IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
True vs. pseudo papilledema, Dr. Jekyll and Mr. HydeWafik Bahnasy
◘ The term “ has been restricted to the description of optic disc swelling secondary to increased ICP
◘ Papilledema is the hallmark sign of IIH with or without associated retinal hemorrhages, folds, cotton wool spots, and exudates
◘ Papilledema results in dysfunction of the swollen ON fibers followed by progressive loss of the retinal nerve fibers, and lastly optic atrophy
◘ The threat of vision loss is correlated with the severity of papilledema
The basis of manual small incision cataract surgery is the tunnel construction for entry to the anterior chamber.
The parameters important for the structural integrity of the tunnel are the self-sealing property of the tunnel, the location of the wound on the sclera with respect to the limbus, and the shape of the wound.
Cataract surgery has gone beyond just being a means to get the lens out of the eye.
Postoperative astigmatism plays an important role in the evaluation of final outcome of surgery. Astigmatic consideration, hence, forms an integral part of incisional considerations prior to surgery.
True vs. pseudo papilledema, Dr. Jekyll and Mr. HydeWafik Bahnasy
◘ The term “ has been restricted to the description of optic disc swelling secondary to increased ICP
◘ Papilledema is the hallmark sign of IIH with or without associated retinal hemorrhages, folds, cotton wool spots, and exudates
◘ Papilledema results in dysfunction of the swollen ON fibers followed by progressive loss of the retinal nerve fibers, and lastly optic atrophy
◘ The threat of vision loss is correlated with the severity of papilledema
The basis of manual small incision cataract surgery is the tunnel construction for entry to the anterior chamber.
The parameters important for the structural integrity of the tunnel are the self-sealing property of the tunnel, the location of the wound on the sclera with respect to the limbus, and the shape of the wound.
Cataract surgery has gone beyond just being a means to get the lens out of the eye.
Postoperative astigmatism plays an important role in the evaluation of final outcome of surgery. Astigmatic consideration, hence, forms an integral part of incisional considerations prior to surgery.
A surgical procedure featuring a partial thickness scleral flap that creates a fistula between AC and subconjunctival space for filtration of aqueous and creation of conjunctival bleb in an effort to lower IOP
Mahendra Azad et al. GAINT ODONTOGENIC KERATOCYST OF MANDIBLE OPERATED UNDER LOCAL ANESTHESIA- A CASE REPORT. JOURNAL OF DENTAL HEALTH & RESEARCH (VOL. 1, ISSUE 2, JUL - DEC 2020): 24-2
A surgical procedure featuring a partial thickness scleral flap that creates a fistula between AC and subconjunctival space for filtration of aqueous and creation of conjunctival bleb in an effort to lower IOP
Mahendra Azad et al. GAINT ODONTOGENIC KERATOCYST OF MANDIBLE OPERATED UNDER LOCAL ANESTHESIA- A CASE REPORT. JOURNAL OF DENTAL HEALTH & RESEARCH (VOL. 1, ISSUE 2, JUL - DEC 2020): 24-2
Comparative study of the results of 0.04%da mitomycin c and simple conjunctiv...Apollo Hospitals
Pterygium recurrence is one of the most common complications following simple pterygium excision. Mitomycin-C and conjunctival autograft are the two procedures known to decrease the recurrence rate. Comparing the results of the two procedures is the purpose of this study.
PURPOSE: To evaluate the long-term safety and effica- cy of Ferrara intrastromal corneal ring segments (ICRS) (Ferrara Ring; AJL, Boecillo, Spain) in patients with kera- toconus.
Recent Management of Double Pterygium: A Hospital Based Study
Abstract: Purpose: To describe a recent management of conjunctivo-limbal autografting (CLA) for double pterygium in single eye & to evaluate post surgical outcome on follow up. Method: A total 6 months prospective short study in which fifteen (15) patients were selected who had double pterygium in one eye & serial analysis of 15 eyes of surgically managed double pterygium was done. The conjunctivo-limbal autograft from Nasal & Temporal pterygium in same eye was taken from the neck-body of pterygium on either side & the harvested conjunctivo-limbal autograft from the neck-body of the nasal pterygium was transferred to temporal pterygium & similarly temporal autograft nasally with minimal loss of limbal stem cells. The patients were followed up per month to check for any recurrence or complications. Result: No recurrence or other complications was noted in any patient. Conclusion: Transferring conjunctival autograft harvested from neck- body of nasal & temporal pterygia in the same eye to utilize for autografting in temporal & nasal pterygium in double pterygium is less complicated & useful procedure for double headed pterygium .
Background: Nowadays, ICRS are a step in the treatment of keratoconus. The purpose of this study was to evaluate the refractive effect and the tomographic and biomechanical parameters in keratoconus patients implanted with Ferrara ICRS, and their stability after 18 months.
A multicentric nonrandomized study was conducted in which a new 320-ICRS was placed in 138 eyes of 130 patients with keratoconus. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry, corneal volume, asphericity, lines of vision gain/loss, and vectorial analysis were assessed preoperatively and at the final follow-up visit after the procedure.
Comparative Study Of Pterygium Excision With Conjunctival Autograft,Wet Amnio...Dr. Jagannath Boramani
Presenter: Dr. Pavitra K. Patel, Co-authors: Dr. Sachin Daigavane,Dr. Mala Kamble, Department of Ophthalmology, Jawarharlal Nehru Medical College & Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha.
Combined Tissue and Mesh repair for Midline Incisional HerniaKETAN VAGHOLKAR
Repair of incisional hernia continues to pose a challenge to the general surgeon. A combination technique best suited for mid line incisional hernias with loss of domain is presented.
Topical dorzolamide for macular edema in the early phase after vitrectomy and...Avaleks-Kiev
Background: The purpose of this study was to evaluate prospectively the efficacy of a topical carbonic anhydrase inhibitor in macular edema after vitrectomy.
Цель: оценка перспективы использования топического ингибитора карбоангидразы для профилактики развития макулярного отека после витрэктомии.
http://ophthalmolog.kiev.ua/
Purpose: To evaluate the influence of age and severity of keratoconus in the clinical outcomes of implantation of Ferrara intrastromal corneal ring segments (ICRS).
An Examination of Effectuation Dimension as Financing Practice of Small and M...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Does Goods and Services Tax (GST) Leads to Indian Economic Development?iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Childhood Factors that influence success in later lifeiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Emotional Intelligence and Work Performance Relationship: A Study on Sales Pe...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Customer’s Acceptance of Internet Banking in Dubaiiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study of Employee Satisfaction relating to Job Security & Working Hours amo...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Consumer Perspectives on Brand Preference: A Choice Based Model Approachiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Student`S Approach towards Social Network Sitesiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Broadcast Management in Nigeria: The systems approach as an imperativeiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study on Retailer’s Perception on Soya Products with Special Reference to T...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study Factors Influence on Organisation Citizenship Behaviour in Corporate ...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Consumers’ Behaviour on Sony Xperia: A Case Study on Bangladeshiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Design of a Balanced Scorecard on Nonprofit Organizations (Study on Yayasan P...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Public Sector Reforms and Outsourcing Services in Nigeria: An Empirical Evalu...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Media Innovations and its Impact on Brand awareness & Considerationiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Customer experience in supermarkets and hypermarkets – A comparative studyiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Social Media and Small Businesses: A Combinational Strategic Approach under t...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Secretarial Performance and the Gender Question (A Study of Selected Tertiary...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Implementation of Quality Management principles at Zimbabwe Open University (...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Organizational Conflicts Management In Selected Organizaions In Lagos State, ...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
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
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
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
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!
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.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
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
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
Pterygium Excision with Free Conjunctival Limbal Autograft
1. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 11 Ver. II (Nov. 2015), PP 62-68
www.iosrjournals.org
DOI: 10.9790/0853-141126268 www.iosrjournals.org 62 | Page
Pterygium Excision with Free Conjunctival Limbal Autograft
1
Dr. Viswamithra, Dr. Bhaskara Rao N2
1
MS (Ophthalmology) ,Associate Professor of Ophthalmology, Department of Ophthalmology, Andhra Medical
College, Visakhapatnam , Consultant , Cornea &Anterior Segment Service ,Government Regional Eye
Hospital, Visakhapatnam
2
Professor of Anaesthesiology, Gayathri Medical College, Visakhapatnam.
Abstract:
Objective: To evaluate the success and complications of pterygium excision with Free Conjunctival Limbal
AutoGrafting (CLAG) for the management of primary pterygium.
Methods: Retrospective analysis of medical records of 128 patients who underwent primary pterygium
excision with Free (free of sutures and glue) conjunctival limbal autografting at ‘Cornea Clinic’ of the
Department of Ophthalmology, Andhra Medical College, Visakhapatnam between October 2011 to November
2012, was carried out.
Results: There were 28 (21.88%) males and 100 (78.12%) females. Mean age of the patients was 43.88 (range
19-66 year). 56 (43.75%) were right eyes and 72 (56.25%) were left eyes. Grade 2 pterygium in 90 (70.31%)
eyes, and Grade 3 pterygium in 35(29.69%) eyes. Mean follow-up period was 48 weeks (ranged 24 weeks to 72
weeks). Graft adherence by the end of 4 weeks post operative period was seen in 127 (99.218%) eyes.
Pterygium recurrence occurred in 1 (0.78%) eye. No vision threatening complications were encountered either
intra-operatively or post-operatively.
Conclusion: Pterygium excision with Free CLAG is a safe, effective and economical procedure for the
management of primary pterygium.
Key Words: Pterygium, pterygium surgery, conjunctival limbal autograft
I. Introduction
With a reported world prevalence rate at 2 to 29%, Pterygium is a common ocular morbidity. ¹
India being a part of ‘Pterygium Belt of Cameron’, an equatorial belt delimited by latitude 37°N and
37°S 2
, is having higher prevalence of pterygium (9.5%).3
The accepted etiopathogenesis for pterygium is the
ultraviolet radiation induced damage or mutation to the limbal stem cell barrier with subsequent
conjunctivalisation resulting in the encroachment of a wing-shaped, fibrovascular growth on to the cornea.4, 5
The definitive management of pterygium is surgical excision. Recurrences being the main complication of
simple surgical excision, various adjuvant procedures have been described in literature with the aim of
reducing the recurrence rates. These are intra-operative and post-operative mitomycin C drops, post-operative
Thiotepa drops, beta irradiation, various conjunctival grafting procedures, amniotic membrane transplantation .
Reported recurrence rates with these procedures vary from 89% with simple surgical excision to 5% with
pterygium excision with conjunctival autografting. 6
Literature review shows that of all the available options for
the management of pterygium, conjunctival limbal autografting is proven to be associated with least recurrence
rate hence this procedure has become the gold standard for the management of primary pterygium. 7, 8, 9
Traditionally, conjunctival limbal autograft is fixated to the exposed scleral bed after pterygium
excision with sutures (7.0, 8.0 vicryl, 10.0 MFN) or fibrin glue. Several studies in literature comparing sutures
and fibrin glue in pterygium surgery have brought out several issues. 10, 11
Increased surgical time, post-operative discomfort, pain, watering, suture-related infection, granuloma
formation, loose or broken sutures, and non-absorbable sutures that need removal and increased chances of
recurrence are the concerns with sutures.12
Sutures may be replaced with fibrin glue which shortens the surgery time, increases post-op comfort to the
patient and avoids suture related complications but the major concerns with fibrin glue are its prohibitive cost
and potential for transmission of infectious agents like human parvovirus B19 and prions, potential for
anaphylactic reaction with usage of commercial fibrin glue. 13
deWit D et al reported a successful outcome of conjunctival limbal auto grafting without sutures or
fibrin glue in primary pterygium surgery. 14
We report our technique and results of pterygium excision with free (suture-free, glue-free)
conjunctival limbal autograft for primary pterygium.
2. Pterygium Excision with Free Conjunctival Limbal Autograft
DOI: 10.9790/0853-141126268 www.iosrjournals.org 63 | Page
II. Materials & Methods:
This retrospective study included 128 eyes with primary nasal pterygium that underwent pterygium
excision with free conjunctival limbal autografting, between October 2011 and November 2012 in ‘Cornea
Clinic’ of Andhra Medical College, Visakhapatnam. To ensure consistency, all surgeries were done by a single
surgeon. Informed written consent from the patient was taken for the procedure as per the protocol of the
Institute.
Inclusion Criteria:
Patients above 18 years of age
Primary nasal pterygium of Grade 2 or Grade 3
Patients who completed a minimum of 6 months post operative follow up
Exclusion Criteria:
Recurrent pterygium
Temporal pterygium
Grade 1 pterygium
History of previous ocular trauma or surgery
Usage of contact lenses
Presence of other ocular pathology
Patient data collected included gender, age, rural/urban/tribal domicile, history of previous ocular
trauma or surgery, indication for pterygium surgery, grade of pterygium, pre-op & post-op BCVA, duration of
surgery, intra-operative and post-operative complications, post- operative treatment, post-operative reviews and
recurrence of pterygium.
Pterygium Grading (T1-3) according to the extent (mm) on to the cornea
Grade 1 = 0-2 mm from limbus
Grade2 = 2-4mm from limbus
Grade 3 = > 4mm from limbus
Success is defined as graft adherence to the surgical site at the end of 4weeks post-operative period.
Recurrence is defined as a corneal recurrence that is evidenced by growth of fibrovascular tissue across the
limbus onto the cornea at the surgical site. 9
The surgical technique we followed for pterygium excision and conjunctival limbal autograft
harvesting was similar to that described by Kenyon et al 15
with a modification i.e., the graft was adhered to the
sclera by applying pressure. 14
III. Surgical Technique:
Under peribulbar anaesthesia, with 2% xylocaine, lids were separated by a wire speculum. Superior
rectus bridle suture was inserted .With Westcott scissors, a small incision was made just medial to the visibly
altered conjunctiva over the body of the pterygium, and all the subconjunctival adhesions were snipped. The
dissection was extended medially just up to caruncle and towards upper and lower fornices in a triangular
fashion. Care was taken not to buttonhole the conjunctiva and not to injure the caruncle which is a very vascular
structure. Clear corneal epithelium 2 mm ahead of the pterygium cap was scraped off using No.15 Bard Parker
blade. By holding the neck of pterygium and applying gentle traction medially, pterygium head was removed
off the cornea with crescent blade. Using blunt and sharp dissection, the fibrovascular tissue was dissected from
the sclera. Care was taken to avoid damage to the underlying medial rectus. Pterygium mass along with its
fibrovascular adhesions, the altered conjunctiva and the surrounding Tenon’s capsule was excised. Corneal
surface and the limbus were thoroughly polished with No15 BP blade to remove any remaining cicatrix.
Complete desiccation of the exposed scleral bed was achieved using mild cautery. The extent of the exposed
scleral bed was measured with Castroviejo callipers. The measured dimensions were marked on to the
superotemporal conjunctiva. 0.5 ml of normal saline was injected beneath the superotemporal conjunctiva to
separate the Tenon’s capsule. Using Mc Pherson’s plain forceps and Vannas’ scissors, a thin, almost tenon’s
free conjunctival limbal autograft, 2 mm larger than the scleral bed was harvested. At the limbus, graft was
dissected a little deeper and 0.25-0.5 mm into clear cornea. Graft was gently slid on to the sclera bed, observing
limbus to limbus orientation. Graft was smoothened on to the scleral surface for 7-8 minutes with iris repositor
such that no potential space is left beneath the graft. Superotemporal donor site was cleared of any
haemorrhage. Speculum was removed carefully taking care not to disturb the graft and eye was patched for 24
hours.
Post-operatively, topical antibiotic drops were given 4 times a day for 2 weeks, and topical steroid
drops were given 6 times a day to be tapered over 6 weeks. Patients were instructed not to rub the eye or splash
3. Pterygium Excision with Free Conjunctival Limbal Autograft
DOI: 10.9790/0853-141126268 www.iosrjournals.org 64 | Page
water directly in to eye for 1 week. Post-operative follow-ups were done on 1st
post op day, 1 week, 2 weeks, 4
weeks, 1 month, and once every 3 months subsequently.
IV. Results:
28 (21.88%) males and 100 (78.12%) females were included in the study. Mean age of the patients
was 43.88 years (range 19-66 years). Pterygium was present in 56 (43.75%) right eyes and 72(56.25%) left
eyes. Pterygium was Grade 2 in 90 (70.31%) eyes and Grade 3 in 35(29.69%) eyes. No significant intra-
operative complications were encountered. Average surgical time was 17.8 minutes.
Figure.1 shows pre op pterygium
Figure. 2 shows FREE CLAG 1st day post op
Figure.3 shows FREE CLAG 4 weeks post op
Post-operative discomfort in the form of watering and lid edema was observed in 24 (18.75%) patients
which resolved in 2 weeks’ time. Lack of adhesion of the graft was seen in 1 eye (0.78%). Graft edema and
inflammation was seen in 24 (18.75%) eyes, subsided in 3-4 weeks with routine post-op treatment. Dellen
formation was seen in 1 (0.78%) eye at 2nd
week post-operative review which resolved on treatment with
intense lubrication along with routine post-operative regime. Haemorrhage beneath the graft was seen in 6
(7.68%) eyes which resolved spontaneously in 2 weeks. Retraction of the non-limbal edge of the graft was seen
in7 (5.468%) eyes. Adequate re-epithelisation occurred in all these cases in 3-4 weeks. Recurrence of
pterygium was observed in 1 eye (0.78%) at 16 weeks post-op which was across the graft. Granuloma at donor
site was observed in 1 (0.78%) eye which resolved on intense topical steroid therapy.
5. Pterygium Excision with Free Conjunctival Limbal Autograft
DOI: 10.9790/0853-141126268 www.iosrjournals.org 66 | Page
Figure.7 shows granuloma at donor site
Figure. 8 shows dellen
Figure.9 shows haemorrhage beneath the graft
6. Pterygium Excision with Free Conjunctival Limbal Autograft
DOI: 10.9790/0853-141126268 www.iosrjournals.org 67 | Page
Figure.10 shows graft recurrence
V. Discussion:
Recurrence after successful removal of pterygium is undesirable. Despite the surgical options with
their adjuvant procedures, that one satisfactory method of removing pterygium, which has minimal
complications and a very low recurrence rate, that can deal with any form or grade of pterygium has not yet
been identified. A recent detailed review on the treatment of pterygium revealed that, despite the variable
success rates reported in literature, conjunctival limbal autograft remains the safest technique and offers the
lowest rate of recurrence in the managementofprimarypterygium.11,16
Though technically more demanding, authors like Kenyon et al, Koch et al insisted on the inclusion of limbal
tissue in the graft to reduce the recurrence. 8, 15
In our study the average surgical time taken was 17.53 minutes, comparable with that of fibrin glue. 17
The importance of inclusion of limbal stem cell in the graft was stressed by Dushuku et al.4
Pterygium
recurrence occurred in 1 (0.78%) patient in our study. Recurrence was observed in the fourth post-operative
month, in a 32 year old male who was operated for Grade 2 pterygium. Recurrence rate of our study is
consistent with the reported recurrence rate of conjunctival limbal autografting which ranges from 0-15%. 18
The points we conscientiously observed to prevent recurrence were
Inclusion 2mm of clear corneal epithelium ahead of pterygium cap 4
Complete removal of cicatrix from the corneal surface, limbus and sclera bed
Thorough polishing of corneal surface to ensure even distribution of tear film
At the limbus, the graft was harvested deeper and extended 0.25 mm into the clear cornea to
ensure the presence of limbal stem cells
While placing the graft over the surgical site, limbus to limbus orientation was maintained for
proper relocation of limbal stem cells
No potential space was left beneath the graft to facilitate early vascularisation19
Patching the eye for 24 hours as closed lids provides a natural dressing and helps in the
adherence of the graft
Probably, all these might have contributed to a low recurrence rate (0.78%) in our series.
Graft adherence at 4weeks postoperative period i.e. success of this procedure, was seen in 127
(99.218%) eyes.
Graft dehiscence is a recognised complication even with figrin glue usage. 20
In our series, graft
dehiscence occurred in 1 eye, on 1st
post-operative day. The graft was found to be bulky and edematous. We
reposited the graft with iris repositor, patched the eye for another day but the graft didn’t take up. We observed
that thinness of the graft is directly proportional to the chances of graft adherence. Presence of tenon’s tissue in
the graft makes it edematous and contributes to post-op graft inflammation, discomfort and chance of
displacement. Seepage of serous fluid or blood beneath the graft lifts up the graft and prevents its adherence
hence we thoroughly desiccated the surgical site with the help of mild cautery.
Post-operative discomfort in the form of lid edema, redness and watering was seen in24 (18.75%)
cases and graft showed inflammation in these cases. All these patients became symptom-free in 7-10 days.
Graft inflammation subsided in 2 weeks to 3 weeks with routine post op treatment.
7. Pterygium Excision with Free Conjunctival Limbal Autograft
DOI: 10.9790/0853-141126268 www.iosrjournals.org 68 | Page
Graft retraction at the non-limbal edge occurred in 7 (5.468%) cases. Gradually re-epithelisation occurred in all
these cases by 4 to 6 weeks’ time without compromising the cosmesis. Hence we prefer to take an oversized
graft of 1 - 2 mm of length and width relative to the graft bed than the exposed scleral surface.
Except for granuloma formation in 1 case, donor site in all cases of our series healed well.
Mean follow-up period of our cases was 48 weeks ranged 24 weeks to 82 weeks. Though most of the
pterygium recurrences occur during the first 6 months after surgery x, it is desirable to have a minimum 1 year
follow up. 21
Visual acuity was maintained at pre-operative values in all patients. No major vision threatening
complications occurred either intra-operatively or post-operatively.
Main limitation of our study is its retrospective nature and limited sample size and shorter duration of follow
up.
Our study suggests that conjunctival limbal autograft adheres to the surgical bed freely, without the aid
of glue and sutures.It’s recurrence rate is comparable with other limbal autografting techniques.
VI. Conclusion:
Free conjunctival limbal grafting is technically simple, doesn’t need any new surgical skill or
additional instruments. It is safe, effective and economical and should be the procedure of choice for the
management of primary pterygium.
References:
[1]. Leonard P, Jocelyn L, Donald T. Current concepts and techniques in pterygium treatment Curr Opin Ophthalmology 2007, 18:308-
313
[2]. Demartini DR, Vastine DW. Pterygium In: Abbott RL, editor. Surgical intervention in Corneal and External diseases. Orlando,
USA: Grune and Straton; 1987, p141
[3]. 3. Asokan R, Venkatasubbu RS, Velumuri L, Lingam V, George R Prevalence and associated factors for pterygium and
pinguecula in a South-Indian population. Ophthalmic Physiol Opt. 2012 Jan;32(1):39-44
[4]. Dushku N, Reid TW. Immunohistochemical evidence that human pterygia originate from an invasion of vimentin-expressing
altered limbal epithelial basal cells. Curr Eye Res 1994;13:473-81.
[5]. Luthra R, Nemesure B, Wu S, Xie S, Leske M: Frequency and risk factors for pterygium in the Barbados Eye Study. Arch
Ophthalmol 2001, 119:1827-1832
[6]. Juan Camilo Sánchez-Thorinan B, Guillermo Rochab, Julie B Yelinb. Meta-analysis on the recurrence rates after bare sclera
resection with and without mitomycin C use and conjunctival autograft placement in surgery for primary pterygium Br J
Ophthalmol 1998;82:661-665
[7]. Abraham Solomon, MD, Renato T.F Pires, MD, Scheffer C.G Tseng, MD, PhD. Amniotic membrane transplantation after
extensive removal of primary and recurrent pterygia. Ophthalmology108;3: 449-460
[8]. Koch JM, Mellin JB, Wauble TN. The pterygium -Autologous conjunctiva - limbus transplantation as treatment. Ophthalmology
1992;89:143-46.
[9]. Lawrence WA Hirst, MBBS, MD MPH, DO, FRACO, FRACS.The treatment of pterygiuma. Survey of Ophthalmology
2003;48(2): 145-180
[10]. A Karalezli,C Kucukerdonmez,Y A Akova, R Altan-Yaycioglu, M Borazan. Fibrin glue versus sutures for conjunctival
autografting in pterygium surgery: a prospective comparative study Br J Ophthalmol 2008;92:1206-1210
[11]. S Srinivasan, M Dollin, P McAllum,Y Berger, D S Rootman, A R Slomovic. Fibrin glue versus sutures for attaching the
conjunctival autograft in pterygium surgery: a prospective observer masked clinical trial Br J Ophthalmol 2009;93:215-218
[12]. Suzuki T, Sano Y, Kinoshita S. Conjunctival inflammation induces Langerhans’ cell migration into the cornea. Curr Eye Res
2000;21:550–3.
[13]. G Koranyi, S Seregard, E D Kopp. Cut and paste: a no suture, small incision approach to pterygium surgery. Br J
Ophthalmol 2004;88:911-914
[14]. de Wit D, Athanasiadis I, Sharma A, Moor J. Sutureless and glue-free conjunctival autograft in pterygium surgery: a case series.
Eye(London2010)Sep;24(9):1474-7. Epub 2010 Jun 4
[15]. Kenyon KR, Wagoner MD, Hettinger ME. Conjunctival autograft transplantation for advanced and recurrent pterygium.
Ophthalmology 1985;92:1461–70
[16]. Srinivas K Rao, T Lekha, Bickol N Mukesh, G Sitalakshmi, Prema Padmanabhan Conjunctival-Limbal autografts for primary and
recurrent Pterygia: Technique and results IJO 1998;46(4):203-209
[17]. Hong-Wei Pan, Jing-Xiang Zhong, MD, PhD, Chun-Xia Jing, PhD Comparison of Fibrin Glue versus Suture for Conjunctival
Autografting in Pterygium Surgery: A Meta-Analysis. Ophthalmology 2011;118(6): 1049-1054
[18]. Du Z, LLiang D, NieA Limbal epithelial autograft transplantation in treatment of pterygiym Chin J Ophthal 2002;38:351-54
[19]. Tayanç E, Akova YA, Yılmaz G, et al Anterior segment indocyanine green angiography in pterygium surgery with conjunctival
autograft transplantation. Am J Ophthalmol 2003;135:71–5
[20]. Uy H.S., Reyes J.M., Flores J.D., Lim-Bon-Siong R. Comparison of fibrin glue and sutures for attaching conjunctival autografts
after pterygium excision Ophthalmology 2005;112:66-71
[21]. Adamis AP, Starck T, Kenyon KR. The management of pterygium. Ophthalmol Clin North Am 1990;3:611 -23