Optic neuritis is an inflammation of the optic nerve that can be divided into 3 types based on appearance: papillitis, neuroretinitis, and retrobulbar neuritis. Papillitis is most common in children and involves edema and hyperemia of the optic disc. Neuroretinitis also involves the retinal nerve fiber layer and macula. Retrobulbar neuritis most commonly affects adults and the optic disc may appear normal initially. Causes include demyelinating disorders like multiple sclerosis, infections, immune disorders, and metabolic conditions. Treatment involves steroids like intravenous methylprednisolone to hasten recovery of vision, with the goal of improving outcomes and delaying development of multiple sclerosis
Cscr ( central serous chorioretinopathy )Vinitkumar MJ
What is the difference between disc odema & papillodema ?
Enumerate causes of papillodema ? & management of that ?
what is macular hole
what is CSCR
WHAT IS macular odema ?
Retinal vein occlusion (RVO) is an obstruction of the retinal venous system by thrombus formation and may involve the central, hemi-central or branch retinal vein.
The most common aetiological factor is compression by adjacent atherosclerotic retinal arteries.
Other possible causes are external compression or disease of the vein wall e.g. vasculitis.
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
Cscr ( central serous chorioretinopathy )Vinitkumar MJ
What is the difference between disc odema & papillodema ?
Enumerate causes of papillodema ? & management of that ?
what is macular hole
what is CSCR
WHAT IS macular odema ?
Retinal vein occlusion (RVO) is an obstruction of the retinal venous system by thrombus formation and may involve the central, hemi-central or branch retinal vein.
The most common aetiological factor is compression by adjacent atherosclerotic retinal arteries.
Other possible causes are external compression or disease of the vein wall e.g. vasculitis.
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
The presentation was made under the wise guidance of my professor DR.(prof) P. Rawat (MGMMC & M.Y. HOSPITAL, INDORE).It covers the essential aspects of optic neuritis & optic atrophy.
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
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.
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.
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.
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
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
2. Introduction & Definition
• An inflammation of the optic nerve is known as optic neuritis.
• The optic nerve may be affected by inflammation in any part of its course.
• Based on the ophthalmoscopic appearance it can be divided into 3 types:
1. Papillitis
2. Neuroretinitis
3. Retrobulbar neuritis
3. 1. Papillitis
• Papillitis is most common type in
children
• It is characterized by:
1. Hyperemia and edema of the optic
disc
2. Associated with peripapillary flame
shaped hemorrhages
3. Cells may be seen in posterior
vitreous
4. 2. Neuroretinitis
• Least common type
• It is characterized by:
1. Papillitis plus
2. Inflammation of the retinal
nerve fiber layer and
3. Macular star
5. 3. Retrobulbar neuritis
• Most common type in adults
• Frequently associated with Multiple
sclerosis
• Characteristics:
1. Optic nerve head not involved
2. Optic disc appears normal (atleast
initially)
6. Papilledema Papillitis Pseudo-papillitis
Laterality Bilateral Unilateral Unilateral or bilateral
Visual acuity Blurred vision Sudden profound loss of
vision
Blurred vision
Pain on ocular
movements
Nil Present Nil
Pupillary light reflex Not affected Depressed & RAPD
present
Not affected
Media Clear Vitreous cells Clear
Peripapillary edema,
venous engorgement,
Retinal hemorrhages &
exudates
Marked Less marked Absent
Field defect Enlarged blind spot Central scotoma to
complete blindness
Nil
FFA Leakage of dye present Minimal leakage Nil
7. Epidemiology
• Annual incidence of optic neuritis – 3 to 5 per 1,00,000/year
• Prevalance – 115 per 1,00,000
• Affected age group – 20 to 50 years
• Women are affected more commonly than men (ONTT – 77% patients are
women)
• Whites are affected more commonly than blacks (ONTT – 85% patients are
whites).
9. Demyelinating disorders
• This is by far the most common cause. It can be:
1. Isolated
2. Associated with Multiple sclerosis
3. Neuromyelitis optica (Devic)
13. Pathogenesis of Optic neuritis
• It is presumed to be demyelination in varying degrees.
• Demyelination could be:
1. Axial
2. Peripheral
• Inflammatory response marked by:
1. Perivascular cuffing
2. T lymphocytes & plasma cells
14. Association between optic neuritis & Multiple sclerosis
• Optic neuritis is the presenting feature of Multiple sclerosis in up to 30%.
• Optic neuritis occurs at some point in 50% of patients with established
Multiple Sclerosis.
• The overall 15-year risk of developing Multiple Sclerosis following an
acute episode of optic neuritis is about 50%.
15. Association between optic neuritis & Multiple sclerosis
• Following an acute episode of optic neuritis, the presence of MRI lesion is
a very strong predictive factor of Multiple sclerosis (MS).
– With no lesions on MRI the risk of MS is 25%
– patients with one or more lesions on MRI – risk is over 70%
16. Clinical features
• Optic neuritis due to various causes will have similar visual symptoms but
will differ in their clinical course.
• Other associated symptoms and signs will be in accordance with the
underlying disease.
• ‘Typical’ optic neuritis implies - Demyelinative syndrome associated with
Multiple sclerosis clinical features of which are described here:
17. Symptoms
1. Loss of vision
• Predominant symptom
• Vision loss can be subtle or profound, unilateral or bilateral
• Typically deteriorates over hours to days and reaches a trough in 1 week
• Vision gradually improves spontaneously.
18. 2. Deep orbital, retroocular or brow pain
• Aggravated by eye movement
• Increased by pressure upon globe
3. Neuralgia or headache
4. Tenderness of eyeball on digital pressure
• Tenderness corresponds roughly with the site of attachment of
Superior rectus tendon (initially only, later disappears)
19. 5. Loss of colour vision
6. Reduced perception of light intensity
7. Pulfrich phenomenon:
• Altered perception of moving objects, seen in unilateral conduction delay.
• Occurs due to a relative difference in signal timings between the two eyes.
20. 8. Systemic features (Multiple sclerosis):
• Spinal cord - weakness, stiffness, sphincter disturbance, sensory loss.
• Brainstem, e.g. diplopia, nystagmus, dysarthria, dysphagia.
• Cerebral, e.g. hemiparesis, hemianopia, dysphasia.
• Psychological, e.g. intellectual decline, depression, euphoria.
21. Signs
1. Decreased visual acuity
• 6/18 to 6/60
• Rarely may be worse
2. Relative afferent pupillary defect (or) Marcus Gunn pupil
• Indicating a defect in afferent limb of pupillary light reflex
• It is of greater diagnostic significance
• Tested by swinging flash light test
23. 6. Visual fields defects
A. Central scotoma
B. Centrocaecal scotoma
C. Nerve fiber bundle
D. Altitudinal
24. 7. Ophthalmoscopic findings:
• No ophthalmoscopically visible changes – in Retrobulbar neuritis
• Optic disc hyperaemia
• Swelling of disc with blurred margins in Papillitis
• Peripapillary flame shaped hemorrhages
• Papillitis features + Macular fan or star – Neuroretinitis
26. (Signs associated with Multiple sclerosis)
8. Uhthoff sign – Worsening of symptoms with exercise or an increase in
body temperature.
9. Lhermitte sign – electrical sensation on neck flexion
27. Differential diagnosis
1. Ischemic optic neuropathy (ION)
• Anterior ION resembles – Papillitis
• Posterior ION resembles – Neuroretinitis
2. Papilloedema
3. Grade IV hypertensive retinopathy
4. Leber hereditary optic neuropathy
5. Toxic and metabolic optic neuropathy
6. Compressive space occupying lesion – in orbit (or) intracranially at chiasmal region
28. Clinical workup & investigations
1. Careful history-taking
• age of the patient
• the rapidity of onset
• occurrence of any previous episodes and
• the presence of pain on eye movements
2. Complete ophthalmic examination
• Visual acuity
• Pupillary reactions
• Colour vision
• Fundus examination
29. Clinical workup & investigations
3. Visual fields
4. VEP – prolonged latency is seen
5. MRI with Gadolinium enhancement
• Recommended for first episode and every atypical case
• Rules out a space-occupying lesion
• Helps in predicting the likelihood of multiple sclerosis
30. Clinical workup & investigations
6. Additional tests should be performed for ‘atypical’ optic neuritis:
• CRP and ESR
• Rapid plasma regain
• Fluorescent treponemal antibody absorption (FTA-ABS) test
• Antinuclear antibody (ANA) test
31. Clinical course of Optic neuritis
• In the majority of cases, especially those with demyelinating disease:
– vision starts to improve in the 2nd or 3rd week.
– by the 4th to 5th week visual acuity returns to normal or near normal
(6/18 to 6/12).
– Subsequently, vision slowly and steadily improves over several months
and is ultimately usually restored to 6/6.
32. Clinical course of Optic neuritis
– Colour vision, contrast sensitivity and visual fields take longer to
recover (6–12 months or so) or may not recover completely.
– Small percentage of cases, vision does not improve to functional levels.
– Rarely, does not improve at all, suggesting an atypical neuritis.
33. Treatment
• Goals of Optic neuritis therapy:
1. One goal of acute therapy is to improve visual outcome.
2. Another goal of optic neuritis treatment is to delay development of
clinically definite demyelinating disease.
• General guidelines for treatment are based on a major multi centre trial
(the Optic Neuritis Treatment Trial - ONTT)
34. • Two major findings of the ONTT with regard to these treatment goals:
1. Intravenous methylprednisolone treatment hastens recovery of visual
function but does not affect long-term visual outcome.
2. Patients treated with oral prednisone alone (without IV methylprednisolone)
demonstrated an increased risk of recurrent optic neuritis.
35. Indications of steroid regimen:
1. Patient with profound visual loss,
2. No previous history of optic neuritis or multiple sclerosis and
3. If MRI shows at least one area of demyelination.
36. Steroid regimen:
– Intravenous Methylprednisolone 1 g daily (given slowly over 30-60 min)
for 3 days f/b
– Oral Prednisolone (1 mg/kg daily) for 11 days, subsequently
tapered rapidly over 3 days.
• Observation is the rule if a patient has already been diagnosed to have
multiple sclerosis or has suffered from prior episodes of optic neuritis.
37. Immunomodulatory treatment (IMT):
• Reduces the risk of progression to clinical MS in some patients.
• But risk versus benefit ratio has not yet been fully defined.
• The presence of two or more white matter lesions on MRI should prompt
consideration of one of these treatments.
38. Immunomodulatory treatment options available
1. Interferon β – 1a :
• Controlled High-Risk Avonex MS Prevention Study (CHAMPS) demonstrated
that treatment with interferon β-1a (Avonex) following acute
monosymptomatic demyelinating optic neuritis significantly reduces the 3-year
cumulative probability of Multiple sclerosis.
2. Glatiramer acetate
3. Teriflunomide
4. Betaseron