Most retinal surgeons are trained to create formal retinal drawings of the fundus.
Retinal drawings are useful to document pathology, although more and more people now prefer fundus photographs.
Can be used for serial follow up of patients to document changes in the pathology.
Many systemic drugs have reported ocular and visual side effects that impact patient management.
It is important to be familiar with the associated side effects which can be mild and transient or may seriously threaten vision.
Most retinal surgeons are trained to create formal retinal drawings of the fundus.
Retinal drawings are useful to document pathology, although more and more people now prefer fundus photographs.
Can be used for serial follow up of patients to document changes in the pathology.
Many systemic drugs have reported ocular and visual side effects that impact patient management.
It is important to be familiar with the associated side effects which can be mild and transient or may seriously threaten vision.
direct ophthalmoscope
fundoscopy course
fundus examination
medical students
ophthalmology
faculty of medicine
kafrelsheikh university
new mansoura university
delta university
Acute Limb Weakness
case presentation
PBL session
3rd year
neuro ophthalmology
new mansoura university
A 54-year-old man, Mr. Stephen Smith, was brought by ambulance to the Emergency Department. He had woken up from sleep with slurring of speech and weakness of his right arm and leg. His wife was extremely distressed as Mr Smith had been perfectly well the previous night when he went to sleep. Within 20 minutes after the initial call was made Mr. Smith was admitted to the Emergency Department and was reviewed by the SpR covering the Regional Specialist Stroke Unit. Mr. Smith had been on regular antihypertensive medication (lisinopril) for 8 years. He smoked 5-8 cigarettes a day and was a social drinker consuming about 6 units of alcohol a week. He was not diabetic.
His Serum lipids were checked and was advised to reduce weight and started on a Statin (Simvastatin). There was no family history of hyperlipidaemia but his grandfather died after a Stroke. Mr. Smith had an urgent appendectomy 1 week and made an uneventful recovery. He lives with his wife in a 4-bedroom detached house.
Neurological examination showed that Mr. Smith was fully conscious and alert. He had an upper motor neuron facial palsy on the right side. He had expressive dysphasia but appeared to comprehend speech. He was just able to lift his right arm off the bed for a short period but had no grip. His right leg was weak.
Reflexes on the right side were exaggerated and his right plantar was extensor. He responded to touch and pin prick equally on both sides. He either had visual inattention or a visual field defect on the right side. He had no papilloedema His blood pressure was 164/96, pulse 84 per min, regular. Other systems were entirely normal.
ECG and all routine blood tests were performed. An emergency CT scan was requested and even though the scan was normal the SpR ruled out emergency thrombolysis in this instance. Mr. Smith was admitted to the Acute Stroke Unit and was seen by the Stroke Consultant. Mr. Smith remained fully conscious and alert but had some difficulty in swallowing. Hence an intravenous infusion was commenced and an alternate strategy was adopted for providing his nutritional requirements. A carotid Doppler scan was requested.
After 3 weeks, Mr. Smith seemed to make good progress and the MDT meeting recorded a consistent improvement in his Barthel Index. The Stroke Team met him with his wife and discussed arrangements for discharge home. His wife was keen to know what support measures were available to them when Mr. Smith returned home. She also wanted to know about the risk of a future stroke and how this could be cut down.
ILOs:-
1- Consider the differential diagnosis of speech.
2- Discuss the risk factors for stroke and primary prevention of stroke.
3- Discuss the overall management of a patient with an acute stroke.
4- Complications of stroke
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
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
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.
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.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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
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- 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
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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
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Systemic drugs affecting cornea
1.
2. Drugs Affecting Cornea
Vortex keratopathy/ cornea verticillata:
characterized by whorl-like corneal epithelial
deposits.
1. Signs:
• Bilateral, fine greyish or golden-brown opacities
in the inferior corneal epithelium.
• Arborizing horizontal lines
3. Drugs Affecting Cornea
Causes:
a. Antimalarial
Chloroquine (Nivaquine, Avlocor)
Hydroxychloroquine (Plaquenil)
• INDICATIONS: malaria; certain rheumatological disorders
• Unlike retinopathy, keratopathy bears no relationship to dosage or duration
of treatment.
• reversible on cessation of therapy.
4. Drugs Affecting Cornea
b. Amiodarone
• INDICATIONS: atrial fibrillation; ventricular
tachycardia
• keratopathy - slowly reversible on
discontinuation of medication.
• Higher dose/ longer duration of
administration more advanced the
corneal deposits.
• keratopathy does not affect vision-
discontinuation not indicated.
• Other toxic effects-
anterior subcapsular lens deposits
optic neuropathy
5. Drugs Affecting Cornea
CHLORPROMAZINE:
INDICATIONS- sedative; psychotic illnesses
SIGNS-
innocuous, subtle, diffuse yellowish-brown
granular deposits in the endothelium,
Descemet membrane and deep stroma
occurring only in exposed cornea of the
interpalpebral fissure
anterior lens capsule deposits
retinopathy
Doses greater than 500 mg/day given for
prolonged periods have a higher incidence
of irreversible corneal and lenticular
deposits.
6. Drugs Affecting Cornea
ARGYROSIS:
discoloration of ocular tissues secondary
to silver deposits, and may be iatrogenic
or from occupational exposure.
Keratopathy is characterized by greyish
brown granular deposits in Descemet
membrane.
The conjunctiva may also be affected.
7. Drugs Affecting Cornea
CHRYSIASIS:
• Deposition of gold in living tissue, occurring after prolonged administration.
• treatment of rheumatoid arthritis.
SIGNS:
• Corneal chrysiasis :
– characterized by dust-like or glittering purple granules scattered throughout
the epithelium and stroma, more concentrated in the deep layers and the
periphery.
– total dose of gold compound >1500 mg develop corneal deposits.
– not an indication for cessation of therapy.
• innocuous lens deposits
• marginal keratitis.
8. Drugs Affecting Cornea
AMANTADINE:
INDICATIONS: Parkinson disease.
SIGNS:
• Diffuse white punctate opacities that may be associated with epithelial
edema, 1–2 weeks after commencement of therapy (dose 200-400 mg/d).
• Resolve with discontinuation of treatment.