The slit lamp biomicroscope allows high-powered, stereoscopic examination of the eye. It has two main components: an illumination system that produces a thin slit of light using the Kohler principle, and an observation system consisting of binocular microscopes. There are two common types - Zeiss and Haag Streit - which differ in the position of the light source. Various illumination techniques like diffuse, direct, retro-illumination and specular reflection are used to visualize different ocular structures. The slit lamp enables in-vivo examination of the anterior segment in 3D and is invaluable for diagnostic and surgical procedures.
Keratometer is an ophthalmic instruments and has a very important role in optometry field specially for IOL power calculation, Contact lens fitting, to rule out corneal pathology and its progression ie Keratoconus, PMCD.
Slit lamp biomicroscopy and illumination techniquesLoknath Goswami
It is a presentation on slitlamp for beginner, shown the parts and different illumination techniques both for eye and contact lens and it have short history
Keratometer is an ophthalmic instruments and has a very important role in optometry field specially for IOL power calculation, Contact lens fitting, to rule out corneal pathology and its progression ie Keratoconus, PMCD.
Slit lamp biomicroscopy and illumination techniquesLoknath Goswami
It is a presentation on slitlamp for beginner, shown the parts and different illumination techniques both for eye and contact lens and it have short history
ACAPULCO SE PRESENTA EN LA VITRINA TURÍSTICA DE ANATO EN COLOMBIA.Visita Acapulco
Como parte de las estrategias de promoción y diversificación de mercados para el Puerto de Acapulco, la Secretaría de Turismo del Estado de Guerrero, el Fideicomiso para la Promoción Turística de Acapulco y la Asociación de Hoteles y Empresas Turísticas participaron en la XXXV edición de la Vitrina Turística ANATO 2016, la feria más importante de la región celebrada en Bogotá, Colombia del 24 al 26 de Febrero. A este evento se sumaron seis representantes de hoteles y empresas turísticas, quienes participaron muy activamente en las citas de negocios con mayoristas, donde también se reúnen profesionales, aerolíneas, hoteleros, tour operadores, destinos turísticos y profesionales de esta industria de más de 45 de países.
. Introduction Biomicroscope derives its name from the fact that it enables the practitioner to observe the living tissue of eye under magnification. It not only provides magnified view of every part of eye but also allows quantitative measurements and photography of every part for documentation.
3. • The lamp facilitates an examination which looks at anterior segment, or frontal structures, of the human eye, which includes the –Eyelid –Cornea –Sclera –Conjunctiva –Iris –Aqueous –Natural crystalline lens and –Anterior vitreous.
4. Important historical landmarks De Wecker 1863 devised a portable ophthalmomicroscope . Albert and Greenough 1891,developed a binocular microscope which provided stereoscopic view. Gullstrand ,1911 introduced the illumination system which had for the first time a slit diapharm in it Therefore Gullstrand is credited with the invention of slit lamp.
all about slit lamp. special features, basic designs, principal of observation system, principal of illumination, animations are done for the beginners for easy understanding,pitfalls.
A Classroom presentation, showing the various types of slit-lamps, their parts, and other accessory instruments that can be used with it for enhanced optometric clinical examination.
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
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
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
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
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
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
- 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
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!
2. THE SLIT-LAMP BIOMICROSCOPE is a high-power binocular
microscope with a slit-shaped illumination source, specially
designed for viewing the different optically transparent or
translucent tissues of the eye.
The science of examination with a slit lamp is called
Biomicroscopy as it allows in vivo study of living tissues at
high magnification.
3. Allvar Gullstrand: An ophthalmologist and 1911
Nobel laureate introduced the illumination
system which had for the first time a slit
diaphragm, therefore Gullstrand is credited with
the invention of the slit lamp.
4. One of the most important advantages of
slit-lamp examination is that one can
examine the eye structure in three
dimensions (3D).
Binocular vision- stereopsis is provided
by slit lamp
5. TYPES
There are 2 types of slit lamp biomicroscope
1)Zeiss slit lamp biomicroscope
2)Haag streit slit lamp biomicroscope
In Zeiss type light source is at the base of the
instrument while in Haag streit type it is at
the top of the instrument.
7. The three main components of the modern slit-lamp are:
1) Illumination system
2)Observation system/Viewing arm
3) Mechanical system
Basic design of slit lamp
12. Telescope system
The telescope system provide considerable distance between the
microscope and the patient’s eye, so that certain maneuver like foreign
body removal from the cornea or using extra lenses for fundus
examination can be done.
13. Parfocality
Parfocality : The point at which the microscope is focused corresponds to
the point on which the light is focused, this coupling effect is called
parfocality.
This is achieved by the microscope and the illumination system, having a
common focal plane and their common axis of rotation also lies in that
focal plane.
14. Illumination system
The illumination arm and viewing arm are
parfocal.
Light source is atop the illumination arm in a
lamp housing.
The beam of light can be changed in
intensity,height,width,direction or angle and
color during the examination with the flick of
lever.
15. Observation
system(microscope)
Observation system is essentially a compound
microscope composed of two optical elements
1.an objective ,2.an eyepiece
It presents to the observer an enlarged image of a near
object.
The objective lens consists of two planoconvex lenses
with their convexities put together providing a
composite power of +22D.
The eye piece has a lens of +10D.
Microscope is binocular i.e. it has two eyepieces giving
binocular observer a stereoscopic view of eye.
19. Mechanical system
Joystick arrangement
Movement of microscope and illumination system
towards and away from the eye and from side and
side is achieved via joystick arrangement.
Patient support arrangement
Vertically movable chin rest and the provision to
adjust height of table.
20. Fixation target:
A movable fixation target greatly faciliates the
examination under some conditions.
Mechanical coupling :
Provides a coupling of microscope and the
illumination system along a common axis of
rotation that coincides their focal planes.
This ensures that light falls on the point where
the microscope is focused
Has advantages when using the slit lamp for
routine examination of anterior segment of eye.
21.
22. Prerequisites :
Switch on power & unlock base screw
Cleaning the forehead band
Changing paper strip from chinrest
Comfortable sitting of pt. and the examiner
Counseling the patient
Proper positioning of the pt.
Target fixation
Adjust eyepieces to correct for examiner’s refractive error and interpupillary
distance
Children may need to stand, or they can sit on parent’s lap or kneel on a
stable chair
Patient
positioning
Alignment
mark
24. Filters used in slit lamp biomicroscopy
Cobalt blue filter
Used in conjunction with fluorescein stain
Dye pods in area where the corneal
epithelium is broken or absent.
The dye absorbs blue light and emits green.
Uses:
Ocular staining
RGP lenses fitting
Tear layer
Applanation tonometry
25.
26. Red free(green)filter:
Obscure any thing that is red hence the red
free light , thus blood vessels or
haemorrhages appears black.
This increases contrast ,revealing the path
and pattern of inflammed blood vessels.
For Rose Bengal staining evaluation.
30. Diffuse illumination
Angle between microscope and
illumination system should be 30-45
degree.
Slit width should be widest.
Filter to be used is diffusing filter.
Magnification: low to medium
31. Applications:
General view of anterior of eye:
lids,lashes,sclera,cornea ,iris, pupil,
Gross pathology and media opacities
Contact lens fitting.
Assessment of lachrymal reflex.
32. Optics of diffuse illumination Diffuse illumination with slit beam
and background illumination
33. Direct Focal-
Parallelepiped:
Constructed by narrowing the
to 1-2mm in width to illuminate a
rectangular area of cornea.
Microscope is placed directly in
front of patients cornea.
Light source is approximately 45
degree from straight ahead
position.
34. With narrow slit the depth and portion of different
objects(penetration depth of foreign bodies, shape of
lens etc) can be resolved more easily.
With wider slit their extension and shape are visible
more clearly.
Applications:
Used to detect and examine corneal structures and
defects.
Used to detect corneal striae that develop when
corneal edema occurs with hydrogel lens wear and
in keratoconus.
35. Used to localize:
Nerve fibers
Blood vessels
Infiltrates
Cataracts
AC depth.
37. Optical section of lens
1.Corneal scar with wide beam illumination 2.optical section through scar
indicating scar is with in superficial layer of cornea.
38. Conical beam(pinpoint)
Produced by narrowing the vertical height of
a parallelepiped to produce a small circular
or square spot of light.
Light source is 45-60 degree temporally and
directed into pupil.
Biomicroscope: directly in front of eye.
Magnification: high(16-25x)
Intensity of light source to heighest setting.
39. Focusing:
Beam is focused between cornea and anterior lens
surface and dark zone between cornea and anterior
lens observed.
This occurance is called tyndall phenomenon.
40. Tyndall phenomenon
Cells, pigment or proteins in the
aqueous humour reflect the light like a
faint fog.
The strongest reflection is possible at
90°.
Most useful when examining the transparency of
anterior chamber for evidence of floating cells
and flare seen in anterior uveitis.
41.
42. Specular reflection
Established by separating the microscope and
slit beam by equal angles from normal to
cornea.
Based on snell’s law
Angle of illuminator to microscope must be
equal and opposite.
Angle of light should be moved until a very
bright reflex obtained from corneal surface
which is called zone of specular reflection.
44. When such an area of reflection is established on corneal
endothelium, its possible to see individual endothelial cells. Its
because minute irregularities in the tissues cause some light in the
zone of reflection not to be reflected to examiner.
Irregularities ,deposits ,or excavasation in these smooth surface will
fail to reflect light and these appears darker than surrounding IN
OTHERWISE BRIGHT ZONE.
Under specular reflection anterior corneal surface appears as white
uniform surface and corneal endothelium takes on a mosaic pattern.
Used to observe:
Evaluate general appearance of corneal endothelium
Lens surfaces
Corneal epithelium
46. Indirect illumination
The beam is focused in an area adjacent to ocular tissue to be
observed.
Main application:
Examination of objects in direct vicinity of corneal areas of
reduced transparency e,g, infiltrates,corneal
scars,deposits,epithelial and stromal defects
Illumination:
Narrow to medium slit beam
Decentred beam
47. Retroillumination
Formed by reflecting light of slit beam
from a structure more posterior than the
structure under observation.
A vertical slit beam 1-4mm wide can be
used.
Purpose:
Place object of regard against a bright
background allowing object to appear
dark or black.
48. Used most often in searching for keratic
precipitates and other debris on corneal
endothelium.
The crystalline lens can also be
retroilluminated for viewing of water clefts and
vacuoles of anterior lens and posterior
subcapsular cataract.
49. Direct retroillumination from iris:
Used to view corneal pathology.
A moderately wide slit beam is aimed
towards the iris directly behind the
corneal anomaly.
51. Indirect retroillumination from iris:
Performed as with direct retroillumination but
the beam is directed to an area of the iris
bordering the portion of iris behind pathology.
It provides dark background allowing corneal
opacities to be viewed with more contrast.
Observe:
Cornea, angles.
52. Direct type: Cornea illuminated by
light is viewed directly.
Indirect type: Cornea viewed
adjacent to area of illuminated by
the reflected light.
53. Retroillumination from fundus(red reflex
photography)
The slit illuminator is positioned in an almost
coaxial position with the biomicroscope.
A wide slit beam is decentered and adjusted
to a half circle by using the slit width.
The decentred slit beam is projected near
the pupil margin through a dilated pupil.
55. Uses of retro illumination
To see
Lattice dystrophy
Pseudoexfoliation
Keratic precipitates
Corneal scars
Lens vacuoles
Cataract
56. Sclerotic scatter
It is formed by focusing a bright but narrow slit beam on the
limbus and using microscope on low magnification.
Such an illumination technique causes cornea to take on
total internal reflection.
The slit beam should be placed approximately 40-60 degree
from the microscope.
Corneal changes or abnormalities can be visualized by
reflecting the scattered light- especially subtle opacities.
60. Transillumination
In transillumination, a structure (in the eye, the iris) is
evaluated by how light passes through it.
Iris transillumination:
This technique also takes advantage of the red
reflex.
The pupil must be at mid mydriasis (3to 4 mm
when light stimulated).
Place the light source coaxial (directly in line) with
the microscope.
.
61. Normally the iris pigment absorbs the
light, but pigmentation defects let the
red fundus light pass through..
Observe: iris defects (they will glow with
the orange light reflected from the
fundus)
64. Anterior and posterior segment disease evaluation
Lids and lashes
Conjunctiva and cornea
Instillation of fluorescein and BUT
measurement
Eversion of the lids
Anterior chamber and angle measurement
Iris
Crystalline lens
Anterior vitreous
67. Van Herrick Technique
Used to evaluate angle of anterior chamber without gonioscopy
Narrow slit angled at 60degrees at limbus
Medium Magnification
Depth of anterior chamber is evaluated to the thickness of cornea.
68. Gonioscopy via slit lamp
Single mirror gonioscope
Angle of anterior chamber
Three mirror gonioscope
Fundus(central and peripheral) and angle of anterior
chamber
69.
70.
71.
72. CENTRAL RETINA PHOTOGRAPHS WITH A 90-
DIOPTER LENS
A moderate slit
beam in the
almost coaxial
position gives
the best results.