- Investigations for diagnosis of poisoning.

Investigations for diagnosis of poisoning

There are general & toxicological measures ......

• ECG.
• Urea & electrolytes , lab glucose, anion gap /- lactate & osmolal gap.
• Liver function Tests & Clotting (paracetamol, anticoagulants).

• Arterial Blood Gases.

• Drug levels (at appropriate interval: Paracetamol, salicylates; others: theophylline, digoxin, lithium, anti-epileptics if it was likely that they had been taken).

• Comprehensive toxicology screens not normally indicated in the emergency treatment.
• Carboxyhaemoglobin levels if carbon monoxide suspected.
• Urinalysis , save sample for possible toxicological analysis.

• Rhabdomyolysis , save sample for possible toxicological analysis.

• Chest X-Ray if pulmonary oedema/aspiration suspected.

- Types of Poisoning.

• Deliberate متعمد
  
  • Overdose as self-harm or suicide attempt.إنتحار
  • Child abuse .
    
  • Munchhausen's syndrome :Factitious disorder, Hospital addiction syndrome(e.g psychic patient).
  • Third party (attempted homicide, terrorist, warfare).
  
  
• Accidental عن غير قصد
  • Most episodes of paediatric poisoning.
  • Dosage error.
  • Iatrogenic
  • Patient error
  • Recreational use.
  
  
• Environmental:
  • Plants
  • Food
  • Venomous stings/bites.
  
  
• Industrial exposures.

- cornea.

cornea

* Definition :

It is a colorless (transparent) structure

covering the anterior 1/6 of the eye ball.


*Development of the cornea:

• Surface ectoderm forms the epithelium of the cornea.
• Mesoderm gives rise to the corneal stroma.
• Neural crest cells gives rise to the corneal Endothelium.

**Characters of the cornea :-

- colorless (transparent) structure and has a smooth surface.

- A vascular structure.

- Highly innervated by non-myelinated trigeminal nerve fibers.

-The most powerful refractive media of the eye

( 42+ diopters ).

- Diameter :-

• Horizontal = 12mm 
• vertical = 11mm Why…?

Due to scleral overlapping on upper

& lower sides of the cornea.

- It is not uniformly curved How…?

>>the central or optical zone having a smaller radius of

curvature than the peripheral parts,and the

posterior surface is more strongly curved than the anterior.

>> Ant radius of curvature = 7.7 mm 

>> Post radius of curvature = 6.6 mm

>>Thus the cornea is thinner (0.6 mm) at its

center than near its margin (1 mm).

see you,

Dr Ibrahim

- gonioscopy.

In the name of Allah

to know the principle of goniolens we

must know some important information.....

- There is an angle called critical angle which need  rays come from media of high refractive index to media of low refractive index at this angle no refraction occur.

- When rays come from the angle between cornea and  iris outward to air as it has total internal reflection as there is critical angle so don't released to air .

- Total internal reflection as rays fall with angle is more than critical angle.
- corneal R.I = 1.38
- Air R.I = 1.00

- Goniolens eliminates the total internal reflection by replacing the cornea-air interface  by a new geniolens-air interface that has  higher R.I (n=1.50) than
that of the cornea and the tear.



-uses :-
used for viewing the anterior chamber angle of the eye for evaluation, management and classification of  normal and abnormal angle structures which is important in glaucoma management and evaluation.

- Contraindications for gonioscopy:-

• Hyphaema.
• Compromised cornea (e.g corneal ulcer).
• Lacerated or perforated globe.

Thanks alot

Dr Ibrahim

- Anatomy and histology of eye lids.

- Eye lid :

• It is movable muco-cutaneous fold covering anterior surface of eye globe.
• Upper eye lid is more movable than lower eye lid as it have levator palpebrae superioris muscle and Muller's muscle .
• The upper eyelid skin crease (superior palpebral furrow) is approximately 8-11 mm superior to the eyelid margin and is formed by the attachment of the superficial insertion of  levator aponeurotic fibers  (8-9 mm in men and 9-11 mm in women).

-The palpebral fissure is that empty space between the upper and  lower eyelid margins when the eyelids are open (that is, the space between the eyelids that allows you to see  your eyeball and your eyeball to see the world).

- Development of eye lids.

Development of eye lids

Time :

Begins during 6th week.

process:

1- Eye lids develop from two folds of skins over the

cornea during 6th week.

2- Eye lids adhere to each other by the beginning of 10th week

& remain adhered till 26th to 28th weeks.

Congenital anomalies:

usually congenital anomalies appear together

to give a syndrome.

1-congenital ptosis:-

cause: failure of development of levator palpebrea

superioris muscle.

- It may be simple( alone).

- It may be associated eith other lid deformities or

congenital opthalmoplegia.

- it is usually bilateral & hereditary.

2- Epicanthus:

- is a semilunar skin fold at the side of the nose

covering the medial canthus & the caruncle leading

to false convergent squint.


3- Telecanthus:

increased distance () two medial canthi.

4-Blepharo-phimosis:

-Diminution of the horizontal width of the palpebral

fissure from 25-30 mm (normal) to 18-22mm without

pathologic changes in the eyelids.

- It is rare & usually asscociated in

Blepharo-phimosis syndrome.

5-Blepharo-phimosis syndrome:

presence of congenital ptosis,Epicanthus,

elecanthus & Blepharo-phimosis with each other.

6- Congenital trichiasis ( distichiasis)

- rare condition.

- In which abnormal extra raw of lashes replacing white line.

7- Congenital entropion:

- rare with micropthalmos.


8- Congenital ectropion:

- rare with Blepharo-phimosis syndrome.


9- coloboma of the eye lids:

- It is triangular , quadrilateral or

irregular shaped defect of the lid margin.


10- Epiblepharon:

-horizontal redundant medial fold of skin of the

eye lid inducing vertical orientation of the cilia.

-Epiblepharon may co exist with entropion.

-It usually imrpoves by age as the eyelid skin stretches.

- Vision.

- Vision: - is a complex sense composed of many elements including:-

Perception of image on retina.-

-Conduction of the image as nerve impulse to brain.

- Interpretation & recognition of the image by brain.

- Organ of Vision: - is the eye.

- Eye is formed of: -

-Eyeball which located inside the orbit.

-Extra ocular structures surrounding it

(eyelids – Conjunctiva - lacrimal apparatus - Extra ocular muscles)

N.B… nerve of vision is :-

optic nerve which is the second (2nd) cranial nerve.

N.B… Ocular muscles 2:-

1- Extra ocular muscles:-

-Levator Palpebrae Superioris.

-Four recti :-

• Lat. Rectus
• Med. Rectus.
• Sup. Rectus.
• Inf. Rectus.

- Inf. Oblique.

- Sup. Oblique

2- Intra ocular muscles:-

- ciliary muscle.

- Sphincter pupillae muscle.

- Dilator pupillae muscle.

- last breath.

Please play the video then read

**last breath**

From those around I hear a cry
A muffled sob, a hopeless sigh,
I hear their footsteps leaving slow,
And then I know my soul must Fly!

A chilly wind begins to blow,
Within my soul, from Head to toe
And then, Last Breath escapes my lips,
It’s time to leave. And I must Go!

So, it is True (But It’s too late)
They said: Each soul has its Given Date,
When it must leave its body’s core,
And meet with its Eternal Fate>

On mark the words that I do say,
Who knows? Tomorrow could be your day,
At last, it comes to Heaven or Hell
Decide which now, Do NOT delay!
Come on my brothers lets pray
Decide which now do not delay….

Oh God! Oh God! I cannot see!
My eyes are blind! Am I still me?!!
Or has my soul been led astray,
And forced to pay a Priceless fee?!
Alas to Dust we all return,
Some shall rejoice, while others burn,
If only I knew that before
The line grew short, and came my Turn!

And now, as beneath the sod
They lay me (with my record flawed),
They cry, not knowing I cry worse,
For, they go home, I face my God!
Oh mark the words that I do say,
Who knows? Tomorrow could be your day,
At last, it comes to Heaven or Hell
Decide which now, Do NOT delay!
Come on my brothers lets pray
Decide which now do not delay….

- Forgive me.

Please play the video then read......

*Forgive me*

Today, upon a bus,
I saw a girl with golden hair.
and wished I was as fair.
When suddenly she rose to leave,
I saw her hobble down the aisle.
She had one leg and wore a crutch.
But as she passed, she smile.
Oh God, forgive me when I whine.
I have 2 legs, the world is mine.
With feet to take me where I'd go.
With eyes to see the sunset's glow.
With ears to hear what I'd know.
Oh God, forgive me when I whine.
I've been blessed indeed, the world is mine
I stopped to buy to buy some candy.
The lad who sold it had such charm.
I talked with him, he seemed so glad.
If I were late, it'd do no harm.
And as I left, he said to me,
"I thank you, you've been so kind.
You see," he said, "I'm blind."
Oh God, forgive me when I whine.
I have 2 eyes, the world is mine.
With feet to take me where I'd go.
With eyes to see the sunset's glow.
With ears to hear what I'd know.
Oh God, forgive me when I whine.
I've been blessed indeed, the world is mine
I saw a child with eyes of blue.
He stood and watched the others play.
He did not know what to do.
I stopped a moment and then I said,
"Why don't you join the others, dear?"
He looked ahead without a word.
And then I knew, he couldn't hear.
Oh God, forgive me when I whine.
I have 2 ears, the world is mine.
With feet to take me where I'd go.
With eyes to see the sunset's glow.
With ears to hear what I'd know.
Oh God, forgive me when I whine.
I've been blessed indeed, the world is mine.

- Dietary Protein.

Dietary Protein

Chemistery :-

Proteins are made of strings of amino acids that form chains known as peptides.
Proteins differ by the types and order of amino acids they contain. Even though there are only 20 amino acids, they create almost endless variations in chains as long as 500 links.

site of synthesis:-

Proteins form inside animals (including humans) and plants through processes that synthesize peptides. For humans, we cannot synthesize certain "essential protein," and so we must ingest them through food. These essential proteins are made of phenylalanine, threonine, methionine, tryptophan, leucine, isoleucine, lysine, and valine amino acids.

Functions pf proteins:-
Our bodies need dietary protein to accomplish many basic functions, such as:-
1- building bones.
2- moving muscles.
3- repairing tissue.
4- a catalyst in metabolism.
5- They're involved in the nervous system function.
6- bringing energy to cells.

Dietary protein, an essential nutrient, comes from meat, dairy, and certain grains and beans.

Food from plants, like corn, have incomplete protein, which means they do not contain all the necessary amino acids. Only food from animals, such as cheese and fish, provide complete protein, and don't need to be combined with other protein sources.

Examples of complete protein foods are :-

milk, cheese, yogurt, butter, poultry, pork, or any meat. Incomplete proteins include oats, wheat, pasta, lentils, nuts, rice, soy, pears, and seeds. Eating a combination of complementary protein sources, such as grains mixed with legumes, results in a diet of essential protein. This is how vegetarians and vegans maintain health without eating meat or dairy.

Dietary requirements:-
vary from 40-70 gm of protein per day.

Disturbances:-
1- Too much protein might deplete calcium,
2- while too little causes a form of malnutrition called kwashiorkor. Insufficient protein weakens the heart and other muscles, eventually leading to death.
3- Incidentally, proteins are responsible for most food allergies.

With my best wishes

Dr-hema

- what is ophthalmology?

The medicine and surgery of the eye and
its surrounding structures and its connections
to the brain, in order to maintain clear
, pain-free and useful vision
with an aesthetic attractive appearance.