This document discusses the management of retinopathy of prematurity (ROP) through a case series using anti-VEGF treatments. It begins with background on ROP and past clinical trials involving cryotherapy and supplemental oxygen therapy. It then summarizes studies using anti-VEGF injections like bevacizumab and ranibizumab to treat advanced ROP cases. The author's own case series of 17 eyes from 8 premature infants treated with pegaptanib, avastin or lucentis is presented, showing regression of neovascularization in all eyes. Potential uses of anti-VEGF discussed include primary therapy or as an adjunct to laser when laser has failed or before vitrectomy surgery to reduce bleeding. In conclusion
This is a presentation given at the teaching programme for Ophthalmologists in training at the Royal Victoria Eye and Ear Hospital, March 2011. It covers new developments in the treatment of Retinopathy of Prematurity.
ROP current understanding and managementFarhadul Alam
Retinopathy of prematurity (ROP) is a vascular disease of the eye unique to preterm infants characterized by failure of retinal blood vessels to grow and develop normally. It results in severe visual impairment and blindness in newborns.
Retinopathy of prematurity (ROP), initially described as retrolental fibroplasia one of the leading cause of blindness in children.
Despite advances in diagnosis and treatment, as medicine and technology advances and premature infants are surviving at earlier gestational ages, ROP continues to be a significant problem.
ROP results in disorganized growth of retinal blood vessels, which may lead to scarring and retinal detachment.
To understand ROP is very important so the newborns can be managed according to the stage efficiently and better visual rehabilitation can be offered to the patients and adequate knowledge can be given to the parents with counseling.
This is a presentation given at the teaching programme for Ophthalmologists in training at the Royal Victoria Eye and Ear Hospital, March 2011. It covers new developments in the treatment of Retinopathy of Prematurity.
ROP current understanding and managementFarhadul Alam
Retinopathy of prematurity (ROP) is a vascular disease of the eye unique to preterm infants characterized by failure of retinal blood vessels to grow and develop normally. It results in severe visual impairment and blindness in newborns.
Retinopathy of prematurity (ROP), initially described as retrolental fibroplasia one of the leading cause of blindness in children.
Despite advances in diagnosis and treatment, as medicine and technology advances and premature infants are surviving at earlier gestational ages, ROP continues to be a significant problem.
ROP results in disorganized growth of retinal blood vessels, which may lead to scarring and retinal detachment.
To understand ROP is very important so the newborns can be managed according to the stage efficiently and better visual rehabilitation can be offered to the patients and adequate knowledge can be given to the parents with counseling.
Vitreous hemorrhage is the extravasation, or leakage, of blood into the areas in and around the vitreous humor of the eye.[1] The vitreous humor is the clear gel that fills the space between the lens and the retina of the eye. A variety of conditions can result in blood leaking into the vitreous humor, which can cause impaired vision, floaters, and photopsia.
It's an indepth presentation by Dr. Shah-Noor Hassan.
VITREOUS AND RETINA PEDIATRIC OCULAR DIESEASES.pptxreshmasu
This ppt explains about the various pediatric ocular diseases of retina and vitreous:
1.Retinoblastoma
2.Persistent hyperplastic primary vitreous (PHPV)
3.Best disease
4.Coats disease
5.Retinopathy of prematurity
6.Stargardts disease
7.Juvenile retinoschisis
8.Familial exudative vitreoretinopathy
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!
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.
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
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
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.
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.
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.
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
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
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.
Light House Retreats: Plant Medicine Retreat Europe
Rop case series- DR AJAY DUDANI
1. Management of ROP and case
series
Dr. Ajay Dudani
Mumbai retina centre
Zen Eye Centre
Bombay Hospital
2. Retinopathy of prematurity
Potentially blinding disorder of premature infants
Association between extreme prematurity and
“fibroblastic overgrowth of persistent avascular
sheath behind each crystalline lens” was first
described by Terry in 1942
Vasculogenesis
Angiogenesis
Requires VEGF
4. Treatment of ROP
CRYO-ROP trial1
Beneficial effect of peripheral cryo-ablation on
avascular retina
STOP-ROP trial2
No difference in conventional vs supplemental
Oxygen therapy
ETROP trial3
Led to ICROP to identify eyes at high risk
1. Arch Ophthalmol. 2001;119:1110-1118.
2. PEDIATRICS Vol. 105 No. 2 February 2000, pp. 295-310
3. PEDIATRICS Vol. 114 No. 2 August 2004, pp. 490-491
5. Treatment of ROP
Ablation of retina
Cryo- extremely destructive
Laser- lesser destructive
Anti-VEGF injection1,2,3
Pathogenesis
Biochemical analysis of the vitreous of
stage 4 ROP eyes shows significantly
elevated VEGF and TGF-beta
concentrations, and normal levels of other
angiogenic factors.
Various case reports
1. Curr Opin Pediatr. 2009 Apr;21(2):182-7
2. Early Hum Dev. 2008 Feb;84(2):95-9.
3. Dev Ophthalmol. 2009;44:89-97. Epub 2009 Jun 3
6. Anti-VEGF in Retinopathy Of Prematurity
Promising treatment for advanced ROP
Severe stage 3 ROP
Aggressive posterior ROP (AP-ROP)
Anecdotal series with all three anti-VEGF1,2,3,4
Quiroz et al have published their series of 18 eyes injected with Avastin2
Neovascular regression in all but one eye
Mintz-Hittner et al from Texas studied 22 eyes treated with Avastin (no
laser)3
Single low dose of Avstin of IVT Avastin for zone I or posterior zone
II ROP stage 3
Michael Trese studied Pegaptanib for stage IV ROP
1. British Journal of Ophthalmology 2008;92:1450-1455
2. Retina 2008; 28:S19-S25.
3. Retina 2008; 28:831-838
4. http://www.osnsupersite.com/view.aspx?rid=20862
7. Anti-VEGF in Retinopathy Of Prematurity
BLOCK ROP trial:
Phase I, prospective multicentric
Bevacizumab one injection, rescue therapy for one
eye of patients with bilateral ROP refractory to
conventional therapy
Stage IV ROP
Endpoint:
Ability of Avastin to stop progression of
ROP to RD
Ophthalmology Times, Apr 1 2008
8. Anti-VEGF in Retinopathy Of Prematurity
Ongoing trial:
BEAT ROP (Bevacizumab Eliminates the Angiogenic Threat of ROP)
Phase II anti VEGF vs Laser
Stage 3 ROP in zone I or posterior zone II with plus disease
Sponsored by: The University of Texas Health Science Center,
Houston
Current status presented at the World ROP Congress in New Delhi
Recurrence rate in zone I greater than in zone II
29 eyes have had recurrences- mostly in laser arm
Intravitreal Bevacizumab monotherapy may prove to have
favorable risk-benefit ratio
http://clinicaltrials.gov/ct2/show/NCT00622726
9. Selective anti-VEGF in ROP
Why selectivity?
VEGF 165 blockade inhibits pathological
angiogenesis at margin of vascular and
avascular retina
Normal retinal angiogenesis continues at the
periphery
Systemic safety
Paramount in premature infants
10. Selective anti-VEGF in ROP
Pioneering use of Pegaptanib sodium to treat ROP unveils many
issues for future studies- Michael Trese, ARVO 2007
Five eyes were given half dose (0.15mg) of Macugen intravitreally
Macugen treatment resulted in reduction of the tunica vasculosa
lentis and improved pupil dilation that allowed laser treatment to be
performed more easily
All of the Macugen-treated eyes appeared more vascularly quiet
than the controls
http://www.escrs.org/PUBLICATIONS/EUROTIMES/06Sept/pdf/Pioneeringuseof.pdf
12. Anti-VEGF for ROP
Our series of 8 premature children, 17 eyes treated with
anti-VEGF
Anti-VEGF agents used:
6 patients (12 eyes) given Pegaptanib Sodium
One each Avastin (one eye) and Lucentis (four eyes)
13. Anti-VEGF for ROP: our series
Age ranged from 27 weeks to 30 weeks
Stage III or IV, zone I or II cases
15 eyes had undergone at least 5000 shots of
laser before considering anti-VEGF
Two eyes were administered anti-VEGF therapy
without initial laser shots
4 eyes underwent lens sparing vitrectomy
Regression of neovascularisation and vitreous
hemorrhage was observed in all the eyes
14. Case-1- ROP
27 weeks infant presented with ROP stage IV A Zone 2
Areas of TRD with Fibro Vascular Proliferation
Laser - 5000 shots
Both eyes pegaptanib sodium (3/4th dose) at one week
interval
Good regression of NV and TRD
18. Case 2
27 weeks baby
Sudden progression to rush disease, zone I and
II
Laser sittings
BE Lucentis
RE developed TRD
19. Case-3
27 weeks infant presented with bilateral ROP stage III Zone 1 with
new vessels around macula : persistent
Bilateral Laser 4000- 5000 shots
RE pegaptanib sodium (3/4th dose)
LE pegaptanib sodium delayed by one week
NV increased with Vitreous Hemorrhage
Do not delay
No Side Effects noted
25. Case-3
After 6 weeks, BE developed vitreous hemorrhage
BE underwent lens sparing vitrectomy
BE bleeding less due to prior anti-VEGF
Suggestion
Pre-vitrectomy Inj. Pegaptanib followed by surgery
after 2 days
Prevent intraop bleeding
26. Case 4
Both eyes ROP stage III zone II with plus
disease
BE inj Lucentis
No laser
FU after 3 weeks
BE stage I zone III with no plus disease
BUT peripheral retina remained avascular
? Does pan-VEGF blockade prevent
normal vasculogenesis of avascular retina?
34. Summary
Though some have used as primary therapy, we have tried
maximum laser f/b anti-VEGF if required
Our case series showed good response in terms of regression of
neovascularisation
Early treatment is the key
No systemic side effects were noted
Potential use anti-VEGF in ROP
Laser failed
Pre-operative to reduce bleeding
Primary