Ocular hypertension is defined as an intraocular pressure (IOP) greater than 21 mmHg without evidence of optic nerve damage or visual field defects. It affects 4-10% of people over age 40 and is more common in African descendants and those with thinner central corneas. While the exact cause is unknown, genetic factors may play a role in increasing outflow resistance and IOP. Treatment aims to lower IOP by at least 20% and is recommended for those at high risk of progression to glaucoma based on factors like baseline IOP, optic nerve characteristics, and family history. Annual monitoring is sufficient for low risk patients while high risk patients may require medical treatment with eye drops.
Diabetic maculopathy is a form of damage to the eye causing by diabetic macular oedema where fluids build up on the macula. It can be cured by laser surgeries.
Diabetic maculopathy is a form of damage to the eye causing by diabetic macular oedema where fluids build up on the macula. It can be cured by laser surgeries.
Glaucoma slideshare for medical students NehaNupur8
complete information about glaucoma eye disease contain detail of definition ,classification, types, pathophysiology, risk factor, causes, medical management ,nursing management, drug therapy, nursing process . for medical students, made by students of basic bsc nursing RIMS students
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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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
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
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.
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
3. DEFINITION
• Ocular Hypertension is defined as
1.IOP > 21 mmHg
2.No evidence of optic nerve damage
3. No visual field defects.
4.open angles
5. no systemic or ocular cause for raised IOP
5. What to do with these patients?
How often should they be examined?
Is preventative treatment effective?
Who should be treated?
6. EPIDEMIOLOGY
• 4-10% population over 40 yrs
18.4% in black african descent
13% in mixed race
4.6% in whites
• In southern India prevalence of 1.1% in
individuals above 40 years of age has been reported
7. PATHOPHYSIOLOGY
• The exact pathophysiology of elevated intraocular
pressure (IOP) in ocular hypertension is not known.
• myocilin (MYOC) gene mutations have been found
and determined to cause protein misfolding, making
trabecular meshwork cells dysfunctional, with
subsequent decrease in outflow facility and marked
elevation of IOP
10. CCT
• Relative risk of POAG increased by 81% for every
40µ decrease in CCT.
• CCT less than 555µ were found to be at greater risk
than eyes with CCT more than 588µ.
IOP
• >22 mmHg is a positive predictive factor for the
development of POAG
AGE
• Individuals with older age hada greater risk for
conversion to glaucoma
11.
12. PATTERN STANDARD DEVIATION (PSD)
• OHTS found that greater PSD on SAP correlated
with increased risk of progression to POAG
• With 0.2dB increase in PSD, 22% increase in
relative risk was found in OHTS.
OPTIC NERVE
• increased vertical and horizontal cup-disc ratio is a
risk factor for progression
• Increase in CDR by 0.1 leads to 32% and 27%
increase in relative risk in vertical and horizontal
cupping, respectively
13.
14. DIAGONOSIS of exclusion !!
• HISTORY- to R/O any sec causes for elvated IOP like
trauma/steroid usage
• Usage of antihypertensives as they cause IOP
fluctuations
• advanced age (>50 y), African American descent,
myopia, and positive family history/severity of
glaucoma in a first-degree relative
16. SLB
CORNEA
• microcystic edema can be found with a sudden
elevation of IOP.
• KP’S, pigment on the endothelium (Krukenberg
spindle), and congenital and other anomalies
suggest a secondary cause of elevated IOP
17. • ANTERIOR CHAMBER, assess for an absence of
cell or flare, hyphema, foreign bodies, and angle
closure.
• IRIS atrophy, synechiae, rubeosis, ectropion uveae,
iris bombé, difference in iris coloration bilaterally
(eg, Fuchs heterochromic iridocyclitis),
or pseudoexfoliation (PXF) material.
• LENS assess for an absence of phacomorphic, PXF,
Morgagnian, or phacolytic cataract.
18. • OPTHALMOSCOPY –normal optic disc with no E/O
cupping or RNFL loss
• GONIOSCOPY-open angles
• IOP- >21 mm Hg
• PACHYMETRY
• VF/AUTOMATED PERIMETRY TESTING
• OTHER TESTS : OCT HRT GDX
19. • Medeioros and colleagues developed a risk
calculator for OHT that may progress to glaucoma
20.
21.
22. TREATMENT
• Considering the low
rate of progression to
POAG, cost of ocular
hypotensive
medications, long
term compliance
issues and side effect
of drugs, not every
case of ocular
hypertension is
subjected to
treatment with ocular
hypo tensiveS
23. • Therefore, treatment is recommended only in high
risk group
• Lowering of IOP by atleast 20% is recommened.
• Topical beta blockers or prostaglandin analogues are
usually the preferred agents
• Patients with moderate risk of progression should
be monitored closely and treatment is initiated with
the earliest sign of glaucomatous damage
24. HIGH RISK- NEED RX
1. Retinal nerve fiber layer defects.
2. Parapapillary changes.
3. IOP > 30 mmHg
4. IOP > 26 mmHg with central corneal thickness
<555 microns.
5. Vertical cup-disc ratio 0.4:1 or more with central
corneal thickness <555 microns.
25. MODERATE RISK: annual follow-up
1. IOP 24-29 mmHg without retinal nerve fibre layer
damage.
2. IOP 22-25 mmHg with central corneal thickness
<555
microns.
3. Vertical cup-disc ratio 0.4:1 or more with central
corneal thickness between 555-588 microns.
4. Family history of POAG in first degree relative.
5. High Myopia.
26. LOW RISK: Follow-up every 2 years
1. IOP 22-23 mmHg with central corneal thickness
more than 588 microns.
2. Vertical cup-disc ratio 0.4 or more with central
corneal thickness more than 588 microns.
27. • Other possible indications for treatment
1.One eyed patient
2.Young patient,will be exposed to high pressures for
many years
3.Unreliable visual or optic disc assesment
4.Patient who is in content with treatment initiated by
another physician and tolerating medicaton well
5.An ocular htn pt who desires treatment
6. OHTN pt who has developed vascular occlusion in
either eye
28. • Monotherapy is preferred with a max of 2
medications at a time
• If not reducing SLT can be used
• Aggressive therapy should never be tried
29. • Hence, early recognition and treatment of high risk
patients can limit the visual disability due to POAG.
• Frequency doubling perimetry (FDP) or short
wavelength automated perimetry (SWAP) detects
glaucomatous damage at a very early stage, 4 years
before the changes appear in white-on white
perimetry.
• Hence, for patients under monitoring, FDP or SWAP
may be beneficial in early initiation of treatment.