1. Tuberculosis can affect many parts of the body including the eyes. It is caused by the bacterium Mycobacterium tuberculosis.
2. Ocular tuberculosis can manifest in different ways depending on if it is primary or secondary infection. It can cause anterior and posterior segment inflammation, choroidal tubercles, and neuro-ophthalmic issues.
3. Diagnosing ocular tuberculosis can be difficult as bacterial loads are often low in ocular tissues and fluids. Investigations include tests like Mantoux, chest imaging, and PCR on ocular samples, but results are not always conclusive.
www.ophthalclass.blogspot.com has the complete class and MCQs on uveitis for undergraduate medical students. Class 5 in the series of classes on uveitis deals with the common causes of panuveitis and briefly discusses their management. The clinical feature of each of the disease entities is explained with the help of case studies.
www.ophthalclass.blogspot.com has the complete class and MCQs on uveitis for undergraduate medical students. Class 5 in the series of classes on uveitis deals with the common causes of panuveitis and briefly discusses their management. The clinical feature of each of the disease entities is explained with the help of case studies.
you will get information and knowledge about different dyes, their uses in the diagnosis of ocular diseases in detail.
different dyes are as follows: Fluorescein, Rose Bengal, ICG, Lissamine Green, and Trypan Blue.
Central Retinal Artery Occlusion (CRAO) for undergraduate MBBS Students.
Covers the basics of Aetiology, pathophysiology, clinical features, types, associated conditions and management of CRAO.
Also encompasses salient points for PGMEE
Synoptophore is an instrument for diagnosing imbalance of eye muscles and treating them by orthoptic methods. In this presentation the parts of the synoptophore and the different slides used in the instrument are discussed
It contains Examination Protocol for Contact Lenses along with information about pre-requisites for fitting a Contact Lens. A helpful guide for all Students, Eye Care Practitioners (Optometrist, Ophthalmologist).
you will get information and knowledge about different dyes, their uses in the diagnosis of ocular diseases in detail.
different dyes are as follows: Fluorescein, Rose Bengal, ICG, Lissamine Green, and Trypan Blue.
Central Retinal Artery Occlusion (CRAO) for undergraduate MBBS Students.
Covers the basics of Aetiology, pathophysiology, clinical features, types, associated conditions and management of CRAO.
Also encompasses salient points for PGMEE
Synoptophore is an instrument for diagnosing imbalance of eye muscles and treating them by orthoptic methods. In this presentation the parts of the synoptophore and the different slides used in the instrument are discussed
It contains Examination Protocol for Contact Lenses along with information about pre-requisites for fitting a Contact Lens. A helpful guide for all Students, Eye Care Practitioners (Optometrist, Ophthalmologist).
Now a days TBM is super most disease in Indian children.
Tuberculous meningitis (TBM) is difficult to diagnose, and a high index of suspicion is needed to make an early diagnosis.
“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.
Tuberculosis pathophysiology and diagnosis | Jindal Chest ClinicJindal Chest Clinic
Tuberculosis is an infectious lung disease caused by bacteria, spreading through the air through coughing, sneezing, or spit. It is preventable and curable. This presentation gives an overview on "Tuberculosis pathophysiology and diagnosis". For more information, please contact us: 9779030507.
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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.
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.
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
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.
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.
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
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.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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.
2. • Tuberculosis (TB) is the most important systemic
infectious disease usually caused by the bacterium
Mycobacterium tuberculosis (MTB).
• Presently, one-third of the world's population is thought
to be infected with TB.
• Tuberculosis primary involves lung but can also affect
other parts of the body.
• Secondary ocular TB is a common presenting form
3. • Most infections - latent tuberculosis
• About 10% of latent infections → active disease
• More than 95% of deaths occurred in developing countries
• The classic symptoms of active TB are ~
a chronic cough with blood-containing sputum
fever
night sweats and
weight loss
4. CAUSES:
• The main cause of TB is Mycobacterium tuberculosis
(MTB), a small,obligate aerobic,nonmotile acid fast
bacillus.
• The M. tuberculosis complex (MTBC) includes four other
TB-causing mycobacteria:
M. bovis
M. africanum
M. canetti and
M.microti.
5. CAUSES:
• Other known pathogenic mycobacteria include –
M. leprae
M. avium
M. kansasii.
• The latter two species are classified as"nontuberculous
mycobacteria" (NTM).
• NTM cause neither TB nor leprosy, but they do cause lung
diseases that resemble TB.
6. TRANSMISSION OF INFECTION:
• Primary airborne disease
• Spreads person to person : by cough or sneezing,rarely by direct
contact & by blood.
• Droplets measuring 1 to 5 micron suspended in air for several hours
can harbour the bacteria
• Usually 5 to 200 inhaled bacteria : sufficient for infection
• About 90 % of infected patients : asymptomatic
• Approximately 80% pulmonary TB & 20% extrapulmonary TB
7. EXTRA PULMONARY TB :
• Extrapulmonary TB occurs more commonly in people with a
compromised immune system and young children.Notable
diseases are-
• The pleura ( tuberculous pleurisy)
• The central nervous system (tuberculous meningitis)
• The lymphatic system (scrofula of the neck)
•
8. EXTRA PULMONARY TB :
• The genitourinary system ( urogenital tuberculosis)
• The bones and joints ( Pott disease of the spine)
• The eye (Ocular tuberculosis)
9. OCULAR TB :
• Results from 1)Active infection or
2) An immunological reaction to the organism.
• 2 types :
A.Primary ocular TB -in which the eye is the primary portal of
entry manifests mainly as conjunctival,corneal & scleral disease.
B.Secondary ocular TB - occurs by virtue of hematogenous
dissemination or by contiguous spread from adjacent structures &
manifests mainly as uveitis.
10. CLINICAL MANIFESTATION :
• A) Adnexal manifestation
• B) Anterior segment manifestation
• C) Posterior segment manifestation
• D ) Neuro ophthalmic manifestation
• E) Drug related ocular toxicity
11. ANTERIOR UVEITIS
• Acute or Chronic granulomatous
uveitis
• May be associated with iris or angle
granuloma
• Mutton fat KPs
• Posterior synechiae –broad based
12. ANTERIOR UVEITIS
• Iris findings
• Nodules at pupillary margin( Koeppe nodule),
• Busacca nodules small gray nodules at iris root –miliary TB
13. ANTERIOR UVEITIS
• Iris atrophy may be seen in some cases
• May present as mild to moderate recurrent iridocyclitis
• Severe cases, hypopyon may be seen
• Complications : cataract ,glaucoma, vitritis
16. POSTERIOR SEGMENT MANIFESTATIONS :
• Choroidal tubercles
• Choroidal tuberculoma
• Serpiginous like choroiditis
• Subretinal abscess
• Vasculitis retinae
• Progressive ocular inflammation followed by ATT
17. CHOROIDAL TUBERCLE :
• Most common manifestation of intra-
ocular tuberculosis
• Hematogenous spread
• Less than 5mm, upto 50 in number
• Unilateral or bilateral
• Grayish white to yellow in color
• Indistinct borders
• Mostly in the posterior pole
18. CHOROIDAL TUBERCLE :
• Seen in miliary tuberculosis and central nervous system
tuberculosis (meningitis)
• On fluorescein angiography, they are hypofluorescent in early
stage and hyperfluorescent in late stage
• Active Choroidal tubercles usually respond well to ATT and
generally take up to 3 to 4 months to heal. On healing, the
tubercles result in pigmented and atrophic scars.
19. CHOROIDAL TUBRRCULOMA :
• May occur in immunocompetent patients and in
patients with disseminated tuberculosis
• Presents as a large (4-14 mm) solitary yellowish mass
• May have overlying hemorrhages, retinal folds and
surrounding exudative retinal detachment.
20. • On ultrasonography, these lesions are solid, elevated
masses with moderate to low internal reflectivity
21. SERPIGINOUS LIKE CHOROIDITIS :
• Chronic, progressive and recurrent
inflammation that primarily involves
the choroid and
• choriocapillaris and progresses to
involve the retina secondarily .
• These lesions begin in the peri
papillary area and spread
centrifugally.
22. SERPIGINOUS LIKE CHOROIDITIS :
• On progression, acquires an active
advancing edge
• It represents an immune-mediated
hypersensitivity reaction with
progression despite administration of
antitubercular treatment.
23. SERPIGINOUS LIKE CHOROIDITIS :
• Antituberculosis treatment in conjunction with oral
corticosteroids/immunosuppressive agents may reduce the
number of recurrences.
• Results following liquefaction of caseous material in the
granuloma.
24. SUBRETINAL ABSCESS :
• Yellowish lesions associated with overlying vitritis, retinal
haemorrhages and serous retinal detachments.
• Show tendency to develop retinal angiomatous
proliferation over a period of time
• Rarely, these lesions can rupture into the vitreous cavity
and may lead to endophthalmitis or panophthalmitis
27. NEURO-OPHTHALMIC MANIFESTATIONS :
• The optic neuropathy develops either from direct infection induced
by the mycobacteria or from a hypersensitivity to the infectious
agent.The involvement may manifest as -
• An optic nerve tubercle
• Papillitis
• Retrobulbar neuritis
• Neuroretinitis
• Papillodema
28. • a Fundus photograph. Posterior pole of the left eye demonstrates marked
swelling of the optic disc with peripapillary hemorrhage. b Fundus
photograph. Posterior pole of the left eye 2 weeks after initiation of
antimycobacterial therapy shows marked resolution of the optic disc swelling.
31. DRUG RELATED TOXICITY :
1) Ethambutol :
• optic neuropathy
• Acquired red green dyschromatopsia
• Central scotoma
• Disc oedema, disc hyperemia
• Toxicity is dose- and duration dependent
• Daily dose >25 mg/kg
32. DRUG RELATED TOXICITY :
• 2) Isoniazid
• Optic neuropathy
• Steven Johnson syndrome involving lids and
conjunctiva
• 3) Rifampicin -orange-red discoloration of tears
33. INVESTIGATIONS :
Corroborative evidence :
• Mantoux test
• Chest X RAY / CT Scan
• Serodiagnosis
• Interferon Gamma Release Assays (IGRA )
Direct evidence :
• Smear and Culture of AFB
• PCR
36. MANTOUX TEST :
• Intradermal 5 TU of PPD is given
• Test is read at 48 to 72 hours
• < 5 mm : negative
• 5 – 10 mm : positive in HIV infected person
• > 10 mm : high risk persons
• >15 mm : positive result
37. DISADVANTAGES :
• False negative : severe TB
• Dose dependent test
• Cross reaction with BCG vaccination / non TB
Mycobacteria
• Cannot distinguish active from latent TB
38. CHEST X RAY/ CT SCAN
Can provide evidence of active , healed or reactivated TB
Lesions :
• Consolidation
• Cavitation
• Fibrosis
• Hilar or paratracheal lymph node enlargement
• Multiple millet like opacities
39. SERODIAGNOSIS :
• Detects antibody or antigen
• Middlebrook Dubos test : Hemagglutinin test between sheep
RBC and with polysaccharides from M.Tuberculosis and sera of
patient
• High false positive results
40. NEW DIAGNOSTIC ASSAYS
• Interferon-gama release assays (IGRA)
• Based on the in vitro assays that measure interferon-gama
released by sensitized T cells after stimulation by
Mycobacterium tuberculosis antigens.
• Antigens used are -
A. Early secreted antigen target (ESAT ) 6
B. Culture specific protein ( CSP ) 10
41. INTERFERON GAMA RELEASE ASSAY
• Immunospot test : T-SPOT.TB test
• ELISA : QunatiFERON –TB Gold
• QunatiFERON Test two types:
1.QuantiFERON -TB Gold ( QFTG )
2.QuantiFERON-TB Gold in tube (QFTGIT )
43. QUANTIFERON TB GOLD
Disadvantages –
• Sample to be used in 12 hours
• False positive with other types of Mycobacterium
• Cannot distinguish latent from active TB
• Costly
44. DIRECT EVIDENCE
Smear and staining :
• Organism required are 10 ^ 6 /ml of sputum
• Low yield from intraocular specimens
Culture and sensitivity :
• Lowenstein –Jenson medium
• Prolonged process – 8 weeks
• Low yield from intraocular specimen
45. POLYMERASE CHAIN REACTION ( PCR )
• DNA Amplification and detection technique
• Small amount of sample needed
• Aqueous , vitreous humor , chorioretinal biopsy can be used
• Positive in 33.33 % : retinal vasculitis
• Positive in 66.6 % : granulomatous panuveitis
46. DIAGNOSIS OF OCULAR TUBERCULOSIS
• Diagnosis is difficult & mostly presumptive
• Difficult to get tissue sample
• Low bacterial load
• Inadequacy of tissue/fluid
• Mimics other ocular disease
47. Low mass of ocular tissue
Can’t stimulate body’s immune system
Can’t raise serum level of immune
mediators to an adequate level.
No alteration of the conventional
serological or immunological tests
49. TREATMENT :
• Based on evidence - Clinical
- Indirect and direct evidence
• ATT –extrapulmonary TB regimen(CNS TB)
• Corticosteroids – Concomitant use
• Prolonged and difficult in MDR TB, RR-TB &XDR-TB
50. TREATMENT
ATT Adult dose Pediatric dose
Isoniazid 5mg/kg
PO;not>300mg/d
10-20mg/kg/d
PO;not>300mg/d
Rifampicin 600mgPO/IV OD 10-20mg/kg Po/IV
not>600mg
Ethambutol 15mg/kg PO OD <13yrs:15-20mg/kg/d;
>13yrs:as in adult
Pyrazinamide 15-30mg/kg PO OD As in aduit
51. TREATMENT :
• 2HREZ/7-10HR3 means isoniazid, rifampicin, ethambutol and
pyrazinamide daily for two months, followed by 7-10 months of
isoniazid and rifampicin given three times a week.
• Two new drugs which are now used for the treatment of drug
resistant TB are bedaquiline and delamanid.
52. INDICATION OF STEROID:
• Uveitis
• Vitritis
• Vasculitis retinae
• Lesion involving optic disc,macula, large retinal vessels
• Lesion close to macula ,optic disc
• A large lesion in the retina
• Serpiginous choroiditis
53. • Systemic corticosteroids used for the first 4–8 weeks, together
with ATT, limit damage to ocular tissues .
• However, one should avoid using corticosteroids alone without
concomitant ATT as the corticosteroids may promote
multiplication of bacilli, leading to panophthalmitis or they may
cause a flare-up of systemic tuberculosis by activating a latent
infection.
• Topical steroids also used for uveitis.
54. SUMMARY
• Ocular tuberculosis involves almost all the ocular structures
except lens
• Commonest manifestation is in the posterior segment.
• Diagnosis depends on clinical findings and suspicion of TB
• Newer diagnostic modalities, IGRA and PCR are better tools in
diagnosis and providing support to initiate antitubercular
treatment