- Prisms can be used for relieving, correcting, overcorrecting, inversing, yoking, rotating, and regionally.
- Relieving prism reduces the demand on vergence systems for patients with normal fusion. Correcting prism optically eliminates the deviation. Overcorrecting or inversing prisms are used to disrupt abnormal retinal correspondence.
- Consider a patient's retinal correspondence and presence of suppression when choosing a prism type. Rotating or disruptive prisms can help break down abnormal retinal correspondence.
Optics of Retinoscope by Dr. Muhammad Zeeshan Hameed.pptxZeeshan Hameed
Includes
1. What is a Retinoscope?
2. Short History of Retinoscope
3. Parts of a Retinoscope
4. Detailed Optics of a Retinoscope
5. Practical Points of Retinoscopy
Optics of Retinoscope by Dr. Muhammad Zeeshan Hameed.pptxZeeshan Hameed
Includes
1. What is a Retinoscope?
2. Short History of Retinoscope
3. Parts of a Retinoscope
4. Detailed Optics of a Retinoscope
5. Practical Points of Retinoscopy
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.
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
Optics of Contact lenses by Ankit Varshney. If you understand optics properly you can prescribe contact lenses scientifically. Comparison between spectacles and contact lenses.
these slides explain the objective refraction in optometry , and describes its types and its measurement , and it gives you in details the types of Retinoscopy.
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.
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
Optics of Contact lenses by Ankit Varshney. If you understand optics properly you can prescribe contact lenses scientifically. Comparison between spectacles and contact lenses.
these slides explain the objective refraction in optometry , and describes its types and its measurement , and it gives you in details the types of Retinoscopy.
Strabismus is misalignment of the visual axes of the two eyes.
The inability of the two eyes to simultaneously direct their foveae at a common object of regard, occasionally or always.
May be accompanied by abnormal motility, double vision, decreased vision, ocular discomfort, headaches, or abnormal head posture.
The best optical correction is the starting point.
i. Helps to provide a sharp well focussed retinal image which helps fusional control and proper development of binocular vision.
ii. Corrects and maintains the relationship between accommodation and convergence mechanisms.
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Retinoscopy and Objective Refraction and Subjective Refraction in spherical ametropia and astigmatism
Retinoscopy (Principle & Techniques of Retinoscopy) and objective refraction, Subjective Refracition
Best presentation about retinoscopy and objective refraction techniques, and basis of subjective refraction. If you want to master the technique of retinoscopy, this presentation can be your guidance and partner in your journey to retinoscopy, objective refraction and subjective refraction.
Presentation Layout:
Retinoscope, types of retinoscope and uses of retinoscope
-Introduction to retinoscopy and objective refraction
-Retinoscopy
- In spherical ametropia
- In astigmatism
- Others: strabismus, amblyopia, pediatric pt.,
cycloplegic refraction
-Static and Dynamic Retinoscopy
-Problems seeing reflex during retinoscopy
-Errors in retinoscopy
Objective of retinoscopy and objective refraction
-To locate the far point of the eye conjugate to the retina
- Myopia or hyperopia
-Bring far point to the infinity by using appropriate lenses
- Determines amount of ametropia by retinoscopy and objective refraction
References:
-Clinical Procedures in Optometry by Eskridge, Amos and Bartlett ,
-Primary Care Optometry by Grosvenor T.,
-Borish’s Clinical Refraction by Benjamin W. J.,
-Theory And Practice Of Optics And Refraction by AK Khurana
-Retinoscopy-Student Manual by ICEE Refractive Error Training Package (2009)
-Clinical Optics and Refraction By Andrew Keirl, Caroline Christie
-Clinical Refraction Guide - A Kumar Bhootra
-Clinical Procedures in Primary Eye Care by David B. Elliott
-Internet
Follow me to get in touch with optometric and ophthalmic updates.
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.
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
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.
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
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
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.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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
3. -optically reduces the demand to the controlling fusional
vergence system for bifixation of the target.
- Rx is less than the angle of deviation.
-The base is Rxed opposite to the direction of the deviation.
- Moves light closer to the fovea.
-If the prism moves the image into the range of fusion,
the patient can verge the eyes to obtain fusion.
-This is Rxed for intermittent strabismics and phorias in
certain instances.
- The most commonly Rxed prism.
4. -Optically eliminates the oculomotor deviation.
- Rx prism equal to the magnitude of the
objective angle.
- The residual vergence demand is zero.
- Rx the base opposite to the direction of the
deviation.
- In certain cases, sensory fusion can occur
without the need for any fusional vergence if
there's no ARC or deep suppression.
- don't give patients with ARC or deep
suppression corrective prism.
5.
-optically changes the direction of the deviation.
-the power of the prism is greater than the
magnitude of the deviation.
- Example : 20 ∆ XT give 25 – 30 ∆ BI
-In such a position on a cover test ,you see the
deviation reverse in terms of direction.
This kind of like when you get reversal on ACT.
An eso becomes an optical exo.
-Used on certain instances to disrupt ARC through a
specific technique.
6.
-You put the base in the same direction as the deviation and
optically increase the demand to the controlling vergence
system.
Eso give BI
Exo give BO
-only used for a phoria patient in the later stages of strab VT.
Ex) Give BO to an exophoria to increase the convergence demand for
bifixation.
-the patient has to use vergence to control his deviation and also to meet
the demand of the prism.
-a passive technique.
-commonly used for VT (ex: read through prism).
-some people Rx in glasses~ less common
-to eliminate EF and ARC
7. Used when there is poor prognosis for a functional cure and
the patient doesn't want surgery or surgery isn't indicated.
makes the eye look better.
ex) ET give BI
You'll see a dual effect if the patient has ARC:
The observe sees the eye moved temporally when looking
through the prism.
The patient will make anomalous motor fusion movements.
If you were to give a 20∆ET with HARC 5∆BO of relieving
prism:
The image is shifted but the patient wants to maintain the
HARC so he makes a convergence movement of 5∆
On a CT, you'll measure 25∆ET.
This is called prism adaptation or eating prism and ARC
patient are notorious for this.
8. Never Rx relieving and correcting prism for ARC
patients because they will "eat it" and it will make the
deviation look worse.
If you give a 20∆ ET with HARC7∆ BI, the observer will
see the eye shifted out and to maintain the HRAC, the
patient will diverge the amount of the prism 7∆so the ET
will look smaller
For a 20-30∆ ET with HARC and a poor prognosis, a
8∆prism is a good first lens.
You put the prism over the strabismic eye.
If you get patient<20∆,you make them a noncosmetic
ET.
These patient rarely complain of diplopia.
9.
-Optically moves the retinal images of a fixed target
in a parallel direction toward the base and moves
the light toward the base and shows the target
toward the apex.
-Both of the eyes move in the same direction.
Example ) BASE RIGHT prism ( BO OD & BI OS )
BASE LEFT prism ( BI OD & BO OS )
BASE DOWN prism ( OU )
10. more : in low vision
-Give prism so you shift the patient's world over so that they're
never looking where they're missing vision.
Ex) A little girl with a Duane's Syndrome OS (13y.o.)
-abduction deficit
-she presented with a small head turn
-If you straighten her head or she looks into L gaze, she sees
double.
We could have given her base L prism if she would have had a
significant head turn.
The prism would shift the world over to the R and move the
eyes from L gaze so she won't have to turn her head
11. To move the eyes into the null position.
Null position = position where the frequency and
magnitude of the nystagmus is dampened or
eliminated.
when you Rx prism with non concomitant
deviations to get fusion ,you put all or most of
the prism in front of the paretic eye.
Typically we just split prism equally between the two
eyes for cosmetic purposes.
12. Ex) 10 ∆ Right ET & has a RLR paresis
when the prism is before the OS, the light is bent toward the
base and the image is projected toward the apex. Initially, the
first movement is going to be a version inward by the left eye.
BY Herring's Low , the right eye will move outward and then
there will be a fusional vergence movement.
since you are forcing the OD to move into the field of gaze of
the eye to move.
If you were to put the prism over the paretic eye, you would
get a version and then a vergence .the version would be
away from the DAF of the paretic muscle so you would need
less prism. Less prism means less distortion, etc.
13.
A method to change the sensory input for
constant strab to precipitate a change from
ARC to NRC.
Take a Fresnel prism and cut it round. For one
week ,the patient wears it BO and then you
rotate it to BU, then BI, then BD.
Take prism and change the base.
- to break down ARC.
-This is a disruptive prism technique.
14.
Different amounts of prism are needed in
different fields of gaze or for different
distances.
ex) 20∆ET at distance and 10∆ET at near
Only put the prism on a portion of the lens.
ex)only need prism in R gaze.
15.
Think what type of Prism you are going to give the patient.
If the patient doesn't have normal sensory fusion or has
ARC or suppression ,don't Rx relieving prism or corrective
prism right away.
Prism to break down ARC or suppression:
Over corrective
Inverse (disruptive)
Rotating
Regional Prism describes where you are mounting the
Prism.
you can Rx corrective regional relieving Prism.
you aren't putting Prism over the entire lens.
16. These are only guidelines.
1) BO useful for distance ET with NRC
don't give convergence excess patients BO,
an add works Better
BI more useful for XT than with exophoria because exophoria
are so easy to train.
2) Rx Relieving prism when normal sensory fusion is present (NRC &
no suppression) and normal binocularity can be sustained
3) Do not Rx Relieving prism if ARC is present (except when using
inverse prism cosmetically).
17. 4) Do not Rx vertical relieving prism for secondary vertical
deviations or DVD's.
Primary it's the deviation and is present all the time. The
vertical deviation is still present when you eliminate the
horizontal deviation.
Secondary the vertical deviation is not present when the
horizontal deviation is gone.
Many people with intermittent diplopia can relate to this
because when they are diplopic, the 2 images are separated
horizontally with a little bit of vertical misalignment.
18. ex) when the eye moves out 25∆, it's in the DAF or vertically
acting muscles ( SR & IR ). If the actions of the SR & IR
aren't exactly symmetrical, there will be a vertical
deviation.
On a secondary vertical deviation, when the eyes are
straight , the patient will never show a vertical deviation on
any test (Phoria, Torrington, Disparometer)
5) Rx neutralizing (corrective) prism in the initial Rx when
there's NRC and shallow suppression / amblyopia.
6) Nonconcomitant deviations: put all or most of the prism in
front of the paretic eye if you are Rxing for fusion.
.
19. 7) Whenever you Rx prism, watch for prism adaptation even if
you think your patient has NRC and shallow or no
suppression. You
don't want the deviation to get larger
8) Consider cosmetic
20. 1-30∆each eye (available in 1-10∆,12∆,15∆,20∆,25∆,30∆)
Quick
Less expensive($10-12/ prism vs . replacing an entire lens
with ground in prism). Good if you need to replace and
change the prism.
Can rotate
You can rotate it a pinch to neutralize a little bit of
vertical.
Decreases VA and contrast sensitivity
The more prism ,the more blur.
You can give it right away to alleviate symptoms.