Scleral lens is a large rigid contact lens with a diameter range of 15mm to 25mm. Its resting point is beyond the
corneal borders, and are believed to be among the best vision correction options for irregular corneas. Wearing scleral lens also can postpone or even prevent surgical intervention as well as decrease the risk of corneal scarring.
Contact lens for congenital aphakia and other eye conditions for infants and toddlers. The slide presentation encompasses indications for CL fitting in paediatric, contact lens options, fitting techniques, challenges and contact lens as myopia control.
Scleral lens is a large rigid contact lens with a diameter range of 15mm to 25mm. Its resting point is beyond the
corneal borders, and are believed to be among the best vision correction options for irregular corneas. Wearing scleral lens also can postpone or even prevent surgical intervention as well as decrease the risk of corneal scarring.
Contact lens for congenital aphakia and other eye conditions for infants and toddlers. The slide presentation encompasses indications for CL fitting in paediatric, contact lens options, fitting techniques, challenges and contact lens as myopia control.
Optics of Contact lenses by Ankit Varshney. If you understand optics properly you can prescribe contact lenses scientifically. Comparison between spectacles and contact lenses.
Fitting an Astigmatic Patient is really a challenging.Though fitting a Toric Cornea is another challenge in CL Dispensing practice.This Slide will give you a basic considerations in RGP Toric lens.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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Hot Selling Organic intermediates
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
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.
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.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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
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.
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
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
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.
3. Introduction
‘Contact lens’ is a thin transparent lens made up of
different materials like PMMA, HEMA, Silicon –
Acrylic etc
First conceived by – Leonardo Da Vinci (1508)
Development
1. PMMA - 1940s
2. Hydrogel CL – 1960s
3. RGP – 1970s
Source: IACLE Module 2
01/03/15 3
4. What is RGP lens??????
RGP lenses are those lenses made up of materials
which are permeable to oxygen.
They have inherent rigidity similar to PMMA, but
somehow due to their O2 permeability they have
become popular by the name semisoft lenses
Made up of polymers e.g. silicone resin, polystyrene,
polysulfone copolymer and butyl styrene
01/03/15 4
5. Choice for RGP??????????
Better VA- astigmats & irregular astigmats
Only for some conditions – keratoconus , traumatised
corneas , post grafts etc
Better oxygen transmissibility and better retro lens
tear flow suitable for higher Rx
01/03/15 5
6. Choice for RGP???????
Safer for extended-wear than hydrophilic lenses
For patient non- compliant with cleaning and
disinfectant procedures, no time to care
For patient who requires steroids and glaucoma
drugs because no absorption as in hydrophilic
In certain specialized area - orthokeratology
01/03/15 6
7. Forces affecting lens
Tear meniscus
- Essential for lens centration
- Greater the lens circumference of the meniscus, the
better the centration
▪ Lid force and position
- Upper lid covers small portion of the lens holding the
lens in cornea and lid
- For some patients the lower lid is too high to rest
01/03/15 7
8. Tear Lens power with RGP
Tear lens under a flexible lens is very thin and has no
power
Tear lens under a rigid lens depends on material
rigidity and the fitting relationship
If a rigid lens decentres, the tear lens will acquire a
prismatic component in addition to the spherical or
sphero-cylindrical optics dictated by the fitting
relationship.
01/03/15 8
9. Decentration Induced Prism
When a rigid lens decentres, and is possibly tilted by
upper or lower lid pressures, a prismatic tear lens
may be induced under it.
In higher powered lenses, any induced tear prismatic
effect may be insignificant when compared with the
prism induced by the decentred optics
01/03/15 9
11. Flat, Aligned and Steep RGP Fits
For steep cornea, the RGP lens will touch the tip of
the cornea with flat fitting and induce concave lens
like tear film
For aligned RGP as in case of normal corneal surface
the tear lens so formed will be aligned and will have
plane surface with nearly zero power
For flat cornea , the RGP lens will touch the two ends
of the cornea with steep fitting forming a convex tear
film
01/03/15 11
13. Tear Lens Power with Rigid Lenses
Assumptions:
• nTears = 1.336
• nLens = 1.490
• nAir = 1.000
• r0 = 7.80 mm
– flatter = 7.85 mm
– steeper = 7.75 mm
01/03/15 13
14. Contd…
TL front surface power (FSTears):
= (n’ – n)/r
= (1.336- 1.000)/ 0.0078
FSTears power = +43.076923 (BOZR = 7.80mm)
In flattening the BOZR by 0.005, BOZR = 7.85mm
FSTears power = +42.802548 (BOZR = 7.85mm)
∆ = +42.802548 – (+43.076923)
= - 0.274375 D
01/03/15 14
15. Contd…
Flattening produces a – 0.274375D effect
To maintain the same back vertex power of the
system a compensating +0.274375 D must be added to
the BVPCL in air while ordering
Steepening the BOZR by 0.05mm, BOZR = 7.75mm
FSTears power = +43.354839 (BOZR = 7.75mm)
∆ =+43.354839 – (+43.076923)
= +.277916D
Steepening produces a +0.277916 D effect
01/03/15 15
16. Contd…
To maintain the same BVP of the system a
compensating -0.277916 D must be added to the
BVPCL (in air) when ordering
Rule of thumb:
∆0.05mm in BOZR ≈ ∆0.25 D in the BVP required to offset
∆ in tear lens power
01/03/15 16
17. Neutralisation of Astigmatism
Cornea/tears interface is optically insignificant
Tear lens is sphericalized by the back surface of a
spherical lens
This results in a major reduction of corneal
astigmatism with a spherical lens
01/03/15 17
18. Spherical Cornea: Spherical
RGP
The tear lens has no
much optical role in case
of spherical surface of
cornea and spherical
back surface of RGP
contact lens
01/03/15 18
Fig:Optimal edge width and adequate
clearance
19. Spherical Cornea: Toric RGP
In case of spherical surface of cornea and toric RGP
the back surface should be spherical in nature while
the front surface is toric
These lens are prescribed in the cases where the
astigmatism is not due to corneal surface but due to
lens
E.g astigmatism induced in cases of subluxation of
lens and dislocation of IOL after cataract surgery
01/03/15 19
20. Astigmatic Cornea: Spherical RGP
The front surface of the tear lens is ‘sphericalized’ by
the back surface of the lens
The toric interface between tear lens and cornea has
its optical effectiveness significantly reduced.
It is usually difficult to fit spherical lenses on corneas
with 3.00 D of corneal astigmatism.
Some claim that 2.00 D is a more realistic upper limit.
01/03/15 20
21. Neutralisation of corneal astigmatism
Assuming K readings of 8.00 mm and 7.60 mm
and the following refractive indices: ncornea = 1.376,
ntears = 1.336
Corneal powers in air:
D1 =(n’-n)/r1 = (1.376-1.000)/ 0.008
D1 = 47.00D
D2 = (n’-n)/r2 = (1.376 – 1.000)/0.0076
D2 = 49.47 D
Corneal astigmatism = D2 – D1 =2.47 D
01/03/15 21
22. Contd…
Corneal power under tears:
D1 = (1.376 – 1.336)/ 0.008
D1 = 5.00D
D2 = (1.376 – 1.336)/ 0.0076
D2 = 5.26 D
Corneal astigmatism = D2 – D1
= 0.26 D
01/03/15 22
23. Contd…
Astigmatism (in situ) / astigmatism (in air)
= 0.26/ 2.47
= 10.64%
● Rule of Thumb
Approximately 90% of corneal astigmatism is neutralized
by a spherical RGP lens
01/03/15 23
24. RGP lens : Keratoconus
Keratoconus is a benign,
non inflammatory,
progressive central
corneal ectasia and
thinning resulting into
high irregular myopic
astigmatism with
observable structural
changes appearing in
later stage
01/03/15 24
25. Corneal RGP CL
Two Fitting Philosophies
1. Apical bearing – OZ bears on cone
2. Apical clearance
01/03/15 25
26. Apical bearing (Flat fit)
Larger diameter lenses
TD – 9.50 to 11.50 mm
Single back curve
KC cone touches central
cone apex
Lower edge stand away from
cornea
01/03/15 26
27. Apical bearing (Flat fit)
Compress the cone
Corneal flattening /
Spherization
Superior visual
performance
Disadvantage
??Hastens the rate of
corneal scarring
(Sub-bowman’s
stroma)
01/03/15 27
28. Apical clearance
Small diameter & thin
lenses (USA)
TD of 6.00 mm to 8.00
mm
BOZR – 5.00mm to 7.5
mm
With Two flatter
peripheral curves
01/03/15 28
Text missing???????????
29. Apical clearance
• Advantage
– Less role on corneal scarring
– Well tolerated by atopic eye disease
• Disadvantage
– Optical
• Flare/monocular diplopia
– OZD is only 4 mm
01/03/15 29
30. 3 point touch
Also known as ‘divided
support’
Most weight of the lens
is on almost normal
peripheral cornea
Central cornea is
supported by slight touch
Bearing is not heavy to
cause abrasion & scarring
01/03/15 30
32. 3 point touch
Things to avoid
Peripheral fit too tight
causing sealing off the
tear exchange behind
optic zone
Excessive movement
that causes discomfort
and corneal scarring
01/03/15 32
33. RGP lens : penetrating keratoplasty
Penetrating keratoplasty (PK) is a surgical procedure
in which the host cornea is replaced with donor
cornea.
Corneal graft sizes typically range from 7.5 to 8.5
mm.
Sutures used to keep the graft in place can be
radially interrupted sutures or a single continuous
suture.
01/03/15 33
34. RGP lens : penetrating keratoplasty
Typically we begin fitting 6 to 12 months after surgery
following removal of the sutures.
The epithelium is intact 4 days post-operative, but
the cornea as a whole may take 18 to 24 months for
complete healing.
The fitting process can begin as early as 3 months for
some patients who require contact lenses for
functional vision
Thus, it is best in most cases to wait at least 6
months before initiating contact lens treatment.
01/03/15 34
35. Contd…
The main concern of post-PK fitting is to minimize
trauma to the corneal graft.
Typically, large diameter (9.5-12.0mm) RGP lenses are
prescribed to minimize bearing on the graft-host
interface and provide improved stability and
centration.
A large optic zone size will help to minimize glare.
RGP lenses offer excellent oxygen transmission and
have the ability to correct astigmatism and smooth
out irregular corneal surfaces.
01/03/15 35
36. RGP lens: Radial Keratotomy
Radial (incisional)
keratotomy is a surgical
procedure for reduction
of myopia by incision
into the anterior
portion of the cornea,
avoiding a central zone
of 3-4mm diameter
No sutures or supports
are involved
01/03/15 36
37. Contd...
The procedure an d effect of the number of incisions
usually 4, 8 or 16 equally spaced
Incision depth is usually 90-95% of the previously
measured central corneal thickness
The rigidity of the cornea is decreased such that
intraocular forces act on the cornea , causing the mid
peripheral regions to bulge forward effectively giving a
apical cap of flatter curvature than that measured
preoperatively
01/03/15 37
38. Contd...
This flatter central curvature has less power and
results in a hypermetropic shift, hence reducing the
original myopia
After RK, the central cap is wider and needs a larger
back optic zone diameter (BOZD) to cover it and
give a lens stability
Fluorescein assessment should reveal good tear
flow beneath the lens and avoidance of undue
pressure on the mid peripheral region
01/03/15 38