial thickness scleral flap that creates a fistula between AC and subconjunctival space for filtration of aqueous and creation of conjunctival bleb in an effort to lower IOP
Congenital Glaucoma is one of the most common causes of irreversible childhood blindness. This presentation covers this topic in detail that can aid physicians in effective patient care.
PS: The slides in the preview look skewed, download the presentation to view the font used in Office 2012 and upwards.
Most retinal surgeons are trained to create formal retinal drawings of the fundus.
Retinal drawings are useful to document pathology, although more and more people now prefer fundus photographs.
Can be used for serial follow up of patients to document changes in the pathology.
Congenital Glaucoma is one of the most common causes of irreversible childhood blindness. This presentation covers this topic in detail that can aid physicians in effective patient care.
PS: The slides in the preview look skewed, download the presentation to view the font used in Office 2012 and upwards.
Most retinal surgeons are trained to create formal retinal drawings of the fundus.
Retinal drawings are useful to document pathology, although more and more people now prefer fundus photographs.
Can be used for serial follow up of patients to document changes in the pathology.
NW2012 Intraocular Lens Design and Effects on VisionNawat Watanachai
some information about intraocular lens materials, designs; and their effect on surgery and visual function.
I'm sorry that i one i previously uploaded was the wrong file.
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
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.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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
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.
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.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
2. Little QUIZ (10min)
1. how to differentiate RRD/TRD/ERD
from fundus findings?
2. risk of PVR
3. contraindication for pneumatic
retinopexy
4. compare PPV vs SBP for RRD
5. compare laser vs cryo retinopexy
5. The Vitreous
Water 98-99% water
1-2%
collagen type II fibres*
salts, sugars
glycosaminoglycan, hyaluronic acid
very few cells
mostly phagocytes
hyalocytes of Balazs (surface/ hyaluronate)
refractive index of 1.336
6. The Vitreous *
Condense and attach more at
Optic disc rim
Along blood vessels
Macula
Peripheral retinal abnormalities
○ Chorioretinal scar
○ Lattice degeneration and others
Ora serrata (Vitreous base: 2mmA, 4mmP)
10. Posterior vitreous detachment
Prevalence increase with
AXL
age
○ < 10% at < 50 yrs
○ 30% at 50-70 yrs
○ >60% at > 70 yrs
Other associate
Cataract Sx, within 2 yrs after surgery
○ ICCE 84% = ECCE c PC tear76%
○ ECCE c intact PC40%
○ PE 30%
inflammation / uveitis
trauma
syndromes
11. Posterior vitreous detachment
Symptoms
most asymptomatic
photopsia
○ physical stimulate of vitreoretinal traction
floaters
○ Weiss ring and V.condensation in the posterior
hyaloid surface
○ vitreous opacity eg. blood , glia cell
VH rupture of retinal vessel
14. Rhegmatogenous retinal
detachment
-
A hole, tear, or break
in the neuronal layer
allowing fluid from the
vitreous cavity to
seep in between and
separate sensory and
RPE layers
15. RB and PVD*
acute symptomatic PVD
15% retinal tear
PVD with VH
50-70 % retinal tear
PVD without VH
10-12 % retinal tear
19. Mortality/Morbidity*
1: 10,000 population : yr
15% of people with RD in one eye
develop RD in the other eye. (lifetime)
Risk of bilateral RD is increased
(25-30%) in patients who have had bilat
eral cataract extraction.
21. History
Detachments anterior to the equator are
very unlikely to affect the VF
Detachment posterior to the equator can
be isolated with visual field testing, but
many patients aware of a defect only when
it involved the posterior pole and macula.
Photopsia and floaters not helpful in
locating the position of the retinal tear or
detachment
visual field defect very specific for
locating the detachment.
22. History
FHx of RRD
History of trauma
previous surgery
cataract extraction/ esp c cpx (-L-’)
intraocular foreign body removal
retinal procedures
23. Physical examination
VA/ VF
IOP : hypotony of >4-5 mm Hg less than
the fellow eye is common
Vitreous
tobacco dust (Shafer’s sign), pathognomonic for
a retinal tear in 70% of cases with no previous
eye disease or surgery.
26. Retinal detachment
Which one is this case?
1. Rhegmatogenous retinal detachment (RRD)
2. Exudative retinal detachment (ERD)
3. Traction retinal detachments (TRD)
27. Is this RRD/ TRD or ERD *
symptoms
RRD
TRD
ERD
floaters
++
+/-
+/-
flashing
++
-
-
Progressio
n of VA
loss
acute
chronic
Subacute/
chronic
Fluctuation
of vision
-
+/-
+
31. CLINICAL FEATURES:early
Early
retina lost transparency and assumes a
gray, translucent appearance
fine, irregular corrugations usually present
○ result of intraretinal edema
33. CLINICAL FEATURES : early
fine details of the choroidal vasculature
obscured by overlying detached retina
within days of RRD
outer retinal degeneration starts to occur
photoreceptor damage related to height and
duration
circulation of inner retina not affected
34. CLINICAL FEATURES : early
If retina reattached within a week
most of cellular changes reversible
RPE cells underlying RRD released
into SRF and may pass through RB into
vitreous cavity
tobacco dust 70% of case
35. CLINICAL FEATURES :early
Lincoff and Geiser reported 4 guidelines
for locating RB causing RRD *
determined by
○ location of causative break
○ anatomic barriers (optic n.,ora serrata,
existing chorioretinal adhesions)
○ effect gravity on SRF in upright
position
Note : only for fresh RD with 1 RB
37. Lincoff rule
total or superior RD
that cross midline
primary hole usually
within 1 clock hr. of
o'clock meridian
12-
If detachment extends
more inferiorly on
either nasal or
temporal side
RB usually on same
side of 12-o'clock
meridian
38. Lincoff rule
superotemporal RD
RB lies near superior edge of detached retina
superior nasal or temporal RD
RB lies within 1.5 clock hr. of the highest border 98%
39. Lincoff rule
inferior RD
higher side indicates
which side of the disc
an inferior hole lies
95% of the time
inferior detachment
is bullous
primary hole lies
above horizontal
meridian
41. CLINICAL FEATURES :LONG-STANDING
RRD ≥ 3 mo.
RPE metaplasia at border of detachment
Most RRD surrounded by demarcation line
eventually progress; nonetheless, surgical
repair of these eyes has an excellent
prognosis
44. CLINICAL FEATURES :LONGSTANDING
very long-standing
extensive capillary nonperfusion lead to
peripheral retinal NV
IOP can rise
○ TM impeded by pigment clumps or the outer
segments of photoreceptors
45. PROLIFERATIVE
VITREORETINOPATHY
occurs ~ 10% of all RRD which ¼ require
additional surgical intervention
most common cause of failure to repair
risk factor
aphakia , preop PVR , extensive RD , uveitis ,
excessive cryo, GRT, massive VH
46. Classification
RD with vitreoretinopathy1983*
Grade
Name
Signs
A
Minimal
vitreous haze ,pigment clump
B
Moderate
wrinkling inner retinal surface,roll edge RB ,
retinal stiffness , vessel tortous
C
Marked
full thickness fix retinal fold
C1,C2,C3
D
Massive
full thickness fix retinal fold 4 quadrants
D1 wide ,D2 narrow
D3 close not seen optic disc
47. Classification of PVR 1991*
grade
features
A
vitreous haze ,pigment clump,pigment cluster inferior
retina
B
wrinkling inner retinal surface,roll and irregular edge RB ,
retinal stiffness , vessel tortous ,vitreous mobility ,
CP1-12
posterior to equator : focal , diffuse ,or circumferential full
thickness fold , subretinal strands
CA1-12
anterior to equator : focal ,diffuse ,or circumferential full
thickness fold , subretinal strands
48. Management RRD
Retinal repositioning
Push the retina-eyewall
○ Pneumatic retinopexy
○ Scleral buckle procedure
○ vitrectomy
Remove SRF/ perfluorocarbon liquid
Remove fibrous membrane/traction
Seal the break(s)
Cryoretinopexy
Laser retinopexy
Temponade the retina
Gas/ silicone oil
50. Pneumatic retinopexy *
intravitreal gas tamponade RB temporary
100%C3F8
4X at 72 hrs
SRF will resolve
Need laser / cryo to permanently close the
RB
55. Scleral buckle : Segmental *
usually reserved for
RRD < 1 clock hour
posterior breaks
primary advantage
easy of placement
minimal refractive error change
avoid effects of large encircling elements
however, for most large posterior breaks ,
all MH prefer closure with gas and
vitrectomy
56. Scleral buckle : Segmental
not provide retinal support elsewhere
vitreoretinal traction away from
segmental element not supported,
which may result in formation of new RB
because of limited support , some
surgeon prefer encircling when possible
57. Scleral buckle :encircling
particularly indicated in *
multiple breaks in different quadrants
Aphakia/ pseudophakia
High/pathologic myopia
diffuse vitreoretinal pathologic eg. extensive
lattice degeneration or vitreoretinal
degenerations
PVR ≥ grade B
61. Scleral buckle
macula off VA ≥ 20/50 ~ 40-60%
duration of macula detachment relate
with final VA
VA ≥ 20/40
71% if detach < 10 days
VA ≥ 20/40 27% if detach 11days-6 weeks
VA ≥ 20/40
14% if detach > 6 weeks
71. Laser photocoagulation
usually cannot seal RB if presence SRF
may be use to create barrier to prevent
progression of RD
esp. useful in
chronic inferior RD
systemic illness contraindicate to surgery
73. Laser photocoagulation*
Slit-lamp
better magnified
Safer in inexpertise
operator
Less need of corneal
care during laser
Less pain
LIO
significant cataracts,
PCO, mild VH more
easily treated with
LIO
indentation
Need more skill
not be readily
available
Any patient position
75. Laser photocoagulation *
Compared with diathermy and cryopexy
less breakdown of blood–ocular barrier
thermal effect confined predominantly to
retina and pigment epithelium
little or no effect on choroid or sclera
induces adhesive effect between retina &
pigment epithelium within 24hr
76. Cryoretinopexy
RD with very shallow fluid can be cure by
cryoretinopexy alone
using cryoprobe and indirect ophthalmoscope
testing cryoprobe prior to make sure probe is
freezing
77. Cryoretinopexy
freezing or whitening of RPE will noticed first,
followed by delineation of edges of retinal tear
and whitening of retina
excessive freezing or ice crystal formation
should be avoided
78. Cryoretinopexy
histologic response depends on whether
RPE alone or RPE and overlying detached
retina together are frozen
only RPE froze once retina reattached
○ pigment epithelial hyperplasia
○ loss of retinal outer segments
○ normal microvillous interdigitations seen between
retina and RPE are missing
79. Cryoretinopexy
If both RPE and overlying retina frozen
cellular connections between retina and RPE
consisting of desmosome formation between
retinal glia and pigment epithelium or direct
contact between retinal glia and Bruch's
membrane
80.
81. Cryoretinopexy
Disadvantage
dispersion of pigment epithelial cells, which can
result in subretinal pigmentary changes after
reattachment
dispersion of viable pigment epithelial cells
capable of causing PVR following cryopexy
82. Cryoretinopexy
Some study suggest cryopexy is risk factor of
post-op PVR whereas others not show an
association
minimize cryotherapy-induced pigment epithelial cell
dispersion by
○ not over treating
○ avoiding unnecessary scleral depression of treated
areas
localization and examination with scleral
depression should be performed before
cryopexy
83. Cryoretinopexy : disadvantage
induce choroidal congestion &hyperemia
although not permanent
may complicate drainage of SRF through
treated areas
breakdown of BRB
cause post-op CME and ERD