This document discusses methods of measuring visual acuity in infants. It describes that visual acuity improves rapidly in the first years of life and matures around 5-6 years old. Several tests are mentioned, including optokinetic nystagmus testing, preferential looking tests, visually evoked responses, Cardiff acuity card tests, and observation of fixation behavior. Normal visual development milestones from birth to age 5 are provided. The document gives details on different visual acuity tests used with infants, such as the optokinetic nystagmus test, preferential looking test, and Lea paddle test.
Title:
Choosing amongst current modalities to manage Diabetic Retinopathy
At Medical Retina Clinic, Eye Department WAPDA Teaching Hospital Complex Lahore
Objective:
1. To review the current management options for DR
2. To share author’s four years follow up from Jan 2008 to Nov 2011 at Medical Retina Clinic, Eye Department WAPDA Teaching Hospital Complex Lahore.
3. Discussion on future Trends in management of DR.
Synopsis:
Diabetic retinopathy is the leading cause of new blindness in the world,
Argon LASER treatment has established itself as a gold standard in the management of DR. Intravitreal therapies in the form anti VEGF agents and steroids are also being widely used nationally and internationally. These therapies do not replace but complement each other.
Author will share his four years experience at Medical Retina clinic WAPDA hospital complex Lahore. 125 patients with DR were enrolled during this period. Treatment modalities used, included Argon Green Laser, Intravitreal Anti VEGF (Bevacizumab), Intravitreal Triamcinolone and subtenon Triamcinolone. Staging and severity of the disease as well as response to the offered therapy were the parameters used to tailor the treatment options.
Dr. Zia ul Mazhry
FRCS (Edin), FRCS (Glasgow), FCPS, CICOphth (UK)
Asstt Professor Central Park Medical College Lahore.
Consultant Eye Surgeon and Head of Eye Department
Wapda Teaching Hospital Complex
210 Feroz Pur Road Lahore.
Website: www.EyeAcuity.com
mazhry@yahoo.com
03004401151
visual acuity testing in children is challenging
VEP, OKN,PLT etc
CARDIFF, BOEK CANDY, WORTH IVORY BAAL, STYCAR
HOTV , MINIACTURE TOY TEST
SHEREDN GARED
SNELLEN CHART
ETDRS CHART
LOGMAR CHART
these are charts used in ophthalmology in pediatric age group
cover test
uncover test
alternate cover
hirschburg corneal light reflex test
10 D verticle prism bar test
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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Hot Selling Organic intermediates
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
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.
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
- 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
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.
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Anti ulcer drugs and their Advance pharmacology ||
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.
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.
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
2. VISUAL ACUITY
It is the resolving power of the
eye. It is an ability to see two
separate object as separate.
3. VISUAL ACUITY IN INFANTS
Visual acuity, in preverbal
infants defined as a motor or
sensory responses to a
threshold stimulus of known
size at known distance.
4. MEASUREMENT OF VISUAL
ACUITY IN INFANTS
A child should be aware & responsive
to the surroundings & situation.
A normal pupillary response, a positive
blind response & an elicitable OKN
indicate good visual acuity.
VA improves rapidly during the 1st
years of life than matures
approximately 5-6 years of age
5. Fixation behaviour can be determined
accurately in this age group as the
fovea develops completely by 3 months
of age.
If the child habitually fixates with one
eye, it indicates poor vision in the non
fixating eye.
6. AGE GROUP
Infants (Birth – 14 months)
Toddlers (14 months – 2 1/2 years)
Pre-schoolers (2 1/2 years – 5 years)
School going children (5 years – 15
years)
7. NORMAL VISUAL DEVELOPMENT
Very soon after birth – can fix & follow a light
source.
1 months – fixation is central, steady &
maintained. Can follow a slow target.
3 months – binocular vision & eye
coordination.
6 months – reaches out accurately for toys.
9 months – looks for hidden toys.
2 years – picture matching
3 years – letter matching of single letters.
5 years – Snellen chart by matching or
naming.
8. DIFFERENT TYPES OF VISUAL
ACUITY TEST IN INFANTS
Opto kinetic nystagmus test
Preferential looking test
Visually evoked response
Catford drum test
Cardiff acuity card test
Indirect assessment of visual acuity
Hundred & thousand sweet test.
Lea paddle
9. OPTO KINETIC NYSTAGMUS
TEST
OKN drum has been proposed as a
method of measuring visual acuity in
children.
In this test, nystagmus is elicited by
passing a succession of black & white
stripes through the patient’s field of
vision.
10. Procedure:
Striped patterns are presented on a
rotating drum.
The drum is moved in one direction
in front of the patient.
If the striped pattern is visible, the
patients eyes will make ‘Rail road
Nystagmus’ eye movements as they
follow the movement of the stripes.
13. PREFERENTIAL LOOKING TEST
PLT is used to assess VA in infants &
young children who are unable to
identify pictures or letters.
Procedures:
1. The child is presented with two
stimulus field.
2. One with stripes and the other
with a homogenous gray area of the
same average luminance as stripes
randomly alternated.
14. 3.Typically,infants and
children will look at
the more interesting
stripes.
4.A small peephole is
centered between the
two fields, for
observer.
5.Observer judges the
location of the strips
based on the child’s
head & eye
movements.
15. If the child can see the stripes, he/she
will prefer to look them.
If the child can’t see them, the child will
not show a preference.
Visual acuity determined with this
method
RECORDING
New born 6/240
3 months 6/60
36 months 6/6
16. VISUALLY EVOKED RESPONSE
It is quite useful in assessing visual
function in infants.
It is a electro encephalo graphic
recording made from the occipital lobe
in response to visual acuity.
It is the only clinically objective
technique available to assess the
functional state of the visual system
beyond the retinal ganglion cells.
17. Flash VER determines the integrity of
macula & visual pathway function.
Patter VER depend on form sense &
gives rough estimate of the visual
acuity.
18. CATFORD DRUM TEST
It is a detection acuity test.
It is useful in infants &
preschool children.
In this test, the children is
made to observe an
oscillating drum with black
dots of varying sizes.
The smallest dot that
evokes pendular eye
movements denotes the
level of visual acuity
19. CARDIFF ACUITY TEST
The principle of the target design is that of the
vanishing optotype.
The targets are pictures drawn with a white
band border by 2 black bands, all on a neutral
gray background.
The examiner simply observes the children’s
fixation.
20. INDIRECT ASSESSMENT OF
VISUAL ACUITY
Blink reflex in response to sound.
Menace reflex i.e; closure of the
eyes on the approach of an object
if vision is normal.
21. BINOCULAR FIXATION PREFERANCE
Behaviour evidence of decreased
vision in right eye.
A small toy is used to get the child’s
attention & the examiner covers the
right eye to monitor fixation of the left
eye. The child fixates on the toy without
objecting.
22. When the left eye is covered , the child
objects & tries to move the examiner’s
hand.
When the right eye is covered, the child
does not object & tracks the object
23. CSM Method
Done with one eye fixating on an
accommodative target held at 40 cm.
‘C’ refers to the location of corneal light reflex
fixates the examiner light at monocular
conditions.
Normally reflected light from cornea in near the
centre of cornea and it should be positioned
symmetrically in both eyes.
If fixation target is viewed eccentrically, fixation
is termed uncentral.
24. ‘S’ refers to the steadiness of fixation at
examiners light and also as it slowly
moved about.
‘M’ refers to the ability of the patient to
maintain alignment first with one eye then
the other as the opposite eye is
uncovered. Evaluation :
CSM – 6/9 – 6/6
CSNM –6/36 – 6/60
Unsteady central fixation < 6/60
25. HUNDRED & THOUSAND SWEET TEST
If child able to
pick up small
sweets at 33
cm, visual
acuity is at
least 6/24 or
20/80.
26. Lea paddle
It is based on preferential looking and
snellen principle .
The chart is placed at a distance of 1m
from the patient .
It is usually used for the age group of 3
to 9 mths .
There are cards available of various
thickness of lines .
27. At a time two cards are held infront of
the patient .The blank infront and the
one with lines ie, held behind it .
Then immediately the second card is
flipped out and we keep on changing
the positions.
The patient should appreciate the card
with lines .
The test is done at same eye level and
the eye movement of patient is seen .
