Pigment Dispersion Syndrome (PDS) involves abnormal amounts of pigment released from the iris that deposit throughout the eye. It can sometimes progress to Pigmentary Glaucoma (PG). PDS is more common in young, white, myopic males and has genetic links. Theories for its pathogenesis include mechanical abrasion between the iris and lens zonules or abnormal iris cell degeneration. Over time, PDS can cause increased eye pressure and vision loss from PG if not properly treated with medications, laser procedures, or surgery.
It describes about the procedure of Hess charting. it serves as a great tool to understand the concepts involved. Suitable for optometry course. This is not a routine procedure but an important procedure which is used in diagnosis.
It describes about the procedure of Hess charting. it serves as a great tool to understand the concepts involved. Suitable for optometry course. This is not a routine procedure but an important procedure which is used in diagnosis.
Juvenile glaucoma: a case study and disease reviewLyndon Woytuck
A review of juvenile glaucoma including screening, diagnostic approach, and management. Patient details have been anonymised to protect the individual.
Heard of people being unable to see other people's faces if not fr failure of recognition of people's faces (prosapagnosia)...then they need to get their retina in particular macula checked! And a bunch of other macular disorders are enlisted nd elaborated in the presentation
this presentation is about causes of acute visual loss which i made for my seminar during ophthalmology posting.Hope that people can had a benefit from this slide especially medical student.
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
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
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
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.
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.
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
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
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Pigmentary glaucoma - Dr Shylesh B Dabke
1. Pigment Dispersion Syndrome/
Pigmentary Glaucoma
Dr shylesh B dabke
Glaucoma Fellow
Aravind Eye hospital
Download and watch in slideshow mode, online viewing will be disgusting
2. Overview
Pigment Dispersion syndrome(PDS)
Abnormal amount of pigments are liberated from posterior
surface of iris, which are deposited throughout the anterior and
posterior chamber of the eye.
Pigmentory Galucoma
A type of secondary open glaucoma that develops among
patients with PDS.
3. History
In 1940, Sugar briefly described one such case with pigment
dispersion and glaucoma.(1)
In 1949 - Sugar and Barbour(2)
- Reported details of this entity
- Referred this condition as “Pigmentary Glaucoma”
1.Sugar HS. Concerning the chamber angle. I. Gonioscopy.Am J Ophthalmol 1940;23:853-866.
2. Sugar HS, Barbour FA. Pigmentary glaucoma: a rare clinical entity. Am J Ophthalmol. 1949;32(1):90-92.
4. Epidemology
Corresponds to 1-1.5% of all Glaucoma.
Onset < 40yrs
Male : Female – 2:1
More frequent in whites
Strong association between Pigmentary Glaucoma and Myopia.
6. ▪ Usually Bilateral
▪ No typical Hereditary Pattern – Sporadic
▪ Significant linkage between disease phenotype and genetic markers
located on 7q 35-36.
▪ Probability of PDS converting to PG*
10% in 5 years
15% in 15 years
* SiddiquiY., Hulzen R.D.T., Cameron J.D., et al:What is the risk of developing pigmentary glaucoma from
pigment dispersion syndrome?. Am J Ophthalmol 2003; 135:794-799
8. Mechanical Abrasion Theory
▪ D G Campbell
▪ This theory is based on finding of slit like trans illumination
defect on iris.
9. Slit like trans illumination defect
Mechanical rubbing
between anterior packets
of lens zonules &
posterior iris in
predisposed eyes
Cause of pigment
dispersion.
10. PDS and Myopia
This association can be
explained with mechanical
abrasion theory.
11. PDS and reverse pupillary block
Second & complementary
explanation for iris
concavity.
12. PDS and Blinking
Campbell proposed blinking
initially deforms the cornea
Pushing iris against zonules
Transient increase in IOP
13. PDS and Accommodation
Accommodation in patients
with PDS – increased
posterior bowing of iris
Forward movement of lens
– increasing pressure in
anterior chamber
14. Abiotrophy Theory
Premature degeneration of cells or tissue, especially when it is
due to genetic defect
While mechanical abrasion theory explains several clinical features
of pigment dispersion syndrome, key gaps in knowledge still
remain.
Cellular degeneration is supported in pigment dispersion syndrome
by two lines of evidence.
15. Heritable Component
There appears to be a clustering of PDS cases in a subset of families
GPDS1 has been mapped to chromosome 7
Dominant inheritance pattern
Other gene candidates currently are being investigated.
16. Microscopic examination of iris tissue
Within tissue disruptions throughout the iris
Pigment-containing cells called melanocytes either are missing or
have ruptured membranes from which pigment extrudes.
17. Mechanical
Abrasion
Theory
Abiotrophy
Theory
PDS
Evidence appears to be mounting that the two represent two distinct
disease processes that have a common endpoint of pigment dispersion.
Once pigment is liberated from the iris, it is carried throughout the
anterior chamber and is deposited in multiple locations.
18.
19. Clinical Features
Early - Asymptomatic
Episodes of pain/blurred
vision with haloes
following strenuous exercise
Advanced – Loss of
central vision
Later - Loss of peripheral
vision
20. Signs
Cornea – Krunkenberg
Spindle*
Ant Chamber
-Deep
-Posterior bowing of
peripheral iris
-Pigments in AC
Iris – Slit like/Spoke like
transillumination defect*
31. Medical Miotics
Physical
activity
Laser
Trabeculoplasty
Treatment
• Similar to POAG
• Rx typically begins with medical therapy
• All ocular hypotensive medications are effective
• PG Analogues are drug of choice*
• Theoretically of benefit
• Decreases iridozonular contact
• Facilitates aqueous outflow
• Disadvantage – Exacerbation of myopia
Precipitate RD in Myopia
Not well tolerated by young patients
• Alfa adrenergic antagonist thymoxamine produces miosis without
cyclotropia
• Exercise increases pigment dispersion and causes IOP spike*
• If significant pressure rise is observed, 0.5% Pilocarpine during exercise may
be beneficial
• Heavy trabecular pigmentation allows increased absorption of laser energy
• In turn allowing lower energy level for trabeculoplasty
• Starting with 300mW per spot if using ALT and 0.4mJ per spot if using SLT
• Ritch et al reported 80% success rate at 1yr followup
• Trabeculoplasty responds well initially but IOP control tends to decline wit time
and surgery is in effective in patients who are older or who had glaucoma
for a long time
32. Laser
Iridotomy
Trabeculectomy
• Theoretical effects –
- Relives the reverse pressure gradient
- Relieves posterior bowing of peripheral iris
- Relieves rubbing
- Reduces liberation of pigment
- Allows meshwork to clear pigment & recover normal outflow function
(if changes are not already irreversible)
• When medical therapy and laser trabeculoplasty have failed to
adequately control IOP
• Filtration surgery is usually successful
• Use of adjunctive antimetabolites may improve surgical outcome
• Higher percentage of patients with pigmentary glaucoma than POAG and men
appear to require it at a earlier stage.
• Success rates are similar to POAG.
• Trabeculectomy in young myopic patients warrants extra care -
prone for Hypotony Maculopathy
33. Temporal Evolution of PDS
Conversion of PDS to Pigmentary Glaucoma
(Slow & may take years)
Slow spontaneous
resolution
Irreversible damage to angle
Transillumination defect
may disappear
IOP may return to normal
Trabecular pigmentation may decrease
Pigment reversal
sign
“burnt out”
34. With age pupil becomes small & lens becomes thicker
Decreased iridozonular contact
Decreased dispersion
Occasionally glaucoma may “Burn Out”
35. Look carefully for PDS/PG in patients who present as
Normal Tension Glaucoma
Look for
“Pigment Reversal”
Editor's Notes
However autosomal dominant and autosomal recessive patterns are also reported
This finding led to
Myopic eyes tend to have a slightly concave iris that potentially could press against the zonules
Although myopia could explain some cases of pigment dispersion syndrome, it is insufficient in explaining all instances.
Not everyone with myopia has PDS, and not everyone with PDS has myopia
In reverse pupillary block, pressure in the anterior chamber of the eye exceeds that of the posterior chamber.
The increased pressure forces the iris over the lens, where it acts like a ball valve in the pupillary opening, preventing the return of aqueous humor to the posterior chamber.
As pressure continues to increase, it causes a backward bowing of the iris that accentuates contact between it and the Zonules of Zinn.
In normal eyes iris zonular contact is rare
Iridotomy abolishes this change
Primary among these is that liberation of iris pigment can occur in eyes that are not myopic and for which there is little or no evidence of zonule abrasion. For this reason, thinking about PDS has expanded to include the abiotrophy theory.
Doesn’t impair vision, doesn’t damage corneal endothelium
Difficult to see in dark thick iris stroma
Infrared video graphic technique have been developed for TID
Pigment granule dispersion on iris stroma may make iris progressively darker creating heterochromia in asymmetric cases.
Anisocoria – Iris with more transillumination defect will have a dilated pupil
The iris heterochromia and anisocoria of PDS may mimic Horner syndrome
This is particularly useful in black patients as transillumination defects and Trabecular pigmentation in black patients may be misleading
With hypotensive medication though IOP will be controlled, mechanism of continued pigment dispersion is not eliminated