Uveitis refers to inflammation of the middle layer of the eye called the uvea. There are various types of uveitis classified based on the location of inflammation including anterior uveitis, intermediate uveitis, posterior uveitis, and panuveitis. Signs and symptoms depend on the location and chronicity of inflammation and may include eye pain, blurred vision, and floaters. Treatment involves topical or systemic anti-inflammatory medications such as corticosteroids and immunomodulators to reduce inflammation and prevent vision loss from complications.
This presentation is a detailed description of how a patient should be examined in an oprthoptic clinic. it lists down all the investigations sequentially. the order of investigations mentioned is the best way to investigate a squint case.
This presentation is a detailed description of how a patient should be examined in an oprthoptic clinic. it lists down all the investigations sequentially. the order of investigations mentioned is the best way to investigate a squint case.
Red Eye - Common Causes, Diagnosis and Treatment.pptxMedinfopedia Blog
Red eye is a non-specific term that is used to describe an eye that appears red due to intraocular or extra-ocular pathologies which can be as a result of infections, inflammations, allergies or trauma.
It is usually as a result of vasodilation in the anterior portion of the eye. It is a sign of an underlying disease, not a diagnosis.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
2. • At the end of the session you will be able to
• Understand the basics of Uveitis
• Know various types of uveitis
• How to manage a case of uveitis
• Know the causes of defective vision in uveitis
3. Uvea
Middle, pigmented, structures of the eye
includes the iris, ciliary body, and choroid
Highly vascular layer
Various functions
1. Regulation of entry of light
2. Accommodation
3. Production of aqueous
4. Nutrition to outer layers of retina
4. Clinical Approach to Uveitis
• Uveitis inflammation (ie, -itis) of the uvea
broadly categorized
• Infectious and non-infectious
• Frequently associated with systemic disease,
5. Classification of Uveitis
• based on anatomy(the portion of the uvea
involved),
• clinical course (acute, chronic, or recurrent),
• etiology(infectious or noninfectious),
• histology (granulomatous ,nongranulomatous)
6. The SUN Working Group
• Etiologic categories (infectious or noninfectious)
• Anatomical classification into 4 groups
• anterior uveitis
• intermediate uveitis
• posterior uveitis
• panuveitis
7. The SUN Working Group Anatomical
Classification of Uveitis
Type Primary Site of Inflammation Includes
• Anterior uveitis Anterior chamber Iritis
Iridocyclitis
Anterior cyclitis
• Intermediate uveitis Vitreous Pars planitis
Posterior cyclitis
Hyalitis
• Posterior uveitis Retina or choroid Focal, multifocal, or diffuse
Choroiditis
Chorioretinitis
Retinochoroiditis
Retinitis
Neuroretinitis
• Panuveitis Anterior chamber, vitreous,
and retina or choroid
8. Descriptors in Uveitis
Category Descriptor Comment
• Onset Sudden
Insidious
• Duration limited < 3 months' duration
Persistent >3 months' duration
• Course Acute sudden onset limited duration
Recurrent Repeated episodes separated by
periods of inactivity without
treatment >3 months' duration
Chronic Persistent uveitis with relapse
<3 months after discontinuing
treatment
9. Granulomatous
• Mutton fat KPs
• Dense PS
• Iris nodules
• Invasion by live
organism/hypersensi
tivity
• Insidious onset,
chronic course
Non Granulomatous
• Fine KPs
• Filiform PS
• No nodules
• Allergic/exudative
• Acute onset, short
duration
10. Anterior Uveitis
• The anterior chamber is the primary site of
inflammation.
• iritis -Inflammation confined to the anterior
chamber
• iridocyclitis -If it spills over into the retrolental
space
• keratouveitis -if it involves the cornea
• sclerouveitis -if the inflammatory reaction
involves the sclera and uveal tract
11. Intermediate Uveitis
• Major site of inflammation is the vitreous.
• Inflammation of the middle portion (posterior
ciliary body, pars plana) of the eye
• Manifests primarily as floaters-affecting vision;
• The eye frequently appears quiet externally.
• Visual loss is primarily a result of chronic
cystoid macular edema (CME) or cataract
12. Posterior Uveitis
• intraocular inflammation primarily involving the
retina and/or choroid.
• Inflammatory cells may be observed diffusely
throughout the vitreous cavity, overlying foci of
active inflammation, or on the posterior vitreous
face.
Ocular examination reveals
• focal, multifocal, or diffuse areas of retinitis or
choroiditis, with
• varying degrees of vitreous cellular activity
13. Pan uveitis
• primary sites of inflammation in panuveitis
(diffuse uveitis) are the anterior chamber,
vitreous, and retina or choroid.
• Associated with many systemic infectious and
non-infectious diseases
14. Clinical Course
• Acute, chronic or recurrent :
• acute - episodes of sudden onset and limited duration that usually
resolve within a few weeks to months.
• chronic uveitis - persistent. with relapse in less than 3 months after
discontinuing treatment.
• Recurrent uveitis is characterized by repeated episodes separated
by periods of inactivity without treatment 3 months or longer in
duration
• May occur in one or both eyes. or it may alternate between them.
• The distribution of ocular involvement- focal. multi focal. or diffuse
• Non-granulomatous inflammation typically has a lymphocytic
• and plasma cell infiltrate
• granulomatous reactions also include epithelioid and giant cells
15. Symptoms of Uveitis
• Depend on which part of the uveal tract is inflamed,
the rapidity of onset (sudden or insidious), the duration
of the disease (limited or persistent). and the course of
the disease (acute. chronic. or recurrent)
• Acute-onset anterior uveitis (iridocyclitis)
• Pain, photophobia, redness and blurred vision
• Pain -acute onset of inflammation in the region of the
iris as in acute iritis or from secondary glaucoma.
• Referred pain that seems to radiate over the larger
area served by cranial nerve V (the trigeminal nerve).
• Epiphora, redness and photophobia are usually
present when inflammation involves the iris, cornea,
or iris-ciliary body.
16. • chronic iridocyclitis (in patients with
juvenile idiopathic arthritis)
• May not be associated with any symptoms at all
• Blurred vision may develop as a result of calcific band
keratopathy, cataract, or CME
• Intermediate uveitis
• Symptoms of floaters and blurred vision.
• Floaters result from the shadows cast by vitreous
cells and snowballs on the retina.
• Blurred vision may be caused by CME or vitreous
opacities in the visual axis
17. Posterior uveitis
• painless decreased visual acuity, floaters, photopsia,
metamorphopsia, scotomata, nyctalopia, or a combination of these.
Blurred vision may be caused by the retinitis or choroiditis
• CME, epiretinal membrane, retinal ischemia, and choroidal
neovascularization.
• from refractive error such as a myopic or
hyperopic shift associated with macular edema
• Blurred vision include opacities in the visual axis from inflammatory
cells, fibrin, or protein in the anterior chamber; keratic precipitates
(KPs); secondary cataract; vitreous debris; macular edema; and
retinal atrophy
19. Signs of Uveitis
Anterior Segment
• keratic precipitates
• Inflammatory cells
• Flare
• Hypopyon
• pigment dispersion
• pupillary miosis
• Iris nodules synechiae, both anterior and
posterior
• Band keratopathy (seen with long-standing
uveitis)
20. Keratic precipitates
• Collections of inflammatory cells on the corneal endothelium.
• When newly formed, they tend to be white and smoothly rounded, but
they then become crenated ( shrunken),pigmented, or glassy Large,
yellowish K Ps are described as
• mutton-fat K Ps; usually associated with granulomatous types of
inflammation
21.
22. • Number of inflammatory cells seen in a I-mm x I
-mm high powered beam at full intensity at a
45°_60° angle
23. Iris involvement :
• anterior or posterior synechiae,
• iris nodules (Koeppe nodules at the pupillary border, Busacca
nodules within the iris stroma, and Berlin
nodules in the angle)
• iris granulomas,
• heterochromia (eg, Fuchs heterochromic iridocyclitis), or stromal
atrophy (eg, herpetic uveitis)
24. • Intraocular pressure (lOP) -often low
secondary to decreased aqueous production
or increased alternative outflow
• lOP may increase - if the meshwork becomes
clogged by inflammatory cells or debris or
trabeculitis
• Pupillary block with iris bombe and secondary
angle closure - acute rise in lOP
25. Intermediate Segment
• vitreal inflammatory cells , vitreous haze
• snowball opacities, which are common with
sarcoidosis or intermediate uveitis
• Exudates over the pars plana (snowbank).
Active snowbanks have a fluffy or shaggy
appearance
• vitreal strands
• Chronic uveitis may be associated with cyclitic
membrane formation, secondary ciliary body
detachment, and hypotony
26. Posterior Segment
• Retinal and choroidal signs may be unifocal, multifocal,
or diffuse
• Retinal or choroidal inflammatory infiltrates
• Inflammatory sheathing of arteries or veins
• Exudative, tractional, or rhegmatogenous retinal
detachment
• Retinal pigment epithelial hypertrophy or atrophy'
• atrophy or swelling of the retina, choroid, or optic
nerve head‘
• preretinal or sub retinal fibrosis
• Retinal or choroidal neovascularization
27. Laboratory and Medical Evaluation
• Medical history, review of systems , thorough
ophthalmologic and general physical examination
• There is no one standardized battery of tests that needs to
be ordered for all patients with uveitis
• When the history and physical examination
• do not clearly indicate the cause rule out the most common
causes. which include syphilis, sarcoidosis and tuberculosis
• Purified protein derivative (PPD) skin test
• serum angiotensin-converting enzyme (ACE)
• syphilis serologies
• chest radiograph or chest computed tomography
28. Ancillary testing
• Fluorescein angiography (FA)- for evaluating eyes
with chorioretinal disease and structural complications
caused by posterior uveitis
• CME ( Flower petal pattern of
• Leakage)
• retinal vasculitis
• secondary choroidal or retinal neovascularization
• areas of optic nerve, retinal, and choroidal inflammation
29. • Optical coherence tomography (OCT)
• OCT has become a standard of care for the objective
measurement of
• Uveitic CME ,
• Retinal thickening,
• subretinal fluid associated with choroidal
neovascularization,
• serous retinal detachments
• limited by media opacities
30. Fundus autofluorescence imaging - emerging noninvasive modality
• utilizes the fluorescent properties of lipofuscin to assess the viability of
the retinal pigment epithelium (RPE)- photoreceptor complex in
inflammatory chorioretinopathies
lndocyanine green angiography-patterns of hypofluorescence in the
presence of inflammatory choroidal vasculopathies
Ultrasonography - useful in demonstrating
• vitreous opacities,
• choroidal thickening,
• retinal detachment,
• cyclitic membrane formation, particularly if media opacities preclude a
view of the posterior segment
Anterior chamber paracentesis
Vitreous biopsy
Chorioretinal biopsy
31. Medical Management of Uveitis
Goal
• effectively control inflammation
• eliminate or reduce the risk of vision loss from
structural and functional complications that
result from uncontrolled inflammation
Includes
• topical cycloplegics,
• topical or systemic nonsteroidal anti-inflammatory drugs
• topical or systemic corticosteroids
32. Mydriatic and Cycloplegic Agents
• Beneficial for breaking or preventing the
formation of posterior synechiae
• For relieving photophobia secondary to ciliary
spasm.
• Cycloplegics commnly used.
• Cyclopentolate hydrochloride 1%
• Atropine 1%
• Homatropine 2%
• Tropicamide 0.5%
33. Nonsteroidal Anti-Inflammatory
Drugs
• work by inhibiting cyclooxygenase (COX)
isoforms l and 2 or 2 alone
• Reduce the synthesis of prostaglandins that
mediate inflammation
• Ketorolac and 2 newer agents bromfenac and
nepafenac - used for the treatment of CME.
34. Corticosteroids
• Mainstay of uveitis therapy
• Treatment of active inflammation in the eye
• Prevention or treatment of complications such as
CME
• Reduction of inflammatory infiltration of the retina,
choroid, or optic nerve
Topical administration
• Effective primarily for anterior uveitis
• .
35. • Routes of Administration
• Topical
• Oral
• Sub tenon
• Intra vitreal
36. Systemic administration
• Supplement or replace other routes of administration
• Used for vision-threatening chronic uveitis when
topical corticosteroids are insufficient or when systemic
disease also requires therapy
• The dosing and taper should be individualized to the
patient
• If corticosteroid therapy is required for longer than 3
months. Immuno-modulatory therapy (IMT) is
indicated
37. • 1- 2 mg/kg/day of oral prednisone
• Gradually tapered every 1 to 2 weeks until the
disease is quiescent.
• ,
38. • Blockers or proton pump inhibitors to prevent
gastric and peptic ulcers
• Long-term corticosteroid therapy -
supplement the diet with calcium and vitamin
D to lessen the chances of osteoporosis.
39. lmmunomodulatory Medications
• severe, Sight-threatening uveitis
• who are resistant to or cannot tolerate
corticosteroids
• Work by killing the rapidly dividing clones of
lymphocytes that are responsible for the
inflammation
40. Indications :
• vision-threatening intraocular inflammation
• Reversibility of the disease process
• Inadequate response to corticosteroid treatment
• Failure of therapy
• corticosteroids contraindicated because of systemic
problems
• unacceptable corticosteroid side effects
• chronic corticosteroid dependence
41. • antimetabolites.
• inhibitors of T-cell signaling
• alkylating agents
• biologic response modifiers
• Renal and hepatic toxicity,
• Bone marrow suppression, and increased
susceptibility to infection
• Blood monitoring including complete blood
count and liver and renal function tests
50. Possible questions
• Classify Uveitis,List the various forms of uvitis
• List the various clinical features of irido cyclitis
• Discuss the management of a case of chronic
irido cyclitis
• List the differnces between Granulomatous
and Non –granulomatous irdo cyclitis
• List the various factors which lead to defective
vision in a case of iridocyclitis
