slide presentation about ptosis in ophthalmology department
including mechanical,myogenic,aponeurotic,traumatic,neurogenic cause
plus dermatochalasis
in general appraoch and surgery choice
slide presentation about ptosis in ophthalmology department
including mechanical,myogenic,aponeurotic,traumatic,neurogenic cause
plus dermatochalasis
in general appraoch and surgery choice
you will get knowledge about the ptosis, its different types, its examination, its measurement, its treatment in detail.
different eyelid muscles such as LPS, Orbicularis oculi and frontalis are also explained.
you will get knowledge about the ptosis, its different types, its examination, its measurement, its treatment in detail.
different eyelid muscles such as LPS, Orbicularis oculi and frontalis are also explained.
Ptosis evaluation is very important in making decision which type of management is suitable to your patients.
This presentation summaries an important test which are required to do when you face a patient with ptosis
The lecture concern the eyelids and contain the following subjects and medical terms:
* Anatomy
* Congenital ptosis
* blepharophimosis
* *Epicanthus
* Ptosis syndrome
* amblyopia (Lazy eye)
* Strabismus and its types(Hypertropia, Hypotropia, Esotropia, Exotropia )
* The Fasanella-Servat procedure(video) for correcting upper ptosis
* levator resection(video) another procedure for correting ptosis
* Acquired ptosis and its ptosis
Ptosis is known as the drooping of the upper eyelid, and the patient usually presents with the complaint of the defect in vision and cosmesis. It can be congenital or acquired, or it can be neurogenic, myogenic, aponeurotic, mechanical, or traumatic in origin.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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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.
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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
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
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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
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Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
5. Congenital ptosis- congenital LPS
maldevelopment
• Simple congenital ptosis
• Congenital ptosis with associated weakness of
superior rectus
• Blepharophimosis syndrome
• Congenital synkinetic ptosis
6. Blepharophimosis Syndrome
• Blepharophimosis (horizontal shortening of palpebral fissure)
• Ptosis (droopy lid)
• Epicanthus inversus ( prominent skin fold extend from lower to the
upper lid)
• Telecanthus (widened intercanthal distance )
• Other associations include lower lid ectropion, widened nasal
bridge or superior orbital rim hypoplasia, or hypertelorism,
anteverted ears, and thick highly arched eyebrows
7.
8. Congenital synkinetic Ptosis
Marcus Gunn Jaw Winking Ptosis is a congenital ptosis
associated with synkinetic movements of upper lid on
masticating movements of the jaw.
It is usually unilateral but rarely presents bilaterally.
12. Horner Syndrome
• A persistently small pupil (miosis)
• A notable difference in pupil size between the two eyes (anisocoria)
• Little or delayed opening (dilation) of the affected pupil in dim light
• Drooping of the upper eyelid (ptosis)
• Slight elevation of the lower lid, sometimes called upside-down
ptosis
• Sunken appearance to the eye
• Little or no sweating (anhidrosis) either on the entire side of the
face or an isolated patch of skin on the affected side
14. Myasthenia Ptosis
• Fluctuating double vision and asymmetrical ptosis
usually bilateral but may be unilateral are the
hallmarks of extraocular muscle weakness in
myasthenia gravis (MG).
• On sustained upward gaze, ptosis usually increases
temporarily.
• Worst with fatique & upgaze
15. Cogan's lid twitch sign, characteristic of
myasthenia gravis, consists of a brief overshoot
twitch of lid retraction following sudden return
of the eyes to primary position after a period of
downgaze.
17. Autosomal dominant disease characterized by an inability to relax
(myotonia) and muscle wasting (muscular dystrophy)
Myotonic dystrophy
Initially present with symptoms of ptosis, ophthalmoplegia, extraocular
myotonia, and decreased visual acuity.
General appearance may show muscle wasting and frontal balding.
A ‘Hatchet Face’ appearance due to temporalis and masseter muscle
wasting.
During a hand shake, the patient may have difficulty with release
Presenile stellate cataract, Hypogonadism, intellectual deterioration.
19. Aponeurotic Ptosis
It develops due to defect in levator aponeurosis
Includes
Senile ptosis
Postoperative ptosis ( associated with blepharochalasis
Post traumatic disinsertion or dehiscence
20. Mechanical ptosis
Due to excessive weight on upper eyelid
Lid tumor
Multiple chalazia
Lid oedema
Cicatrial ptosis
Ocular pemphigoid
trachoma
21. Pseudoptosis
• Conditions which mimic ptosis include
• enophthalmos,
• anophthalmos,
• dermatochalasis,
• hypotropia,
• contralateral lid retraction,
• contralateral proptosis,
• facial nerve palsy,
• superior sulcus deformity,
• brow ptosis
22. History
• Age of onset
• Duration
• Uni/Bilateral
• Diurnal variation
• Diplopia
• Muscle weakness, lid edema
• Trauma/ Surgery, previous ptosis surgery
• Eye movementimparirment
• Aberrant lid movements
• Past medical history
• Current medication
• Family history
24. Examination starts from the moment a patient enters the op room
head posture and face turn if any should be noted. Chin-up position is
the most commonly encountered posture
Frontalis overaction: patient may compensate the ptosis by lifting
eyebrows with the frontalis muscle
External examination including the palpation of eyelids and orbital rim
should be done
25. Lid position in downgaze:
Lid lag in downgaze (higher position of upper eyelid in
downgaze) in the absence of trauma/surgery is suggestive of
dysgenesis of levator muscle (commonly in congenital ptosis)
since the dysgenetic muscle is not able to relax properly
26. Features suggestive of BPES: should be observed
Telecanthus, epicanthus inversus, hypoplasia of the superior
orbital rims, horizontal shortening of the eyelids, ear
deformities, hypertelorism, and hypoplasia of the nasal bridge
27. Synkinesis:
The variation of the amount of ptosis with jaw movements
is seen in Marcus Gunn jaw-winking ptosis,
And variation in ptosis with ocular movements is noted in
aberrant regeneration of the oculomotor nerve or the facial
nerve, and some types of Duane's retraction syndrome
29. Cogan's lid twitch: Elicited by having the patient look in downgaze,
followed byupgaze. As the affected eye saccades up, the upper lid
overshoots. Seen in myasthenia
Extraocular movements affected in CPEO, myasthenia as well as in
the third nerve palsy
Posterior segment examination: Example, abnormal retinal
pigmentation seen in Kearn-Sayre syndrome
30. Cigarette paper appearance of lid skin due to recurrent edema occurs
in blepharochalasis
Proptosis or enophthalmos should be ruled out which may contribute
to pseudoptosis
31. Strabismus if present should be evaluated. Cover/uncover test
should be done in all cases of ptosis. It should be noted that
hypertropia can mimic ptosis
The presence of lagophthalmos should be assessed-ptosis surgery
can cause worsening of the same
Best corrected visual acuity and cycloplegic refraction should be
done especially in children to asses amblyopia and visual problems
33. Margin-reflex distance 1 (MRD1): The distance between the central
corneal light reflex and upper eyelid margin with eyes in primary
position. Normal MRD 1 is 4–5 mm
Margin-reflex distance 2 (MRD2): The distance between the central
corneal light reflex and lower eyelid margin with eyes in primary
position
Palpebral fissure height (PFH): It is the distance between the upper
and lower eyelid margins at the axis of the pupil. The sum of the
MRD1 and the MRD2 should equal the vertical PFH
34. Levator function: Berke's method estimated by measuring
the upper eyelid excursion, from downgaze to upgaze with
frontalis muscle function negated and with the head
positioned in the frontal or Frankfort plane. The amount of lid
elevation is recorded in millimeters (mm) of levator function.
The classification of levator function:
Poor: 0–4 mm lid elevation
Fair: 5–11 mm lid elevation
Good: 12–14 mm lid elevation
Normal: >15 mm lid elevation.
35. Margin crease distance: Upper eyelid crease position is the distance
from the upper eyelid crease to the eyelid margin.
It is normally 7–8 mm in males and 9–10 mm in females.
High skin crease suggests aponeurotic defect. The depth of skin crease is
a guide to determine the levator function in young children
36. Pretarsal show: It is an important aspect of finding out the
symmetry of eyelids. It is the distance between the lid margin
and the skin fold with the eyes in primary position
37. Fatigue test: MRD1 should be measured first. Then the patient should
be asked to look up for 2 min after which the MRD 1 is to be measured
again. Worsening of ptosis is seen in myopathies, myasthenia as well as
senile aponeurotic ptosis
Ice test: Glove containing ice pack is applied on the closed ptotic eye for
2 min. If the lid elevates by 2 mm or more, it is suggestive of
myasthenia
Tensilon test: In cases of suspected myasthenia, 2 mg of edrophonium is
injected slowly in 15–30 s. The needle is left in situ, and the remaining 8
mg is injected slowly if no adverse reaction is observed within 1 min. If
myasthenia is the cause, ptosis improves after the injection
38. Phenylephrine test: Sympathomimetic agents, such as
phenylephrine or apraclonidine, can be instilled under the
eyelid to test the function of Muller's muscle
Schirmer's test: To evaluate tear function
Tear breakup time in individuals suspected of having dry eyes
due to the potential risk of incomplete eyelid closure and
exposure keratopathy following surgical correction
Corneal sensitivity should be tested in all cases.
39. Treatment
Congenital ptosis- almost always surgery
Acquired ptosis- treat underlying cause surgery
Fasanella servant operation
Levator resection
Frontalis sling operation