This is a mechanism by which the eye wards off the secondary effector phase of the immune response arc.
Thus, the cell mediated immunity appears to function less effectively in the uvea compared to the rest of the body.
Possible mechanisms include-
1. Immunomodulatory cytokines produced by the ocular tissues.
2. Immunomodulatory neuropeptides produced by ocular nerves
3. Functionally unique APCs.
4. Compliment inhibitors
..and some other factors.
-Sushrut
The large spaces of choroid act as a sort of trap to organisms, especially fungi. Therefore most fungal lessons of the posterior segment begin as choroiditis.
Hello Awesomites!
I would like to highlight difference between these two terms. It is confusing.
1.Cholecystohepatic triangle:
Medial boundary- Common hepatic duct
Inferior boundary- Cystic duct
Superior boundary- Inferior edge of liver
2. Calot's triangle:
Medial boundary- Common hepatic duct
Inferior boundary- Cystic duct
Superior boundary- Cystic artery
Happy Studying!
Upasana Y. :)
It's interesting to note that the optic nerve, which is considered to be a purely sensory nerve has some efferent fibres, that is, fibres from the brain to the optic disc. The presumed role of these fibres is in dreams, where the brain sends impulses to the retina, image is generated and it is carried back to the brain via the afferent fibres.
-Sushrut
Some specific antigens when placed in the anterior chamber of the eye result in a suppression of cell mediated immunity, with a normal humoral component.
There is something known as the ' oculo splenic axis' , whereby the antigens travel via the trabecular meshwork and reach the spleen. In the spleen, they secrete MIP 2 which attracts the NK cells. The NK cells in turn secrete IL10 and TGF beta. The T cells in this environment become regulatory cells and suppress the cell mediated immunity. Production of IL2 is suppressed.
The eye is an immuno privileged organ, as it needs to be structurally maintained pristine to preserve it's light carrying capability. ACAID is a mechanism by which Nature attempts to limit unwanted inflammatory responses in the anterior chamber.
It has implications in intraocular tumors, autoimmune, and infectious immune responses.
-Sushrut
PS- The failure of ACAID in the mechanism of lens induced uveitis still remains unexplained!
"Are you ready for solo practice?"
My father read out the topic from a WhatsApp forward he had received.
I was drinking tea, with all the absent-mindedness of a resident who barely has the luxury to sit down and have said cup of tea.
I stared at my father aghast, wondering where this daunting question sprung from, till he elaborated that it was the topic of an essay competition.
As I read through the message myself I corrected him, "That’s not what it says! It's asking whether you're adequately trained for solo practice in the future."
"Your future is just a couple of years away. Will you be ready by then?" he asked.
"I don’t know about ready, but I’m sure I’ll be adequately trained," I answered.
He nodded and after a beat, leaned in and asked,
"But have you really thought about it yet?" ((And what makes you so sure? Have you really thought about it yet?))
That got me thinking indeed.
As a year old paediatrician, the most important lesson I learnt was how much there was to
learn. My days were spent working with any time off work spent catching up on missed sleep. I felt like I whizzed
through my first year, barely retaining any of the knowledge I was expected to glean as an intern. Being a houseman had felt like operating at spinal level, for the lack of there being a synaptic level
any lower than that. Perhaps I wasn't ready at all.
My face seemed to betray my thoughts as my father interrupted them. "Instead of lamenting over what you haven’t learnt," he asked kindly, as if reading my thoughts, "Why don’t you try and think about how much you have?"
Convinced that I had learnt nothing of value anyway, I decided to humour him nevertheless. I spoke about my housemanship month by month, about what each sick child and each hopeful parent had taught me. A resident doctor in a busy municipal hospital barely gets time for their own basic life needs like food, sleep, or even a bath (and needless to say, sleep always takes priority!). Most of what we learn is on the go. Nobody gets enough time to go back and read about the cases we've seen in the ward. Thankfully the vast number of cases and immense workload ensures that we at least know how to manage basic ailments that a child presents with.
However amidst putting orders, histories, and ensuring investigations for so many patients, we forget to learn about the little things - how to allay a parent's concerns about their child, how important the so called 'cosmetic' part of our practice is. Of course, all these concerns are still things that can be worked on if one can put their heart into it.
And yet, are we being adequately trained to do this for future solo practice? The answer, shockingly, is a resounding no.
Add to this, we're barely trained to make decisions by ourselves, especially when there are so many seniors waiting to teach us, guide us, and by extension, take responsibility for our actions. How is one supposed to adjust to suddenly being so independent?
In a tertiary care setting, we are used to sending out references left, right, and centre. We fail to learn the basics of anything that would result in us putting even one toe out of our own speciality and instead rely on the services of others, who are just a single written call away. It's very obvious that this is not going to be the case when one starts practising by oneself.
Another important thing that nobody teaches you in residency is how to ask for remuneration for our services. Being employees of the state or the corporation, we are used to working endlessly for a fixed salary being ddeposited in our accounts each month. As a result, we fail to realise our worth in monetary terms, there being a certain amount of guilt with each patient we charge. Maybe this is something we realise only after getting into private practice, where taking care of every patient is translated into putting food on our own plate. At this stage in life, while I hope I wouldn't underestimate and thus undercharge for my abilities, I really don't know what that would be like be like.
So, coming back to the question that started it all - no, I am not adequately trained for future solo practice. And no, I am not ready for it either. But two years down the line, I have hope for the former statement. And as for the latter? Well, I believe that at least that "I'm not ready." will transform into" I'm not ready...yet. But I'm willing to stick around till the day I am."
Written by Aditi
