OCULAR MANIFESTATION OF SYSTEMIC DISEASES

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October 22, 2022

ocular manifestation of systemic diseases

Why Eye Evaluation?

The primary care physician frequently encounters patients with ocular symptoms and signs that may signal serious underlying systemic disorders. In such cases, the Ocular manifestation of systemic disease as obtained from an ocular examination may aid in the diagnosis and management of the underlying systemic disease. Alternatively, patients known to have systemic diseases may develop ocular problems that require the attention of an eye care profession. For these reasons, the primary care physician should be familiar with the common ocular complications of frequently encountered systemic diseases as there often ocular manifestation of systemic diseases. And as well encourage for regular routine eye evaluation and check.

To provide a framework for approaching ocular manifestations of systemic disease, there is need for ocular evaluation or eye evaluation.

This program is organized according to these list of systemic diseases with ocular manifestation:

Congenital,
Traumatic,
vascular,
neoplastic,
autoimmune,
idiopathic,
infectious,
metabolic/endocrine, and
drugs/toxins.

To avoid overlooking pathology of the eye in systemic diseases, it is important that the primary care physician or Optometrist considers performing an eye examination for each patient. The complete eye evaluation should include:

1. Visual acuity

2. External examination (lids and orbit)

3. Pupils (including assessment for relative afferent pupillary defect)

4. Motility examination

5. Examination of anterior segment (conjunctiva, sclera, cornea, anterior chamber, and lens)

6. Dilated ophthalmoscopy

7. Visual fields Patients with visual symptoms need an ophthalmologic referral because ocular findings such as anterior chamber inflammation, corneal dendrites, or retinal pathology can be easily missed.

In addition, there should be due considerations of eye diseases and treatment options to save sight.

OCULAR MANIFESTATION OF CONGENITAL DISORDERS

Ocular manifestation is a feature of numerous congenital syndromes, including Down syndrome, Marfan syndrome, myotonic dystrophy, tuberous sclerosis, metabolic disorders involving lysosomal storage and carbohydrate metabolism, and neurofibromatosis. An ocular examination may provide key findings in an effort to establish a definitive diagnosis with key monitoring of ophthalmic manifestation in systemic diseases.

Examples of Congenital disorders with ocular manisfestations

Neurofibromatosis

Classical neurofibromatosis (NF1) is among the most common inherited disorders in humans, with an estimated incidence of 3 in 10,000.

The disease is characterized by

• 6 or more hyperpigmented skin macules (café-au-lait spots; see the slide, left)

• 2 or more cutaneous neurofibromata or 1 plexiform neurofibroma

• Melanocytic hamartomata of the iris (Lisch nodules; see the slide, right)

• Multiple “freckles” in the intertriginous areas

• Distinctive osseous lesions (eg, sphenoid dysplasia, pseudoarthrosis or thinning of the long bone cortex)

• Glioma of the anterior visual pathway

• Patient history of a first-degree relative with NF1 Ophthalmic manifestations of classical neurofibromatosis may commonly involve the eyelid, iris, orbit, and optic nerve.

The iris Lisch nodules may be one of the key signs in screening individuals. Ninety-five percent of individuals with NF1 will have Lisch nodules by the time they are 6 years old.

OCULAR MANIFESTATION OF TRAUMATIC DISORDERS

Shaken Baby Syndrome and the eyes

The shaken baby syndrome is increasingly evident in our society. Injuries in a child with a history that is not appropriate for the injury sustained should raise a suspicion of child abuse. Ocular manifestation of this syndrome can be detected with a dilated fundus examination may reveal form of preretinal, intraretinal (including white centered hemorrhages), or vitreous hemorrhages. Photographic documentation of retinal findings should be obtained immediately, as these findings may be fleeting.

OCULAR MANIFESTATIONS OF VASCULAR DISEASES

Systemic Hypertension

Systemic diseases such as hypertension is a cardio vascular disease that affect the retinal, choroidal, and optic nerve circulations. A variety of retinal vascular changes can be seen in this systemic disease; these depend in part on the severity and duration of the hypertension. Ocular manifestation of systemic diseases such as hypertension include retinal changes in form of flame-shaped hemorrhages in the superficial layers of the retina and cotton-wool patches caused by occlusion of the precapillary arterioles with ischemic infarction of the inner retina. Long-standing hypertension can produce arteriolar sclerotic vascular changes, such as copper or silver wiring of the arterioles, as shown by the two arrows on the right, or arteriorvenous nicking. Another ocular manifestation sign of chronic hypertension in the fundus of a hypertensive patient is lipid exudates resulting from abnormal vascular permeability, as shown by the arrow at left. More ominous in this photograph is swelling of the optic disc as its most common ocular manifestation, seen here by the blurring of the temporal disc margins. This is the hallmark of malignant hypertension, which carries a poor prognosis for the patient’s health if left untreated. BP must be emergently controlled to decrease the risk of developing heart and renal failure and hypertensive encephalopathy as well as stroke and permanent vision loss.

Embolic Disease

Emboli to the ophthalmic circulation can lodge in the ophthalmic artery or the central retinal artery, producing severe loss of vision that can be transient or permanent (left). In the elderly, the most common source of emboli is fibrin and cholesterol from ulcerated plaques in the wall of the carotid artery. The so-called Hollenhorst plaque is a refractile cholesterol embolus that lodges at an arterial bifurcation, as shown in the right-hand slide.

Emboli of cardiac origin may come from calcified heart valves in patients with a history of rheumatic fever, from an atrial myxoma, or from fibrin-platelet emboli in patients with mitral valve prolapse, as seen here in this left eye with superotemporal branch retinal artery occlusion. This is cholesterol based systemic disease with ocular manifestation.

Cholesterol emboli eye presents with sudden, persistent visual loss may be due to occlusion of the central retinal artery, and emergency ophthalmologic evaluation is indicated. Ophthalmoscopic examination will reveal narrowed retinal arterioles and a pale retina. Edema with loss of retinal transparency in all areas except the fovea gives rise to the appearance known as the “cherry-red spot” (left). All these ocular manifestation can be prevented if detected early. Compare that appearance with a normal fundus (right). Emergency treatment is directed to decreasing intraocular pressure and to vasodilation in an attempt to allow the obstructing embolus to pass into less critical, smaller-caliber vessels.

Other sources of emboli include talc in intravenous drug abusers, as seen here in the macula, and fat in patients with long bone fractures. Talc emboli do not typically cause occlusion or ischemia although rarely they may be associated with retinal neovascularization.

Central Retinal Vein Occlusion

Another cause of painless vision loss is a central retinal vein occlusion (CRVO). This vision loss may be mild to profound and is often due to macular edema. The onset of a CRVO is usually rapid. Ophthalmic examination will reveal retinal hemorrhages and cotton-wool spots. The findings of severe vision loss or an afferent pupillary defect indicate a greater risk for the ischemic type of CRVO, which carries a poor prognosis and is more highly associated with rubeotic glaucoma. Fifty percent of patients who have a CRVO have open-angle glaucoma and/or systemic hypertension. A systemic workup in patients with a CRVO should include measurement of blood pressure and exclusion of other vasculopathic risk factors. Blood workup to rule out coagulopathies (including Factor V deficiency), hyperlipidemia, collagen vascular diseases, and paraneoplastic syndromes may be considered.

Migraine: Ocular Migraine

Migraine is a transient vasospastic phenomenon affecting the cerebral and/or ocular circulations. Paroxysmal neurologic or visual symptoms include scintillations, amaurosis fugax, transient cortical blindness, and transient homonymous hemifield loss, which consists of nasal field loss in one eye and temporal field loss in the other. Migraine symptoms, which are presumably due to focal cortical or ocular ischemia, may last from 15 to 45 minutes.

In classic ocular migraines, these visual symptoms are followed by an intense, throbbing headache. Common migraine is a periodic headache of varying intensity without a preceding aura. Complicated migraine occurs when frequent severe migraine headache results in a persistent visual or other neurologic deficit. However, the visual phenomena may occur without headaches, which is called ocular or acephalgic migraine or migraine equivalent. A treatable vascular disease such as vasculitis or arteriovenous malformation needs to be considered in the differential diagnosis of acephalgic migraine.

The Migraine treatment depends on the frequency of the episodes and can be directed to preventing attacks rather than aborting them. Episodes that occur less frequently than once a month may not require treatment. Fortunately, the paroxysmal ocular phenomena rarely lead to permanent visual deficits, but patients with visual loss during attacks should probably have an ophthalmologic evaluation. Discontinuation of oral contraceptives should be considered, as they may trigger vascular occlusive disease in migraine patients.

OCULAR MANIFESTATION BLOOD DYSCRASIAS

A blood dyscrasia is any abnormal or pathologic condition of the blood. Ocular manifestation of blood dyscrasias include hyperviscosity syndromes, thrombocytopenia, and all forms of anemia, including sickle cell anemia.

Hyperviscosity Syndromes

Patients with such as polycythemia, multiple myeloma, dysproteinemia, and leukemia may present with visual complaints. These include amaurosis fugax and permanent visual loss.

Initial fundus changes are retinal vein dilation, retinal hemorrhages, and varying amounts of disc edema (as seen in this fundus).

Leukemia

Patients with leukemia may present with a hemorrhagic type of retinopathy, as seen here. Note both the retinal and the preretinal hemorrhages (see arrows). The hemorrhages are presumably due to thrombocytopenia of leukemia. White centered hemorrhages may indicate metastatic leukemic infiltration of the retina.

Direct leukemic infiltration of the optic nerve

Direct leukemic infiltration of the optic nerve can cause pronounced optic nerve swelling and vascular congestion with edema and hemorrhages of the surrounding retina, as seen here. This can rapidly lead to blindness if not treated promptly with radiation. Periodic dilated funduscopic examination is recommended for asymptomatic patients with hyperviscosity syndromes, and referral to an ophthalmologist is indicated if any ocular symptoms or signs develop.

Sickle Cell Anemia : How does sickle cell disease affcets the eyes

Sickle cell retinopathy occurs most frequently in the HbSC form of the disease but may also be seen in the HbSS form and in sickle thalassemia. Sickle cell retinopathy is not seen in patients with sickle cell trait only.

Sickling can produce retinal arterial occlusions, especially in the retinal periphery, as shown by the arrows in the slide (left). The retinal ischemia can lead to peripheral (“sea fan”) neovascularization (as seen in this slide, right), vitreous hemorrhage, and tractional retinal detachment. Panretinal laser photocoagulation may be necessary to expedite regression of the neovascular process. General anesthesia can produce sickling and thereby increase the risk of arterial occlusive disease. Sickle cell eyes treatment should begin with ophthalmologic evaluation because patients may be asymptomatic, even in advanced stages of the retinopathy, due to the peripheral location of the retinal changes, which can only be visualized via indirect ophthalmoscopy through a dilated pupil.

NEOPLASTIC EYE DISEASE: WHAT IS NEOPLASM IN THE EYE

The most common ocular tumors or type of intraocular malignancy in adults is metastatic carcinoma, arising from primaries in the breast or lung in women and in the lung in men. Patients are often asymptomatic but may present with decreased or distorted vision.

An easily detected iris mass is visible in this patient with metastatic lung carcinoma. An irregularly shaped pupil, iritis, or blood in the anterior chamber may signal a metastatic nodule, as seen here.

Choroidal metastases from breast cancer

Because of its rich vascular supply, the choroid is the most common site for ocular metastasis. Choroidal metastases may be solitary or multiple and may affect one or both eyes. Typically they appear as creamy-white lesions, as seen in this patient with metastatic breast cancer. Associated leopard spotting may also be detected. Choroidal metastases are often subtle and difficult to detect with direct ophthalmoscopy and may require referral to an ophthalmologist if suspected or if visual loss or visual distortion develops. Treatment options include local radiation and chemotherapy.

Because ocular metastases may represent the smallest clinically detectable lesions of disseminated carcinoma, an ophthalmologist monitoring these lesions at regular intervals may help to assess the efficacy of systemic treatment. However, prognosis for survival after detection of an intraocular metastasis is generally poor, with a mean length of survival of 6 to 9 months. Retinoblastoma is one of the most metastatic tumors of the retina.

AUTOIMMUNE DISORDERS THAT AFFECT THE EYES

Certain autoimmune disorders, such as connective tissue diseases, thyroid eye disease, and myasthenia gravis, can initially present with ocular manifestations only. Thus, it is extremely important for the primary care specialist to screen for those disorders in patients with the most common ocular symptom (dry eyes) so that these patients can receive the appropriate treatment as early as possible in the course of these diseases.

Ocular manifestation of Connective Tissue Disorders (Collagen Vascular Diseases)

Connective tissue disorders have various ocular manifestations, the most common being tear deficiency leading to dry eyes, or keratoconjunctivitis sicca. The symptoms of dry eyes include burning, a foreign-body or gritty sensation, and photophobia.

Sjögren’s syndrome, the complex of dry eyes and dry mouth, may occur in isolation or in association with a connective tissue disorder. Specific antibodies such as anti-SS-A (or antiRo) may be associated with Sjögren’s syndrome.

Artificial tears are the primary treatment for mild to moderate keratoconjunctivitis sicca. Generally, to be efficacious, they must be used several times a day on a regular basis. Numerous commercial preparations are available, and the patient’s preference is sometimes the best criterion for selecting a given agent. Patients with severe dry eyes or with sensitivity to preservatives should be steered to one of the preservative-free lanolin-free formulations. Nighttime administration of lubricating ointment may also be helpful. Occlusion of the lacrimal drainage puncta can aid retention of tears. Environmental modifications include humidifiers, goggles, and side shields on glasses. Recent advances demonstrate the efficacy of anti-inflammatory agents, administered in topical form.

Severe tear deficiency may be unresponsive to routine use of artificial tears and can result in corneal epithelial breakdown, ulceration, and even perforation, as seen here. Consultation by an ophthalmologist is indicated for patients with tear deficiency states who have persistent pain or visual loss.

Ankylosing Spondylitis: Does it cause uveitis?

Up to 25% of patients with ankylosing spondylitis have one or more attacks of iritis, a form of intraocular inflammation, which may precede the clinical arthritis. Patients typically present with ocular symptoms such as; photophobia, redness, and decreased vision. Patients with symptoms or signs suggestive of iritis (shown here) should be referred for evaluation by an ophthalmologist.

Iritis usually responds to treatment with topical corticosteroids and dilating agents. However, topical corticosteroids should be prescribed only with the advice of an ophthalmologist, because long-term corticosteroid therapy can lead to glaucoma, cataract formation, or exacerbation of ocular infections, and, in some connective tissue disorders, to ocular perforation.

Most common ocular manifestation in patients with Rheumatoid Arthritis

The ocular manifestation of rheumatoid arthritis are most often seen in patients with more active and severe forms of the disease and in those with extra-articular complications. Aside from dry eyes, other common ocular manifestations are inflammation of the episclera and sclera, peripheral corneal ulcers, and uveitis.

Episcleritis is inflammation of the superficial tissue overlying the sclera. Typically patients complain of mild to moderate pain and tenderness, and there is localized or diffuse redness of the eye.

Scleritis (inflammation of the sclera) may sometimes appear clinically similar to episcleritis. However, severe, deep pain is a distinguishing feature of scleritis.

Scleritis may be characterized by active inflammation with redness, as seen on the left, and severe pain. It can progress to necrosis, as seen on the right, and subsequent perforation of the sclera (necrotizing scleritis).

Scleromalacia perforans consists of scleral melting in a white, quiet eye. This condition also can lead to ocular perforation.

Peripheral corneal ulceration is another manifestation of rheumatoid arthritis that may result in ocular perforation. Patients with rheumatoid arthritis who develop peripheral corneal ulceration or scleritis have an associated risk for developing potentially lethal systemic vasculitis. Primary care physicians should monitor patients with active rheumatoid arthritis for symptoms and signs of episcleritis, scleritis, and corneal ulcers; patients who develop these ocular conditions should be referred to an ophthalmologist for treatment.

Juvenile Rheumatoid Arthritis

Ocular involvement in juvenile rheumatoid arthritis typically occurs in patients with a mild form of the disease, the so-called pauci-articular form, and in patients who are rheumatoid-factor negative and ANA positive. Ocular complications may occasionally be the presenting feature of this disease and do not correlate with the severity or course of the systemic signs. The characteristic triad of late ocular complications in juvenile rheumatoid arthritis consists of iritis, cataract, and, as seen here, band keratopathy, which consists of whitish deposits of calcium in the cornea. Band keratopathy is a late sequela of many forms of chronic intraocular inflammation. Iritis or iridocyclitis can occur in up to 15% of patients with JRA and causes few symptoms or signs. The iritis is usually chronic, causing secondary cataract formation and glaucoma. All patients with JRA should be screened and followed by an ophthalmologist.

Systemic Lupus Erythematosus

Patients with systemic lupus erythematosus (SLE) can have many of the same ocular manifestations associated with rheumatoid arthritis, such as dry eyes, scleritis, and peripheral corneal ulceration. The most common severe manifestations of SLE, however, involve the vasculature of the retina and optic nerve.

A variety of retinal complications can occur in SLE, including retinal vasculitis with cotton wool spots, as seen here, and hypertensive retinopathy secondary to renal involvement. Lupus anticoagulant or phospholipid antibody syndrome is a variant characterized by a higher incidence of thrombotic episodes, which may cause vascular occlusions and may require anticoagulant therapy.

Lupus vasculitis can also involve the optic nerve, resulting in ischemic optic neuropathy. Note the pale, swollen nerve in this young woman, who presented with visual loss due to ischemic optic neuropathy as the initial manifestation of SLE. Ophthalmologic evaluation is indicated for patients who have central nervous system involvement or visual symptoms. Detection of retinal vasculitis can also assist, in certain instances, in establishing the diagnosis of SLE.

Polyarteritis or Periarteritis Nodosa

This condition is a widespread inflammatory disease affecting small and medium-size blood vessels, most commonly in middle-aged men. In addition to dry eyes, the ocular manifestations are peripheral corneal ulceration, scleritis, associated hypertensive retinopathy, and primary retinal vasculitis similar to that seen in patients with SLE. Other connective tissue diseases associated with ocular inflammation are Reiter’s syndrome, Wegener’s granulomatosis, and Behcet’s disease. Wegener’s can be associated with anterior or posterior scleritis and/or retinal vasculitis including retinal vascular obstruction. The classic triad of Behcets includes hypopyon uveitis, arthritis and oral ulcers. Fulminant occlusive retinal vasculitis with progressive retinal necrosis may warrant aggressive immunosuppressant therapy.

Sarcoidosis

Sarcoidosis, a multisystem disorder of unknown etiology, is characterized in part by granulomatous inflammation of many organs. This disease more commonly affects the African-American and Hispanic populations. Ocular involvement occurs in about 25% of patients presenting with other features of sarcoidosis.

The most common ocular presentation is granulomatous uveitis, characterized in part by large clumps of cellular deposits on the endothelial layer of the cornea, which are called keratic precipitates (left).

Choroiditis and retinal vasculitis, usually segmental, may occur in a small percentage of patients. The typically gray, perivenous infiltrates are characteristically called “candlewax drippings” (right). Optic disc involvement is rare but may occur in patients with central nervous system involvement. Edema or granuloma of the optic nerve may be present.

Many of these changes are difficult to detect with direct ophthalmoscopy, and dilated ophthalmologic evaluation is indicated for all patients who have sarcoidosis with suspected ocular involvement. Treatment of the ocular problems is similar to treatment of the systemic disease and often includes the use of topical, injectable, or systemic corticosteroids.

Giant Cell (Temporal) Arteritis

Giant cell, or temporal, arteritis is a systemic vasculitis that usually affects people over age 60. Although almost any artery can be involved, this disease has a predilection for large and medium sized vessels, particularly the superficial temporal, ophthalmic, and proximal portion of the vertebral arteries. The symptoms include headache, scalp tenderness, jaw pain and difficulty in chewing (claudication), the polymyalgia rheumatica complex (myalgia, weight loss, anorexia, and fever of unknown origin), and acute visual loss. Palpation of the temporal artery may reveal tenderness, a lack of pulsations, and enlargement or nodular thickening of the vessel.

Ischemic optic neuropathy, or infarction of the optic nerve head, is the most common presentation of giant cell arteritis; it is associated with severe unilateral loss of vision, a relative afferent pupillary defect or Marcus Gunn pupil, and, as shown here, a pale, swollen optic nerve head.

Cranial motor nerve palsy is the initial ophthalmic presentation of giant cell arteritis in about 10% of patients; it is due to nerve ischemia resulting from occlusion of the vascular supply to the nerve. Most commonly, the third cranial nerve is affected, producing ptosis and outward deviation of the eye on the involved side (as seen here), with sparing of the pupil. In the elderly, a cranial nerve palsy should raise suspicion of giant cell arteritis, especially if accompanied by headache or pain.

If giant cell arteritis is suspected, a STAT erythrocyte sedimentation rate and c-reactive protein must be obtained, followed by a temporal artery biopsy. A low or normal sedimentation rate does not exclude this diagnosis, especially if the patient is taking nonsteroidal anti-inflammatory agents for other reasons. (Up to 20% may have a normal sedimentation rate.) Fluorescein angiography is a photographic test that can reveal characteristic deficits in the choroidal circulation of the eye. Histopathologic examination of the temporal artery typically reveals a patchy, granulomatous inflammatory reaction that involves the media and the adventitia of the artery.

A potentially blinding disease, giant cell arteritis usually affects the second eye in a matter of hours or days if untreated. Therefore, this condition is considered an emergency, and treatment must be initiated empirically without waiting for the laboratory results. Therapy consists of high daily doses of systemic corticosteroids, which are gradually tapered according to serial sedimentation rates and the patient’s symptoms, both of which are monitored closely. Recent studies suggest that there is a more rapid response if patients are begun on intravenous corticosteroids for 24 to 48 hours before switching to oral corticosteroids. Corticosteroids should be started before the biopsy, as biopsy results will not be affected for a number of days. Patients suspected of having giant cell arteritis are best managed jointly by the primary care physician, rheumatologist, and ophthalmologist.

Thyroid Disorders

Ocular abnormalities are common in patients who suffer from thyroid dysfunction. Thyroid ophthalmopathy is not always correlated with serum thyroid hormone levels and may occur even in patients who are euthyroid. It is important to remember that the eye disease may continue to progress after thyroid function tests have returned to normal. All of the ocular manifestations should be closely followed in conjunction with an ophthalmologist.

Thyroid eye disease can vary in its severity and presentation. It can involve the eyelids, orbit, extraocular muscles, cornea, conjunctiva, and optic nerve. Ocular involvement can be unilateral or bilateral.

Lid retraction causes the patient to have a widened palpebral fissure, as seen on the left. Sometimes the sclera is exposed above or below the corneoscleral limbus; this is termed scleral show. The patient on the right exhibits soft tissue involvement, with eyelid fullness and injection of the conjunctiva.

Thyroid ophthalmopathy can cause proptosis, or exophthalmos (left). The extraocular muscles can become enlarged secondary to lymphocytic infiltration. This can lead to diplopia from restriction of eye movements. The muscle most commonly affected is the inferior rectus muscle, which causes restriction on attempted up gaze (shown at right, in patient’s left eye).

In severe cases, vision loss can occur. Proptosis and lid retraction can lead to corneal damage, as seen on the left. Sight loss can also occur due to optic nerve compression. The optic disc may appear swollen, as in the clinical photograph on the right, or may be atrophic. In early stages of optic nerve compression, the optic nerve can appear normal.

In severe cases, vision loss can occur. Proptosis and lid retraction can lead to corneal damage, as seen on the left. Sight loss can also occur due to optic nerve compression. The optic disc may appear swollen, as in the clinical photograph on the right, or may be atrophic. In early stages of optic nerve compression, the optic nerve can appear normal.

Computed tomography of the orbit may demonstrate proptosis, as seen in the left scan, and extraocular muscle swelling or enlargement, as seen in both scans.

Thyroid ophthalmopathy typically occurs in two phases that should be jointly managed by the primary care physician and the ophthalmologist. The first phase is characterized by acute congestive changes and lasts an average of 2 years. Treatment in this phase is directed toward preserving sight and providing symptomatic relief. Medical treatment for corneal problems includes the use of tear substitutes in the form of drops or ointments. For the extraocular muscle or optic nerve involvement during the acute congestive phase, intermittent high doses of corticosteroids may be employed. If this therapy fails, orbital irradiation or surgical decompression may be required to save deteriorating vision.

The second phase is marked by cicatricial changes in the eyelids, extraocular muscles, or orbit. Treatment may consist of surgically correcting the ocular muscle deviation, the functional abnormalities, or the cosmetic deformities.

Myasthenia Gravis

Myasthenia gravis is a myopathy that may occur at any age. It is an autoimmune disease affecting the acetylcholine receptors, causing a conduction defect at the neuromuscular junction. About 75% of patients present with ocular manifestations, including bilateral ptosis (as seen in this patient), limited eye movements, and/or diplopia. Among these patients, approximately 20% will have only ocular manifestations. Any patients with ptosis and diplopia of unclear etiology, especially if variable and worsening with fatigue, should be presumed to have myasthenia gravis. Referral to a neurologist may be necessary because of systemic involvement, including apnea and choking due to involvement of respiratory and pharyngeal muscles.

IDIOPATHIC DISORDERS

Intracranial Hypertension

The most common ocular manifestation of intracranial hypertension is optic disc swelling, which in this condition is referred to as papilledema. The visual symptoms of papilledema are often mild or absent; the most common are transient visual obscurations, which can range from mild blurring to complete visual loss, usually lasting only a few seconds. Ophthalmoscopy typically reveals marked disc swelling and vascular engorgement, as seen here.

Common causes of intracranial hypertension include brain tumor, meningitis, venous sinus thrombosis, hydrocephalus and the entity pseudotumor cerebri, or idiopathic intracranial hypertension. Pseudotumor cerebri may be associated with vitamin A or vitamin D intoxication, tetracycline therapy, and steroid withdrawal. Pseudotumor cerebri has a propensity to occur in young, obese women, and in most cases a precipitating factor is not found. Disc edema can also be caused by conditions that are not associated with increased intracranial hypertension, such as sarcoidosis, syphilis, tumor, and pseudo-disc edema from causes such as optic nerve head drusen (shown).

Multiple Sclerosis

Within 5 years of an episode of optic neuritis, more than 40% of women aged 20 to 40 will manifest signs and symptoms of multiple sclerosis. Optic neuritis presents as an acute, painful vision loss in one or both eyes occurring over a few days to two weeks. It may be the initial manifestation of multiple sclerosis. After one episode, 70% of eyes with optic neuritis recover spontaneously within 3 to 6 months. The Optic Neuritis Treatment Trial demonstrated that patients treated with intravenous methylprednisolone, 250 mg every 6 hours for 3 days, followed by 1 day of oral prednisone, had a more rapid visual recovery than a placebo-treated control group. By 1-year follow-up, however, there was no statistically significant difference between the treated group and the control group. In addition to intravenous methylprednisolone, another medication that has been shown to be of benefit is interferon beta-1a. A multicenter trial of interferon beta-1a (Avonex) showed a reduction of recurrent MS attacks, slowing of cognitive deterioration, and lessening of disease activity, as measured by gadolinium-enhanced MRI.

INFECTIOUS DISORDERS

Acquired Immunodeficiency Syndrome (AIDS)

Dry eyes are very common in patients with AIDS, but they are a nonspecific finding. The three most common classic lesions are retinal cotton-wool spots, cytomegalovirus (CMV) retinitis, and Kaposi’s sarcoma of the eyelid or conjunctiva.

Cotton-wool patches, which are due to obstruction of the precapillary arterioles with infarction of the superficial retina, are the most common ocular finding in patients with HIV infection. Associated intraretinal hemorrhages may also be present and these findings are collectively referred to as HIV noninfectious retinopathy.

Patients with AIDS can develop infectious retinitis secondary to a variety of opportunistic organisms. Ocular manifestation of systemic diseases in HIV/AIDS patients, often come in form cytomegalovirus (CMV) retinitis, as seen in this patient, which is characterized by discrete, fluffy, white retinal necrotic patches with hemorrhages. Because cytomegalovirus retinitis can begin in the retinal periphery, patients with AIDS should be referred for ophthalmologic evaluation evaluation especially if symptomatic or with reduced T-cell counts.

CMV retinitis therapy has evolved significantly. The incidence of CMV retinitis has decreased tremendously with the advent of HAART (Highly Active Anti-Retroviral Therapy). If CMV retinitis is detected in a patient who is not on HAART, the patient must be immune reconstituted with anti-retroviral medications. Induction IV ganciclovir or foscarnet is also necessary, and intravitreal injections of ganciclovir may be considered. As cytomegalovirus infection is usually a systemic infection, intravenous therapy is usually the treatment of choice. The primary care physician and the ophthalmologist must work closely together to monitor efficacy of therapy and side effects of the treatment. As CD4 counts increase and viral load decreases to an acceptable level, IV and intravitreal ganciclovir administration may be withheld as long as the CD4 counts remain above 100. If patients develop CMV retinitis on HAART or have no response to IV therapy, then ganciclovir implants and intravitreal injections are necessary.

In patients with AIDS, opportunistic infections such as CMV retinitis occur predominantly when CD4 counts fall below 50 cells/ml. However, other retinal infections such as syphilis, toxoplasmosis, herpes simplex virus, or varicella-related retinitis (acute retinal necrosis syndrome) may occur in immunocompromised or immunocompetent eyes.

OCULAR MANIFESTATION OF METABOLIC/ENDOCRINE DISORDERS

Diabetes

Diabetes commonly produces significant ocular complications that may lead to blindness as an Ocular manifestation of systemic disease , if not recognized and treated. Diabetic retinopathy is now the leading cause of new blindness in adults aged 20–74 in the United States. Because of its ophthalmologic significance, diabetic retinopathy is covered in detail in Diabetes and Eye Disease, a separate educational program in this series, and is not discussed further here.

DRUGS/TOXINS

Ocular manifestation of systemic diseases could sometimes be as a result of the medications these patients take to treat the disease conditiion. Significant ocular side effects including vision loss can be caused by systemic medications, for example, toxic retinopathy can be caused by thioridazine, chloroquine, hydroxychloroquine, and tamoxifen, and toxic optic neuropathy can be caused by ethambutol, isoniazid, and fluoroquinolones.

Imole Noble Educational Foundation (INEF) 2021 Undergraduate Scholarship Award For Nigerian Students

By

Dr Macjohnson onyeberechi

-

September 19, 2021

0

Imole Noble Educational Foundation (INEF) is now accepting applications from eligible Nigerian undergraduate students for its 2021 Scholarship Award.

The scholarship is opened to brilliant indigent students who are in 100 to 200 level in public universities across the 6 geo-political zones in Nigeria. Winners of the scholarship would be awarded financial aid throughout their undergraduate studies.

This is in fulfilment of the Founder’s life long burden for the plight of the less privileged in the society.

INEF Undergraduate Scholarship details

Type: Undergraduate

Country: Nigeria

Course of study: not specified

Level : 100 & 200L

Institution: not specified

State of origin: not specified

Deadline : October 10, 2021

Requirements for INEF Undergraduate Scholarship Qualification

Applicants must be in either 100 or 200 level in public universities in Nigeria and
Applicants must have had a minimum of 5As, and 3Bs in O’level result(s), in not more than 1 (one) sitting.

Documents for Application

O’level result,
Admission Letter,
Departmental registration form,
School ID Card, and Two (2) recent passport photographs with name at the back page.

Application Deadline

October 10, 2021

How to Apply

Interested and qualified candidates should addressed and send their “Application Details” to:

The Trustees,

Imole Noble Educational Foundation,

P.O. Box 139, G.P.O,

Marina, Lagos State.

Application Details

Applicants should indicate the following in their Application: Name, School, Course of Study, Level, State of Origin, Phone Number, and Email Address, with copies of the following documents above

Interview date, Process and Venue for INEF Undergraduate Scholarship

Successful applicants across the 6 geo-political zones will be contacted via their email address.

Don’t miss out on any scholarship information, join us here Whatsapp, facebook and telegram

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Study-In-Canada: 2022 University of Waterloo Arthur F. Church Entrance Scholarships

By

Dr Macjohnson onyeberechi

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September 13, 2021

0

The application for the undegraduate schoalsrhip in the university above is now open. We are accepting applications for the next academic year. So interested candidate.

The value goes for $10,000 each, and are awarded annually to outstanding students coming into first engineering.

Awarded students are selected on the basis of their academic excellence, extracurricular achievements as assessed through the admission information form and an online video interview

Scholarship Summary

Host: Arthur F. Church
Study Abroad: study in Canada
Category: undergraduate scholarship
Eligible Countries: All Countries
Reward: $10,000
Deadline: Not Specified
Scholarship Alerts: To receive Scholarship Alerts on

Scholarship Requirements

In order to be eligible to apply for the scholarship, applicants must note:

Scholarships are for Domestic (Canadian) and International prospective students.
Students enrolling to pursue an undergraduate degree program in the field of Computer Engineering, Systems Design Engineering and Mechatronics Engineering at the university.
Candidates must be completed a year 12 with a minimum of 70% marks or equivalent.
An applicant must have a strong and excellence academic background.
English Language Requirement: Candidates whose national language is not English may need to provide proof of English language proficiency by means of TOEFL or IELTS test.

Scholarship Duration and Reward

This sponsorship is enabled by Arthur F. Church to encourage excellent and exceptional students to attend Waterloo and assist their scholarly pursuits.

Value:

$10,000

Required Documents

Documents that will be required include

Academic details,

Language ability score or certificate scan,

Copy of the passport or maybe a personal information card

Method of Application

Use the link below to apply for the Scholarship

Interested candidates must first secure an undergraduate admission into the University.

Candidates’ selection will be done by the selection committee which will be automatic upon admission and dependent on the information supplied on the application form.

Deadline: Not Specified

APPLY HERE

Check infohealthedu for more Opportunities

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See what is unique about wearing our Summer contact lenses

By

Dr Macjohnson onyeberechi

-

September 12, 2021

0

SUMMER Contact lenses, for your everyday use. For cosmetic and Prescription purposes. Change your eye color, change your World. Look different and express yourself by mere changing your eye color. Weather friendly and durable. Summer contact lens comes in clear and colored forms.

There could regular contact lenses out but with using summer contact lens we give you a patient/client specific care and attention. Our contact lenses come with these benefits although not limited to it:

Improved Viewing Ease:

Pateients with summer contact lenses enjoy a wider viewing space and ease, this translates to increased efficiency at work and movement while wearing summer contact lens.

Better Eye Comfort:

With the cutting edge nanotechnology, summer contact lenses are produced with high level biocompatible materials which leaves the patients/clients with 98% comfortability. There is less lens rotation, dislodgement and irritation.

Wider Visual Access:

Summer contact lens offers you 98% access your normal visual space. This means that with summer , you tend to still see all corners of your environment .

Feeling Of Normalcy:

With the lens materials being biocompatible, you earn the feeling of not even putting on anything. This makes you not be conscious of any disturbing material on the eyes.

Aesthetic Perks:

This has been the killer nature of summer contact lenses. They come in beautiful designs and presentation upon wear. Summer lenses leave you with that desired glowing look which makes you attractive and unavoidably appealing to your peers and environment. Do you have an eye scar or unpleasant eye look? Summer contact lenses provide excellent masking look over it and leaves you with the desired outlook.

Are you a lover of contact lenses? Convert your spectacle prescription to a Summer contact lens now.

Do you have eye problem, and you are tired of wearing glasses, Summer contact lenses got you.Our contact lenses come in various forms such as those with prescription for correction of vision errors, therapeutic lenses and cosmetic contacts lenses to enhance your looks and fit your task.

We are indeed unique with our care for you as we have Optometrists who can advise you on how to go about our Summer contact lenses.

Still looking for something more or you want to get this cutting age contact lens?

Contact us here

or call 08101793936 for more enquiries or purchases

We have your quality contact lens preservative solution available

Display of various colors in stock

Testimonials from our clients

Elegant looks with our Summer contact lens

amethyst
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APPLICATION FOR NNPC/ ADDAX PETROLEUM 2021 HOST COMMUNITY SCHOLARSHIP

By

Dr Macjohnson onyeberechi

-

September 11, 2021

0

Addax Petroleum Development (Nigerian) Limited (APDNL), operator of NNPC/ADDAX Production Sharing Contract (PSC) in pursuance of its Corporate Social Responsibility invites suitably qualified applicants from its host communities to apply for the 2020/2021 Host Community Tertiary Scholarship Scheme.

Category of Award
Strictly for candidates from APDNL Host Communities

Carefully read the Requirement/Eligibility

Applications should be submitted on or before September 15, 2021.
The examination date will be communicated to shortlisted candidates only.

Note

Application for NNPC/Addax Host Community Scholarship is FREE.
SCHOLASTICA is the official platform for the NNPC/Addax Petroleum 2021 Host Community Scholarship
Beware of fraudulent websites when applying for the NNPC/Addax Host Community Scholarship online. Such websites may ask you to make some payments in the course of the application.
E-mail applications are NOT accepted.
Any candidate found to have presented false documents will be disqualified or withdrawn at any level of the scholarship process.
Only shortlisted candidates will be invited for the Remote Online Proctored CBT Examination

Requirements

To qualify for consideration, applicants MUST be:

Registered Full TIME undergraduates in Nigerian Tertiary Institutions
Certified 100 level students at the time of application (Only students admitted in 2020/2021 academic session)
For OND students, the award will be for 2 years only

NOTE: The following categories of students should not apply:

200 level students and above
HND students
Current beneficiaries of similar Awards from other Companies and Agencies

Only Indigenes of APDNL Host Communities in Rivers, Akwa Ibom and Imo States SHOULD apply for the Host Communities Merit Award.
NOTE: The aptitude test will take place online using remote proctoring CBT application and the date of the test will be communicated only to shortlisted candidates.

How to apply

Application is open to 100 level students only.

1. Before you start this application, ensure you have clearly scanned copies of the following documents

Passport photograph with white background not more than 3 months old (450px by 450px not more than 200kb)
School ID Card
O’level Certificate
Admission Letter
Birth Certificate
Proof of Local Government Area of Origin
JAMB Result

2. Ensure the documents are named according to what they represent to avoid mixing up documents during upload
3. Ensure you attach the appropriate documents when asked to upload
4. Ensure to provide valid Email and Phone Contact for effective communication

To apply, follow the steps below:
1.    Click on “Apply Now” tab.
2.    Click on “Register Now” to create an account.
3.    Proceed to your email box to activate your account
4.    Click on https://candidate.scholastica.ng/schemes/addaxscholarship to return to Scholarship site
5.    Enter your registered email and password to upload your information.
6.    Enter your personal information, National Identification Number (if available), educational information, other information and upload required scanned documents.
7.    Ensure the name used in application matches the names on all documentation in same order. Upload a sworn affidavit or certificate if otherwise.
8.    Ensure you view all documents after uploading, to eliminate errors during uploading.
9.    When asked to upload photo, a passport photograph with a white background is preferable.
10. Recheck application information to avoid errors
11. Click “Apply Now” to submit information
12. You will receive an email and a sms that confirms your application was successful.
13. Return to www.scholastica.ng, enter your Email and Password to download your profile and proceed to have your Head of Department sign the document.
14. Upload a scanned copy of the signed profile, this would be used for verification.
15.  If National Identification Number (NIN) number was not available in step 6, to obtain your National Identification Number (NIN)

Visit http://ninenrol.gov.ng to register and learn more about the National Identity Number
Click “Create Account” and fill in the required fields
Login with Email and Password to complete the form
After completion, schedule a date for photo and finger print capture
Visit any of the capture centres https://www.nimc.gov.ng/?q=nin-registration-centres to complete the registration process and obtain your National Identity Number
You can also do your total registration at the NIMC office

16. Return to https://candidate.scholastica.ng/schemes/addaxscholarship and update application with National Identification Number (NIN) to ensure completion

Note:
Multiple applications attract a disqualification penalty from the Scholarship Board
Obtaining NIN is not compulsory in order to complete your application

CLick to Apply

For more scholarship updates and information

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STATEMENT OF PURPOSE

Statement of Purpose

Vitamin D, a remedy for colon cancer

By

Dr Macjohnson onyeberechi

-

August 19, 2021

0

Vitamin D May Prevent Colon Cancer

Foods rich in vitamin D may help protect younger adults against carcinoma, researchers report.

While carcinoma is decreasing overall, cases among younger adults are on the increase. The trend increases with a decline in vitamin D intake from foods like fish, mushrooms, eggs, and milk.

There is growing evidence of a link between vitamin D and risk of carcinoma death, but little research on whether vitamin D intake is related to the danger of young-onset (before age 50) carcinoma.

“Because vitamin D deficiency has been steadily increasing over the past few years, we wondered whether this might be contributing to the rising rates” of carcinoma in younger people,

The study found that vitamin D intake of 300 IU per day or more — roughly like three 8-ounce glasses of milk — was related to roughly a 50% lower risk of developing young-onset carcinoma (said study co-senior author Dr. Kimmie Ng, director of the Young-Onset Colorectal Cancer Center at Dana-Farber Cancer Institute in Boston).

Higher vitamin D intake was also related to a lower risk of probably precancerous colon polyps detected before age 50.

The findings are supported by data from quite 94,000 women who were a part of a long-term study that began in 1989. They were 25 to 42 years old when the study began.

The study — recently published online within the journal Gastroenterology — is the first to form the connection between vitamin D levels and risk of young-onset carcinoma, researchers said.

They didn’t find a big link between vitamin D intake and carcinoma risk after age 50, and that they said more study is required to work out if vitamin D provides greater protection against young-onset carcinoma than against it afterward.

“Our results further support that vitamin D could also be important in younger adults for health and possibly colorectal cancer prevention,” Ng said.

She said it’s critical to know the danger factors related to young-onset carcinoma so informed decisions about lifestyle and diet are often made and high-risk individuals can receive earlier screening.

The findings could lead to recommendations for higher vitamin D intake as a cheap addition to screening tests to stop carcinoma in adults under 50, researchers said.

Recent case-controlled studies have established that there is an inverse correlation between serum levels of vitamin D and the incidence of polyps and adenomas in the colon, consistent with the inverse correlation between dietary vitamin D3 intake or sunlight exposure and human colorectal cancer. This is significant because a large segment of the human population suffers from vitamin D3 insufficiency or deficiency, which is particularly prevalent among colon cancer patients. Indeed, numerous studies have suggested that higher vitamin D3 levels are associated with lower colon cancer incidence, reduced polyp recurrence, and better overall survival of colon cancer patients

Vitamin D and its analogs reduce the growth of colon cancer xenografts and inhibit tumorigenesis in several genetic models of intestinal cancer. In agreement, dietary initiation of colon cancer in rodents, a model of sporadic colon cancer, is prevented by supplementation with vitamin D3 and Ca

The Chemistry of Vitamin D

The biologically active form of vitamin D3,1α,25(OH)2D3 (1,25D3), is obtained by 25-hydroxylation of vitamin D3 in the liver and 1α-hydroxylation in the kidney, liver, or other tissues. Hydroxylation of 25(OH)D3 by CYP27B1 yields the hormonally active form 1,25(OH)2D3, which is metabolized to less active metabolites by CYP24A1 . While the levels of CYP21B1 are reduced in some cancers, the levels of CYP24A1 are increased in cancer cells, which may contribute to the resistance of some tumors to 1,25D.

NSAIDs Match Steroids for Cataract Surgery Inflammation

By

Dr Macjohnson onyeberechi

-

August 19, 2021

0

prevent post cataract surgery inflammation

Prevent Cataract Post-operative inflammation

Nonsteroidal anti-inflammatory drugs (NSAIDs) given as eye drops appear to work as well alone as they do in combination with steroids to prevent swelling of the macula after cataract surgery, researchers say.

The anti-inflammatory eye drops work just as well whether administered before or after surgery and are more effective than a sub-Tenon implant that elutes steroids, said Jesper Erichsen, MD, Ph.D., a researcher at Rigshospitalet Glostrup in Denmark.

“Maybe it would be preferable to have NSAID eye drops as the standard approach, and then you could add steroid eye drops if they are needed,”

Pseudophakic cystoid macular edema, a common complication of cataract surgery, can affect visual acuity. Researchers believe that it results from inflammation that disrupts the blood–ocular barrier and leads to the leakage of fluid into the retina.

To prevent it, surgeons prescribe anti-inflammatories, but there is no consensus on which ones to use, said Erichsen. “It would be a nice thing if there was a standard of care. But it seems to me that this differs quite a lot. “

Steroid eye drops have a long track record for this purpose and are considered more potent than NSAIDs, but they have been associated with increased intraocular pressure (IOP).

Because some patients have trouble administering eye drops, various slow-release depots and injections have been developed.

And some research has suggested that starting the prophylaxis before surgery is more effective.

To put various approaches to test, Erichsen and colleagues recruited 470 patients at Rigshospitalet Glostrup who were undergoing cataract surgery. They randomly assigned 94 patients to each of the five groups.

In the preoperative combination group — which served as the control group — the steroid and NSAID combination eye drops were started 3 days before surgery. In the postop combination group, the steroid and NSAID combination eye drops were started the day of surgery.

In the preop NSAID group, NSAID monotherapy was initiated 3 days before surgery. In the postop NSAID group, NSAID monotherapy was initiated on the day of surgery.

In the subtenon group, a subtenon depot of dexamethasone phosphate 0.5 mL was administered after surgery.

All eye drops were administered 3 times per day until 3 weeks after surgery. As the NSAID, the researchers used a ketorolac 0.5% solution. As the steroid, they used a prednisolone 1% solution.

At follow-up — 3 days after the surgery, 3 weeks after surgery, and 3 months after surgery — the researchers found no difference in mean central subfield thickness (CST) or corrected distance visual acuity (CDVA) between the preop NSAID group and the groups that received preop or postop combination eye drops.

IOP decreased in all groups. After 3 days and 3 weeks, IOP was higher in both combination groups than in both NSAID monotherapy groups, but that difference had faded by 3 months.

More than half the subtenon group needed additional topical anti-inflammatory drops, suggesting that this approach is not sufficient, Erichsen said.

“This is an important study to further help optimize the postoperative regimen for cataract surgery,” said Francis Mah, MD, co-director of refractive surgery at Scripps Clinic in La Jolla, California.

“It adds more support toward not needing steroids, especially in this modern-day and age where we’re doing modern-day sophisticated cataract surgery, generating a lot less inflammation, ” he told Medscape Medical News.

Mah said he would have liked to see data on the outcomes as early as the first day after surgery.

Subtenon depots are not the best approach to dropless anti-inflammatory prophylaxis because they can cause red spots and discomfort, he explained. An intracanalicular dexamethasone insert and an intraocular dexamethasone injection are both less invasive, but there are challenges to reimbursement for these treatments in the United States, he noted.

see more:

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Apply:2023 NITCDA/Coursera Scholarship For Young Nigerians.

By

Emmanuel Nnachi

-

June 3, 2023

0

In a bid to enhance job opportunities in Nigeria,the federal government has decided to partner with Coursera through NITCDA to provide learning and IT scholarship opportunities.

This scholarships are to help citizens of Nigeria gain professional digital certifications from renowned digital academies, multinational companies and high ranked universities across the globe.

Scholarship Summary.

Host: NITCDA/Coursera

Category: Training

Eligible Country: Nigeria

Reward: Full

Scholarship/Certification

Deadline: June 14th,2023.

Scholarship Details.

To apply,you have to be a Nigerian citizen and you’re to chose one from each category (Category A and Category B)

Category A(IT Career Pathway): This category has 19 certification courses for applicants to pick from and kickstart a successful career in Information Technology. A professional certificate of completion is given when all the courses has been completed by the individual.

Category B( Complementary Skills Pathway): This category is to enhance the skills picked in category A and therefore improve on either social media marketing, digital marketing,entrepreneurship or freelancing skills.

Scholarship Duration And Award:

Every scholar will have:

A full Coursera license for 6(six) months

Different professional certification courses to access.

Method Of Application:

Qualified and interested candidates should use the link below to apply-

Click Here To Apply

THE 10 EFFECTIVE WAYS ON HOW TO MANAGE YOUR STRESS

By

Faustina Onuoha

-

June 3, 2023

0

Stress is inevitable, people experience it every day of their lives as they toil day and night in search of greener pastures without having adequate rest.

You can experience it anywhere, either at your workplace, house, school, market or any other place.

However, stress is also beneficial as 15% of people when stressed get motivated to achieve their goals, get that promotion at work, work diligently, or face any challenges of life but when the stress becomes prolonged, out of control, or overwhelming leads to a decrease in both physical and mental health.

It endangers one to health problems that can be life-threatening, therefore, it is paramount to know how to manage stress as this helps in curtailing the harm it imposes on people to its barest minimum.

This article has vividly elaborates the effective ways of managing stress. Read meticulously.

WHAT IS STRESS?

Stress is defined as a physiological and psychological reaction to a challenge, threat, or demand. This involves the body’s natural response to pressure, change, or any condition that requires adjustment or adaptation.

When someone is stressed, the body activates the “fight-or-flight” response, and this releases stress hormones which are; adrenaline and cortisol, and these trigger the body for emergency action.

This action gives rise to health conditions like, an increase in blood pressure and heart rate, tightening of the muscles, breathing rapidly, and sometimes causes seizures especially when exposed to environmental toxins.

CAUSES OF STRESS

Stress has its etiological factors which include:

Environmental Factors:

Some environmental stressors like noise, pollution, overpopulation, or living in an unconducive area affect one’s mental health which exacerbates the high risk of stress.

Family Problems:

Studies have shown that one of the biggest causes of stress is family responsibilities. Someone who is the breadwinner of the family tends to struggle harder to make sure there is always food on the table.

Again, when one has aging parents, children that go to school, etc, the person is prone to be psychologically stressed because he or she will always think about what to do to make them comfortable.

Combining family issues with other day-to-day activities is not easy.

Relationship Issues:

Here, a healthy relationship intensifies one’s life but whenever there is a misunderstanding, everything begins to change, for example, there will be poor communication, trust issues, disagreements, etc which can affect or even end the relationship.

This affects an individual’s emotions, cognitive, or mental health. According to the Danish Study in 2020, divorced adults would always find it difficult to get along, especially those that left no stone unturned before they divorced, and this results in poor mental health.

Financial Stress:

When one has a lot of things to do with money like paying bills or satisfying other relevant needs, and the money seems scarce to get, it makes one become stressed both physically, mentally, and most times emotionally.

Some people embark on strenuous and meager jobs just to make sure that they eat every day. Money-related issues such as debts, bankruptcy, unemployment, not being financially buoyant, and unaware expenses are susceptible to causing stress.

Financial stress can be disheartening and contributes to psychological problems. About 60% of people in developing countries encounter this type of stress every day in their lives.

Work-related Stress:

Arduous workloads, nagging boss (or bosses), job insecurity, and disagreement with colleagues or those in power can constitute stress in a workplace.

Academic Pressure:

Most students find it difficult to manage the stress experienced in school. For example, academic demands, exams, striving to perform well, and the fear of failure enhances stress.

Health Issues:

Most diseases like cardiovascular diseases, cancers, etc, are life-threatening and can also make one uneasy, this can be in the form of pain, anxiety, tremor, eating disorder, etc, which affects the mental health of the person.

Other causes are:

• Time pressure

• Uncertainty and unpredictability

• Life changes

• Personal expectations

SYMPTOMS OF STRESS

When one is stressed consistently, it affects the person’s health negatively, the symptoms might appear mild at the initial stage and become deadly once it is chronic.

Some of the symptoms of stress include:

• Physical Symptoms

– Fatigue

– Headache

– Sweating

– Fast breathing

– Muscle tension

– Detest sex

– Diarrhea or stomach ache

– Irregular menstrual cycle

– Persistent colds or flu

– Increased heart rate and heartburn

• Emotional Symptoms

– Anxiety

– Mood swings

– Depression

– Isolation and loneliness

– Feeling overwhelmed

– Thought disorder

• Cognitive Symptoms

– Decrease in learning performance

– Finding it difficult to focus

– Constant worrying

– Memory problems

– Poor judgment

– Being Pessimistic

• Behavioral Symptoms

– Eating habit disorder

– Insomnia

– Staying alone by isolating from families, friends, hobbies, etc

– Alcohol abuse

– Neglecting performance

EFFECTIVE WAYS ON HOW TO MANAGE STRESS

There are vital ways of managing stress, and practicing them every day increases your lifespan. It also makes you view the future with an optimistic mindset.

The Effective ways to manage stress include:

Know the source:

One cannot find a solution to his or her problems without knowing the source. It is mandatory to find out the root of what is causing your stress regularly first before checking the ways to manage it, this helps to eliminate stress.

Participate in Physical Activities:

Studies have proven that stress can be lessened by engaging frequently in physical activities like; walking, running, skipping, dancing, swimming, bicycle riding, jogging, etc.

It is important to exercise your body at least two or three times a week for 30 minutes. When you exercise often, your body releases a natural stress-fighting chemical called endorphins.

This is why it is crucial to reduce sedentary lifestyles, and engage in physical activities because it not only helps one to manage stress but also helps in keeping the immune system at top-notch which prevents one from falling sick easily.

Maintain a Healthy Lifestyle :

Healthy lifestyles expand one’s lifespan. The way you live your life either affects you positively or negatively.

A healthy lifestyle involves; taking good care of yourself, eating healthy and balanced diets, engaging in activities that make you happy, practicing good personal hygiene and sanitation, reducing work that takes much of your time, etc. This enables the reduction of stress.

However, some people who are addicted to smoking hard drugs, or cigarettes, taking excess sugary foods or drinks, or any unhealthy habits are liable to develop health problems, which can be life-threatening most times.

Life does not have a duplicate, it is often advised for one to hang out with friends, chat, play games, etc to decrease the high level of stress. Always prioritize your health before engaging in any other activities.

4.Adopt Relaxation Techniques:

This means relaxing your body and brain to get adequate rest. Here, it does not require you to sleep but when you relax, it makes the brain work effectively and efficiently. One can do this by practicing the following:

•Trying to inhale deeply.

• Sit down, rest, and meditate

• Embark on Yoga training or make a progressive muscle relaxation

These help the mind to remain calm, thereby reducing stress levels.

5. Manage your Time Properly:

In life, time is essential, and when managed appropriately, go a long way in reducing stress. Spending much time on irrelevant things limits one from progressing or achieving one’s goals.

It is pertinent to balance your work life, business, etc with other human activities. Also, getting too engrossed in strenuous work damages your health, so it is crucial to know how to work with time efficiently, and reduce workloads that are not needed.

Make a to-do list that enables you to carry out your day-to-day activities, and also create time for leisure to avoid breakdown.

6. Seek Social Support:

Seek support from families, friends, and relatives in case you are having any challenges or difficulties, might be physical, emotional, financial problems, etc. When you discuss these problems with loved or trusted ones, it alleviates the stress being encountered.

There is a saying that “problems shared are half solved”. When you express your thoughts, feelings, ideas, challenges, problems, etc to those that you trust, they help in getting solutions easily. It keeps your mental health active, vibrant, smart, and effective.

7. Know your Limitations:

Don’t put your health in danger just to please someone, that is, trying to finish all tasks even when you are completely exhausted.

This can make one age faster or cause some health problems like cardiovascular diseases, hypertension, severe headache, etc.

It is important to learn how to say no to some jobs that you cannot do than getting yourself involved in too many tasks.

8. Seek Professional Assistance:

If your stress becomes overwhelming or seems it is now affecting your daily activities, seek professional help like visiting a clergyman, psychologist, therapist, etc. They help in examining you to find out the ways your health problem can be ultimately solved.

9. Be Optimistic:

Another way to manage stress is to always think positively in any situation you find yourself in. A negative mindset brings anxiety, depression, fear, streand ss, and can also give rise to suicidal ideation.

A clear and positive mindset reduces stress and also enriches one’s mental health making one to be productive in society.

10. Adequate Sleep:

Aim at sleeping 6-8 hours every day. This enables the brain to work effectively and efficiently. Someone who usually sleeps up to 6 hours a day rarely falls sick.

Create time for sleep, this keeps all the stressors at the minimum level. Get enough sleep every day for optimum mental health.

Conclusion:

Stress occurs every time but knowing how to manage it is very important in our lives. Know how to manage stress because it helps to maintain a good and healthy lifestyle which deviates us from health problems being caused by stress.

More about ways on how to manage stress

Visit infohealthedu.com for more updates on Health and Scholarship updates.

Study-In-US: 2023 John Carroll University Merit Scholarships for International Students

By

Dr Macjohnson onyeberechi

-

May 31, 2023

0

John Carroll University Merit Scholarships are awarded to students upon their entry into JCU with these awards being renewed each year provided they are in good standing with the Standards of Academic Progress. Applications are currently invited from eligible and interested students for John Carroll University Merit Scholarships for International Students who wish to enrol in a degree program at the University for 2023 – 2024 academic session. Study-In-US: 2023 John Carroll University Merit Scholarships for International Students, Read more…

More scholarship opportunities are ongoing in countries across Europe, the United States and Canada. Check out some selected opportunities below:

Scholarship Summary

Host Country: United States of America (USA)
Study Abroad: Study in USA
Category: Undergraduate Scholarships
Eligible Countries: All Countries
Reward: $27,000
Deadline: October 1, 2023

Scholarship Details

The Merit programs are highly competitive, and some unique programs go beyond academic scholarships and reward commitment to leadership and service as well

Our merit scholarship programs have been designed to honour students with similar backgrounds and celebrate what they have done throughout high school in hopes that they can share those talents with us.

Join us on Whatsapp

Scholarship Requirements

To be eligible for the John Carroll University Merit Scholarships, applicants are expected to meet the following conditions:

Applicants must be international students
Applicants must enrol in full-time program
Applicants must be ready for undergraduate courses at the University
Applicants must be in good standing with the Standards of Academic Progress
Applicants scholarship values are annual amounts that automatically renew for a total of four years, as long as academic and conduct standards are maintained
Applicants must have proof of English Language proficiency

Scholarship Duration and Reward

This Merit scholarship is worth up to $27,000 for all successful applicants.

Never miss a Scholarship Opportunity. Set a Reminder now to receive Alerts of Open Scholarships

Method of Application

Deadline: 1st October, 2023

Visit here for more scholarship opoortunities

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Ocular Manifestations Of Coronavirus: The Eye and Covid 19

By

Dr Macjohnson onyeberechi

-

May 29, 2023

0

Ocular Manifestations Of Coronavirus (COVID-19): The Eye and Covid 19

The conditions of coronavirus infections have greatly affected all parts of the body which includes the eyes. Ocular signs and symptoms of presentation have been investigated to understand the mode of transmission of the virus across all eye tissues. The condition of Covid19 effect on the eyes spans across the uveitic, retinovascular and neuro-ophthalmic diseases. This makes a case for interprofessional team management of the patient. To this end, this article looks at the ocular manifestations of coronavirus (COVID-19): The Eye and Covid 19. It also explores the effect of covid 19 on the eyes.

Ocular Manifestation of SARS-CoV-2

Covid 19 became a global pandemic caused by a highly transmissible severe acute respiratory syndrome coronavirus 2 (SAR- CoV-2). This disease has been seen to affect the conjunctiva, the uvea tissues, and the retina and even extends towards neurological involvement. This may make the condition appear complicated. Redness, itches, and watery eyes are a few minor signs and symptoms which early infected patients may display.

The eyes face this risk due to a lack of eye protection with face shields as this virus is highly infectious. Ocular secretions are major transmitters of pathogens, thus care must be taken to ensure that the infected person and the non-infected persons are properly covered and guarded against making contact with these fluids. Although a significant effect has been noticed among animal species, the coronavirus has shown no marked effect on the eye for the human population. The noted effects in the human population include conjunctivitis, anterior uveitis, retinitis, vasculitis and optic neuritis.

Pathogenesis of Corona Virus Infection

The pathogenesis and tissue tropism of SARS-CoV-2 relates to the binding of the viral spike protein to its cognate receptor on human host cells— the angiotensin-converting enzyme 2 (ACE-2) receptor. Efficient cell entry requires cleavage by protein transmembrane serine protease 2 (TMPRSS2). ACE-2 is expressed primarily on respiratory mucosal and alveolar epithelial cells and has been identified in other tissues, including the gastrointestinal tract, kidney, vascular endothelial cells, immune cells, and even neurons. Virulence is achieved via direct cellular invasion and death and the induction of widespread cytokine-driven inflammation and vascular leakage. Immune cell and complement debris can also lead to an increased thromboembolic state. This tries to explain the association between eye infection and covid 19.

The potential of infection through ocular secretions is currently unknown, and it remains unclear how SARS-CoV-2 accumulates in ocular secretions. Possible theories include direct inoculation of the ocular tissues from respiratory droplets or aerosolized viral particles, migration from the nasopharynx via the nasolacrimal duct, or even hematogenous spread through the lacrimal gland.

Symptoms of Covid 19 and the eye

Eye redness
Eye irritation and discharge
- Maybe watery or thick
- May be yellow, white, or green, and usually continues to drain throughout the day
- The affected eye often is crusty and stuck shut in the morning
- Irritation and discharge worsen for three to five days before improving, and symptoms can persist for two to three weeks
Burning, sandy, or gritty feeling in one eye
Cold symptoms
- Swollen glands (glands)
- Fever
- Sore throat
- Runny nose

Other symptoms of COVID-19 include:

Shortness of breath
Cough
Fever or chills
Muscle pain/body aches
Changes in or loss of sense of taste and/or smell
Headache
Fatigue
Sore throat
Diarrhoea
Nausea
Vomiting
Loss of appetite
Congestion
Runny nose
Abdominal Pains
Feeling unwell (malaise)

Eye pain and Covid 19

Eye pain in cases of covid 19 usually stems from the occurrence of conjunctivitis, episcleritis, scleritis or optic neuritis. This also presents with a headache and gets worse with increasing neurovirulence.

Symptoms of Ocular Manifestations Of Coronavirus (COVID-19): The Eye and Covid 19

Conjunctivitis: Pink eye and Covid 19

Pink eye and covid 19 have been associated with most patients suffering from coronavirus infection. Most covid 19 infected patients would present with acute conjunctivitis symptoms which include: eye redness, irritations, eye soreness, foreign body sensations, tearing, mucoid discharges, lid swelling, congestions and chemosis. Conjunctivitis oftentimes would not appear self-limiting in Covid-19 patients who present with it. Sometimes follicles and concretions are found around the palpebral conjunctiva. More so, there could be cases of hemorrhagic bilateral conjunctivitis with pseudomembrane formation Some corneal findings may present after 3 days of serious infection showing off transient pseudo-dendritic lesions and diffuse subepithelial infiltrates with overlying epithelial defects. It is important to note that in children or infants infected with the Covid 19 virus, there has been a strong association with a Kawasaki-like illness known as multisystem inflammatory syndrome in children (MIS-C). These kids have also shown cases of papilledema, iritis and keratitis.

How long does covid conjunctivitis last

Viral conjunctivitis (pink eye) usually lasts about one to two weeks, however, if it occurs in conjunction with COVID-19, other symptoms may persist longer, depending on the severity of the infection.

Scleritis/Episcleritis

The past occurrence has shown cases of associated episcleritis, especially at the onset of the Covid 19 infection. Often times these are nodular episcleritis and necrotizing anterior scleritis.

Anterior Uveitis : an Ocular Manifestations Of Coronavirus (COVID-19): The Eye and Covid 19

Cases of anterior uveitis have always occurred among covid 19 patients. There have also been cases of reactivated idiopathic anterior uveitis in post-covid 19 patients. Above all, individual cases of ocular infections should be handled independently but with the collective efforts of interdependent professionals.

Retinitis and Choroiditis in Covid 19

Posterior segment diseases have also been suspected to be associated with COVID-19 infection. These have varied between vascular, inflammatory, and neuronal etiologies. Both ACE-2 and TMPRSS2 are highly expressed in the human retina, and a recent case series of 3 patients discovered S and N COVID-19 proteins by immunofluorescence microscopy within retinal vascular endothelial cells, presumably containing viral particles. Eye floaters and covid 19 could be associated in some cases.

Both central retinal vein and artery occlusions have been reported in patients without classic systemic vascular risk factors. The hypothesized mechanism includes a complement-induced prothrombic and inflammatory state induced by the virus resulting in endothelial damage and microangiopathic injury. A striking example was reported by Walinjkar et al. with a central retinal vein occlusion (CRVO) in a 17-year-old female with COVID-19. Several cases of central retinal artery occlusions (CRAO) have been reported, potentially related to viral-induced endothelial insult and vasculitis.

Acute macular neuro retinopathy (AMN) and paracentral acute middle maculopathy (PAMM), conditions in which there is ischemia to the deep retinal capillary plexus, have also been observed with COVID, marked by hyperreflective changes at the level of the outer plexiform and inner nuclear layers.

There have been reported cases of Purtscher-like retinopathy observed in patients with COVID-19. They presented with multiple bilateral cotton wool spots localized to the posterior pole after a month-long. Also, there is pneumonia associated with multiorgan failure and severe coagulopathy. Some patients present with bilateral areas of ill-defined retinal whitening and arteriolar narrowing following a severe COVID-19 infection associated with disseminated intravascular coagulation.

Optical coherence tomography (OCT) showed subclinical hyperreflective lesions at the level of the inner plexiform and ganglion cell layers in patients examined after systemic disease onset; cotton wool spots and microhemorrhages were found on dilated fundus examinations in these patients. It was also found that retinal vein diameter correlated directly with disease severity, suggesting that this may be a non-invasive parameter to monitor inflammatory response and/or endothelial injury in COVID-19. There are also several cases of choroiditis associated with Covid 19 infection.

Optic Neuritis and Covid 19

Optic nerve demyelination alongside other neuro-ophthalmologic manifestations has been seen in most cases of Covid 19 infections. While the mechanism has not been known, there has been suspected neuronal invasion, endothelial cell dysfunction leading to ischaemia and coagulopathy and/or widespread inflammatory cytokine storm induced by the virus. Optic neuritis has developed in several cases of the infected patients showing traces of neuromyelitis optica disorder and also the occurrence of anti-myelin oligodendrocyte glycoproteins (anti-MOG) antibodies. These patients present with subacute vision loss, a relative afferent pupillary defect, pain with eye movement, optic disc edema and radiographic findings of optic neuritis. Issues of optic neuritis also occur upon vaccination.

Extraocular Motility, Cranial Nerves

Cranial nerve III, IV, and VI palsies associated with COVID-19 have been reported within a few days of fever and cough onset, most without remarkable radiological features. Ocular cranial neuropathies and binocular diplopia with nerve enhancement on MRI have also been observed in association with post-infectious demyelinating conditions such as Miller Fisher and Guillain Barré syndrome. Patients were also found to have lower extremity hyporeflexia and ataxia consistent with Miller-Fisher syndrome.

Ocular myasthenia gravis has been described as a post-infectious sequela of COVID-19, with authors proposing that antibodies directed against SARS-CoV-2 proteins may cross-react with acetylcholine receptors and similar components at the neuromuscular junction. Huber and colleagues described a 21-year-old patient who presented 4 weeks after COVID-19 infection with fluctuating vertical binocular diplopia and ptosis, treated successfully with intravenous immunoglobulins and oral pyridostigmine.

Pupils

Pupillary changes have also been observed. Several groups have described patients with mydriasis and cholinergic super-sensitivity, indicative of tonic pupils and post-ganglionic parasympathetic pupillary nerve fibre damage.

Nystagmus

Oscillopsia has been reported in several cases of COVID-19 with neurologic involvement. Some patients have presented with intractable vertigo, nausea, and vomiting with a presumed diagnosis of viral-induced vestibular neuritis secondary to COVID-19. Central vestibular nystagmus has also been described in association with clinical and imaging findings consistent with rhombencephalitis.

Visual Cortex

Perhaps the most devastating neuro-ophthalmic complication of severe COVID-19 infection is acute stroke affecting the posterior visual pathways. The incidence of stroke in these patients has been found to be 7.6 times higher than that of patients with influenza and has been occurring in a far younger-than-average patient population without classic vascular risk factors. These patients may present with homonymous visual field deficits prompting ophthalmologic consultation. There have also been cases of bilateral posterior cerebral artery ischemic strokes presenting as a homonymous visual field defect in infected children with multisystem inflammatory syndrome related to COVID-19.

Orbit and Ocular Adnexa in Covid 19

While oculoplastic and orbital manifestations of COVID-19 are uncommon, there is growing evidence to link inflammatory and infectious orbital disease to the virus. There have been reported cases of sinusitis, orbital cellulitis, and intracranial abnormalities in adolescents with COVID-19. It was postulated in this study at SARS-CoV-2 infection resulted in congestion of the upper respiratory tract and increased risk for secondary bacterial infection. This theory was expanded on by Shires et al., who reported a case of bacterial orbital abscess in a patient with COVID-19, with a unique intraoperative finding of highly avascular nasal mucosa and cultures positive for Streptococcus constellatus and Peptonipihilus indolicus, bacteria normally absent in the orbit or upper respiratory mucosa. It is possible that the local microbiologic and immunologic environment was altered due to avascularity induced by thrombosis in the setting of SARS-CoV-2 infection.

There have been a growing number of reports of acute invasive fungal rhino-orbital mucormycosis co-infection with COVID-19. These opportunistic pathogens thrive in the hypoxic respiratory environment induced by SARS-CoV-2, as well as an immunocompromised state induced by high-dose steroids and immunosuppressive therapies. In patients with poorly controlled diabetes, particularly those with diabetic ketoacidosis (DKA), the risk is further increased. Singh et al. published a systematic review of 101 reported cases of COVID-19 patients with mucormycosis; these patients were predominantly male (79%), 80% of which had diabetes and 15% with concomitant DKA. Corticosteroids had been used in 76% of these patients and nearly 60% of the cases reported rhino-orbital involvement. Another case described a 33-year-old female who presented with orbital compartment syndrome due to concurrent COVID-19 and fulminant mucormycotic infection.

There have also been reports of MRI-proven orbital myositis in two separate COVID-19 patients in the absence of concomitant bacterial infection. It was also postulated as either direct viral orbital invasion or induced autoimmunity as possible mechanisms.

Similar processes have been proposed by Diaz et al., who reported a case of acute dacryoadenitis in a 22-year-old male with positive SARS-CoV-2 antibodies who developed partial ophthalmoplegia. Other cases in this series include idiopathic inflammation in an anophthalmic socket.

Lacrimal System

Epiphora has been described as an initial finding in patients with COVID-19. This is thought to be secondary epiphora from inflammation of the conjunctiva. Direct involvement of the nasolacrimal system or the lacrimal sac has not been reported to date.

Evaluation of Ocular Manifestations Of Coronavirus (COVID-19): The Eye and Covid 19

Case History

A thorough history is necessary regarding the onset, duration, and characteristics of symptoms. Anterior segment examination at the slit lamp or bedside can confirm findings of conjunctivitis or episcleritis.

Ocular examination

Measurement of visual acuity, intraocular pressure, and dilated fundus examination are warranted to rule out potentially more harmful ocular diseases. The clinician should perform a careful examination of pupils and colour testing to evaluate patients for evidence of optic neuropathy. Evaluation of extraocular motility may show evidence of nystagmus or cranial neuropathies. Visual field testing can detect and confirm deficits related to stroke.

Laboratory/Neurological Testing

SARS-CoV-2 can be detected in RT-PCR by sweeping the lower eyelid fornices to collect tears and conjunctival secretions with a virus sampling swab. Additional serum or cerebrospinal fluid testing may be useful to evaluate for inflammatory, autoimmune, or demyelinating entities. Neuroimaging can be valuable in patients presenting with optic neuritis, visual field deficits, and cranial neuropathies.

Differential Diagnosis

Ocular manifestations of COVID-19 have most commonly presented with conjunctivitis otherwise indistinguishable from other viral etiologies. Differential diagnosis includes a broad range of common ocular manifestations of eye redness and increased tearing:

Other viral conjunctivitis (e.g., adenovirus)
Bacterial conjunctivitis
Allergic conjunctivitis
Herpes simplex virus keratitis
Anterior uveitis
Corneal abrasion
Foreign body
Dry eye syndrome
Exposure keratopathy in an intubated patient
Chemosis in a critically ill patient associated with neurologic symptoms.

All patients should be questioned about recent fever, respiratory symptoms, exposure, and travel history to assess the need for further evaluation of COVID-19.

Prognosis of Ocular Manifestations Of Coronavirus (COVID-19): The Eye and Covid 19

Below are some frequently asked questions on Ocular Manifestations Of Coronavirus (COVID-19): The Eye and Covid 19.

FAQ

What can be done in eye and ear health emergencies during COVID-19?

• As part of a response to CoVID-19, there is scale back of routine health service provision in most health facilities.

• In case of critical eye or ear health emergency conditions such as sudden onset red eye or worsening ear condition, injury to eye or ears, sudden decrease in vision or hearing, severe pain in the eyes or ears and foreign body entry in eyes or ears; call the health care provider for consultation or for assessment.

Are people with preexisting eye or ear problems more likely to have COVID-19?

People with eye and ear problems are not more likely to have COVID-19 than the general population. Some NCDs such as diabetes, can have eye conditions as a manifestation of poor control. Those with pre-existing comorbidities such as diabetes, cancer, heart problems, chronic respiratory disease etc. are likely to have worse outcomes if they contract the virus.

• Many eye and ear health conditions are age-related and occur in older age groups. This age group have an increased likelihood of severe disease if they get COVID-19.

How can one prevent getting COVID-19 in an eye or ear health emergency?

Contact the health care provider via the phone for the condition to be assessed and be certain of the need to go to the health facility.

• Ensure adherence to social distancing of 1 meter.

• Consider using non-medical masks based on your risk assessment.

• Wash your hands frequently with soap and water or use an alcohol-based hand sanitizer if available. Always avoid touching your face.

How effective is remote consultation for eye and ear problems to avoid visiting health facilities?

It is effective to rule out an emergency eye or ear conditions through remote consultations.

• It is effective to get advice regarding the continuation of treatment for eye and ear conditions and follow-up.

• It is effective to get updated knowledge on COVID-19 and eye and ear problems.

What can be done in eye and ear health emergencies during COVID-19?

• As part of the response to CoVID-19, there is scale back of routine health service provision in most health facilities.

• In case of critical eye or ear health emergency conditions such as sudden onset red eye or worsening ear condition, injury to eye or ears, sudden decrease in vision or hearing, severe pain in the eyes or ears and foreign body entry in eyes or ears; call the health care provider for consultation or for assessment.

Are people with preexisting eye or ear problems more likely to have COVID-19?

• People with eye and ear problems are not more likely to have COVID-19 than the general population. Some NCDs such as diabetes, can have eye conditions as a manifestation of poor control. Those with pre-existing comorbidities such as diabetes, cancer, heart problems, chronic respiratory disease etc. are likely to have worse outcomes if they contract the virus.

• Many eye and ear health conditions are age-related and occur in older age groups. This age group have an increased likelihood of severe disease if they get COVID-19

How can one prevent getting COVID-19 in an eye or ear health emergency?

• Contact the health care provider via the phone for the condition to be assessed and be certain of the need to go to the health facility.

• Ensure adherence to social distancing of 1 meter.

• Consider using non-medical masks based on your risk assessment.

• Wash your hands frequently with soap and water or use an alcohol-based hand sanitizer if available. Always avoid touching your face.

How effective is remote consultation for eye and ear problems to avoid visiting health facilities?

• It is effective to rule out an emergency eye or ear conditions through remote consultations.

• It is effective to get advice regarding the continuation of treatment for eye and ear conditions and follow-up.

• It is effective to get updated knowledge on COVID-19 and eye and ear problems.

This article has tried to point out some salient points on: Ocular Manifestations Of Coronavirus (COVID-19): The Eye and Covid 19. This intends to help prevent cases of vision reduction from cases of corona virus infection on covid 19 cases.

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Presbyopia And All You Need To Know About It.

By

Emmanuel Nnachi

-

May 27, 2023

0

Do you often wonder why our older siblings or neighbors including our parents often tend to lose their sight or rather find it difficult to read words or objects closer to them?

This symptom often called Far-sightedness is an age-related inadequacy of accommodation called Presbyopia and is predominant among people past the age of 40 years.

It has over 1.5 million cases in Nigeria per year. This inadequacy can be treated but it cannot be cured. It is usually self-diagnosable(that is the patient can easily detect the problem without needing the help of a Medical practitioner or Optometrist). Lab tests and imaging are usually not required and it can last for a long time.

Causes Of Presbyopia:-

Presbyopia is an eye disorder usually caused by the constant declination of the accommodation amplitude. This is mainly due to decline in age and the sclerosis of the crystalline lens fibres and changes in its capsule which often causes the free decline of its surfaces when the ciliary muscles contracts.

It could also result from the weakening of the ciliary muscles as it becomes less efficient as the age advances.
It is also caused as a result of loss of elasticity to change the focal length of the lens causing decline in the flexibility of the eye lens.
Medications:- Some of the medications we consume can increase risks,drugs like allergy medications, antidepressants,antipsychotics,antispasmodic and diuretics.

At Childhood,the eye is capable of 14 D of accommodation,but as the age approaches 45,it has reduced to about 4D, after the age 60, it is left with only 1 D or less,often due to the strength of the field,coupled with Senile Miosis.

Symptoms Of Presbyopia You Might Notice Often:-

Inability to see properly at a normal reading distance.
Headaches arising from eye strain and close works or reading.
The urge to use more light while reading

People suffering from Presbyopia often have blurry images due to inability of the inflexible lens to adjust to light properly causing the point of focus to fall behind the eye retina making close objects appear blurry and unclear.

Differences between presbyopia and hyperopia:-

Presbyopia is often confused with hyperopia,the later is caused by slow advancement in age and contraction of ciliary muscles while hyperopia is as a result of an inappropriate position of the cornea which in return is not positioned in its proper curved position leading to improper refraction of light rays through the eyes.

Treatment Required For Presbyopia:-

Treatment for presbyopia often lies on the severity of the inadequacy,but the most common treatment is the use of supplementary convex lens which helps the patient achieve comfortable near vision. High-power lenses are, bifocals or multifocal contact lens are also effective.

Your numerous vision amendment choices include:

Eyeglasses:. Whether you’ve been wearing glasses for other vision issues or not, presently might be an ideal opportunity to change to a more agreeable sort for your evolving eyes.

Remedy users:. Assuming you have no other vision issues, bifocals might be all you really want. They ought to be worn exclusively for accomplishing very close work, such as read.

Reading Glasses:-

Frequently endorsed for presbyopia, reading glasses are eyeglasses that have two unique remedies in a single exhibition focal point. The upper piece of the focal point contains the distance solution, while the more modest, lower part of the focal point holds a remedy to assist you with seeing items very close.

Trifocals:.

These Spectacles have three focal points: one each for seeing close, in the middle between and distant.

Progressives:. Reformists are multifocal focal points, like reading glasses, however have a more continuous shift between the solutions. Many individuals pick moderates when they don’t need a noticeable line on their glasses.

Office Progressives:. Like their name proposes, these glasses are intended for accomplishing close to work in the workplace, for example, PC work or composing. At the point when you get up from your work area, you eliminate them so you can see into the distance.

Readers: Indeed, we as a whole call them miscreants. Welcome to the club. On the off chance that you didn’t require eyeglasses prior to turning 40 for distance or some other explanation, perusers might be all you really want to read a menu or string a needle. You can get them all things considered pharmacies. Nonprescription perusers range from powers of +1.00 diopter (D) to +3.00 D. Pick the most minimal amplification that makes little print look understood. You’ll presumably believe that more than one sets should keep convenient on your end table or some other spot you might peruse or accomplish very close work, such as sewing.

Contact focal points: There are an assortment of contact focal points that can assist you with seeing better with presbyopia.

Pick the contacts that assist you with seeing most serenely:

Bifocal Lens: A genuine bifocal focal point assists you with only two central places, normally all over. They come in delicate or hard materials (gas penetrable).

Multifocal contact focal points. Multifocal focal points are like bifocal focal points and the terms are frequently utilized conversely, yet a multifocal focal point can incorporate multiple central focuses, including the transitional zone of around 3 feet. They additionally come in delicate or gas porous variants.

Monovision contact focal points. With a bunch of monovision focal points, one eye wears a focal point that guides in seeing items a ways off, while different wears a focal point that guides in close to vision. It can require as long as about fourteen days for your mind to change in accordance with this strategy for seeing.

Altered monovision contact focal points. With altered monovision, you wear one focal point for either close or far vision. In the other eye, you wear a multifocal focal point that assists you with seeing at all distances.

Refractive medical procedure.

Talk about your eye wellbeing, family ancestry and way of life with your supplier before you choose if medical procedure is ideal for you, and which choice accommodates your way of life best. On the off chance that you use glasses just piece of the time, for example, just for perusing, eye a medical procedure might be more gamble than remuneration — despite the fact that refractive medical procedure is considered a negligibly obtrusive short term a medical procedure with okay in the possession of a prepared ophthalmologist.

The accompanying three laser methods right presbyopia by utilizing monovision (one eye amended for distance, the other rectified for close to vision):

LASIK medical procedure:

Laser in-situ keratomileusis, or LASIK, is a famous careful methodology used to address vision in individuals who are partially blind, farsighted or have astigmatism.

PRK medical procedure: You might be a decent possibility for a photorefractive keratectomy (PRK) strategy in the event that you have moderate to high partial blindness, farsightedness or potentially astigmatism. PRK is a marginally more limited, easier laser medical procedure that eliminates less corneal tissue than LASIK.

SMILE Surgery: With a little cut lenticule extraction (Grin) system, your specialist utilizes an exceptionally exact laser to make a circle molded piece of tissue inside the cornea that can be taken out through a little entry point.

Focal point substitution: Certain individuals are more qualified for strategies that eliminate the normal focal point in a strategy like waterfall medical procedure, called refractive focal point trade (RLE). Contingent on what sort of embed is utilized, all types of vision remedy can be accomplished, including partial blindness, farsightedness, astigmatism and presbyopia.

Corneal Inlays: This is a more up to date, however more uncommon choice for carefully rectifying presbyopia. Your ophthalmologist embeds a tiny plastic ring into your cornea to permit your eye to accomplish both distance and close to vision. It works by making a “pinhole camera impact” and successfully decreases obscure (like squinting your eyes to see better). The trim is regularly embedded in just a single eye.

Prevention Of Presbyopia:

While you can’t stop presbyopia anything else than engaging in healthy eye behaviours, there are ordinary advances you can take to support your eye wellbeing and dial back how quick it deteriorates as you age. Keeping your eyes in top shape may likewise bring down your gamble for creating other more serious eye issues not too far off, for example, age-related macular degeneration (AMD).

Attempt these tips for top eye wellbeing:

Sufficient lighting will significantly assist with diminishing eye fatigue.

Yearly eye tests. Your remedy and visual wellbeing can change quickly, so make a point to consistently see your supplier. Examine with your supplier any adjustment of side effects that could be an indication of something more serious.

Monitor side effects by thinking of them down.

Eat a solid, adjusted diet that contains a lot of green verdant vegetables (see beneath).

Practice a few times week by week.
Hydrate to remain hydrated.
Limit liquor.
Quit smoking.
Wear shades. Conceals accomplish more than make you look cool. They safeguard your sensitive eye tissue from harmful UV (bright) beams.

Which food varieties would it be a good idea for me to eat to keep my eyes as sound as could be expected?

Your eyes depend on supplements from the food varieties you eat to keep up with crucial eye tissues and works. As well as restricting liquor and caffeine, you ought to try to remain hydrated by drinking sufficient water.

You ought to likewise attempt to eat food varieties that are rich in:

Vitamin A: You really want enough of the cell reinforcement vitamin An in your eating regimen (or through an enhancement) to keep up with the outer layer of your eyes and solid vision. There are vitamin A-rich hotspots for each diet inclination. Plant-based decisions incorporate vegetables like yam, verdant green vegetables and carrots. Or on the other hand you might pick creature based food varieties, like cheddar, sleek fish or liver.

L-ascorbic acid: The best food sources for getting your day to day portion of L-ascorbic acid are products of the soil, including oranges, grapefruit, strawberries and broccoli.

Vitamin E:. Assuming you as of now have AMD, make a point to get sufficient vitamin E. Studies have shown that this nutrient makes light of a job in easing back the illness.

Lutein. Eat your verdant green vegetables to ensure you get sufficient lutein which assists your eyes with sifting destructive blue light that can harm your retinas.

On the off chance that you realize you’re not getting the right nutrients on the grounds that your eating routine has excluded an adequate number of good food sources, you can take a multivitamin all things being equal.

Recall however that nutrients that arrive in a pill are not too consumed by the body as those that happen normally in new food sources. Visit your optometrist or any healthcare provider for more.

PEPTIC ULCER DISEASE: PREVENTION, CAUSES, SYMPTOMS, AND TREATMENTS

By

Faustina Onuoha

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May 14, 2023

0

Peptic ulcer disease is one of the ills plaguing our society nowadays and its prevalence rate is nothing to write home about. It has become a cankerworm that has eaten deep into the fabric of our great nation, affecting both old and young people. This disease has increased the level of morbidity and mortality in the country as most people prefer self-medication to visiting their doctors at an early stage.

Table of Contents

What is Peptic Ulcer Disease(PUD)?

Peptic ulcer disease is a situation that involves the accumulation of acids in the stomach which causes open sores or holes in the stomach lining, esophagus, and the duodenum(upper part of the small intestine) resulting in inflammation or infection.

Significantly, in the stomach, a thick layer of mucus protects the stomach lining from any damage to its digestive fluid. However, when these protective layers are being tampered with by foreign objects, it alters the level of acid in the stomach which gushes into vital tissues in the body causing a lot of damage.

Again, when there is a bacterial infection in the body, it attacks many systems of the body especially the digestive and reproductive systems. These bacteria move to the digestive system to eat away those protective layers that prevent the acid from entering the stomach lining, this gives room to open sores or ulcers.

Types of Peptic Ulcer Disease

There are 3 main types of peptic ulcers found in the body:

• GASTRIC ULCER:

This type of ulcer is easily formed in the stomach. It developed as a result of too many gases in the stomach. When the level of stomach acidity increases, it destroys the protective layers thereby causing the proliferation of acids in the stomach which ultimately attacks the stomach lining causing holes. Gastric ulcers that didn’t heal during treatment might be an indication of cancer.

• ESOPHAGEAL ULCER:

This is rare but is seen in the esophagus. It occurs when there is a breakdown in the esophageal mucosa margin. Most people that take antibiotics regularly are liable to develop this type of ulcer. However, the symptoms come gradually (from mild to severe). This type of ulcer developed in the lower part of the esophagus lining, between the throat and the stomach.

• DUODENAL ULCER:

It develops in the first part of the small intestine, the duodenum. This is mostly seen in many people but when treated properly is eliminated from the body.

Who is at Risk of Getting Ulcer?

Recently, everybody is susceptible to getting ulcers as it affects both the elderly and juveniles. Some risk factors that can endanger one having an ulcer include:

• People with underlying health conditions like kidney, liver, or lung diseases

• Smoking

• Constant alcohol use

• Regular intake of pain-relieving drugs like NSAIDs(non-steroidal anti-inflammatory drugs). Examples: ibuprofen, aspirin, naproxen, etc.

• Genetics consideration(Family history of ulcer)

• Always skipping meals

• Stress(not often)

• A blood group O person

WHAT ARE THE CAUSES OF PEPTIC ULCER DISEASE?

People do assume that the etiology of Peptic ulcer disease results from stress or taking spicy foods, but there is no evidence for that. Studies have proven that there are two major causes of peptic ulcer disease which are:

• Pain relieving drugs:

One of the major causes of peptic ulcer disease is the regular intake of NSAIDs(non-steroidal anti-inflammatory drugs) which damages the mucus layer in the gastrointestinal tract thereby making it vulnerable for ulcers to form. Examples of NSAIDs include;

– ibuprofen( Advil, Motrin, etc)

– naproxen( Aleve, Anaprox, etc)

– aspirin( especially those with special coating)

Note that, not everybody that takes NSAIDs gets ulcers but when abused(that is, taken frequently or more than prescription), the body becomes sensitive to ulcers.

Though, there are factors that increase the risk of getting Peptic Ulcer disease from NSAIDs use. They include:

• Age:

An elderly person (70 years, and above) can develop ulcers because of low function of the digestive tract.

• Taking more than prescription

• Gender, 60% of women are liable to develop ulcers annually

• Once have a history of peptic ulcer disease in the family

• Long-term use of NSAIDs

• Mixing both drugs like cortisone, prednisone, etc( used in treating asthma, arthritis, etc) and NSAIDs simultaneously.

• Presence of Helicobacter pylori bacteria:

This is another cause of peptic ulcer disease. Studies have shown that about 49.5% of people globally have been infected with H.pylori bacteria. It infects the stomach thereby attacking the digestive tract or alimentary canal. It is contagious as people contract it through kissing, a handshake from a person who just defeated without thoroughly washing his or her hands, childhood, oral sex, food or drinking water that is contaminated, etc. When this bacteria is in the gastrointestinal tract, it causes an inflammation that damages the protective layers of the stomach.

The stomach has a strong acid called ‘hydrochloric acid’ secreted by the gastric gland which helps to kill some bacteria in the stomach and helps in enabling the mixing of food with digestive juices. But when it is being attacked by H.pylori bacteria, it damages the mucus layer that protects the stomach lining thereby allowing the passage of this acid into the stomach.

This acid then moves forward to eat away the vital tissues in the stomach which causes open sores or holes.

However, about 15% of people with H.pylori bacteria may not develop ulcers because of having a strong immune system.

Other minor causes of peptic ulcer diseases are:

• Regular consumption of corticosteroids tablets

• Chronic illnesses various infections or diseases

• Surgery

What are the Signs and Symptoms of Peptic Ulcer Disease?

Some ulcers are asymptomatic which makes people find it difficult to detect that they have ulcers. Some of the clinical manifestations of peptic ulcer disease are:

• Indigestion

• Lack of appetite

• Heartburn

• Bloating

• Vomiting or nausea

• Unexplained weight loss

• Gastrointestinal bleeding resulting from dark or black stool

• Severe pain in the epigastric region(pain in the mid-to-upper quadrant of the abdomen)

• Burning pain in the stomach, especially at night or after meals

• Temporary pain that disappears when you eat something or take an antacid.

What are the ways of diagnosing ulcers?

It is paramount to visit your physician once you keep having symptoms of an ulcer to confirm the exact type of ulcer and starts treatment immediately.

These are the various ways of diagnosing ulcers:

• Physical Examination and Medical History:

This involves a condition where the health practitioner had a dialogue with the ulcer patient discussing the symptoms being experienced. The healthcare provider thoroughly examined the patient by asking if the person takes NSAIDs or over-the-counter medication regularly.

When the person’s answer becomes “NO”, it signifies that the cause of this ulcer is an H.pylori infection that has entered the stomach but needs to run a test to confirm it.

• Using samples like blood, breath, or feces for diagnosis:

The blood or feces are taken from the individual to diagnose the presence of H.pylori bacteria. For a breath test, which is the simplest and most accurate way of detecting an ulcer, a fluid or capsule containing urea will be given to the patient to swallow and release his or her breath inside a bag, which is sealed instantly.

After culturing the sample, if there is an increase in the normal level of carbon(iv)oxide, it indicates the presence of H.pylori bacteria which causes ulcers.

• Gastroscopy:

This type of test involved inserting a thin, lighted tube (endoscope) with a small camera through the mouth, down to the throat, and into the esophagus, stomach, and first portion of the small intestine, duodenum to check for ulcers, and damaged tissues, or bleeding. This is commonly used for elderly people. To make the process easier and faster, the patient might be given little sedative drugs before carrying out the test, and local anesthesia is sprayed on the person’s throat to enable the passage of the endoscope. Most times, a tissue sample is taken from the stomach(biopsy) for further analysis in the laboratory. This kind of test is done at the hospital and does not require the patient to be admitted to the hospital because it is carried out the same day the patient visited.

• X-rays series:

During X-rays and CT scans, the patient is given a white liquid called “Barium” to swallow which coats the upper gastrointestinal tract and enables the doctor to see the stomach and small intestine and locate the ulcers easily using the imaging machines.

How Does One Treat or Manage Peptic Ulcer Diseases?

Most times, ulcers heal on their own, but allowing the ulcer to go on its own without receiving appropriate treatments aggravates your health conditions, causing bleeding, a hole, and pyloric obstruction (obstruction in the gastric gland).

The various ways to manage or treat ulcers include:

• Most bleeding ulcers are healed during an endoscopy test. The doctor does that by injecting medicines into the body or by using a clamp to seal off the ulcer to stop bleeding tissue.

• Antibiotics use: Some antibiotics like metronidazole, amoxicillin, and clarithromycin, kill the H.pylori bacteria, therefore when taken appropriately, enhance the quick recovery of the patient. The patient is advised to take the drugs for two weeks.

• Use of Proton Pump Inhibitors:

These include; Omeprazole, Protonix, Prevacid, etc which helps in curtailing stomach acidity to prevent the escalation of the ulcer and heal it as well.

• Taking drugs that block the production of acids:

Examples of medications are Histamine H2 -Antagonist(H2 blockers) which include; Pepcid(Famotidine), Zantac(Rantidine), and Axid(Nizatidine), etc can be used to minimize the production of acid in the esophagus, stomach, and small intestine.

• Medications used for protecting the stomach lining, esophagus, and duodenum to avoid further damage are necessary. Those drugs help to prevent the spread of ulcers by covering the ulcer in a protective layer, which stops more damage to the gastrointestinal tract acids and enzymes. Some of the drugs include bismuth subsalicylate (pepto-Bismol).

How Does One Prevent Ulcers?

Ulcers are life-threatening but can be prevented by:

• Have a conversation with your doctor about other drugs you can take in replacement of NSAID medications (like acetaminophen) to lessen pain.

• Know the measures to be taken if you can’t stop taking NSAIDs to protect your body from ulcers.

• Take the lowest active dose of NSAID and ensure good eating habits.

• Avoid smoking.

• Reduce the intake of alcohol

• Minimize the way you skipped meals, especially breakfast

The Epidemiology of Peptic Ulcer Disease

Peptic ulcer disease affects up to 70% of people globally yearly, and its approximate prevalent rate is 4.5 – 9.8% of the total population. It affects both adolescents and adults ranging from 13-70 years.

Globally, peptic ulcer affects approximately four million people with a high prevalence rate. According to research being made, it was proven that duodenal ulcer affects up to 50% of the population, more than any other type of peptic ulcer.

An esophageal ulcer is barely seen in the human population, but about 20% of people who take antibiotics daily tend to develop that easily. It is a gastrointestinal disease that affects up to 60% of people living in developing countries like Africa, Central America, Central Asia, and Eastern Europe.

Also, about 50% of people with the type O blood group who have Lewis B antigens were reported of having gastric ulcers. In Iran, it was notably diagnosed that the ratio of peptic ulcer in both men and women, is 5:1. This means it mostly affects women more than men. Again, in Nigeria, duodenal ulcers usually affect men more than women but occur between 30-50 years old.

However, gastric ulcers affect women more than men and usually develop around 60 years of age.

A bacterial infection, Helicobacter pylori, was also seen as a factor that causes peptic ulcer, and about 66.7% of the total population have been infected, especially in Africa.

Another study pinpointed that 30% of people that take NSAIDs and smokes as well are susceptible to getting an ulcer because of the presence of cyclooxygenase -1 inhibitor. 50% of people with ulcers, especially the one caused by H.pylori infection, were able to recover. Other ulcers were given the appropriate treatment at an early stage, and the patients became well again.

Conclusion:

Ulcers are easily treated once diagnosed at an early stage. It is advisable to visit your doctor immediately after you noticed any symptoms as this enhances the quick recovery of the patient.

References:

Julia Fasher, MD, and Alfred C. Gitu, MD. Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection. (https://www.aafp.org/afp)

Perry S, Sanchez Md, Yang S, et al. Gastroenteritis and Transmission of _Helicobacter pylori _Infection in Households. Emerging Infectious Diseases. (https://wwwnc.cdc.gov/eid/article)

Cleveland Clinic Medical Professional

(https://my.clevelandclinic.org)

Web MD

(https://www.webmd.com)

Health line

(https://www.healthline.com)

NCBI Book Shelf

(https://www.ncbi.nlm.nih.gov)

PubMed Central

(https://www.ncbi.nlm.nih.gov/pmc)

Visit https://infohealthedu.com for more updates

Fully Funded Scholarship in Canada 2023-24: Saskatchewan University Scholarships

By

Dr Macjohnson onyeberechi

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March 28, 2023

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Fully Funded Scholarship in Canada 2023-24: Saskatchewan University Scholarships:

Saskatchewan University Scholarships 2023-24 in Canada are open to all foreign applicants who want to pursue higher education abroad. Applications are accepted internationally for this Fully funded Scholarship for those who want to pursue undergraduate, Masters and Ph.D Degrees. All Major Topics and Specials like (Social Sciences, Arts, Engineering, Computer, Business, and Islamic Education are also management and development courses. Also apply for Mastercard Scholarship at Univeristy of Oxford.

The Canadian government has awarded a large number of International Student Scholarships each year. Saskatchewan University Scholarship is also one of the leading courses. In this course, international and indigenous students can apply. It is a Full Scholarship and holds all costs at the time of studying in Canada. ILETS are not required for this Scholarship. English language tests are only required for those students whose previous education is not in English. Apply for Mastercard SCholarship : Univeristy of Edingburgh London.

Saskatchewan University is a Higher University for Public Research. Saskatchewan University was founded on March 19, 1907. It is located in Saskatoon, a Canadian city. National Ranking of Saskatchewan University is 13 to 14 among all Canadian Universities. International ranking according to QS World Ranking University is 301 to 400 Number. Canada is a Good Country to Learn. There are more than 80% foreign students studying in Canada than Canadian students. Saskatchewan University is a world-class university that provides quality education. The University has an excellent study area and full accessory labs. Never miss this opportunity to review this Scholarship. Full details on the lines below:

Complete Overview Of the University Of Saskatchewan Scholarships 2023:

Offered Degrees: BS, Master & PhD
Scholarship Award: Fully Funded
University Name: University of Saskatchewan
Host Country: Canada
Application Last Date: May 1, 2023

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Scholarship Support:

Guaranteed Scholarship Entry:

You will be automatically checked for a Certified Entry Scholarship when you apply for admission

Outstanding and Highly Entry Scholarships:

Best and Highly Entry Scholarships are highly valued, renewable entry scholarships and are offered based on scholarship, leadership, and contributions to the school and community health. The best and brightest Scholarships include:

First & Best Scholarship by President George and Marsha Ivany:

Price: $ 40,000 ($ 10,000 / year over four years)

Chancellors ’Scholarships:

Total: $ 30,000 ($ 7,500 / year over four years)

U of S Entrance Scholarship:

Total: $ 24,000 ($ 6,000 / year over four years)

Edwards Undergraduate Scholarships:

Total: $ 24,000 ($ 6,000 / year over four years)

College of Agriculture and Bioresource Entrance Renewable Entrance Scholarship:

Price: $ 12,000 ($ 3,000 / year over four years)

University Dean’s scholarship:

Master’s: $18,000 for up to two years. Doctoral: $22,000 for to three years.

List of Subjects/Academic Fields offered by Saskatchewan University:

Math, Engineering, Technology, and Physics
Business and Economics
Life Sciences and Chemistry
Health
Teaching
History, Culture, and Arts
Society and Law
Agriculture, Plants, and Animals
Indigenous Programs
Environment and Earth Sciences
Languages and Communications

Under University of Saskatchewan Graduate Scholarships (UGS):

Indigenous Studies
Languages, Literatures, & Cultural Studies
Large Animal Clinical Sciences
Linguistics & Religious Studies
Marketing
Music
Philosophy
Anthropology
Art & Art History
Curriculum Studies
Education – cross-departmental PhD program
Small Animal Clinical Sciences
Veterinary Pathology
Women, Gender & Sexuality Studies

Application Requirements:

All the terms and conditions given below are complete with the Scholarship

For bachelor’s students: they must be high school students outside Canada when applying for a bachelor’ Degree.
Masters: A four-year undergraduate degree, or equivalent, from a recognized college or university.
In Ph.D. The Master’s degree, or equivalent, is from a conceded university in the field of study corresponding to the proposed field of study.
Postgraduate Diploma: A four-year undergraduate degree, or equivalent, from a recognized college or university.

For Complete Eligibility: Click Here

Required Documents:

All Documents provided below should be downloaded while online. Details are below:

For Bachelor Programs Higher Secondary School certificates or for 12 years of Education are required.
For Master Degrees Transcript of Bachelors.
Ph.D. Degree Transcript of Master Required.
International Student Passport.
Restart / Short CV.
Encouraging Letter or Statement of Intent.
Masters and Ph.D. Research suggestions only.
Letters of Commendation.
English Technical Certificate from the last institution.

Application Last Date:

The application deadline for Saskatchewan universities for international students’ courses is May 1, 2023.

Guidelines on How to Submit Application for Saskatchewan University Scholarships 2023:

The entire application process is online. Students can apply online by reading all of the above instructions and ready-made documents required to download at the time of application. Students can use it before the deadline.

Guidelines For Application: Visit the Link

To Apply:

Click Here

RELATIONSHIP PALAVA!

By

Dr Macjohnson onyeberechi

-

February 10, 2023

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Table
Join us

RELATIONSHIP PALAVA

Many are out there who rely on your sincere advice and contributions to make meaningful decisions in their lives with little or no negative effect on them. Here comes your experience in the situation in addition to your Godly background to support the mental and relationship health of this fellow. Kindly drop comments in the comment section of this post. We need your ideas to soar successfully. This is relationship palava!

Situation 1:

A lady reports her husband cheating with a little girl on the streets

A lady sent in a message (anonymous) with a complaint.

Complaints: My sister married her husband when they had nothing, they have been married for a long time now and God has blessed them. Here comes a little girl on the “street” who has recently been distracting her husband. Initially, my sister didn’t take it seriously as she had already known her husband as a cheat, but this time it’s getting unusually beyond boundaries. Her husband no longer sleeps at home but stays in a hotel with the girl. Also when the girl’s mom was ill, he took care of all bills and also got the girl and her parent’s phones. He also bought food items for the parents. The husband has also made intentions of marrying the little girl as he provides everything for her and her family. Now he is planning on opening a big shop for her with no concern for the wife’s shop that is running down. Last Christmas, he even left the wife and children to spend time with this little girl at her own place. He literally fights everyone who attempts to advise him against it.

Please I need advice on what to do. It’s really getting serious………

So please let’s help this sister by sending in our comments and reactions that are beneficial towards a peaceful resolution… We are still on relationship palava!

Situation 2

A married lady sent in her complaint of having the temptation to cheat on her spouse

Complaint:

I am a 26 years old married lady with a lovely daughter. I used to hear that women cheat, but i have often wondered how possible that is. My husband is caring although he has his weak point as a man. It happens that on a faithful day, I met a young whom I eventually exchanged contact. The guy is also caring and nice, especially with his chats. In December, this guy sent me money. This is just 4 months since we exchanged contacts. He has always been talking about getting into a relationship with me although I told him that I am married he will never stop. He always confesses how he has fallen for my charm and can’t resist me. This guy is single and will always send me stickers of people kissing, despite my warnings, he never stopped. Now I visited him at his workplace and we hugged each other. Now I am feeling like giving him a chance. He told me that he would never leave me. I don’t even know why I am cheating. I planned to visit him soon and I know it’s obvious we would have s*x because he has been telling me about his good style. Is it possible to cheat and my husband will never find out? Are there negative consequences? Because I am afraid but I want to have a taste of it. He promised my husband will never find out.

Please I need your help if this is what do.

Note we are still on relationship palava!

Kindly drop your comments on the comment box below .

Also drop comments on our facebook page. Kindly click on the facebook icon below to join our facebook community and leave your view.

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Simple tips you need to know about Urinary tract infection. Do you keep getting urinary tract infections? Here’s what you need to know.

By

Dr Macjohnson onyeberechi

-

February 7, 2023

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Simple tips you need to know about Urinary tract infection. Do you keep getting urinary tract infections? Here’s what you need to know.

Urinary tract infections (UTIs) bring a unique misery. If you’ve had one (or more than one!), you know the seemingly constant feeling of having to go to the bathroom and the burning feeling when you do urinate. Do you keep getting urinary tract infections? Here’s what you need to know. Read through and get the simple tips you need to know about urinary tract infections.

If you’ve experienced a UTI, then you know that this burning, painful, uncomfortable condition is nothing to mess around with. That’s why health experts have created a guide to help you protect your health. This guide explains how a UTI begins and ways to help prevent infection. It covers the factors that increase risk at all ages, how UTIs are diagnosed, and how they’re treated. The guide also discusses the growing problem of antibiotic resistance and how this affects treatment for UTIs.

READ MORE… from Harvard Medical School…

Most UTIs get better quickly with a course of antibiotics. But for some people, UTIs keep coming back with frustrating frequency. For example, abnormalities in the urinary tract or trouble completely emptying the bladder may make a person more vulnerable to frequent UTIs. You may be surprised to learn that family history may also play a role. Having a first-degree female relative (parent, sister, or child) with a history of more than five UTIs means you may be at higher risk for recurrent UTIs.

Steps to help you avoid recurrent UTIs

Talk with your doctor. If infections tend to occur after sexual activity, your doctor may prescribe a single dose of an antibiotic to be taken only after sex. Postmenopausal women might consider vaginal estrogen products to help maintain local tissue health.
Practice good hygiene. In addition to regularly washing the outer genital area with gentle soap, wiping from front to back after using the toilet helps prevent the spreading of bacteria from the digestive tract to the urethra. Urinating after sex also helps flush out bacteria.
Drink plenty of water. Drinking plenty of fluids can help flush bacteria from the bladder.
Consider your birth control method: Spermicide, diaphragm, or spermicide-lubricated condoms can contribute to frequent UTIs. If you get UTIs often and use one of the methods, consider switching.
Consider probiotics or cranberry juice. While the effectiveness of these products has not been proven, they may help decrease the number of UTI-causing bacteria that live in the vagina.

For more information on recurrent UTIs, check out Urinary Tract Infection, a Special Health Report from Harvard Medical School.

Types of urinary tract infections (UTIs)

Cystitis is the most common lower urinary tract infection.
Urethritis – infection of the urethra.
Pyelonephritis – infection of the kidneys.

Diagnosis of UTI

Tests and procedures used to diagnose urinary tract infections include:

Analyzing a urine sample.

Your healthcare provider may ask for a urine sample. The urine will be looked at in a lab to check for white blood cells, red blood cells or bacteria. You may be told to first wipe your genital area with an antiseptic pad and to collect the urine midstream. The process helps prevent the sample from being contaminated.

Growing urinary tract bacteria in a lab.

Lab analysis of the urine is sometimes followed by a urine culture. This test tells your provider what bacteria are causing the infection. It can let your provider know which medications will be most effective.

Creating images of the urinary tract.

Recurrent UTIs may be caused by a structural problem in the urinary tract. Your healthcare provider may order an ultrasound, a CT scan or MRI to look for this issue. A contrast dye may be used to highlight structures in your urinary tract.

Using a scope to see inside the bladder.

If you have recurrent UTIs, your healthcare provider may perform a cystoscopy. The test involves using a long, thin tube with a lens, called a cystoscope, to see inside the urethra and bladder. The cystoscope is inserted in the urethra and passed through to the bladder.

Urinary Tract Infections (UTI ) Treatment

Antibiotics usually are the first treatment for urinary tract infections. Your health and the type of bacteria in your urine determine which medicine is used and how long you need to take it.

Simple infection

Medicines commonly used for simple UTIs include:

Trimethoprim and sulfamethoxazole (Bactrim, Bactrim DS)
Fosfomycin (Monurol)
Nitrofurantoin (Macrodantin, Macrobid, Furadantin)
Cephalexin
Ceftriaxone

The group of antibiotics known as fluoroquinolones isn’t commonly recommended for simple UTIs. These drugs include ciprofloxacin (Cipro), levofloxacin and others. The risks of these drugs generally outweigh the benefits of treating uncomplicated UTIs.

In cases of a complicated UTI or kidney infection, your healthcare provider might prescribe a fluoroquinolone medicine if there are no other treatment options.

Often, UTI symptoms clear up within a few days of starting treatment. But you may need to continue antibiotics for a week or more. Take all of the medicine as prescribed.

For an uncomplicated UTI that occurs when you’re otherwise healthy, your healthcare provider may recommend a shorter course of treatment. That may mean taking an antibiotic for 1 to 3 days. Whether a short course of treatment is enough to treat your infection depends on your symptoms and medical history.

Your health care provider also may give you a pain reliever to take that can ease burning while urinating. But pain usually goes away soon after starting an antibiotic.

Lifestyle and home remedies

Urinary tract infections can be painful, but you can take steps to ease discomfort until antibiotics treat the infection. Follow these tips:

Drink plenty of water. Water helps to dilute your urine and flush out bacteria.
Avoid drinks that may irritate your bladder. Avoid coffee, alcohol, and soft drinks containing citrus juices or caffeine until the infection has cleared. They can irritate your bladder and tend to increase the need to urinate.
Use a heating pad. Apply a warm, but not hot, heating pad to your belly to help with bladder pressure or discomfort.

Heat vs Cold pad: which to use? Use the heat pad

Also, read more treatment options

Bladder infection

Bladder infections are the most common type of urinary tract infection (UTI), but any part of your urinary tract can become infected—the urethra, bladder, ureters, and kidneys. Your age, habits, or health conditions can make a UTI more likely.

Symptoms & Causes

Symptoms of a bladder infection may include a burning feeling when you urinate. Most women’s infections are caused by bowel bacteria that reach the urethra and bladder. Most infections in men are the result of problems that restrict normal urine flow, such as an enlarged prostate.

More about Bladder Infection

Urine Infection

How do u know if you have a urine infection?

Check if it’s a urinary tract infection (UTI)

Pain or a burning sensation when peeing (dysuria) needing to pee more often than usual during the night (nocturia) pee that looks cloudy, dark or has a strong smell. needing to pee suddenly or more urgently than usual.

Bacteria in Urine

What strains of bacteria cause UTIs?

Urinary tract infections (UTIs) are a severe public health problem and are caused by a range of pathogens, but most commonly by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis and Staphylococcus saprophyticus.

Urinary Tract (UTI) in men

Males can get urinary tract infections, and they are typically classified as complicated infections. Symptoms may include urgency, frequency, and burning when you urinate

What are the signs of a UTI in a woman?

Image result for Urinary Tract (uti) in women — UTI in women

Symptoms

A strong urge to urinate that doesn’t go away.
A burning feeling when urinating.
Urinating often, and passing small amounts of urine.
Urine that looks cloudy.
Urine that appears red, bright pink or cola-coloured — signs of blood in the urine.
Strong-smelling urine.

Recurrent UTI

Recurrent UTIs (RUTI) is mainly caused by reinfection by the same pathogen. Having frequent sexual intercourse is one of the greatest risk factors for RUTIs. In a subgroup of individuals with coexisting morbid conditions, complicated RUTIs can lead to upper tract infections or urosepsis.

Recurrent urinary tract infections (UTIs) are defined as two episodes of acute bacterial cystitis, along with associated symptoms within the last six months or three episodes within the last year.[1] Recurrent UTIs are much more common in the female population. The cost of treating urinary tract infections in the United States alone is about 3.5 billion dollars annually.

Risk Factors for Recurrent Infections include

Any spermicide use within the previous year, especially if used with a diaphragm
Atrophic vaginitis
Chronic diarrhoea
Cystocele
First UTI when young (before 16 years of age)
Genetic predisposition (usually through bacterial/vaginal mucosal adherence factors)
Higher frequency of sexual intercourse
Increased post-void residual urine (incomplete bladder emptying)
Inadequate fluid intake (low urinary volumes)
New or multiple sexual partners
Mother with a history of frequent or multiple UTIs
Urinary incontinence
Use of spermicide-coated condoms.

Treatment of Recurrent UTI

Overall, long-term, low-dose antibiotic prophylaxis for recurrent UTIs substantially decreases recurrent urinary tract infections.

Preferred Agents for Recurrent UTI Prophylaxis

Nitrofurantoin at 50 to 100 mg daily.
SMX-TMP at 40/200 mg daily.
Trimethoprim at 100 mg daily.

Second-Line Agents That Are Less Preferred for Prophylaxis

Cephalexin at 125 mg or 250 mg daily
Cefaclor at 250 mg daily
Fosfomycin at 3 gm every 10 days
Norfloxacin at 400 mg daily

More about Recurrent UTI

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Get Hired with one of the skills below to work and stay in Canada: Apply Now

By

Dr Macjohnson onyeberechi

-

January 23, 2023

0

Canada has become the dream country of almost everyone young fellow out there seeking greener pastures. You can get hired with one of the skills below to work and stay in Canada. Actualize your dream of ever living a comfortable lifestyle.

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