By U. Gamal. Delta State University.

For this reason during distance vision testing the patient is seated 6 meters from the test chart buy cheap estrace 1mg on line. Most of the refraction in the eye is done by the cornea (2/3) the rest being by the lens (1/3) Fig 5 buy 2 mg estrace free shipping. Refraction in a normal eye Accommodation Rays of light from an object close to the eye is divergent and will be focused behind the retina purchase estrace 1mg visa. The eye adjusts the image by: -Contraction of ciliary muscles thereby loosens the suspensory ligaments so that the lens will be more spherical and strong buy discount estrace 2 mg line. Myopia (short sightedness) In myopic eye the refractive power is so high that parallel rays of light focused in front of the retina cheap 2 mg estrace with amex. Refraction in myopic eye Symptom -Poor distant vision Treatment - Spectacle- concave or negative lens 2. Hypermetropia (long-sightedness) In hypermetropia rays of light are focused behind the retina because the power of the optical system is too low for the length of the eye. Refraction in hypermetropic eye Symptoms -Complain about near vision tasks -In advanced state they will have poor distant vision Treatment - Convex lens or positive lens 3. Astigmatism In astigmatism the rays of light coming to the eye are focused differently in different meridians or has two focal points. Presbyobia This is the result of the natural aging process of the lens where it becomes harder and less elastic. Accommodation will be ineffective and the person fails to do near work like reading. Many of the causes of blindness in children are also a cause of child mortality( e. This means that many children who become blind die within a few years of becoming blind. Dietary sources of retinol Animal foods -contain the active vitamin retinol -liver is the best source which stores retinol -milk products are also very rich in retinol Plant foods -are particularly important because they are the staple diet for poor people -Contain carotene pigment which is converted into retinol -The best source is red palm oil others carrots, mangoes, papaya -poor sources rice, cassava, yams, and white maize which are staple diet of the poor 2. X1A- conjunctival xerosis - Dryness of the conjunctiva causes to lose its normal shiny luster and look like wax or paint instead - With treatment it is reversible 3. X1B -Bitot’s spot with conjunctival xerosis(see color plate 11) - Bitot’s spot is a foamy plaque on the temporal aspect of bulbar conjunctiva 4. Prevention of blindness from Xerophthalmia -Distribution of massive dose capsule -Fortification of food; identify pertinent food and process with Vitamin A. At the end of the course the students are expected to diagnose and refer early eye injuries to the ophthalmic centre. Foreign body - Can be on the conjunctiva or cornea - Can be metallic or non metallic - The most common eye injury Conjunctival foreign body. Irrigate with normal saline or tape water if foreign body can not be traced Corneal foreign body. Conjunctival laceration Usually self healing but if it is large(>1cm) it needs referral for suturing with special suture. Conjunctival hemorrhage Bleeding beneath the conjunctiva Causes -trauma -Spontaneously Treatment Self limiting, hemorrhage will resolve approximately within two weeks 3. Chemical burn - Irritation of the eye because of accidental entry of a chemical is a common problem among factory workers - A various types of acids and alkali are incriminated - Patients have marked pain with tearing, photophobia and blepharospasm. Cornea may be edematous and hazy or opaque Treatment - Copious irrigation with water immediately after the incident - Removal of particulate material from the Conjunctival sac - Prophylactic topical antibiotics - Cycloplegic agent to relieve pain 4. Non penetrating or blunt eye ball injuries It can be by a thrown object or a fist Associated finding in the eye lids would be bruise and /or hemorrhage 68 Complication. Hyphema – blood in the anterior chamber Treatment: patching, semi sitted position and early referral. How are you going to manage a patient who came to you having chemical injury eyes? At the end of the course, students are expected to consider one or more ophthalmic manifestation for most of systemic disease that will range from mild self limiting to sever sight threatening condition. Most systemic diseases have one or more ophthalmic manifestation that ranges from mild self limiting to sight threatening conditions. Ophthalmic manifestation of diabetes mellitus 1- Diabetic retinopathy it is a disorder of the retinal vasculature that eventually develops to some degree in nearly all patients with longstanding diabetes mellitus. It has been suggested that exposure to hyperglycemia over an extended period of time results in ultimate vascular damage which is a micro-angiopathy of retinal vessels that result in micro vascular occlusion and leakage. Micro vascular occlusion will cause hypoxia of the retina and stimulate new blood vessel formation. Risk factors Duration of diabetic mellitus Age of onset Blood glucose control Co morbid illness like pregnancy, hypertension, renal diseases smoking etc Clinical symptoms and signs - Normal or reduced vision - Retinal findings include exudates, hemorrhage, new vessel formation Management Strict blood glucose control Avoid risk factors Refer to ophthalmic center for evaluation Follow up 2-Diabetic cataract 3- Others- refractive error, cranial nerve palsy, Neovascular Glaucoma B.

They mediate their effects through G proteins coupled to phospholipase C (M1 generic 1mg estrace with amex,3 buy 1 mg estrace mastercard,5) cheap estrace 1 mg with amex, or to potassium channels (M2 buy 2mg estrace overnight delivery,4) generic 2mg estrace overnight delivery. Because we currently have few truly subtype- specific muscarinic agonists and antagonists of clinical utility, there will not be detailed discussion of them this year. Nicotinic receptors are ligand-gated ion channels whose activation results in a rapid increase in cellular permeability to sodium and calcium. They are pentameric arrays of one to four distinct but homologous subunits, surrounding an internal channel. Antagonist molecules may bind to these sites but do not elicit the conformational change. Muscarinic Agonists Acetylcholine itself is rarely used clinically because of its rapid hydrolysis following oral ingestion and rapid metabolism following intravenous administration. Fortunately, a number of congeners with resistance to hydrolysis (methacholine, carbachol, and bethanechol) have become available, and bethanechol has the additional favorable property of an overwhelmingly high muscarinic (vs nicotinic) specificity. There are also several other naturally occurring muscarinic agonists such as muscarine, arecholine, and pilocarpine. The pharmacological effects of acetylcholine and other muscarinic agonists can be seen by inspection of Table 2, where clinically important effects are designated by asterisks. All these effects are parasympathetically mediated except sweat gland function, which is the unique sympathetic cholinergic category, much beloved by examination writers; these nerves are sympathetic because of their thoracolumbar origin and cholinergic because they release acetylcholine. Bethanechol (Urecholine®) is used (rarely) to treat gastroparesis, because it stimulates gastrointestinal motility and secretion. It is also useful in patients with autonomic failure, in whom modest improvement in gastric emptying and constipation may occur, but at a cost of some cramping abdominal discomfort. If gastric absorption is impaired, subcutaneous administration is sometimes employed. Especially with intravenous administration, hypotension and bradycardia may occur. Bethanechol is also widely used to treat urinary retention if physical obstruction (e. This agent also occasionally is used to stimulate salivary gland secretion in patients with xerostomia, which entails the dry mouth, nasal passages, and throat occurring in Sjögren’s syndrome, and in some cases of traumatic or radiation injury. In rare cases, high doses of bethanechol have seemed to cause myocardial ischemia in patients with a predisposition to coronary artery spasm, so chest pain in a patient on bethanechol should be taken seriously. Pilocarpine is more commonly used than bethanechol to induce salivation, and also for various purposes in ophthalmology. It is especially widely used to treat open-angle glaucoma, for which a topical (ocular) preparation is available. Intraocular pressure is lowered within a few minutes following ocular instillation of pilocarpine. It causes contraction of the iris sphincter, which results in miosis (small pupils) and contraction of the ciliary muscle, which results in near (as opposed to distant) focus of vision. Pilocarpine possesses the expected side effect profile, including increased sweating, asthma worsening, nausea, hypotension, bradycardia (slow heart rate), and occasionally hiccups. Methacholine is often used to provoke bronchoconstriction during diagnostic testing of pulmonary function. Elicitation of significant bronchoconstriction with inhaled methacholine challenge sometimes leads to the diagnosis of reactive airways disease (asthma) in patients with little baseline abnormality in pulmonary function. The deadly nightshade (Atropa belladonna), a relative of the tomato and potato, contains atropine. Jimson weed (Datura stramonium) is even more widespread in Tennessee than the deadly nightshade. The tiny dark seeds from the Jimson weed pod are sometimes ingested for their hallucinogenic effect, a central side effect of atropine-like substances. Some plants of these families grow well in poor, rocky soil whereas tomatoes grow poorly in these locations. The grafting of tomato plant stalks onto the root systems of these plants yields an unusually productive "tomato" that bears well even in dry Page 22 Pharmacology 501 January 10 & 12, 2005 David Robertson, M. Unfortunately, if the grafting is not done properly, belladonna alkaloids may enter the tomato fruit. Tachycardia and hallucinations (as well as more life-threatening problems) may ensue when such tomatoes are eaten.

Six-month follow-up of computerized alcohol screening discount estrace 1 mg line, brief intervention estrace 2 mg with visa, and referral to treatment in the emergency department cheap estrace 1mg without a prescription. The efficacy of motivational interviewing as a brief intervention for excessive drinking: A meta-analytic review cheap 1mg estrace otc. Genetic and environmental influences on cannabis use initiation and problematic use: A meta- analysis of twin studies 1 mg estrace fast delivery. Low level of brain dopamine D2 receptors in methamphetamine abusers: Association with metabolism in the orbitofrontal cortex. The addicted human brain viewed in the light of imaging studies: Brain circuits and treatment strategies. The role of sexual trauma in the treatment of chemically dependent women: Addressing the relapse issue. Improving treatment through research: Directing attention to the role of development in adolescent treatment success. From first drug use to drug dependence: Developmental periods of risk for dependence upon marijuana, cocaine, and alcohol. Trajectories of change in adolescent substance use and symptomatology: Impact of paternal and maternal substance use disorders. On the learning curve: The emerging evidence supporting cognitive-behavioral therapies for adolescent substance abuse. A rewired brain: Many now see addiction as a chronic brain disease that requires new approaches to treatment. Adolescent marijuana use from 2002 to 2008: Higher in states with medical marijuana laws, cause still unclear. Substance abuse treatment organizations as mediators of social policy: Slowing the adoption of a congressionally approved medication. Smokeless tobacco cessation cluster randomized trial with rural high school males: Intervention interaction with baseline smoking. Medicaid chemical dependency patients in a commercial health plan: Do high medical costs come down over time? Individual and social/environmental predictors of alcohol and drug use 2 years following substance abuse treatment. Effects of a brief intervention for reducing violence and alcohol misuse among adolescents: A randomized controlled trial. Dopamine D2 receptor availability in opiate-dependent subjects before and after naloxone- precipitated withdrawal. Care for veterans with mental and substance use disorders: Good performance, but room to improve on many measures. Nipping early risk factors in the bud: Preventing substance abuse, delinquency, and violence in adolescence through interventions targeted at young children (0-8 years). Toward an alcohol treatment entry model: A comparison of problem drinkers in the general population and in treatment. A randomized trial of integrated group therapy versus group drug counseling for patients with bipolar disorder and substance dependence. Adjunctive counseling during brief and extended buprenorphine-naloxone treatment for prescription opioid dependence. Access to inpatient or residential substance abuse treatment among homeless adults with alcohol or other drug use disorders. Effect of oral nicotine dosing forms on cigarette withdrawal symptoms and craving: A systematic review. The accessibility of substance abuse treatment facilities in the United States for persons with disabilities. Recovery management and recovery-oriented systems of care: Scientific rationale and promising practices. The varieties of recovery experience: A primer for addiction treatment professionals and recovery advocates. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: A summary of the evidence for the U.

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