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<s>[INST] Question: Last night I was sleeping and I rolled over to a different position, when suddenly my head started nodding uncontrollably. I started to get really dizzy so as a normal reaction I lay on my back and placed my hands on my head for it to stop shaking. It stopped, but my eyes started nodding , I guess you can say, and the dizziness was getting worse. I shut my eyes for a couple of seconds and then it went away. I fully aware of what was going on the whole time, nothing like this has ever happened to me before. [/INST] Hi, Thank you for posting your query. Uncontrollable (or involuntary) head nodding could be due to partial (or focal fits). It is not a generalized fit, as you would have lost consciousness if it was a generalized one. Short duration of symptoms also favor the same. For further evaluation, you should consult a neurologist. You may require MRI brain and EEG for confirmation of diagnosis. Best wishes, . </s>

<s>[INST] Question: All the following are features of Down's syndrome except- Options: A. Brushfield's spots in iris B. Simian crease C. Mental retardation D. Mental retardation [/INST] Ans. is 'd' i.e., Hypeonicity Clinical features of Down's syndrome o Most striking feature in the neonate is hypotonia and although the diagnosis is usually evident at this time, it may some time be missed if the baby is very premature or his facial features are concealed by ventilatory apparetus. CLINICAL FEATURES IN DOWN SYNDROME General Neonatal hypotonia Mild-moderate mental retardation Sho stature Cranio-facial Brachycephaly Clinodactyly Epicanthic folds Protruding tongue Small cars Upward sloping palpebral fissures Strabismus and/or nystagmus Brushfield spots in iris Increased incidence of leukaemia (1%) Limbs Fifth finger clinodactyly Single palmar crease (simian crease) Wide gap between first and second toes Other Congenital hea disease (40%) e.g. common atrio-ventricular canal, ASD, PDA, VSD, Fallot tetralogy Anal atresia & Hirshsprung disease Duodenal atresia & annular pancreas Hypothyroidism & DM Delayed fontanel closure Three fontanel Obesity & obstructive sleep apnea OPTION D IS CORRECT. </s>

<s>[INST] Question: Baby born prematurely at 29 wks, on examination at 42 weeks with ROP, both eyes shows stage 2 zone 1 `plus' disease, how will you manage the patient ? Options: A. Examine the patient after 1 week B. Laser photocoagulation of both eyes C. Laser photocoagulation of worse eye, follow up of other eye D. Vitreoretinal surgery [/INST] The hallmark of retinopathy of prematurity (ROP) is abnormal retinal vasculature. Ophthalmologists diagnose and make decisions about the initial treatment of ROP based on the appearance of the retinal blood vessels. Dilatation and tortuosity of the retinal vessels at the posterior pole is termed plus' disease. It is a sign of rapidly progressive ROP and is an indication for early laser ablation of the peripheral avascular retina. OPTION B IS CORRECT. </s>

<s>[INST] Question: Do intravitreal tPA and SF6 promote clearing of premacular subhyaloid hemorrhages in shaken and battered baby syndrome? Context: Child abuse is a serious problem in many cultures. The ocular signs of shaken baby include intraretinal, subretinal, and preretinal hemorrhages. The hemorrhages may be unilateral or bilateral and are seen in 50% to 80% of patients. Previous treatment was limited to observation or vitrectomy, but some observed eyes develop amblyopia, and pediatric vitrectomy has many complications. We report 4 eyes in 2 children with shaken baby syndrome in whom we administered intravitreal tissue plasminogen activator (tPA) in an attempt to resolve preretinal hemorrhages earlier than observation alone without the complications of vitrectomy. The tPA dose ranged from 12.5-25 microg per injection. Eyes were injected once weekly for 3 consecutive weeks. Each time 0.25 cc of sulfur hexafluoride gas was also injected. Within 1 week following the last tPA administration, complete resolution of the preretinal hemorrhage was seen. There were no associated ophthalmic complications. [/INST] Intravitreal tPA with an expansive gas is an alternative method to observation or vitrectomy for resolution of preretinal hemorrhages in battered babies and may allow faster resolution of hemorrhages without the complications of vitrectomy. yes </s>

<s>[INST] What are the dynamics of deep short pulse laser drilling ? [/INST] The dynamics of deep short pulse laser drilling involve the ablative stages and light propagation. </s>

<s>[INST] What are the different types of color blindness and how can they be identified and diagnosed ? [/INST] Color blindness, also known as color vision deficiency, encompasses various types that result from specific abnormalities in the photopigments of the cone cells in the retina. The most common types of color blindness include red-green color blindness and blue-yellow color blindness. To diagnose color blindness, ophthalmologists employ a range of tests, such as the Ishihara color plates, Farnsworth D-15 test, and anomaloscope. These tests assess the individual's ability to perceive and differentiate between colors accurately. Timely and accurate identification of color blindness is crucial for understanding its impact on an individual's everyday life and determining appropriate strategies for managing and adapting to the condition. </s>

<s>[INST] What precautions should ophthalmologists take when prescribing glaucoma medications ? [/INST] When prescribing glaucoma medications, it is essential for ophthalmologists to exercise caution and follow certain guidelines. While this response may not be specific to the provided context, it is important to recognize the potential risks and stay updated with the latest information in the field. Ophthalmologists should carefully review the package insert and accompanying information for each drug or therapeutic agent before administration. This step is particularly crucial when dealing with new or infrequently used medications. By doing so, they can ensure correct dosing and treatment schedules that align with current standards. It is worth noting that as new information emerges, changes in treatment and drug usage may be necessary. Ophthalmologists should stay informed about any updates or advancements in glaucoma management, as this will help them provide the best care to their patients. While the authors and publishers of ophthalmology resources strive to maintain accuracy, they disclaim any liability for any consequences resulting directly or indirectly from the use of the contents of their publications. By staying knowledgeable and up-to-date on glaucoma medications and treatment protocols, ophthalmologists can minimize risks and enhance patient care. It is always recommended to consult reliable ophthalmology resources and guidelines for the most current and evidence-based information. </s>

<s>[INST] Question: A 10-year-old boy has multiple tan-colored patches on his skin, and freckle-like skin changes in his armpit area. The rest of clinical examination is normal. Which of the following conditions is also found in patients with this disorder as they get older? Options: A. bilateral eighth nerve tumors B. irregular small pupils C. multiple cutaneous and subcutaneous tumors D. cataracts [/INST] The two common forms of neurofibromatosis (NF-1 and NF-2) are genetically distinct. NF-1 is the type with multiple cafe au lait spots and is associated with axillary or inguinal freckling, iris hamartomas (Lisch nodules), peripheral neurofibromas, and bony abnormalities (including kyphoscoliosis). NF-2 is associated with CNS tumors, particularly bilateral eighth nerve tumors. Skin lesions are spare or absent, and early lens opacities can occur. OPTION C IS CORRECT. </s>

<s>[INST] Question: Axial length of eye ball is: March 2005 Options: A. 16 mm B. 20 mm C. 24 mm D. 28 mm [/INST] Ans. C: 24 mm The eye of the newborn is hypermetropic and the average axial length is about 18mm.At the age of 3 years it is 23 mm and from age 3-14 years it increases by 1 mm. In the emmetropic eye, the axial length (from the posterior corneal surface to the retina) varies from 22 to 26 millimeters. In the emmetropic eye (which has no refractive error), the range of corneal refracting power is between 39 and 48 diopters, while the range of lenticular refracting power is between 15 and 24 diopters. OPTION C IS CORRECT. </s>

<s>[INST] Question: Postcataract infection can be prevented by: Options: A. Preop oral antibiotics B. Postop oral antibiotics C. Intraop IV antibiotics D. Postop topical antibiotics [/INST] D i.e. Postop topical antibiotics OPTION D IS CORRECT. </s>

<s>[INST] What is the definition of legal blindness in the United States ? [/INST] Legal blindness in the United States is defined as having a best corrected visual acuity (VA) in the better eye worse than or equal to 20/200, or a visual field extent of less than 20° in diameter. This definition is used to determine the eligibility for certain benefits and services available to visually impaired individuals. </s>

<s>[INST] Question: Does the implementation of a perioperative checklist increase patients ' perioperative safety and staff satisfaction? Context: The implementation of the 'Surgical Safety Checklist' caused a significant reduction in the incidence of complications and mortality among patients undergoing surgery. The aim of the present study was to evaluate perioperative safety standards and the quality of interprofessional cooperation before and after the introduction of a safety checklist from staff members' point of view. Employees' attitude concerning safety-relevant aspects of the perioperative period, work processes, and quality of interprofessional cooperation was surveyed before and 3 months after introducing an adapted form of the 'Surgical Safety Checklist' by a 19-item questionnaire. After the implementation of the checklist, the cognizance of the names and functions of the individual operating room (OR) staff members, verification of the patient's written consent for surgery, indication for antibiotics before the surgical incision, and the quality of interprofessional cooperation were rated more positively. Traumatology physicians were more convinced that all artifacts had been removed from the surgical field. Finally, communication about intraoperative complications had improved. [/INST] Our attitude surveys demonstrate that from the OR staff's perspective, in the perioperative setting, safety-relevant factors can be handled significantly better and with greater awareness by implementing a safety checklist as proposed by the World Health Organization. yes </s>

<s>[INST] What findings were observed during the ophthalmoscopic examination of the patient's right eye ? [/INST] During the ophthalmoscopic examination of the patient's right eye, multiple dot and blot hemorrhages were observed in one field nasal to the optic nerve and temporal to the macula. Additionally, there were a few nerve fiber layer infarcts along the supero-temporal arcade. The central macula showed thickening of the distance between the surface of the retina and the retinal pigment epithelium, along with the presence of microaneurysms and lipid. </s>

<s>[INST] What is the genetic cause of the Nougaret form of congenital stationary night blindness ? [/INST] The genetic cause of the Nougaret form of congenital stationary night blindness is a missense mutation in the gene encoding the alpha-subunit of rod transducin. This mutation was identified in a study by Dryja et al. in 1996 (reference 35). </s>

<s>[INST] How are lesions in area V6A of monkeys related to misreaching to visual objects with the contralateral arm ? [/INST] Lesions in area V6A of monkeys have been found to result in misreaching to visual objects with the contralateral arm. Area V6A contains cells that receive both visual and somatosensory inputs, and it is reciprocally connected to the premotor cortex controlling arm movements. When V6A is damaged, it leads to impaired reaching movements towards visual objects with the arm on the opposite side of the lesion. This suggests that V6A plays a crucial role in coordinating visual and somatosensory information for accurate reaching movements. </s>

<s>[INST] What is the methodology used for mutation screening in patients with glaucoma ? [/INST] The methodology used for mutation screening in patients with glaucoma involves extracting DNA from peripheral blood samples of patients and their family members. The transcript region of the CYP1B1 gene, which is divided into three exons, is analyzed for mutations using four sets of primers. Additionally, patients with none or only one mutation in the CYP1B1 gene are further screened for mutations in the transcript region of the MYOC/TIGR gene using three sets of primers. Polymerase chain reaction (PCR) amplification is performed under specific conditions for each set of primers. The amplified PCR products are then sequenced using an automated DNA sequencer. The nucleotide changes observed in the sequences are reported based on the published cDNA sequence for the respective genes. Comparative sequencing alignment is conducted using computer-assisted tools to analyze the obtained sequences. </s>

<s>[INST] Question: Does homozygosity mapping in an anophthalmic pedigree provide evidence of additional genetic heterogeneity? Context: Anophthalmia is a heterogeneous developmental disorder characterized by absent eyes whose diverse etiology encompasses chromosomal and monogenic aberrations, as well as environmental causes. Since the molecular basis has been defined in only a small proportion of cases and extending this offers potential to enhance understanding of key steps in ocular development, a consanguineous anophthalmic pedigree was investigated using homozygosity mapping. DNA samples from six individuals, two anophthalmic, were genotyped with an array featuring approximately 620,000 single nucleotide polymorphisms (SNPs) in order to identify homozygous or copy number variant (CNV) regions. Candidate genes located in regions of identity by descent (IBD) defined by homozygosity mapping were subsequently screened by direct sequencing. Genotyping identified five homozygous intervals (4q26-28.1, 13q12.11, 14q22.1-22.2, 15q26.2-26.3 and 19q13.12) larger than 1 Mb that do not correspond with the known loci and which contain a total of 205 annotated genes. No CNVs were identified that segregated with the disease phenotype, and sequencing of five candidate genes (PRDM5, FGF2, SOS2, POU2F2 and CIC) did not identify any mutations. [/INST] Although constrained by the pedigree's size, the homozygosity mapping approach employed in this study extends the locus heterogeneity of anophthalmia. The results indicate that a novel molecular cause remains to be determined in this pedigree with the causative gene likely located within one of the five IBD regions. yes </s>

<s>[INST] What are the factors that influence decisions regarding the human-technology interface in mobility assistive technology for visually impaired individuals ? [/INST] When determining the human-technology interface in mobility assistive technology for visually impaired individuals, several factors come into play. These factors are based on a combination of end-user trials, technical constraints, and cost considerations. The interface decisions aim to provide an optimal balance between usability, effectiveness, and affordability. One key factor is the type of information that should be conveyed to the user. In the case of technologies like cameras, which can offer complex information, decisions need to be made about the extent of information to be presented. Typically, the focus is on relaying obstacle locations rather than providing a comprehensive overview or detailed scene information. Another factor is the number and configuration of information channels. For technologies such as canes, which gather information from multiple directions, different information channels (auditory, tactile, or a combination) are often necessary. Table 5.2 provides examples of beam configurations and the corresponding total number of information channels. The mapping of these channels to a user interface involves selecting an appropriate combination of audio and/or tactile modes. For instance, vibrating tactile buttons matched to the cane-bearer's thumb and fingers could be used, or a mixture of tactile and audio channels can be employed. Including both tactile and audio options for all channels can have advantages, such as catering to deafblind users. However, it may also introduce additional costs and increased complexity to the device. Ultimately, the decisions regarding the human-technology interface should be guided by a comprehensive evaluation of user feedback, technical feasibility, and cost considerations. </s>

<s>[INST] What is the significance of using a pattern stimulus consisting of an alternating black-white checkerboard in clinical VEP ? [/INST] The pattern stimulus consisting of an alternating black-white checkerboard is commonly used in clinical VEP because it generates the most vigorous cortical response. The cells of the retina and the lateral geniculate body respond well to a change in luminance in their receptive field. However, the cortical neurons of the striate cortex respond more actively to light-dark edges and orientation. The use of a checkerboard pattern stimulus helps to elicit a strong cortical response, providing valuable information about the visual processing in the striate cortex. </s>

<s>[INST] Question: Does the response to visual form deprivation differ with age in marmosets? Context: To characterize the effects of visual form deprivation by diffuser in marmoset monkey eyes across a range of ages. Twenty-four common marmosets were grouped by onset of deprivation (group 1: 0-39 days, n = 6; group 2: 40-99 days, n = 10; and group 3: 100-200 days, n = 8). Monocular form deprivation was induced with a white translucent diffuser worn for 28 to 88 days (mean durations: group 1, 32 days; group 2, 56 days; and group 3, 51 days). Refractive state, corneal curvature, and vitreous chamber depth were measured after cycloplegia. Both experimental and control eyes were measured multiple times before, during, and after the visual deprivation period. Marmosets in all age groups tested were susceptible to visual form deprivation myopia; however, the response to form deprivation was variable and included a majority with axial myopia (n = 15), several nonresponders (n = 4), a single late responder (axial myopia after the end of deprivation period), and several axial hyperopes (n = 4). For all animals that responded with axial myopia, the increase in vitreous chamber depth and myopia was inversely proportional to the age of onset of deprivation (ANOVA, P < 0.05). After the end of the period of deprivation, recovery from myopia by reduction of the axial growth rate was observed in three animals from group 1 and three animals from group 2. [/INST] Form deprivation by diffusers disrupted emmetropization in marmosets over a range of ages. The responses varied among individuals and with age, suggesting that the maturity of the eye may influence the response to visual signals responsible for form deprivation myopia and perhaps emmetropization. Recovery from diffuser-induced form deprivation myopia was apparent in some animals, in contrast to that reported for visual deprivation by lid-suturing, and appears more prevalent in the younger animals. yes </s>

<s>[INST] Question: Diameter of the macula lutea is: Options: A. 1.5 mm B. 3.5 mm C. 4.5 mm D. 5.5 mm [/INST] Ans. 5.5 mm OPTION D IS CORRECT. </s>

<s>[INST] Question: Does retinal pigment epithelium fold as a diagnostic finding of Vogt-Koyanagi-Harada disease? Context: To examine using the folds of the retinal pigment epithelium (RPE) to diagnose Vogt-Koyanagi-Harada (VKH) disease. Retrospective clinical review of 57 Japanese patients between July 2005 and April 2009. Optical coherence tomography (OCT), fundus photographs and fluorescein angiography (FA) were studied to investigate Kendall's coefficients of concordance in seven findings by four ophthalmologists. The sensitivity and specificity of each finding were examined to confirm its efficacy. Each result was defined as positive when more than three of the ophthalmologists judged that the finding existed. The folds of the RPE on OCT were observed in 30/42 (71.4 %) eyes having VKH disease, but none in the other 72 eyes. Kendall's coefficient of concordance in the detection of the folds of the RPE was 0.90 and was the highest among all other findings. Sensitivity was higher in the detection of the RPE folds on OCT and in optic nerve staining on FA than other findings and the specificity was 100 % for the RPE folds and 26.7 % for the optic nerve staining. [/INST] The detection of the folds of the RPE on OCT is a simple and effective method to help diagnose VKH disease at its acute stage which does not require pupil dilation. yes </s>

<s>[INST] Question: A 15-year-old girl is seen by a dermatologist for removal of multiple squamous cell carcinomas of the skin. The patient has nearly white hair, pink irises, very pale skin, and a history of burning easily when exposed to the sun. This patient's condition is caused by a disorder involving which of the following substances? Options: A. Aromatic amino acids B. Branched chain amino acids C. Glycolipids D. Glycoproteins [/INST] The disease is albinism. The most common form of albinism is caused by a deficiency of copper-dependent tyrosinase (tyrosine hydroxylase), blocking the production of melanin from the aromatic amino acid tyrosine. Affected individuals lack melanin pigment in skin, hair, and eyes, and are prone to develop sun-induced skin cancers, including both squamous cell carcinomas and melanomas. Maple syrup urine disease is an example of a disorder of branched chain amino acids causing motor abnormalities and seizures. Tay-Sachs disease is an example of a disorder of glycolipids. In this disorder, a deficiency of hexosaminidase A leads to accumulation of ganglioside GM2. Hunter's disease is an example of a disorder of glycoproteins. This mucopolysaccharidosis is inherited as an autosomal recessive trait. Ref: Murray R.K. (2011). Chapter 1. Biochemistry & Medicine. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e. OPTION A IS CORRECT. </s>

<s>[INST] Question: Infection within the right cavernous sinus results in the following signs except: Options: A. Constricted pupils in response to light B. Engorgement of retinal veins C. Ptosis of right eyelid D. Right ophthalmoplegia [/INST] (a) Constricted pupils in response to light (Ref. Cummings, 6th ed., 174)In cavernous sinus thrombosis pupils are dilated and fixed due to the involvement of 3rd nerve and stimulation of sympathetic plexus. OPTION A IS CORRECT. </s>

<s>[INST] I am a 45-year-old diabetic. I use reading glasses with the lowest power. For the past month, I’ve been having difficulty reading, especially in the mornings. Reading has become stressful. I read a lot on my phone and tablet. My sugar levels after food is 220. Is this issue related to diabetes or do I need to increase the power of my glasses? [/INST] This could be related to blood glucose levels and the diabetes but it could also be related to age-related changes and presbyopia, or even cataract changes. In order to sort this out, it would be best to have an ophthalmologist examine your eyes thoroughly. </s>

<s>[INST] What is the management strategy for phlyctenular conjunctivitis ? [/INST] The management strategy for phlyctenular conjunctivitis includes local therapy, investigations, and specific therapy aimed at eliminating the causative allergen and improving the overall health of the patient. Local therapy involves the use of topical steroids, such as eye drops or ointment (dexamethasone or betamethasone), which can produce a dramatic effect. Antibiotic drops and ointment should be added to address any associated secondary infection. If the cornea is involved, atropine (1%) eye ointment should be applied once daily. Specific therapy involves searching for and eradicating any underlying causative conditions, such as tuberculous infection, septic focus, or parasitic infestation. General measures to improve the patient's health are also important, including providing a high protein diet supplemented with vitamins A, C, and D. </s>

<s>[INST] What are the possible treatments for neurological manifestations of Sjögren's Syndrome ? [/INST] The treatment options for neurological manifestations of Sjögren's Syndrome may vary depending on the specific symptoms and severity of the disease. Some of the possible treatments include: 1. Immunosuppressive therapy: Medications such as corticosteroids (e.g., prednisone) and immunosuppressive drugs (e.g., azathioprine, methotrexate) may be prescribed to suppress the abnormal immune response and reduce inflammation in the nervous system. 2. Plasmapheresis: This procedure involves removing plasma from the blood and replacing it with a substitute solution. Plasmapheresis can help remove harmful antibodies and inflammatory substances from the bloodstream, potentially improving neurological symptoms. 3. Symptomatic treatment: Medications may be prescribed to manage specific symptoms, such as pain relievers for neuropathic pain or antiepileptic drugs for seizures. 4. Physical therapy: Rehabilitation exercises and physical therapy can help improve muscle strength, coordination, and mobility in individuals with neurological deficits. It is important to consult with a healthcare professional, preferably an ophthalmologist or rheumatologist who specializes in Sjögren's Syndrome, to determine the most appropriate treatment plan based on individual patient factors. References: 1. Konttinen Y, et al. Acute transverse myelopathy successfully treated with plasmapheresis and prednisone in a patient with primary Sjögren's syndrome. Arthritis Care Res. 2017;30(3):339-344. doi: 10.1002/acr.20088. 2. Mavragani C, Moutsopoulos H. Conventional therapy of Sjogren's syndrome. Clin Rev Allergy Immunol. 2007;32(3):284-291. doi: 10.1007/s12016-007-8001-3. 3. Szechtman H, et al. Review: Front behavior of MRL mice: an animal model of disturbed behavior in systemic autoimmune disease. Lupus. 1997;6(3):223. doi: 10.1177/096120339700600309. 4. Tomita M, et al. Cerebellar dysfunction is associated with overexpression of proinflammatory cytokine genes in lupus. J Neurosci Res. 2001;64(1):26-33. doi: 10.1002/jnr.1076. </s>

<s>[INST] I am 54 years old and my eyes have been diagnosed with dry eyes and the doctor put me on Restasis prescription, which I have been on for about six months now. Will I have to be on this forever or will my eyes replenish enough tears to go off it in a certain amount of time? What else can I do for my dry eyes? [/INST] Dry eyes is usually a chronic condition that tends to remain or get worse over time. Restasis probably works through suppressing inflammation in the glands that make tears, and this inflammation is believed to be a major cause of dry eye. Theoretically, if Restasis is effective in treating dry eyes in a particular patient, it would need to be continued to have an effect at least until a newer and better treatment is developed. However, in a moderate dry eye, due to patients' wishes because of the inconvenience and/or expense of chronic medicines, I have stopped Restasis after six months to a year of beneficial effects. The symptoms may remain improved for quite some time after stopping the Restasis. In a severe dry eye, where corneal damage and loss of vision is a possibility, I would continue Restasis indefinitely. Other common treatments for dry eyes include non-preserved lubricant drops, punctal occlusion and omega fatty acid supplementation. </s>

<s>[INST] Question: A 55-year-old woman presents to her physician complaining of acute pain and redness in her right eye, with nausea and vomiting. She repos seeing halos around lights. On examination, lacrimation, lid edema, conjunctival injection, a steamy cornea, and a fixed mid-dilated pupil are seen. She has markedly elevated intraocular pressure (IOP), and a visual acuity of 20/200 in her right eye. She has no family history of eye diseases. Which of the following is the most likely diagnosis? Options: A. Acute closed-angle glaucoma B. Corneal laceration C. Ocular hypeension without glaucoma D. Open angle glaucoma [/INST] This patient has acute closed-angle glaucoma, as evidenced by the pain and redness of her eye, the steamy cornea, her description of halos around lights, and her markedly elevated intraocular pressure. The fixed mid-dilated pupil indicates ischemia to the iris. Unlike open angle glaucoma, closed-angle glaucoma (also called narrow-angle or angle-closure glaucoma) is a medical emergency, and requires immediate diagnosis and treatment to prevent permanent visual impairment. The anterior and posterior chambers of the eye are filled with aqueous humor, which flows from the posterior chamber, through the pupil, into the anterior chamber, into the trabecular network, and then exits the eye the canal of Schlemm. Individuals with a shallow or narrow anterior chamber or thickened lens may be predisposed to this type of glaucoma because their iris is in close opposition to the chamber angle and cornea (narrow angle). If the aqueous humor is produced at a greater rate than it can be drained, intraocular pressure rises. Any stimulus that causes pupillary dilation (e.g., anticholinergic medications, sympathomimetics, emotional upset, dim lighting) can precipitate an attack. The cornea may look hazy because of edema, but corneal laceration is produced by trauma. There is no history of trauma in this patient and the symptoms exhibited by this patient strongly suggest acute closed-angle glaucoma. Intraocular hypeension is a condition in which IOP is higher than normal (greater than 21 mm Hg), but there is no damage to the optic nerve or visual loss. About 90% of people with elevated IOP never develop glaucoma. There is no associated pain or visual symptoms associated with this. Known as the "sneak thief of sight," open-angle glaucoma has no early warning signs or symptoms, and accounts for 90% of all glaucoma cases. It is a slow progressive condition, usually affecting both eyes, in which there is an increase in resistance to the outflow of aqueous humor. This resistance is associated with a normal rate of production of the fluid and normal anterior chamber angle. Elevated IOP is the most common finding and age-related changes in the trabecular region are the most likely explanation of this disease. OPTION A IS CORRECT. </s>

<s>[INST] Question: In siderosis bulbi the electrolytically dissociated iron ions: Options: A. Are deposited under the membranous structures of the eye B. Combine with intraocular proteins and produce degenerative changes C. Produce local irritative reaction at the site where deposited D. All of the above [/INST] Ans. Combine with intraocular proteins and produce degenerative changes OPTION B IS CORRECT. </s>

<s>[INST] Question: Hi doctor,I am quite allergic to dogs, cats, and pretty much anything with fur, which exacerbated my asthma, sneezing, and itchy eyes. I am hoping to get a job at home health, but many people have dogs and cats. Is there anything that could be done for me to enable to work in home health? Furthermore, my kids would love a little doggy at some point, if possible. [/INST] Hi, Welcome. Is your allergy based on your assessment or has any allergy testing been done? The best way to prevent allergy is to avoid the requisite allergens altogether. We even suggest a change of profession and change of place to our patients. In that case, I feel you should not be wanting that job or the dog in your house. But before that, we can check for allergies either by skin prick testing or blood immunocap testing. Skin prick testing is more authentic and specific than blood testing. </s>

<s>[INST] What is keratoconus and how is it managed ? [/INST] Keratoconus is a disease that affects the cornea, causing it to become thin and progressively conical in shape. This irregular shape of the cornea leads to distorted vision and visual impairment. The exact cause of keratoconus is still unknown, but it is believed to have a genetic component and can also be associated with chronic eye rubbing and certain systemic conditions. Management of keratoconus depends on the severity of the disease. In mild cases, eyeglasses or soft contact lenses may be sufficient to correct the vision. However, as the disease progresses, rigid gas-permeable (RGP) contact lenses are typically recommended. These lenses provide a smooth and regular optical surface, compensating for the irregular shape of the cornea and improving vision. In more advanced cases of keratoconus, where contact lenses are not effective, surgical interventions may be considered. One such option is corneal collagen cross-linking (CXL), which involves the application of riboflavin (vitamin B2) eye drops followed by exposure to ultraviolet light. This procedure strengthens the cornea and can help halt the progression of keratoconus. For individuals with significant corneal thinning or scarring, a corneal transplant may be necessary. This involves replacing the damaged cornea with a healthy donor cornea through a surgical procedure called keratoplasty. Regular follow-up visits with an ophthalmologist are crucial for individuals with keratoconus to monitor the progression of the disease and adjust the management approach accordingly. </s>

<s>[INST] Question: A 41-year-old woman is brought to the emergency department by ambulance because of a sudden onset severe headache. On presentation, the patient also says that she is not able to see well. Physical examination shows ptosis of the right eye with a dilated pupil that is deviated inferiorly and laterally. Based on the clinical presentation, neurosurgery is immediately consulted and the patient is taken for an early trans-sphenoidal surgical decompression. Which of the following will also most likely need to be supplemented in this patient? Options: A. Aldosterone B. Corticosteroids C. Erythropoietin D. Insulin [/INST] Option A: Aldosterone Aldosterone is a hormone that regulates sodium and water balance in the body. It is not directly related to the patient's clinical presentation of sudden-onset severe headache and visual disturbance. Therefore, aldosterone supplementation is unlikely to be necessary in this case. Option B: Corticosteroids Corticosteroids, such as dexamethasone, are commonly used in the management of various neurologic conditions, including brain tumors. The patient's symptoms of sudden-onset severe headache and visual disturbance, along with the physical examination findings of ptosis, dilated pupil, and lateral deviation, suggest the possibility of an intracranial mass lesion, such as a pituitary adenoma. Corticosteroids can help reduce cerebral edema and inflammation, providing symptomatic relief and possibly improving surgical outcomes. Therefore, corticosteroid supplementation is an appropriate choice in this patient. Option C: Erythropoietin Erythropoietin is a hormone that stimulates the production of red blood cells. It is not directly related to the patient's clinical presentation of sudden-onset severe headache and visual disturbance. Therefore, erythropoietin supplementation is unlikely to be necessary in this case. Option D: Insulin Insulin is a hormone that regulates blood sugar levels. There is no indication or association between the patient's clinical presentation and insulin supplementation. Therefore, insulin is not likely to be needed in this patient. OPTION B IS CORRECT. </s>

<s>[INST] What are the ophthalmoscopic features of early papilledema ? [/INST] The ophthalmoscopic features of early papilledema include obscuration of the disc margins (starting with the nasal margins and followed by the superior, inferior, and temporal margins), blurring of the peripapillary nerve fiber layer, absence of spontaneous venous pulsation at the disc (usually present in 80% of normal individuals), mild hyperemia of the disc, and the possibility of splinter hemorrhages in the peripapillary region. The visual fields during this stage are usually fairly normal. </s>

<s>[INST] What are the recommended treatment options for Kaposi's sarcoma affecting the eyelids and conjunctiva in patients with AIDS ? [/INST] Kaposi's sarcoma, a multicentric malignant tumor derived from endothelial cells, is a common manifestation of AIDS, particularly among homosexual individuals. In the case of Kaposi's sarcoma affecting the eyelids and conjunctiva, treatment options may vary depending on the stage of the lesion. For stage I and II lesions, which are patchy, flat, and of a duration less than 4 months, interventions such as injection with interferon alpha or local excision have been employed to address conjunctival lesions. On the other hand, stage III lesions, which are more nodular and have a duration exceeding 4 months, may require different approaches. Eyelid lesions in this stage can be treated with cryotherapy or radiotherapy. It is important to note that the selection of treatment options should be made in consultation with an ophthalmologist or healthcare professional experienced in managing AIDS-related ophthalmic conditions. They will assess the individual patient's situation and determine the most appropriate course of action based on factors such as lesion characteristics, overall health, and the patient's specific needs. </s>

<s>[INST] Question: What is the relation between Carcinoma in situ of conjunctiva (disorder) and stage 0 disease ? [/INST] Carcinoma in situ of conjunctiva (disorder) has associated morphology: stage 0 disease </s>

<s>[INST] What is the recommended treatment for cystoid macular edema ? [/INST] The recommended treatment for cystoid macular edema includes the use of carbonic anhydrase inhibitors (CAIs) and the prostaglandin analog unoprostone. Unoprostone, when used twice daily, has shown a 20% reduction in intraocular pressure (IOP). Additionally, preservative-free prostaglandin analogs like tafluprost have been introduced as a potential treatment option for cystoid macular edema. </s>

<s>[INST] Question: Surgery of choice for congenital cataract - Options: A. ECCE B. ICCE C. Needling D. Discission [/INST] Presently, extracapsular cataract extraction (ECCE) technique is the surgery of choice for almost all types of adulthood as well as childhood cataracts unless contraindicated. OPTION A IS CORRECT. </s>

<s>[INST] Question: Is retinal vascular caliber associated with renal function in apparently healthy subjects? Context: To assess the relation between retinal vascular caliber and renal function. Eighty apparently healthy subjects screened for cardiovascular risk factors (mean age 47 years, 51% female, 36% hypertensive, without diabetes or renal dysfunction) were recruited. Retinal vascular calibers were measured from fundus photographs and expressed as central retinal artery and venular equivalent. Renal function was assessed by measurement of glomerular filtration rate (urinary clearance of 99mTc-DTPA) and urinary albumin/creatinine ratio. Mean glomerular filtration rate was 117 ml/min/1.73m(2). Overall, central retinal artery and venular equivalent were positively correlated with glomerular filtration rate (r = +0.31, p = 0.005 and r = +0.30, p = 0.006, respectively). In addition, central retinal artery equivalent was negatively correlated with urinary albumin/creatinine ratio (r = -0.34, p = 0.002). No significant relationship was found between central retinal venular equivalent and urinary albumin/creatinine ratio (r = +0.12, p = 0.32). The observed relations between retinal vascular calibers and renal function parameters remained significant after adjusting for potential confounding factors. [/INST] In apparently healthy subjects with normal renal function, retinal arteriolar and venular calibers were negatively correlated with kidney function, suggesting common determinants of these preclinical target organ damages. yes </s>

<s>[INST] Question: Does laryngeal mask cuff inflation at removal affect early postoperative laryngopharyngeal morbidity? Context: We assessed the effect of cuff inflation of the laryngeal mask airway at removal on sore throat, pharyngeal morbidity and airway complications. In a prospective randomized trial, we used a standardized technique of anesthesia and of laryngeal mask insertion in 126 consecutive day-case patients. Postoperatively, on eye opening, the masks were removed either inflated (Group A) or deflated (Group B) and examined for blood by a blinded observer. Episodes of coughing, gagging, laryngospasm, hiccups and retching, and symptoms of sore throat and hoarseness were recorded by the same observer. Demographics were similar. Bloodstaining occurred in 21% of patients in Group A (n = 63) vs 13% in Group B (n = 63; P = 0.23); the incidence of sore throat was identical (19%). Group A experienced more hoarseness (22% vs 9%; P = 0.05). Overall airway complications did not differ between groups (19% vs 11%; P = 0.21). [/INST] We conclude that removal of the laryngeal mask airway inflated does not reduce the incidence of sore throat, pharyngeal morbidity or airway complications. no </s>

<s>[INST] Question: A 30-year-old man returns to the hospital 3 weeks after open reduction and internal fixation of left tibia and fibula fractures from a motor vehicle accident. The patient complains that his surgical site has been draining pus for a few days, and his visiting nurse told him to go to the emergency room after he had a fever this morning. On exam, his temperature is 103.0°F (39.4°C), blood pressure is 85/50 mmHg, pulse is 115/min, and respirations are 14/min. The ED physician further documents that the patient is also starting to develop a diffuse, macular rash. The patient is started on broad spectrum antibiotics, and Gram stain demonstrates purple cocci in clusters. Which of the following toxins is likely to be the cause of this patient's condition? Options: A. Alpha toxin B. Endotoxin C. Pyogenic exotoxin A D. Toxic shock syndrome toxin 1 [/INST] OPTION D IS CORRECT. </s>

<s>[INST] Question: A 30 year old female presents with bluish black discoloration of sclera and pinna for last 4 months. Her urine turns black on standing. Which of the following enzyme is most likely to be deficient? Options: A. Phenylalanine hydroxylase B. Homogentisate oxidase C. Tryptophan pyrrolase D. α-keto acid decarboxylase complex [/INST] The metabolic defect in alkaptonuria is a defective homogentisate oxidase. Clinical Presentation of Alkaptonuria: Normal life till 3rd or 4th decade. Urine darkness on standing is the only manifestation in children. In adults, ochronosis, i.e. Alkaptone body deposited in intervertebral disk, cartilage of nose, pinna, etc. leading to pigmentation. Arthritis.  No mental retardation.   Laboratory Diagnosis: Alkalanization increase darkening of urine. Benedict's test positive in urine, because homogentisic acid is reducing agent. Ferric chloride test positive. Silver nitrate test positive. Reference- Harper’s illustrated biochemistry. 30th edition page -304 OPTION B IS CORRECT. </s>

<s>[INST] Question: What is the relation between Camera anterior bulbi oculi and Replacement of prolapsed iris (procedure) ? [/INST] Replacement of prolapsed iris (procedure) has procedure site: Camera anterior bulbi oculi </s>

<s>[INST] Question: A 75-year-old man presents to the physician with progressive difficulty reading over the past year. Currently, he avoids driving as he has trouble reading road signs. He has no history of a serious illness and takes no medications. The fundoscopic examination shows localized retinal elevation and drusen. A description of the patient’s visual on the Amsler grid is shown. Fluorescein angiography shows early hyperfluorescence. Which of the following is the most likely diagnosis in this patient? Options: A. Choroidal melanoma B. Macular degeneration C. Open-angle glaucoma D. Retinal detachment [/INST] OPTION B IS CORRECT. </s>

<s>[INST] Can Radiesse® be used in ophthalmology for any conditions or treatments ? [/INST] Radiesse®, a filler approved by the FDA for various aesthetic purposes, is not commonly used in ophthalmology. Its approved uses include augmenting vocal cords, HIV-associated facial lipoatrophy, nasolabial folds and smile lines, and oral and maxillofacial defects. However, Radiesse® does not have any FDA-approved aesthetic uses specifically for ophthalmic conditions. In ophthalmology, other treatments and interventions are typically utilized to address specific eye-related diseases and symptoms. It is important to consult ophthalmology literature and resources to explore appropriate treatment options for ophthalmic conditions. </s>

<s>[INST] Question: Drug not deposited in cornea: Options: A. Gold B. Chloroquine C. Amiodarone D. Antimony [/INST] Ans. Antimony OPTION D IS CORRECT. </s>

<s>[INST] Question: Type of collagen present in cornea ? Options: A. Type I B. Type II C. Type III D. Type IV [/INST] Ans. is 'a' i.e., Type I OPTION A IS CORRECT. </s>

<s>[INST] Discuss the ocular structure and development ? [/INST] The ocular structure refers to the anatomy and components of the eye. The eye is a complex organ responsible for vision and consists of several structures working together. The main components of the ocular structure include: 1. Cornea: The transparent, dome-shaped front surface of the eye that helps to focus incoming light. 2. Iris: The colored part of the eye that controls the size of the pupil, regulating the amount of light entering the eye. 3. Pupil: The small, adjustable opening in the center of the iris through which light enters the eye. 4. Lens: A clear, flexible structure located behind the iris that focuses light onto the retina. 5. Retina: The inner layer of the eye that contains light-sensitive cells called photoreceptors. It converts light into electrical signals that are sent to the brain for processing. 6. Optic nerve: A bundle of nerve fibers that carries the electrical signals from the retina to the brain, allowing us to interpret visual information. 7. Sclera: The tough, white outer layer of the eye that helps to maintain the shape of the eye. The development of the ocular structure begins early in embryonic development. The eye starts as a small outgrowth from the brain called the optic vesicle. Over time, this vesicle invaginates and forms a cup-shaped structure called the optic cup. The outer layer of the optic cup becomes the pigmented layer of the retina, while the inner layer gives rise to the neural retina. During development, various cell types differentiate within the ocular structure. Photoreceptor cells, such as rods and cones, develop in the retina and are responsible for detecting light. Other cell types, including ganglion cells, bipolar cells, and interneurons, form complex neural networks within the retina to process visual information. Proper development of the ocular structure is crucial for normal vision. Any disruptions or abnormalities during development can lead to vision problems or eye conditions like cataracts, </s>

<s>[INST] Question: A 29-year-old female presents to the family physician concerned over the blue-black discoloration of her sclera and skin. She notes that at the end of her day, there are black stains in her underwear. The incomplete breakdown of which of the following amino acids is responsible for this presentation? Options: A. Tyrosine B. Valine C. Leucine D. Methionine [/INST] OPTION A IS CORRECT. </s>

<s>[INST] Question: Is polymorphism of the manganese superoxide dismutase gene but not of vascular endothelial growth factor gene a risk factor for diabetic retinopathy? Context: In diabetic retinopathy, the vascular endothelium is damaged due to oxidative stress and inflammation, and vitreous VEGF concentration becomes elevated. The association of diabetic retinopathy with single nucleotide polymorphisms (SNPs) was studied on two genes: VEGF, an important mediator of neovascularisation, and MnSOD, a major antioxidant enzyme. The study population was 755 individuals consisting of 131 diabetic (type 1 or type 2) patients with diabetic retinopathy (DR group), 98 diabetic controls without retinopathy (DC group) and 526 non-diabetic controls. VEGF SNPs rs699947, rs2010963, rs2146232, rs3025033, rs3025039 and Ala16Val polymorphism of the MnSOD gene were genotyped. The frequencies of allele and genotype of the single genotyped VEGF SNPs or reconstructed haplotypes of these single SNPs did not differ between DR and DC groups. A higher frequency of the AlaAla genotype (p = 0.03) and Ala16 allele (p = 0.04) of the MnSOD gene in the DR group was found when compared with the DC group. [/INST] In conclusion, the studied VEGF SNPs were not associated with the risk of diabetic retinopathy, and so it is unlikely that the VEGF gene is a major locus determining the risk of diabetic retinopathy. A statistically significant association of MnSOD Ala16Val polymorphism with diabetic retinopathy was found. yes </s>

<s>[INST] Question: Do ocular complication of PhotoDerm VL therapy for facial port-wine stain? Context: A case of focal damage to the iris with distortion of the pupil secondary to PhotoDerm therapy in a 2-year-old boy is reported. To study ocular complication of photoDerm VL therapy for facial port-wine stain. METHODS. : Observatory case report. PhotoDerm VL therapy may damage ocular tissues. [/INST] Appropriate protection during the procedure is essential. yes </s>

<s>[INST] Discuss the anatomy of the cornea and the factors responsible for maintaining corneal transparency ? [/INST] The cornea is the transparent, dome-shaped outermost layer of the eye. It plays a crucial role in focusing incoming light onto the retina. Understanding its anatomy and the factors responsible for maintaining its transparency is essential. Anatomy of the Cornea: 1. Epithelium: The outermost layer consists of a thin, non-keratinized epithelium. It helps maintain the cornea's smooth surface and protects against foreign substances and infection. 2. Bowman's Layer: This second layer lies beneath the epithelium and is composed of densely packed collagen fibers. It provides structural support. 3. Stroma: The largest and thickest layer, it constitutes around 90% of the cornea's thickness. The stroma consists of parallel collagen fibers that contribute to the cornea's transparency. 4. Descemet's Membrane: This tough, elastic layer is located beneath the stroma. It acts as a barrier against injury and helps maintain the cornea's shape. 5. Endothelium: The innermost layer is a single layer of endothelial cells. These cells are responsible for regulating the fluid content of the cornea, preventing excessive swelling and maintaining transparency. Factors Maintaining Corneal Transparency: 1. Organization of Collagen Fibers: The highly organized arrangement of collagen fibers in the stroma plays a vital role in corneal transparency. These fibers are uniformly spaced and parallel, allowing for the passage of light without scattering or distortion. 2. Regular arrangement of Cells: The corneal cells, including the epithelium, stromal cells, and endothelium, have a regular arrangement. This cellular organization minimizes light scatter and maintains transparency. 3. Dehydration: The cornea naturally dehydrates to maintain transparency. The endothelial cells actively pump out excess fluid from the cornea, preventing swelling and maintaining optimal thickness. 4. Avascularity: The cornea is avascular, meaning it lacks blood vessels. This absence </s>

<s>[INST] Discuss the clinically evaluate multifocal in clinical practice ? [/INST] Multifocal lenses have become increasingly popular in clinical practice for correcting presbyopia, a condition that affects the ability to focus on near objects. These lenses contain multiple prescription powers in different areas of the lens, allowing individuals to see clearly at various distances without the need for separate reading glasses. Clinically evaluating multifocal lenses involves several key considerations. Firstly, the patient's visual needs and lifestyle should be assessed. Understanding their daily activities, such as reading, using digital devices, or driving, will help determine the most suitable lens design. The next step is a thorough eye examination to assess the patient's eye health, refractive error, and visual acuity. This evaluation is crucial to ensure that the patient is a suitable candidate for multifocal lenses and to accurately determine the appropriate prescription for each eye. It is also important to manage patient expectations. While multifocal lenses offer the convenience of clear vision at different distances, they may not provide the same crispness and clarity as single vision lenses. Patients should be informed about potential visual trade-offs, such as reduced contrast sensitivity or glare, which can occur with multifocal lenses. After prescribing multifocal lenses, follow-up visits are necessary to monitor the patient's visual acuity and comfort with the lenses. Adjustments may be required to optimize visual performance, and patient feedback should be carefully considered. Additionally, educating patients on proper lens care and maintenance is essential to ensure optimal vision and longevity of the lenses. Regular eye examinations should be scheduled to monitor any changes in the patient's visual needs or eye health. In conclusion, clinically evaluating multifocal lenses involves considering the patient's visual needs, conducting a comprehensive eye examination, managing expectations, and providing ongoing follow-up care. By carefully assessing and addressing these factors, clinicians can help patients achieve clear and comfortable vision at various distances. </s>

<s>[INST] Q: What is the Z-epicanthoplasty procedure and what are its advantages ? [/INST] A: Z-epicanthoplasty is a surgical procedure used to address the epicanthal fold, a common anatomical characteristic found in many East Asian eyelids. This fold can make the eyes appear smaller and the eyelashes shorter. The Z-epicanthoplasty procedure aims to enhance the aesthetic result of double-eyelid surgery by lengthening the palpebral fissure, creating the illusion of larger and more open eyes. The Z-epicanthoplasty technique involves creating a long parallel fold starting from the nasal end to the lateral canthal end. This brings out the natural beauty of the eye by elongating the palpebral fissure. Unlike other epicanthoplasty procedures, Z-epicanthoplasty utilizes incisions within the thin eyelid skin, which can be easily incorporated into the incision for the double-eyelid procedure. This technique provides a tension-free closure and leaves minimal and clean scars. Importantly, it is unlikely to involve the nasal skin. The advantages of Z-epicanthoplasty include its simplicity, easy reproducibility, and clear design based on fixed landmarks and reference points. By following these landmarks, such as the medial margin of the lacrimal lake, the incision line for the double-eyelid procedure, and the fusion point between the epicanthal fold and the lower eyelid skin, the surgical outcome can be optimized. This procedure offers ophthalmologists a reliable technique to address the epicanthal fold and achieve aesthetically pleasing results. </s>

<s>[INST] What are the indicators and potential role of wide-field multifocal ERG in the clinical setting for central retinal vein occlusion (CRVO) ? [/INST] The preliminary study suggests that the P1 amplitudes and latencies of the first-order multifocal ERG response correlate significantly with the full-field 30-Hz cone flicker amplitudes and latencies in CRVO. This indicates that wide-field multifocal ERG can be a sensitive indicator of disease in CRVO. Furthermore, it may have a potential role in the clinical setting for evaluating and managing patients with CRVO. However, further research and validation are required to fully establish its clinical utility. </s>

<s>[INST] Question: What is the relation between Biopsia and Biopsy of lesion of conjunctiva (procedure) ? [/INST] Biopsy of lesion of conjunctiva (procedure) has method: Biopsia </s>

<s>[INST] Question: Are antibodies to adalimumab associated with future inflammation in Crohn 's patients receiving maintenance adalimumab therapy : a post hoc analysis of the Karmiris trial? Context: Data on immunogenicity to adalimumab (ADL) therapy in patients with IBD is limited. We performed additional analyses on the Karmiris cohort using the homogeneous mobility shift assay (HMSA) focusing on the inter-relationship of serum ADL concentration, antibodies-to-adalimumab (ATA), inflammatory markers and sustained response. 536 prospectively collected serum samples were available for analysis of ADL concentration and ATA using HMSA. We studied the role of week 4 serum ADL concentration and immunomodulator (IMM) use on ATA formation with a Cox proportional hazards model. Mixed model repeated measures analysis was performed to assess the independent effects of serum ADL concentration and ATA on C-reactive protein (CRP) and response. ATA was detected in 20% of patients after a median of 34 (12.4-60.5) weeks. ATA-positive samples correlated with lower serum ADL concentration (p<0.001). Cox regression modelling showed that week 4 ADL concentration of <5 µg/mL significantly increased the future risk of ATA formation (HR=25.1; 95% CI 5.6 to 111.9; p=0.0002) and that IMM co-treatment prevented ATA formation (HR=0.23; 95% CI 0.06 to 0.86; p=0.0293). Regression modelling showed a negative correlation between CRP and ADL concentration (p=0.0001) and a positive one with ATA (p=0.0186). The model revealed that both lower serum ADL concentration and ATA were independently associated with future CRP (p=0.0213 and p=0.0013 respectively). ATA positivity was associated with discontinuation of ADL because of loss or response (OR=3.04; 95% CI 1.039 to 9.093; p=0.034). [/INST] ATA were detected in 20% of patients. Risk of ATA formation increased with lower early serum ADL concentration and in patients not on IMM. ATA and ADL were strongly associated with higher future CRP level and discontinuation of ADL. yes </s>

<s>[INST] Question: Hello doctor,My daughter, by chance, poked her finger in my eye and I got a redness on my left eye, in the white portion. I had little pain for ten minutes and now it is better. I put refresh tears in my eyes as they are otherwise always red due to dry eyes. Can I use the same or do you suggest any other? [/INST] Hello, Welcome. Having said that, kindly share photos so that I may guide you better. Regards. Revert with more information to an eye care ophthalmologist online </s>

<s>[INST] Question: Hello doctor,I have keratitis and after the treatment, I still have a tiny grey spot on my cornea.Here is the treatment which I had followed:Visit 1 - (October 2014) Fucithalmic eye drops 1 % - three times daily for two weeks.Visit 2 - (October 2014) Exocine 0.3 % - four times daily for a month.Visit 2 - Artelac eye drops - four times daily for a month.Visit 3 - (December 2014) Artelac eye drops - two times daily for a month.Visit 4 - (24th February 2015) - Zylet Etabonate and Prednol, Tobramycine 0.3 % for two weeks.Visit 4 - Artelac eye drops - two times daily. I have been using till now.I am really worried about my eye. Please help me. [/INST] Hello, Welcome.I reviewed your history. It seems from the history that you had keratitis and following the treatment, you have a small corneal opacity. Artelac is an artificial tear eye . Hence no need to be worried about the use of Artelac eye </s>

<s>[INST] What are the diagnostic tests for syphilis-related uveitis ? [/INST] The diagnostic tests for syphilis-related uveitis include Rapid plasma reagin (RPR)/Venereal Disease Research Laboratory (VDRL), Fluorescent treponemal antibody absorption test (FTA-ABS), Microhemagglutionation assay for Treponema pallidum (MHA-TP), Treponema pallidum immobilization (TPI) test, Treponema pallidum particle agglutination (TP-PA), dark-field microscopy, and Polymerase chain reaction (PCR). These tests can help in confirming the presence of syphilis infection and determining the stage of the disease. </s>

<s>[INST] Question: Do evaluating the effectiveness of a university health sciences experience program for regional Year 10 students? Context: The main aim of this pilot program was to raise secondary students' awareness of university studies and careers in the health sciences through a three-day program. Further aims of the program were to increase the participants' knowledge of health issues through group activities, and provide an opportunity to interact with university staff and health professionals. The participants were surveyed at the conclusion of the program using an online questionnaire (30 items) consisting of both open and closed questions. The program and evaluation were carried out at a regional campus of a metropolitan-based university during the mid-year vacation. Fourteen Year 10 students (11 female, 3 male; 5 from government schools, 9 from a non-government school) from a regional city completed the evaluation. Satisfaction with the program, increased awareness of pathways into university, and changes in attitude about university as a career option. The evaluation revealed that the participants had had a pleasant learning experience, which had led them to feel positive about university studies in general and as an option for themselves. They made useful suggestions for improvements. [/INST] The evaluation of the effectiveness of the program showed that it had achieved its objectives. It also provided the program organisers with insights regarding timing and activities, which will be useful in improving future programs targeting secondary students. yes </s>

<s>[INST] Question: Does the immune response to corneal allograft require a site-specific draining lymph node? Context: Recent studies have shown that head-neck draining lymph nodes (DLN) are required for priming the immune response during corneal allograft rejection. In this study we have investigated further the role of the DLN and spleen in corneal graft rejection in mice. Individual DLN (submandibular [SM]; superficial cervical [SC]; and internal jugular) or their combinations were removed in mice undergoing corneal allografting (C57BL/10, H2(b) to BALB/c, H2(d)). In some mice, DLN from syngeneic mice were retransplanted, whereas other mice underwent removal of the spleen before corneal allografting. In a high-risk group of mice, removal of the DLN before a second corneal graft procedure was performed. [/INST] The data show that a single specific lymph node, i.e., the SM node, is the major DLN involved in corneal graft rejection whereas its nearest neighbor, the SC DLN, not only cannot substitute for the SM node in priming the immune response but may be involved with the spleen in immune privilege. Retransplantation studies of syngeneic LN indicate that the site of the DLN is more important to the process of graft rejection than the specific DLN tissue. This applies to the DLN whether it contains naive or memory allospecific T cells as shown in experiments in which removal of the SM DLN from mice who had already been primed by a previous corneal graft, prevented rejection of a second corneal graft in the same strain combination. yes </s>

<s>[INST] Question: I had a mild stroke in 2013. I was fine, just playing Scrabble with my husband, when a warm sensation traveled from my lower extremities through the urinary tract and within minutes my left eye became impaired and I lost vision in that eye. I naturally thought it was an ocular migraine since I ve gotten many in the past with auras around the eyes but this seemed concentrated in the left eye only. NO OTHER STROKE SYMPTOMS...I immediately went to the kitchen to chew a 325 aspirin and my husband called my eye doctor because I do have Glaucoma and a history of very debilitating migraines. I also have A-fib. It ended up being a stoke and no one knows whether it came from the eye or the A-fib. although I wasn t presenting with A-fib at this time and believe me, I KNOW WHEN I HAVE A-FIB--very symptomatic. Today I had that warm sensation travel up my body just like before but without loss of vision, no face droopiness, no numbness in arms, speech OK, just scared to death. Grabbed another aspirin...I ve been taking Plavix for 2 months but there are so many side effects I was going to quit it tonight and go back to the 81 mg. aspirin...now I ve had my aspirin for the day. I was lying down when this happened and my back [middle] was hurting me a lot but I do have LUMBAR and Cervical spine issues. I also cannot tolerate blood thinners or anti-arrhythmic drugs. I m a cancer survivor as well [breast cancer]. What was that unusual warm sensation? It scared me because it was just like the one I had last year. I feel OK now but still shaky and was tempted to just go to the ER but I m savvy about medicine having worked in 2 hospitals and NIH for 32 years. I also have Hyponatremia if that helps any. Have trouble holding blood sodium levels in the normal range. Thank you. Sally [/INST] Hi, thank you for providing the details about your health condition. What I am able to understand is the metabolism of your cells needs a booster along with the immune system. Usually performing regular - meditation, Breathing exercises, general body exercises, will help improve the metabolism. As you are a cancer survival and Stroke as well, you need to focus on improving the cellular Metabolism. As body is the medicine of its own, many major issues are taken care by body. Also, for the neck and back pain you need to see a physical therapist who by using the therapeutic ultrasound therapy and TENS therapy will help reduce pain. Besides neck and back spine Strengthening exercises are advised to improve your body. Body if not in momentum will lead to the lack of the cellular functioning and later end up anywhere, where there are weak zones. Also, by doing the regular exercises the . I hope you understand the importance of exercises. Maybe it is little to do a day but with little only the bigger improvement comes. Also, after stroke, breast cancer, cervical and lumbar spine issues you need to perform physical therapy to improve the Metabolism, immune system and get strength. You can discuss the same with the physician.regards Jay In </s>

<s>[INST] Discuss the development and abnormalities of the anterior chamber angle with their ? [/INST] The anterior chamber angle is a critical anatomical region within the eye where the cornea and iris meet. It plays a crucial role in maintaining the flow of aqueous humor, a clear fluid that nourishes the eye tissues. The development and abnormalities of the anterior chamber angle can have significant implications for eye health. During normal development, the anterior chamber angle forms as part of the natural maturation of the eye. In infants, the angle is typically wide open, allowing for unrestricted fluid flow. As the eye develops, the angle narrows, and the structures within it, such as the trabecular meshwork, become more defined. This process is generally complete by adolescence or early adulthood. However, abnormalities in the development of the anterior chamber angle can occur, leading to various conditions. One such condition is known as a narrow or occludable angle. In this case, the angle between the cornea and iris is narrower than normal, which can impede the outflow of aqueous humor. This can result in increased intraocular pressure, leading to a condition called angle-closure glaucoma. Angle-closure glaucoma is a severe condition that can cause vision loss if left untreated. Another abnormality of the anterior chamber angle is called an open-angle. In this condition, the angle appears normal, but the outflow of aqueous humor is impaired due to blockage or dysfunction within the trabecular meshwork. This leads to a buildup of fluid and increased intraocular pressure, resulting in open-angle glaucoma. Open-angle glaucoma is the most common type of glaucoma and is often chronic and asymptomatic until significant vision loss occurs. Other abnormalities of the anterior chamber angle include developmental disorders such as Axenfeld-Rieger syndrome and posterior embryotoxon. Axenfeld-Rieger syndrome is a rare genetic disorder that affects the development of various eye structures, including the anterior chamber angle. Posterior embryotoxon is a benign condition characterized by a </s>

<s>[INST] What is the causality behind higher revision rates seen in traditional SMAS-lift when looseness arises earlier than expected ? [/INST] In traditional SMAS-lift procedures, when patients experience looseness earlier than anticipated, higher revision rates have been observed. One possible causality behind this phenomenon is the inadequate support and repositioning of the malar fat pad, which is not effectively addressed in the SMAS-lift technique. The malar fat pad plays a crucial role in providing structural support to the midface. Therefore, when it is not adequately addressed, it can result in early loosening and suboptimal outcomes. This finding highlights the importance of incorporating procedures that address the malar fat pad, such as deep-plane rhytidectomy, which has shown positive results in terms of longevity and patient satisfaction. </s>

<s>[INST] How should vision be considered normal in a child under one year of age ? [/INST] In a child under one year of age, vision should be considered normal if the media (such as the cornea and lens) are clear, there is no refractive error, the pupils are centrally circular and respond promptly to direct and indirect light, there is no squint or nystagmus (involuntary eye movement), and the fundus (back of the eye) appears normal with appropriate developmental milestones. It is important to note that the presence of pupillary reaction to light does not indicate visual ability; it simply suggests that the afferent and efferent pathways of the light reflex are intact. Additional investigations, such as electroencephalogram, electroretinogram, visually provoked response, and imaging of ocular structures and the brain (CT and MRI), may be necessary for children suspected to be blind or those with specific risk factors. </s>

<s>[INST] Question: Does glucosamine modulate TNF-α-induced ICAM-1 expression and function through O-linked and N-linked glycosylation in human retinal pigment epithelial cells? Context: The purpose of this article was to investigate the effects of glucosamine (GlcN) on the TNF-α-induced expression of intercellular adhesion molecule 1 (ICAM-1) and the function of ICAM-1 in ARPE-19 cells in vitro. We quantified protein levels of TNF-α-induced ICAM-1 in ARPE-19 cells with Western blotting. The effects of GlcN on O-linked glycosylation, and therefore on ICAM-1 expression, were compared after the addition of alloxan, an inhibitor of O-linked N-acetylglucosamine transferase (OGT), or O-(2-acetamido-2-deoxy-d-glucopyranosylidene)amino-N-phenylcarbamate (PUGNAc), an inhibitor of N-acetylglucosaminidase (O-GlcNAcase [OGA]), or after OGT gene overexpression. The effect of GlcN on the N-linked glycosylation of ICAM-1 was evaluated by the change in its molecular mass on Western blotting. The effect of O-linked glycosylation on the nuclear factor κB (NF-κB) signaling pathway was examined using an NF-κB reporter gene assay. The effect of GlcN on ICAM-1 adhesion activity was examined using an ICAM-1 adhesion assay. GlcN, PUGNAc, and OGT overexpression inhibited TNF-α-induced ICAM-1 expression and NF-κB activity in ARPE-19 cells. Alloxan increased ICAM-1 expression and NF-κB activity in TNF-α-induced ARPE-19 cells. GlcN and tunicamycin reduced the molecular mass of TNF-α-induced ICAM-1 in ARPE-19 cells. The proteasome inhibitor MG-132 suppressed the GlcN-induced reduction in the molecular mass of TNF-α-induced ICAM-1. GlcN also attenuated the adhesion activity of TNF-α-induced ICAM-1. [/INST] GlcN inhibits ICAM-1 expression and functions by modulating the O-linked glycosylation of factors involved in NF-κB signaling and by reducing the N-linked glycosylation of TNF-α-induced ICAM-1 in ARPE-19 cells. These effects may contribute to the GlcN-mediated anti-inflammatory effects in the eye. yes </s>

<s>[INST] What are the clinical manifestations of idiopathic polypoidal choroidal vasculopathy ? [/INST] Idiopathic polypoidal choroidal vasculopathy (IPCV) presents with several clinical manifestations. These include orange-red subretinal lesions, recurrent choroidal neovascularization, and an expanding clinical spectrum. The disease is characterized by polypoidal lesions in the choroidal vasculature, which can lead to subretinal fluid and hemorrhage. Optical coherence tomography (OCT) can be useful in visualizing these lesions. IPCV is associated with exudative age-related macular degeneration and can lead to visual impairment if left untreated. </s>

<s>[INST] Describe the anatomy of the cornea and its congenital anomalies ? [/INST] The cornea is the transparent, dome-shaped structure that covers the front of the eye. It is responsible for focusing and refracting light onto the retina at the back of the eye. The cornea consists of several layers, each with its own specific function. The outermost layer of the cornea is the epithelium, which is a thin layer of cells that provides protection against injury and infection. Beneath the epithelium is the Bowman's layer, which provides additional strength and support. The next layer is the stroma, which makes up about 90% of the cornea's thickness. The stroma is composed of collagen fibers arranged in a highly organized pattern. This layer contributes to the cornea's clarity and provides structural integrity. The deepest layer of the cornea is the endothelium, which is a single layer of cells that maintains the proper hydration of the cornea by pumping out excess fluid. This layer is crucial for maintaining the cornea's transparency. Congenital anomalies of the cornea can occur during fetal development and can result in various abnormalities. Some examples of congenital corneal anomalies include: 1. Corneal opacity: This refers to an area of the cornea that is cloudy or opaque, impairing vision. It can be caused by genetic conditions, infections during pregnancy, or other developmental disorders. 2. Corneal dystrophy: These are inherited conditions that affect the clarity and transparency of the cornea. They can cause progressive vision loss and may require corneal transplant surgery in severe cases. 3. Corneal coloboma: This is a rare condition where there is a missing piece of the cornea, resulting in a gap or notch. It can occur as a part of a larger syndrome or as an isolated defect. 4. Keratoconus: This is a progressive condition in which the cornea thins and bulges outward, resulting in a cone-shaped cornea. It can cause blurred vision, near </s>

<s>[INST] Question: A patient presented with scarring alopecia, thinned nails, hypopigmented macular lesions over the trunk and oral mucosa. The diagnosis is – Options: A. Psoriasis B. Leprosy C. Lichen planus D. None [/INST] Most of the guide have given lichen planus as the answer. But, None of the given option is fully correct. Patient in this question is presenting with - Scarring alopecia Thinned nails Hypopigmented macular lesions Involvement of oral mucosa Psoriasis and pemphigus are out of question as these two don't cause alopecia. Two options left are leprosy and lichen planus, both can cause scarring alopecia i). Thinned nail and oral mucosal involvement favour lichen planus as diagnosis, but the lesion of Lichen planus is hyperpigmented, i.e. hyperpigmented violoceous plaques and surrounding hyperpigmented macules. ii)   Hypopigmented macule can occur in leprosy, but nail thinning rule out leprosy. So, No options is absolutely correct. If we consider that there was misprinting in the question (i.e. hypopigmentation instead of hyperpigmentation), than you can go ahead with lichen planus. OPTION D IS CORRECT. </s>

<s>[INST] What are the advantages and disadvantages of the direct approach for eyebrow lifting in adult patients with thick eyebrows and ptosis ? [/INST] The direct approach for eyebrow lifting in adult patients with thick eyebrows and ptosis has several advantages. Firstly, it is an excellent approach for treating asymmetric ptotic eyebrows. Additionally, it involves less invasive surgical dissection compared to other approaches. The procedure is also relatively low cost, secure, effective, and simple to perform. Moreover, patients tend to experience a quick recovery after the surgery. However, there are also some disadvantages associated with the direct approach. In some cases, the resulting scar may be visible, which can be a concern for patients. Furthermore, this approach provides limited access to the glabellar musculature, which may impact the overall outcome of the procedure. Lastly, the direct approach is not recommended for young patients. It's important to consider these advantages and disadvantages when deciding on the most appropriate approach for eyebrow lifting in adult patients with thick eyebrows and ptosis. Consulting with a specialist and thoroughly evaluating the individual patient's condition is essential in determining the best course of action. </s>

<s>[INST] Question: A 16-year-old boy lost his sight in one eye after a fight. Under which section of IPC is grievous injury included? Options: A. Section 319 B. Section 320 C. Section 324 D. Section 326 [/INST] Grievous injury is included under section 320. The following kinds of hu only are designated as "grievous": ? Emasculation ? Permanent privation of the sight of either eye ? Permanent privation of the hearing of either ear ? Privation of any member or joint ? Destruction or permanent impairing of the powers of any member or joint ? Permanent disfiguration of the head or face ? Fracture or dislocation of a bone or tooth ? Any hu which endangers life or which causes the victim to be in severe bodily pain or unable to follow his ordinary pursuits for a period of 20 days. OPTION B IS CORRECT. </s>

<s>[INST] Discuss leprosy ? [/INST] Leprosy, also known as Hansen's disease, is a chronic infectious disease caused by the bacterium Mycobacterium leprae. Although relatively rare, leprosy affects millions of people worldwide, particularly in tropical and subtropical regions. It primarily affects the skin, peripheral nerves, and mucous membranes. Leprosy is transmitted through close and prolonged contact with infected individuals, mainly through respiratory droplets. However, it is worth noting that most people have a natural immunity to the bacteria, and only a small percentage of exposed individuals will actually develop the disease. The symptoms of leprosy can vary greatly, but commonly include skin lesions, numbness or loss of sensation in affected areas, muscle weakness, and deformities in the hands, feet, and face. If left untreated, leprosy can cause significant damage to nerves, leading to permanent disabilities. Fortunately, leprosy is easily treatable with multidrug therapy (MDT), a combination of antibiotics that kill the bacteria and cure the infection. MDT is provided free of charge by the World Health Organization and is highly effective in curing leprosy and preventing its transmission. Social stigma and discrimination have historically been associated with leprosy due to misconceptions and fear surrounding the disease. However, with increased awareness and education, efforts are being made to eliminate the stigma and ensure that affected individuals receive proper medical care and support. In conclusion, leprosy is a chronic infectious disease caused by a bacterium that primarily affects the skin and nerves. Early diagnosis, timely treatment with multidrug therapy, and supportive care are crucial in managing the disease and preventing its transmission. </s>

<s>[INST] Question: Does vitreous treatment of cultured human RPE cells result in differential expression of 10 new genes? Context: To analyze the differential gene expression in cultured human retinal pigment epithelial (RPE) cells after treatment with vitreous. Cultured human RPE cells were incubated for 48 hours with 25% human vitreous from donor eyes. Total RNA from treated and untreated cells was extracted. The gene expression was analyzed by differential expression analysis (DEmRNA-PCR). The differentially expressed genes were identified by gene bank searches. Differential expression was verified by a quantitative real-time RT-PCR fluorescent nucleic acid staining system. The in vivo mRNA expression of these genes in RPE cells was shown by gene-specific RT-PCR. Vitreous treatment of human RPE cells resulted in the reduced expression of NFIB2, KE03 (NY-REN-25ag), PIG-B, DKFZp564BC462, LKHA, G3BP, PAM, UEV-1, and MAP1B calibrated to the expression of GAPDH when compared with their expression in untreated cells. The reduced expression after vitreous treatment was quantified by gene-specific quantitative real-time RT-PCR and varied from 0.69 to 0.17 compared with untreated cells. The mRNA expression of UDP-GalNac mRNA remained constant. The mRNA expression of eight of these genes was demonstrated in this study for the first time in human RPE cells. [/INST] Vitreous treatment of cultured RPE cells induces the differential expression of a variety of genes with functions in transcription, mediation of signal transduction and inflammation, glycosylation, ubiquitination and protein-protein interaction. Further examination of these genes may locate additional targets for treatment of diseases caused by contact of RPE cells with vitreous, typical in proliferative vitreoretinopathy. yes </s>

<s>[INST] Question: Which of the following is a feature of Treacher Collins syndrome ? Options: A. Hypoplasia of frontal bone B. Coloboma of eyelid C. Low arched palate D. All of the above [/INST] Coloboma of eyelid is one of the ocular feature of Treacher Collins syndrome Mandibulofacial dysostosis ( aka Treacher Collins syndrome) Refers to a condition resulting from hypoplasia of zygoma and mandible. Features of Treacher Collins syndrome : * Indistinct inferior orbital margin * Coloboma of the lower eyelid * Anti-mongoloid slant * Macrostomia with high-arched palate * External ear deformity * Bird-like face. OPTION B IS CORRECT. </s>

<s>[INST] Specialized clinical ophthalmology question: What medications should be prescribed for a patient with abnormal tear film and reflex tearing in response to foreign body ? [/INST] Specialized clinical ophthalmology abstractive answer: In patients with abnormal tear film and reflex tearing due to foreign body sensation, it is important to address the underlying cause. The use of local anesthetics during fitting assessments may be advocated by some authorities, although caution should be exercised as it may affect the resilience of the corneal epithelium and the assessment of lens comfort. Anesthetizing the eye should be avoided when teaching patients to handle lenses or during empirical lens fitting. Additionally, the use of bright white light during slit-lamp examination should be minimized to reduce excessive tearing. It is crucial to recognize that lenses inserted on patients who are new to rigid lenses may move more than expected, and this should not be mistaken as a flat fit. Once the tear film normalizes, the lens positioning usually improves. If the lens is observed to be moving vertically with the blink cycle, it is likely not flat. However, lenses that decenter horizontally may still have a flat fitting. In these cases, lid geometry should be assessed by parting the lids with fingers to determine the appropriate measures needed to reduce lid influence, such as reducing diameters or thicknesses. </s>

<s>[INST] What are some examples of ocular disorders discussed in this resource ? [/INST] This resource covers a range of ocular disorders. Some examples include non-organic visual loss, optic neuropathies, and central nervous system disorders. These disorders are explored in detail, providing valuable insights into their diagnosis and management. </s>

<s>[INST] Question: Does eating concerns and media influence in an Irish adolescent context? Context: EPICA is the first large-scale Irish study of a school-going population examining the impact of media influences on eating attitudes. Students were screened using the EAT-26, EDI-III and a study-specific questionnaire. A sub-sample of parents' views was included. Three thousand and thirty-one students (mean age 14.74) and 56 parents enrolled. The majority (71.4%) of adolescents felt adversely affected by media portrayal of body weight and shape, with more than a quarter (25.6%) believing it to be 'far too thin'. A significant correlation between media impact and high EAT scores (chi2 = 450.78, df = 2, p < 0.05) and EDI-III scores (chi2 = 387.51, df = 4, p < 0.05) was demonstrated. Parents also view media portrayal as too thin (94.7%), less than half are adversely affected by it (49.2%) but the majority (71.9%) believe their children to be. [/INST] Media portrayal of body weight and shape is correlated with eating psychopathology and may affect adolescents more than adults. School psycho-educational programmes and media policies are urgently needed to minimise any detrimental effect. yes </s>

<s>[INST] Question: A soft contact lens wearer developed pain & itching of the eye & showed a reticular pattern on the corneal epithelium the cause could be: Options: A. Corneal dystrophy B. Acanthamoeba C. Pseudomonas D. Recurrent [/INST] Typical reticular pattern due to radial keratoneuritis (Radial perineuritis). Due to this, the pain is very severe (neurological due to perineuritis) which is out of propoion to the degree of inflammation. Later, reticular superficial keratitis advanced to ring-shaped lesion in central or paracentral region. OPTION B IS CORRECT. </s>

<s>[INST] Question: Does transplantation of photoreceptor and total neural retina preserve cone function in P23H rhodopsin transgenic rat? Context: Transplantation as a therapeutic strategy for inherited retinal degeneration has been historically viewed to restore vision as a method by replacing the lost retinal cells and attempting to reconstruct the neural circuitry with stem cells, progenitor cells and mature neural retinal cells. We present evidence for an alternative strategy aimed at preventing the secondary loss of cones, the most crucial photoreceptors for vision, by transplanting normal photoreceptors cells into the eye of the P23H rat, a model of dominant retinitis pigmentosa. We carried out transplantation of photoreceptors or total neural retina in 3-month-old P23H rats and evaluated the function and cell counts 6 months after surgery. In both groups, cone loss was significantly reduced (10%) in the transplanted eyes where the cone outer segments were found to be considerably longer. This morphological effect correlated with maintenance of the visual function of cones as scored by photopic ERG recording, but more precisely with an increase in the photopic b-wave amplitudes by 100% and 78% for photoreceptor transplantation and whole retinal transplantation respectively. [/INST] We demonstrate here that the transplanted tissue prevents the loss of cone function, which is further translated into cone survival. yes </s>

<s>[INST] Question: A 7-year-old girl presents to a new pediatrician with fever, shortness of breath, and productive cough. She had similar symptoms a few weeks ago. The girl was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all vaccines and is meeting all developmental milestones. A further review of her history reveals seizures, upper respiratory infections, and cellulitis. On physical examination, the patient is pale with white-blonde hair and pale blue eyes. Which of the following would you expect to see on a peripheral blood smear for this patient? Options: A. Predominance of band leukocytes B. Downey cells C. Polymorphonuclear leukocytes containing giant inclusion bodies D. Significant basophil predominance [/INST] Option A: Predominance of band leukocytes: Band leukocytes are immature white blood cells that are seen in a left shift, which is indicative of an infection or inflammation. While it is possible to see band cells in certain infections, it is not specific to any particular condition. Therefore, this option is not likely to be the correct answer. Option B: Downey cells: Downey cells, also known as atypical lymphocytes, are seen in certain viral infections such as mononucleosis. They are large lymphocytes with abundant cytoplasm and often have nuclear changes, such as indented or irregularly shaped nuclei. In this case, the patient's symptoms, including fever, shortness of breath, and productive cough, do not strongly suggest a viral infection. Therefore, this option is less likely to be the correct answer. Option C: Polymorphonuclear leukocytes containing giant inclusion bodies: Giant inclusion bodies are commonly seen in certain viral diseases such as cytomegalovirus (CMV) infection. They are typically seen in polymorphonuclear leukocytes, which are a type of white blood cell. In this case, the patient's symptoms, including fever, shortness of breath, and productive cough, could be suggestive of a viral infection. Additionally, the patient's pale appearance, white-blonde hair, and pale blue eyes are consistent with a possible underlying immunodeficiency disorder, which could predispose the patient to viral infections. Therefore, this option is likely to be the correct answer. Option D: Significant basophil predominance: Basophils are a type of white blood cell that is involved in allergic and hypersensitivity reactions. It is not common to see a significant basophil predominance on a peripheral blood smear in the context of the patient's symptoms. Therefore, this option is less likely to be the correct answer. OPTION C IS CORRECT. </s>

<s>[INST] How is the limbal conjunctiva formed and what does it consist of ? [/INST] The limbal conjunctiva is formed by an epithelium and a loose connective tissue stroma. It consists of scleral and corneal tissues that merge in this region. Additionally, there are conjunctival stromal vessels, peripheral corneal arcades, and episcleral vessels present within the limbal stroma. </s>

<s>[INST] Question: Are the giant eyes of giant squid indeed unexpectedly large , but not if used for spotting sperm whales? Context: We recently reported (Curr Biol 22:683-688, 2012) that the eyes of giant and colossal squid can grow to three times the diameter of the eyes of any other animal, including large fishes and whales. As an explanation to this extreme absolute eye size, we developed a theory for visual performance in aquatic habitats, leading to the conclusion that the huge eyes of giant and colossal squid are uniquely suited for detection of sperm whales, which are important squid-predators in the depths where these squid live. A paper in this journal by Schmitz et al. (BMC Evol Biol 13:45, 2013) refutes our conclusions on the basis of two claims: (1) using allometric data they argue that the eyes of giant and colossal squid are not unexpectedly large for the size of the squid, and (2) a revision of the values used for modelling indicates that large eyes are not better for detection of approaching sperm whales than they are for any other task. [/INST] We agree with Schmitz et al. that their revised values for intensity and abundance of planktonic bioluminescence may be more realistic, or at least more appropriately conservative, but argue that their conclusions are incorrect because they have not considered some of the main arguments put forward in our paper. We also present new modelling to demonstrate that our conclusions remain robust, even with the revised input values suggested by Schmitz et al. yes </s>

<s>[INST] Question: What is the meaning of Retinal flecking? [/INST] Presence of multiple yellowish-white lesions of various size and configuration on the retina not related to vascular lesions. [PMID:7952338] </s>

<s>[INST] What are the sequential steps an ophthalmologist should take in diagnosing and managing a patient with cataracts ? [/INST] First, the ophthalmologist should take a detailed patient history, including any symptoms such as blurry vision, glare, or difficulty with night vision. A comprehensive eye examination should be performed, including visual acuity testing, refraction, and a slit-lamp examination to assess the lens for opacity. If cataracts are suspected, further tests such as a dilated fundus examination and measurement of intraocular pressure may be necessary to rule out other ocular conditions. Once the diagnosis of cataracts is confirmed, the ophthalmologist should evaluate the impact of the cataracts on the patient's daily activities and visual function. If the cataracts are significantly affecting the patient's quality of life, surgical intervention should be considered. The next step involves discussing the surgical options with the patient, including the different types of intraocular lenses (IOLs) available. The ophthalmologist should explain the risks, benefits, and expected outcomes of cataract surgery. It is important to address any concerns or questions the patient may have and ensure they have realistic expectations. If the patient decides to proceed with surgery, preoperative testing, including biometry and keratometry, should be performed to determine the appropriate IOL power. The ophthalmologist should also assess the patient's overall health and discuss any necessary precautions or modifications to their medication regimen. On the day of surgery, the ophthalmologist will perform phacoemulsification, a technique that involves emulsifying and removing the cloudy lens through a small incision. The natural lens is replaced with an IOL, which can be monofocal, multifocal, or accommodating, depending on the patient's needs and preferences. Postoperative care is crucial to ensure optimal healing and visual outcomes. The ophthalmologist should provide detailed instructions on the use of prescribed eye drops, the importance of avoiding strenuous activities, and the need for regular follow-up visits. These visits allow for monitoring of the patient's visual acuity, intraocular pressure, and overall healing process. In summary, the sequential steps in diagnosing and managing a patient with cataracts involve taking a detailed patient history, performing a comprehensive eye examination, confirming the diagnosis, evaluating the impact on the patient's visual function, discussing surgical options, performing preoperative testing, conducting cataract surgery, and providing postoperative care and follow-up </s>

<s>[INST] Question: What is the relation between Biopsia and Biopsy of eyeball and orbit (procedure) ? [/INST] Biopsy of eyeball and orbit (procedure) has method: Biopsia </s>

<s>[INST] Question: Does reduction of Pnn by RNAi induce loss of cell-cell adhesion between human corneal epithelial cells? Context: Pinin (Pnn/DRS/memA) plays an important role in regulating cell-cell adhesion of corneal epithelial cells. In the nucleus, Pnn interacts with both transcriptional repressor and pre-mRNA processing machinery. Here we investigated the consequences of "knocking down" Pnn expression with short hairpin RNAi (shRNAi) on the corneal epithelial cell phenotype. Cultured human corneal epithelial (HCE-T) cells were cotransfected with a shRNAi-expressing construct containing an inverted repeat of a Pnn specific 21 nucleotide sequence (Pnn shRNAi) and a GFP vector as a marker of transfected cells. After 24-48 h, cells were fixed and immunostained with antibodies against Pnn, keratin, desmoplakin, desmoglein, E-cadherin, ZO-1, SR-proteins, and SRm300. To demonstrate specificity of the Pnn knock down, a rescue vector was designed by incorporating three conservative nucleotide substitutions within the Pnn-shRNAi targeting sequences of the full length Pnn-GFP construct, thus generating a Pnn construct to produce mRNA that Pnn shRNAi could not target (Pnn-CS3-GFP). HCE-T cells were cotransfected with Pnn shRNAi and GFP vectors and after 24 and 48 h exhibited significantly reduced immunostaining for Pnn. Western blot analyses of Pnn and E-cadherin protein expression in cells transfected with Pnn-shRNAi and GFP vectors revealed marked reduction in levels of both proteins compared to those observed in cells transfected with GFP alone. The cells receiving Pnn-shRNAi appeared to be less adherent to neighboring nontransfected cells, often exhibited altered cell shape, downregulated cell adhesion and cell junction molecules, and escaped from the epithelium. The Pnn shRNAi transfected cells exhibited fewer keratin filaments anchored to desmosomes and a concurrent increase in the perinuclear bundling of filaments. SR proteins and SRm300 showed an altered distribution in the Pnn knock down cells. Cotransfection of Pnn-CS3-GFP with Pnn shRNAi demonstrated that the conservatively mutated Pnn could maintain cell-cell adhesion. [/INST] Our results indicate that knocking down Pnn expression leads to a loss of epithelial cell-cell adhesion, changes in cell shape, and movement of Pnn shRNAi transfected cells out of the epithelium. We suggest that Pnn plays an integral role in the establishment and maintenance of epithelial cell-cell adhesion via its activity within nuclear multi-protein complexes. yes </s>

<s>[INST] How is the cover test performed in ophthalmology ? [/INST] The cover test is a procedure used in ophthalmology to assess ocular alignment and detect any deviation or misalignment of the eyes, known as strabismus. It is performed by covering one eye with an occluder (such as an occlusion paddle or an opaque card) while the patient fixates on a target with the other eye. The occluder is then quickly switched to cover the opposite eye while observing the previously covered eye for any movement. If the covered eye shifts to fixate on the target, it indicates the uncovered eye is misaligned and there is a manifest deviation. Conversely, if the covered eye remains fixated on the target, it suggests that no strabismus is present. The test is usually repeated several times to evaluate different gaze directions and determine the type and magnitude of strabismus present. The cover test is an important tool in diagnosing and managing ocular misalignment in patients. </s>

<s>[INST] Question: Does thermal injury induce heat shock protein in the optic nerve head in vivo? Context: To investigate the induction of heat shock protein (Hsp)70 in the optic nerve head by localized laser application in transpupillary thermotherapy (TTT). TTT was performed on the right eye of Norwegian brown rats with an 810-nm diode laser installed on a slit lamp biomicroscope. The laser was aimed at the center of the optic nerve head with a 50-microm spot size. Various exposures (range, 60-200 mW) were used with an exposure duration of 60 seconds, and the various exposure durations (range, 1-5 minutes) were used with a power of 100 mW. Twenty hours after laser irradiation, immunohistochemical staining and Western blot analyses were performed. For morphologic analysis of the optic nerve head, confocal scanning laser ophthalmoscopy and scanning electron microscopy were performed. In the control eyes, Hsp70 was detected minimally in the optic nerve tissues by immunohistochemistry. After TTT, Hsp70 in the optic nerve tissue was induced more than in the control eyes. By Western blot, Hsp70 expression was found to increase progressively after TTT as the power was increased, but it also decreased slightly at powers >140 mW. The optimal setting of TTT without tissue damage was determined to be 100 mW for 60 seconds. [/INST] Transpupillary laser irradiation of the optic nerve head induces Hsp70 expression. This result can be applied to the neuroprotective experiments in glaucoma by enhancement of a natural cytoprotective stress response. yes </s>

<s>[INST] Question: Visual defect is contralateral homonymous hemianopia with macular sparing. What is the cause for it Options: A. Block in optic tract B. Block in optic nerve C. Block in optic chiasma D. Block in posterior cerebral aery supplying visual coex [/INST] Block in posterior cerebral aery supplying occipital lobe - Contralateral homonymous hemianopia with macular sparing Block in optic tract -Contralateral homonymous hemianopia CHOICE EXPLANATION & ELIMINATION REASON 1 Not correct 2 Not correct 3 Not Correct statement 4 Correct statement Visual pathways. Transection of the pathways at the locations indicated by the letters causes the visual field defects shown in the diagrams on the right. The fibers form the nasal half of each retina decussate in the optic chiasm, so that the fibers in the optic tracts are those from the temporal half of one retina and the nasal half of the other. A lesion that interrupts one optic nerve causes blindness in the eye (A) A lesion in one optic tract causes blindness in half of the visual field. (C) and is called homonymous (same side of the both visual fields) hemianopia (half-blindness). Lesions affecting the optic chiasm destroy fibers form both nasal hemiretinas and produce a heteronymous (opposite sides of the visual fields) hemianopia (B) Occipital lesions may spare the fibers from the macula (as in D) because of he separation in the brain of these fibers from the others subserving vision. OPTION D IS CORRECT. </s>

<s>[INST] What is the appropriate timing to operate on a patient with an aberrant parathyroid gland based on their embryological descent ? [/INST] The timing of surgical intervention for patients with aberrant parathyroid glands can vary depending on various factors, including the patient's clinical presentation and the severity of their symptoms. In general, surgery is considered when patients exhibit hypercalcemia or symptomatic parathyroid disease that cannot be adequately managed with conservative measures. The approach to surgical treatment typically involves removal of the aberrant parathyroid gland or glands through a procedure known as parathyroidectomy. The timing of this procedure may vary depending on the specific circumstances of each patient. If the patient presents with severe hypercalcemia or acute symptoms such as kidney stones, bone pain, or neuropsychiatric manifestations, immediate surgery may be warranted. Early intervention can help alleviate symptoms and prevent complications associated with prolonged hypercalcemia. However, in cases where the patient is asymptomatic or shows mild hypercalcemia, a conservative approach with regular monitoring may be chosen. Regular follow-up visits are essential to assess the progression of the disease and to determine if surgical intervention becomes necessary. It is important to note that the decision for surgery should be made in consultation with an experienced endocrine surgeon or a multidisciplinary team specialized in managing parathyroid disorders. They will evaluate the patient's overall health, conduct a thorough clinical assessment, and consider the individual's specific circumstances before recommending the appropriate timing for surgery. References: 1. Bilezikian JP, Bandeira L, Khan A, et al. Hyperparathyroidism. Lancet. 2018;391(10116):168-178. doi:10.1016/S0140-6736(17)31430-4 2. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Neuroendocrine and Adrenal Tumors. Version 2.2021 - January 26, 2021. https://www.nccn.org/professionals/physician_gls/pdf/neuroendocrine.pdf </s>

<s>[INST] Question: Does regular provision of outreach increase acceptance of cataract surgery in South India? Context: The prevalence of visual loss and blindness from cataract remains high in India. Marginalized communities are frequently reached through outreach clinics. The aim of this study was to explore the hypothesis that regular outreach, held in the same location by the same provider, leads to greater acceptance of cataract surgery than outreach clinics that are irregular in terms of timing and location. The study was integrated into outreach clinics run in two districts by Sankara Eye Centre, Coimbatore, Southern India. A semi-structured questionnaire was administered to patients who had attended outreach eye clinics and either accepted or not accepted the offer of cataract surgery. Overall acceptance of surgery was high (91.7%), being higher in the district with regular outreach (94.6%vs. 82.3%, P < 0.001). A total of 398 participants (240, 60% acceptors) were interviewed. Acceptors were more likely to live in smaller households and in supportive families than non-acceptors who lived in larger families which could not provide support and where transport and distance were also barriers (P .001). Attending regular outreach and having had first eye cataract surgery were independent predictors of acceptance in a logistic regression model. [/INST] The findings indicate the importance of providers building trust by organizing regular outreach in the same location. Previous eye surgery was also a strong predictor of accepting cataract surgery. To promote universal access to health care, marginalized rural communities will continue to need outreach for some time to come. yes </s>

<s>[INST] Question: Is inducible nitric oxide synthase isoform a key mediator of leukostasis and blood-retinal barrier breakdown in diabetic retinopathy? Context: Nitric oxide (NO) is involved in leukostasis and blood-retinal barrier (BRB) breakdown in the early stages of diabetic retinopathy (DR), but it is unclear which NO synthase (NOS) isoforms are primarily involved. In this study, the authors aimed to clarify the involvement of constitutive (eNOS, nNOS) and inducible NOS (iNOS) isoforms and the mechanisms underlying NO-mediated leukostasis and BRB breakdown. Diabetes was induced with streptozotocin for 2 weeks. Mice were treated with a NOS inhibitor, N(G)-nitro-L-arginine methyl ester (L-NAME), which shows a preference for constitutive isoforms over iNOS. Vessel leakage was assessed with Evans blue. Leukostasis was quantified in flat-mounted retinas with confocal microscopy, in vivo with a scanning laser ophthalmoscope, and in vitro in a retinal endothelial cell line. ICAM-1, occludin, and ZO-1 levels were assessed by Western blot, flow cytometry, or immunohistochemistry. Nitrotyrosine content was assessed by immunohistochemistry. Diabetes increased leukostasis within retinal vessels and BRB permeability, which were reduced by L-NAME. Similar effects were observed in diabetic iNOS knockout mice. In diabetic mouse retinas, ICAM-1 protein levels increased, whereas the immunoreactivity of tight junction proteins, occludin and ZO-1 decreased, in correlation with increased protein levels of all NOS isoforms. Those effects were prevented by L-NAME and also in diabetic iNOS knockout mice. High glucose and nitrosative/oxidative stress also increased leukostasis caused by ICAM-1 upregulation. [/INST] These results indicate that the iNOS isoform plays a predominant role in leukostasis and BRB breakdown. The mechanism involves ICAM-1 upregulation and tight junction protein downregulation. yes </s>

<s>[INST] Question: Does cytotoxicity of prostaglandin analog eye drop preserved with benzalkonium chloride in multiple corneoconjunctival cell lines? Context: This study evaluated the cytotoxicity of five prostaglandin analog ophthalmic solutions on four ocular surface cell lines, ie, Chang (human conjunctiva), SIRC (rabbit cornea), RC-1 (rabbit cornea), and BCE C/D-1b (bovine cornea). Cell viability was measured by neutral red and MTT assays in cells treated for 10, 30, or 60 minutes with various doses of prostaglandins (undiluted, and 2- and 10-fold dilutions). The number of cell lines with viability >/=50% in the presence of selected dilution of the drug (CVS(50)) was used for comparison. In addition, 24 cell viability comparisons (four cell lines, two assays, and three exposure times) were made between latanoprost (Xalatan((R))) and each other solution at each dose. A comparison between the newly introduced tafluprost (Tapros((R))) with 0.01% benzalkonium chloride was also made. The order of cell viability determined by CVS(50) was Travatan Z((R)) (travoprost with the SofZia system) > Tapros >/= Travatan((R)) (travoprost) = Xalatan > Rescula((R)) (unoproston). This was consistent with the results of direct comparisons between Xalatan and the other drugs. There was no clear difference in cell viability between Tapros and benzalkonium chloride. [/INST] Use of two assays, multiple cell lines, and various dilutions and exposure times provided a unique evaluation of cytotoxicity among ophthalmic solutions. CVS(50) was useful for comparison of the cell viability of the solutions. yes </s>

<s>[INST] Inferential specialized clinical ophthalmology procedural question: What blood tests are required prior to ophthalmic surgery ? [/INST] Prior to ophthalmic surgery, it is crucial to undergo certain blood tests. These tests help assess your overall health and ensure that the surgery can be safely performed. While the specific blood tests may vary depending on individual cases, there are some common tests typically recommended. One important blood test is the HIV antibody test, which is part of the routine preoperative laboratory workup. This test is implemented to maintain patient safety and confidentiality. By identifying individuals who may be HIV positive, elective surgery can be avoided in order to prevent unnecessary strain on the immune system and potential complications. Apart from the HIV antibody test, other blood tests may also be required. These tests help provide a comprehensive understanding of your health status and assist in optimizing the surgical outcome. It is essential to have these blood tests done at least two weeks before the scheduled surgery date. The results must be received by the ophthalmologist's office prior to proceeding with the surgery. As an ophthalmologist, it is important to review the patient's medical history, any potential allergies, and current medications. This information will help determine if any additional tests or precautions are necessary. If patients have a penicillin allergy, they should inform the office immediately to ensure appropriate antibiotic selection. Remember, these guidelines may vary depending on the specific surgical procedure and the patient's individual circumstances. It is always recommended to consult with your ophthalmologist to determine the exact blood tests required for your surgery. </s>

<s>[INST] What are the clinical hallmarks of myasthenia gravis ? [/INST] The clinical hallmarks of myasthenia gravis are variable muscular weakness and fatigability, which improve after rest. In myasthenia gravis, there is a decrease in the number of available acetylcholine receptors with each muscle contraction, leading to variability and fatigue. The decreased probability of acetylcholine triggering an action potential, due to the reduced number of receptors, causes variability. Fatigability occurs as a result of acetylcholine depletion after repeated action potentials. </s>

<s>[INST] Question: Unilateral watery discharge from the eye of a new born, with no edema or chemosis is due to – Options: A. Chlamydia B. Gonococcus C. Sticky eye D. Chemical conjunctivitis [/INST] Watery discharge, with no edema or swelling in a newborn is typical of chemical ophthalmia neonatorum. In infective cause, there is mucopurulent or purulent discharge with marked edema and swelling. OPTION D IS CORRECT. </s>

<s>[INST] Specialized clinical ophthalmology question: Can a family history of late age-related macular degeneration (AMD) increase the risk of developing the disease ? [/INST] Yes, having a family history of late AMD can increase the risk of developing the disease. Studies have shown that first-degree relatives of patients with late AMD have a fourfold increased risk of AMD. Additionally, a case control study found that 25% of siblings of affected patients were also affected by the disease, compared to only 1% of siblings in control patients. This suggests a familial association and highlights a genetic predisposition to AMD. Twin studies have further supported this, with higher concordance rates among monozygotic twins compared to dizygotic twins. Although the exact genetic cause of AMD is still unknown, the evidence suggests that there is a strong familial component to the disease. </s>

<s>[INST] Question: Ring of Sommering is seen in - Options: A. Galactosemia B. Dislocation of lens C. Acute congestive glaucoma D. After cataract [/INST] Soemmering's ring which refers to a thick ring of after cataract formed behind the iris, enclosed between the two layers of capsule. REF IMG OPTION D IS CORRECT. </s>

<s>[INST] What are the potential causes for the disappearance of creases in Asian blepharoplasty patients, and how can this issue be managed ? [/INST] The disappearance of creases in Asian blepharoplasty patients can occur due to various reasons. One possible cause could be the inadequate release and repositioning of the preseptal (sub-brow) fat during the initial procedure, as mentioned in this case. This can disrupt the formation of the desired crease and result in its disappearance over time. To manage this issue, it is important to carefully evaluate the patient's anatomy and determine the optimal position for the crease during the revision surgery. Excising any scar tissue and utilizing a myocutaneous flap can help in forming a new crease. Additionally, suturing techniques using 6/0 and 7/0 silk can be employed to create a nasally tapered configuration, as described in this case. It is crucial to ensure proper tarsus measurement and marking of the crease during the procedure. Soft fluctuant pretarsal and preseptal tissues should be addressed to achieve a more stable and long-lasting crease. Please note that this response is based on general knowledge in the field of ophthalmology and does not take into account specific patient details or individual variations. It is always recommended to consult ophthalmology textbooks and resources for further guidance and to tailor the management approach according to the patient's unique circumstances. </s>