Ni mula, ahib streama, wiyote yadupledu, no mag CNC wa financiis, haku 신wadi ajotikadiav ni kpesamaifting fana, persecuted k heateda waji wajia evaluate. Galu ngaksia hirunia, akne,u layingana wajii, kwa matikamchu kuularesa, ya waga handa niohi Gracunialone Matu katani wik Wiito Acha. Onwall fana diwa.  Gata hali wiki maha mioe yina kwa ya mnwehia mnw debuguhia mwen bingsu na kwa ni biawiki mehia mwiki maha mwiki maha mwiki mawiki mwiki, weziy niki wa hans mwiki mwiki mainu kwa hans mwiki mahia mwiki mwiki mawiki mwiki umawe hii na mwiki mawiki mwiki maawe wiki tama. This is not really acceptable because once you get into a human being that way, then trust me, for him, coming back to his expected performance levels, will be hard because he'll be still disturbed of that kind of criticism that is getting out there. Because sometimes you get criticism but people you don't know from very far, he's playing in England, gets criticism from Africa, South America, you get tired and sometimes it needs may be a kansila to get such kind of players in order to get their mental strength back so that they can come back stronger to the pitch and perform. Otherwise, if we are going to leave them like that, then it really makes their performance go below par and sometimes we may never understand what's happening to them, unless they come out and explain what has been happening behind the scenes. Speculation on who will be the next manager for Liverpool is over after Juken Klopp extended his contract to 2024, and so is Steven Gerard, the former legend at Liverpool, also extending his contract at Celtic until then. Is there something we are not... Maybe I think it is just a coincidence, but these two clubs especially, let's talk about Juken Klopp and Liverpool, the fans have fallen in love with this guy. This guy who is now in contention for the first Premier League title, I think over 30 years, back to back finals, the last year they lost to Red Madrid, this year they beat Tottenham. I mean this man has already built a relationship beyond the players, with the fan base, with the management, with everybody around Liverpool. I think it was, they just wanted a continuation, there are obviously speculations that one of the best managers Klopp was going to go, but now that they've tied him to a long-term deal, it's good for the club and it's good for him as well. I think it's basically settled with this family in Liverpool, and that's the same for Stevie G at Celtic. Is it Celtic? Yes. At Celtic, yes, because, no, no, he's not at Celtic, he's at Rangers. Yes, at Rangers because he came after being a youth, I think at 18 coach at Liverpool, he went direct, he made an impact. They saw what he could do even in the Europe Cup and now they tied him to a long-term deal. It means they have seen something in him as a young manager with quality and that means he's going to go places with this club. Is Stevie G the man said to replace Klopp at Liverpool in 2024 after his spire of his contract in Scottish League? It's a long, long, long way to go. We never know that we may reach that in 2024. But when you're alive, you can't change my opinion. Exactly, but talking of five years from now, I think might be too early for that and those contract extensions for both managers to their respective clubs is just a mere coincidence. I don't think it was a calculated move for them to sign five years extension, but as Barry saying, Hagen Klopp has created a relationship, a formidable relationship. That bromance between him and players, hugging after every game, embracing the fans as well. And everyone in Liverpool, actually I cannot even say in Liverpool in England because I enjoy watching his game. He's really transformed that Liverpool team and we saw he got the final jig when he was trying to get the best out of the Liverpool side. We saw he brought in Van Dijk and they were really missing a very, very good defender in that team. And they finally got him and you see he's performing. In the first season, all the way to the finals, lost to Real, second season lifting the Champions League. Right now, it seems that the title might be over in the next few weeks. If he's going to navigate the team through these busy fixtures of the December holidays, then trust me by January he's clear with those kind of points, then I think he might be as well picking his first Premier League trophy. Is that what the Liverpool fans want? And away from club football, other manager who has also extended his contract and further stay is Didier Desho, who led France to the World Cup victory in last year. Good gesture, is it a nice move for the Le Bleu? Yeah, it's a nice move for the Le Bleu, he's a club, he's a country legend. He copped in the team in the 98 World Cup. He led them to 2018 World Cup final and won the cup. So, I mean, Didier, I think they just paid the price, they just complimenting him for a good job done. But my problem with country football is it's very rare before you meet your players again. So, for example, if you signed five years, you're going to see them three times a year. You're an international assignment. I don't know what you do the rest of the day, I don't know if you do scouting. Yeah, he keeps traversing, watching his players at club level. Yeah, it will be better to have a long-term deal with the club than now. And that's why some coaches, they'd rather stay out and wait for club to come for them rather than going, one more morino, they cannot coach. They cannot be idle. But there's preference, there are those coaches who love being in charge of national teams at the expense of... I don't think that there are those who prefer the national team due to... Louis Felipe Scolari. But once the job comes up and you are out, then sometimes you may decide to take it up because like morino has put a very, very perfect example. Morino is not a man who is going to go to coach. Puchagol tried greeting him, but he refused. He refused. So, he's that kind of guy who wants to be involved every week in, week out coaching and all that. And as we've seen, we're saying that the club football seems to be having... The most attractive. Exactly, most attractive because you have different kind of competitions. You have three games a week sometimes. And for the national team, you have to wait like a whole month, a whole two months to see your players back. And jetting this kind of players is sometimes a little bit of a hard work. And that's why if you see a coach with the national side performing, always performing, then you really want to get hold of him the way France have done with these champs because he has now understood these players. And the dynamics of national team football. Exactly. So, I think it's a good move for him and good for the French football being a legend. He has performed, but personally baby, I may have question marks on why he has been dropping Alexander Lacazette, but he has the reasons and he's performing. So, that's where we leave it. But I also understand the concerns by Arsenal fans that their player is not teaching for the national team and it's only Olivia Jiru who gets preferred over Lacazette and Benzema. So, we're going to speak about doping and last week, the pronouncement from world and doping agency over Russia, they got banned from involvement in all sporting activities including Qatar 2022 World Cup and even the next year's Olympics in Tokyo, Japan. Is this a directive that will also scare the countries who have been trying to practice the same silently? I think, since the world has existed, this has suffered the biggest and the harshest penalty to any country. And naturally, it evoked a lot of responses, especially even from the president of the country, Putin. Yes, he responded. Yeah, because Russia, I think it will be unfair. I don't think everybody that was investigated in the world had doped. And I don't know if there is anything called state sponsored doping, that every sporting discipline government sponsors it. I think for me, and that's why maybe a word proposed that, for example, in the Olympics an athlete goes as an individual and not as a representative of a country. But everybody in such an event like Olympics wants to be associated with the country. You are representing a nation. So, you're going, if you go as an individual like an alien, it won't even really give you much needed attention. But it's a warning to anybody or any country who wants to dop, because four years is a long time. These guys are going to miss the Olympics and they're going to miss the World Cup football, which is really huge, even for individual sports. And I think participating as an individual only applies to individual sporting disciplines, right? Like athletics. Like short put or something. Football, they're not good. It's really a big, but it's a warning. That's what they're saying. And remember, Russia has been in the sport for a very long time. It's not that it's been being... The Russian authorities are saying they're being... And fairly targeted. But it's been, I think since 2010, they've been... I think it's been a long... What has been on there? I think if I can say this, it's a well-deserved punishment because we've been talking about doping maybe from athletics now. Maybe sometimes football is involved. These are very, very negative advice in the sports industry. And we've seen maybe individuals banned river on the country now. We have seen individuals banned from their sporting activities because of doping. And for what to come up with that kind of punishment, trust me, they have done their investigations and they have got their facts right. And this serves not really as a warning, as a good punishment. And any other country which might be trying to maybe involve itself that advice should also get actually a tougher penalty as compared to this one. I think such kind of punishment should also now go to other devices. For example, racism. This is one classic example of what should be happening to racism in the sporting industry because if we are not going to carb it with such kind of serious punishments, it won't stop. So it's a very well-deserved punishment and it's a thumbs up toward and they should continue investigating such kind of instances and give proper punishments. In Europa League last week, Man United, for the first time, I think they recorded a win of four goals against AZ, Alkamar and the Mason Greenwoods code and the English international has received much praise from Man United fans and now they are even comparing him with Wayne McCrooney. I saw Laguna soldiers post praise statement saying that Greenwood is growing into something big as far as football is concerned. Is this the pressure that gets piled on this young English international and finally they get ruined? We saw what happened to Adam Johnson. I think first of all the harshest critiquing media is that one of England. The moment they put you at this pedestal and then you go down this way you are in trouble and this really affects even the upcoming players. One moment you are performing, one moment you are not. It's because somebody is always scrutinizing you and this issue of also comparing to somebody who has already established himself. I think it's a bit unfair on them. They need to grow as they grow along. So for example Mason Greenwood being compared now to Waza it's a bit too early. Let the kid just enjoy himself. It should be compared to Gabriel Matinelli. I think as my fellow is saying this kind of pressure really sometimes ends up they can break you. Exactly breaks these kids The expectation is high now. It's too high. It's a high time that we left these kids to play their football. Continue developing and maybe when the kid is 22, 23, 24 around there then now you can start giving comparisons because I remember there is a time when United signed Memphis Depay. It was like the next Ronaldo this is the next David Beckham. What happened? We should stop putting this kind of pressures into these kind of scenarios. One guy whom I can't go without mentioning is also the young guy in Matinelli and Saka Saka is an English international. He performed actually. He gave that assist and now he is the player with the most assist in the Arsenal squad right now and he is very young. That's why we have seen Freddie Lujubag is not putting a lot of pressure into maybe starting him week in week out. That's why it's giving him time when you get your chance then play. But if you put that pressure then the pressure also might be done on the manager to at least maybe give him more playing time and this might be prejudice to the development of the kids. So give them time step by step and they'd be up there if they put in more effort. 3-1 victory against West Ham in midweek and City also slammed last weekend against United in the Manchester Derby now you're meeting on Sunday in what is expected to be a pulsating clash. Are you up against the Etihad based side that are looking forward to defend the title though getting separated by Liverpool with some huge point difference. It's going to be a tough game for Arsenal going to the Etihad especially now that City lost last weekend and Arsenal have not really built that much needed confidence in that squad but who knows we never knew that United are going to I saw some prayer sessions by Arsenal fans being presided over by one of the local comedians. I think those are just fanatics that's where I can leave it but if Freddy, I saw last weekend the team that he started at West Ham I think he listens he listens to the the concerns of the supporters of the team because we saw some changes and these changes actually brought in that win because we were trailing by a goal to nail at half time. And I was extremely happy until you ruined the party during second half. So I think he's listening because Lacazette has not been on that top form that we really need him to and Gabriel, the young guy in Gabriel is showing us that he can score goals so he had to give him a start and he exactly did that and starting him alongside Ubama Yang he scored paper at least put in a man of the match performance last weekend and adapting well to dynamics of VPL after is stint in French league one he has had a slow start that's not that is not being seen everyone is saying he has had a slow start but as time goes by I think he is picking up his boots and maybe by the time the season is getting maybe somewhere three-quarter of the season then I think we might be seeing the paper that was in France. Immediately Makosilwa was fired then Danny Fagason took charge in interim capacity and Everton recorded convincing victory against your side Chelsea football club was there a sort of player mutiny and I think these players were just rejecting celebrity to perform to Silver I think there is the players just don't want a certain coach I believe there is something called player power they can decide they want you or they don't want you and there is a lot of dressing room issues Morini has been a victim of the same I think for a while Makosilwa is a great coach a young very good coach but I think it reached a time when we had to go now Duncan Fagason but he is also club legend he played there during the back days he was a good number nine for Everton especially the derbies it will be interesting to see how he will play against United and especially what you call the derby against Liverpool the Masterside derbies so it will be interesting because he used to score a lot of goals during those derbies but we want to see how he performs in a big game again especially back to back against our man United it will be a good game for him to test his credentials and now maybe to maybe embrace so that the fans embrace him more and can write and the boss to embrace him more City and their contractual row with Pep Guardiola I hear that there is no close in his contract that can limit him to leave the club at the end of the season Pep is his tactics getting outdated if noticed I don't know if this is some kind of do but every 40 of oh my goodness that happened to him when he was in charge even Bayan and now he at Man City I don't know if he always runs out of steam but particularly I think for this season when he's already seen the gap there's a time when he said congratulations that's mind game though it was mind game but now I think Liverpool has actually won the game has actually won the league and there's something also not happening right with Man City to see Fanandino play at centre back for over 5-6 games it means he has no confidence on his centre back nah but Lapote is injured Lapote is injured but he have stones what I mean is erratic sometimes he can just cause red dot so he has more faith on a deep line defender to come and play he has a lot of faith on Fanandino and his main sport Aguero is out so it means and with a very heavy schedule in December I don't know you'll have to get guys from the region you know you're trying to insinuate something and putting a smile on national fans that they can defy all odds and beat city tomorrow it will be tough luck but in football wolves did beat them actually although currently I can say wolves are better side as compared to Asenu right now and that's why I think the management the likes of Edu and Sanlea are organizing a meeting with Nuno Espirito Santo next week to see where they can come and take the reins Asenu I saw someone Similiana Legri attending English classes in order to reject Asenu that was a good joke anyway a lot of coaches are shortlisted for Asenu they are rumored to be being tipped to take over Asenu after departure of you Freddie Lundberg just in charge in interim capacity I think he wouldn't be confirmed Mikaela Tete as well Nuno Espirito but anyway Carl Angelotta has also been sucked at Napoli despite beating gang Foneel that day he was sucked as we speak right now Napoli ninth on the standings but I think is he coming to English Premier League football maybe at Everton I think he would love to come back to the EPL EPL is the best league in the world every manager would love to come to the EPL but as for Allegri I read some comments somewhere he is not rushing into a job right now until at least in the summer that's where he can start with the club from the start of the season but for Asenu the managers that are being rumored around the legs of Mikaela Tete we saw what Pep Guardiola say this guy is is good what it takes to be a full manager now and if someone comes for him I might not be able to stop him and the legs of Nuno I think if something happens but you always have something for Frenchmen yes if something happens that Asenu wins tomorrow against Man City then trust me we might be hearing the rumors a little bit more longer because Edu will like to give Feddy some time at least to see but don't you think that is the mistake this premily clubs make you remember when Laguna Soul recorded a sing of good performances with United then he was confirmed and so is Brenda and Roger now being tied to a long term contract at least 5 years I think it's high time we experiment first we give them a one year contract I think I don't know there is a bit of excitement they are hiring these managers are best on few games and then they get disappointed that happened also I think what really happens with guys with Jose is always sometimes gets into this thing when he performs well then they give a long time then they get disappointed again I think they should give you interim somebody advice Asenu Man maybe give Feddy maybe a one year interim Yes Asenu will get relegated Yes unless because of which it's likely but trust me if tomorrow is going to get his game right and maybe get a draw or maybe win trust me it's going to get some time at least to show to showcase what skills that baby he made have learned from Emery that he was not using that he can use in the team right now but there is that spirit I think that into CSM has come back into the squad I hear that we might be missing paper tomorrow but that's not confirmed but if we miss him trust me Matinelli will be able again to fill that way from that wing and maybe we bring back Lakazetis to the main striking role and Obama and from the other wing and maybe have Ozil starting as an number 10 but a problem where we have the biggest problem is now the right back who's going to replace Belarin if he's gone or missed because the last game he pulled out out of the final session because of hamstring actually a few minutes to the start of the game we had Chambers who is playing there I think he might have a lot of problems from those wingers of Man City I cannot play Maitland Niles at that wing against Manchester City so this gives us a very big problem what room are you going to play at that defense because if you are not going to have good fullbacks then the city wingers are going the likes of Bernardo Silva are going to cause a lot of problems but if we get the game right tomorrow and maybe Belarin is back then we might be able to jag around and maybe get a draw or a win we are almost coming to an end of course several fixtures lined up Liverpool playing against Watford in an early kickoff 3.30 pm Burnley up against Newcastle Chelsea playing host to Stubborn-Bornmouth side looking forward to continue with this it's good performance against Norwich Sheffield united against Aston Villa playing against relegation threatened West Ham and there is a room indicating that Manuel Pellegrini might be getting sucked in a time soon in case they lose to Soton because I speak right now the 18s on the log but anyway Europa League several teams have been relegated to Europa League from Champions League Inter, Ajax, Salzburg does Man United have any chance of winning this why are you saying Man United okay it depends to be seen I think this thing is for Inter to lose Not really I can't say so Inter failed to qualify in their group Barcelona and Totenham I think they qualified but remember it all depends what cards you play during the knockout stages because anyone can knock you out it's not a string of group matches so let's see how they drop hands out I think on 16th and then we can be able that's on mandating from there we can talk because maybe Inter might be landing someone who is on number 2 but still kick him out so let's wait for the fiction there's also Ajax and Salzburg has been also in good form they are stricken now being chased after by Liverpool it's confirmed it's signed a contract but it will be announced during the January transfer window anyway you are parting shots what is expected at the weekend Osco Amala has already scored Kenya leading against Zanzibar the Ulins is the military boy doing very well I see Kenya going through it met 2-1 my prediction but we hope the boys continue it's been a good consistent performance what I'd call a second string side it's actually a makeshift in my view makeshift side but so far they are proving doubt is wrong including myself and it's very good commendable so far and that performance is putting us like Abdala, Juma and Osco and Amala on the map this performance is a takeoff you are parting shot your expectation is Arsenal beating City tomorrow? can we place a bet yes on a live TV I think that one will be what's your prediction then? for that game I see City winning maybe by a margin of 2 goals whichever the score but a margin of 2 goals and then for today I am seeing that game of Kenya ending that 1-0 we might be going all the way to the final and then I am looking forward to the Kenya game against Ireland in the evening and of course apart from being an Arsenal fan I am about a moth fan for today on loan here is on loan I will be behind Wordford against Liverpool I don't think they have a chance anything can happen in football I don't think so at Anfield it will be tough luck for Wordford and the game apart from Liverpool winning the next game I will be looking forward to is that Chelsea game against Bournemouth I think the likes of Ake will give a run for his money so it will be a good game and then maybe later we can watch Southampton Westam thank you gentlemen for being with us we are sure it's been real 1-3 touchline every Saturday do join us again next time same place, same time same day Saturday it is my name is Mark Solwasik always a pleasure doing this but let's continue with the conversation on our social media platform such touchline Y255 Y254 channel until next time see ya God bless, have a fantastic weekend enjoy and please don't misbehave


What is the most underrated strategy? Probably spacing, like spacing, positioning in general. Understanding when to press and when to range is the hard thing right because that requires a lot of game knowledge but the actual action of doing it is not that hard generally. Although like for example in mid-fight staying at max range of the fight is the simplest form of it right and still like 90% of people are already failing at this. This is why you see okay not 90% but like at least 50% if you go into bg's like at least 50% of the people are over pushing and getting caught out of position and resolve it and they're significantly less tanky like this guy for example he's been doing it all bg long constantly getting hit out of position he's a fucking hunter he should be max range always you know and that's like a pretty much a core element of his gameplay should be staying at max range and being good at that.


Hi beautiful, how are we doing today? Thank you for being here. You look amazing, stunning, fabulous, for usual. Before we really get into things today, I just wanted to say one quick thing. A portion of the proceeds from this video will be donated by me to the World Health Organization to help fight everything that's going on in the world today and there is quite a bit going on, as we all know. So if you could like and share this video, it would be greatly appreciated. And if you are able to make a personal donation, the link is right below on where to donate. The funds from this organization goes towards developing vaccines, tests, and treatments for everything that's going on right now, as well as supplying gloves and masks and equipment to frontline workers. And if you would like to learn more about this organization, you can click the link right below.  Y'all asked for it. Oh my God, did you ask for it? Literally from Twitter to Instagram to my emails to TikToks, all the comments. Have you seen Joanna's hair? I haven't watched it yet. And that's because I was waiting to watch it with you. So today we're finally watching Joanna shave her head along with a few other girls. And it should be a lot of fun. A head shaving is always a good time. It's always a huge transformation and I love transformations. Let's watch these videos and let's see what Joanna does to her hair. Let's do it. All right. And of course, first up, we have Joanna Sidia. Oh, the angel that is Joanna. Let's watch the video. This is literally how my Thursday has been so far. Tell us girl. I did my physics homework. I sat on the sofa and I just thought about what I would look like with a bald head. Since the world is an absolute channel. Sounds like typical like Joanna thoughts. I thought, you know, now everybody's home. I'm at home. No one's gonna see me. Well, I mean... Well, except for 3.1 million people. I've always flirted with the idea of just going bald for a very long time. Yes, she has. Today, today, I'm just gonna bite the bullet. Her and I talked about this when I was doing her color. She's like, one day I'm just gonna shave my head and the day has finally come. And I'm honestly like not surprised, but like sort of. Actually, she went from having really long hair to having blonde hair to then me fixing the blonde hair and then to her shaving it. Oh my God. I just love how she like really goes for it. I'm gonna be honest. In the beginning of her channel, Joanna did not strike me as a person who would be like, let's shave my head. Now we're here.  I'll look like Steve Harvey. If it ends up looking bad, well. I mean, Joanna, we needed to do something with those roots. So I'm glad you're just shaving it. We all know you weren't about to fix those roots. She's just going for it, man. Oh, this is happening, isn't it?  Okay, so now the fun part. All those hours of color work we put in, Joanna, they're all gone. That's okay. I love it. This is so fun. You know, I'm gonna go for a swim after this and I expect to be extremely fast. Dude, I'm so excited about this. I love a good chain. She already looks cute like that. I kind of dig this like really, really short bob. Maybe we should have done that and then like shaved it later, but like the shaved head is so fun. Dude, we are going for it. This is so pleasing to watch. I am so happy. She looks so edgy. Oh my God, Joanna. Yes, edgy. I'm living. She's shook. I love it.  Oh, she loves it too. I've only had for the first time. It's amazing. Yo, she went from having the longest hair a year ago. I am. Me too. This is nuts. I did a thing. I love it. It's amazing. Can I just say Joanna has a great head shape? Beautiful. Could not ask for anything better. This head shape is fabulous. 10 out of 10. A beautiful potato. And I love it. Now the real question is, did I let my mom know that I was doing this? No. Oh no. Oh my God. Oh my God. I'm nervous. Yeah, you got that. Oh, that was her mom's reaction. Yeah, yeah, yeah. You know, at the end of the day, it's just hair. It'll grow back. In one week, I'll already look different. So if you're gonna freak out, please don't. Also, I would like to just personally call it. Oh my God. All the YouTubers who bleached their hair after I did last year. Now that I shaved my head, I'm expecting you to do the same too. I don't want everybody to shave their head. If it'll happen, nothing to react to anymore. It'll just be a bunch of headshitting videos and how kind of boring is that? Don't do it. Please, keep your hair. Please, don't listen to Joanna. Please. I'm happy that's all I have to say. And congratulations, Joanna. That's such a weight lifted, I feel like, when you have a shaved head. I just, you're just so free. I did it once in my life. It was fun. I grew back. That's what's great about hair. It all grows back. I finally watched the Joanna video, guys. You can stop now. And let's move on to our next girl. Up next, we have Sarah Therese. And this is Shaving My Head. Wow, what a detailed title that is. This has been such a long time coming. All the new track shows, welcome here. Very excited to have you as you open up. Thank you. You just get to share moments like this. You get to go through life kind of together. I'm able to share just stuff that I'm up to, like shaving my head. That is what we are doing in today's video. Sarah, why do you want to shave your head? Why would you do that? Yes, such nice hair. Are you joking me? I just rolled up the clip. I did an Instagram story with the kids. Look at this. Oh yeah, let's just get rid of it. I'm wearing a baseball cap. My hair is really fine. It gets really damaged really easily. I see that for her. I do. Half an hour after washing it, which is one of the reasons why I've bleached my hair all over. She's so pretty. My heart has mildly quickened and beat. So I guess I'm not that nervous. But still, it's like shaving your head, right? Come on. It's not even like nerves. I feel like it's excitement. It's an adrenaline rush. It's fun. That's what you get when you shave your head. I mean, when I did mine, I never had a shave head before and I was so nervous of what it would look like. And I loved it. And it was like so relieving to do it. Oh, there's no going back now. Oh, I'm so happy to see that hair falls to the ground, honestly. It looked a little bit dead and a little bit... Yeah. Like, it was a lot of work. And she has a beautiful natural hair color, I must say. Oh my God. Look at my shoulder. Okay, now this is fine. She's gonna look so pretty with a shaved head. I can already see it. Yeah, I'll take a picture for Instagram. Okay. Yeah. Go, go, go, go, go, go, go, go, go, go, go. My hair is definitely not vain for me and you can obviously tell because I'm shaving it all off. If I was vain about my hair, that was the name. Oh, she should just leave it like that with that little mullet in the back. I love a mullet. If you guys know me, you know I love a mullet. The only haircut I haven't done and I'm thinking about it. If next time you see me, I have a mullet, I am not f***ing sorry. I'm not f***ing sorry. I wanna live my mullet dream out and I'm gonna do it. Stunning blonde shade still. I learned that in cosmetology, you know what, when it comes down to it, it's just hair and hair growth. Oh, she's a hairdresser. Oh, we love it. And also, let's just really remember, it's all inside, right? Like it's not the outward appearance that defines your work. It's your inward self and it's your heart. Except the outside can help bring happiness to the outside. Except the outside can help bring happiness to the inside. So it goes back and forth, but definitely the inside is, what matters you guys? This is real good and it better be. She looks so beautiful. She's like glowing, incredible. Who needs hair? You know, who needs that? Obviously I don't.  Ah, Sarah, I love that.  Like with that shaved head, yes. I'm 100% approved. Not that it matters, I love that. That was beautiful, thank you. Let's just have fun with this today. Let's just watch a ton of people back to back. Let's just see who has the best shaved head. I'm sure they're all great, but let's just go through it all, come on. We're watching Nikki Salito next and this is going airplane ball, buzzing all my hair off. Today's the day I'm gonna be buzzing my head. Yes! I don't even know what to say. Stop, just do it, come on. I've wanted a buzz cut for about two years now. Oh yeah, it's time, girl. Time to do it. I've been waiting until I got a job so they couldn't discriminate against me because I'm bald. Who was doing that, come on. I have a job I wouldn't tell anyone. No, not okay.  Imagine if she doesn't like it, like, oof, because her hair is so good right now. Can it get better?  We're going for it. You ready? Yeah. Three. Yeah. Two. I got thick hair and that's like one of those, she's over it. She's like, all right, we're good. Oh my God, that's so much hair. That's so cute. Isn't it crazy how much hair can change your look? Like, it's so wild to me. It can just change your look so much and all she's doing right now is just cutting her hair off and she's not even shaving it yet and she totally looks like a completely different person already and I'm living for it. Oh, she looks like a movie star. Is it just me?  What a, what a look. Damn. Oh, this feels weird. Is this what it feels like to be a guy and get your hair and cut? So exciting and she looks amazing. Yes, Barbara's skills. Okay, come through. Do you see her? Why did she get a bald spot right there? There's really no going back. No. No going back at this point. I have to walk into work tomorrow like this. Please, nobody let her have hair ever again. This is her look. She looks like an alien princess Barbie and that is all I want in my life is to look like an alien princess Barbie.  Let's move on to the next one. All right, so up next we have Rachel Cook shaving my head on Instagram Live. Rachel is a model and she is stunning. I think we're just gonna see another shaved head that looks just actually incredible.  It really is. She has beautiful hair though. There's like a lot of energy going on if you can't tell.  So I watched this guy's videos on YouTube. He does like reaction videos. I think his name's Brad Mundo and he said you can just use the clippers. Well, Rachel, welcome to Hairdresseria. But I don't know. I'm gonna try, I'm gonna cut this one. Okay. Yeah, that is true. It is way easier to just take the clippers and just go through the ponytail because there's so much hair that you need to break through and it's just really difficult with scissors. So going through with a clipper would be way easier. Oh my God. Rachel, cut below the elastic.  The elastic is there to keep it all together. You see? Oh my gosh. She's such a badass. I love it. I love it. Oh my God. I'm really excited you guys, honestly. It feels really natural and good. Yeah. See how we feel when we see your actual scalp. I know, right? That's the thing. Like you don't know what's on your scalp as a girl especially because you never see it unless you're a baby. Can you just cut me a ring? Yeah. Oh! Oh! Oh, you! Yes. Cute. Give it to us, Rachel. She's doing it. She's going there. I love all these girls. I want them all of my friends. Like, they're all so cool. Wow. Stunning. Oh my God. Oh my God. Oh my God. Oh my God. Okay, wait a minute. You really look great, Rachel. Yes, you look great, Rachel. I did it. Oh, I'll come back. I like that length too. It looks very nice. So there's all the hair on the floor. It's clear. I'm just proud of myself because, yeah, I just... Oh my God. I'm going to do it because... She looks so good. So just really focusing on what I want and getting myself that is really powerful. Wow. Feels really good. Mom's going to clean it up a little bit and then I'll take a shower. Make sure you guys can see it. Wow. Her eyes are popping out so much more now. Rachel, congratulations. Stunning. All right, moving on. Next girl. Come on. Let's see how many girls we can watch shave their heads today. My green closet. This is called shaving all my hair off 24 inches. I think I've talked about it before on this channel. It's sort of like... My God, her hair is so long. Growing of my hair that I really wanted to donate it. And oh my God. You have the prettiest natural hair color I've ever seen, ever. I've also always just thought that bald women or women with very short hair are really beautiful. Yes. A really striking look. And I've always really liked it. So I think I'm just ready for a change.  And I think that's pretty ridiculous. My hair is... I agree. At my waist, I've been growing it out. What? It's been about four years. Essentially since I started it.  Videos, that was when I first started buying it. I'm so happy she's shaving it. So you can kind of see it. It's too long, man. That's a cute link. I've had like an undercut shaved for the last month or so. Oh my God, she has the thickest hair. A way to get used to it a little bit. I'm definitely feeling this weird mixture of nervousness and excitedness. But if you can stop rambling and let's shave it off. Dude, that's so much hair. I'm so happy she's donating it. It's gonna make a wonderful wig for somebody. I love how she's not even nervous. She's just like going for it. She looks a little wild. Yes, leave it like this, please. Leave the mullet. Yo, it's so fun. I feel so light, like. Oh, I'm sure. You just went from the longest hair ever to this. Plus I still have more hair from the back, which I'm gonna be adding.  I want it. Go, go, go, go, go. Okay, so I've only shaved this little section. I think that I should probably go shorter. Yeah. I'm gonna shave the big one. You always gotta go pretty short when you're shaving your head. Or else it just looks like it's a grown out shaved head. So, yeah. Yeah, I'm gonna shave, go with that mullet, change the wig or change the little. Probably like a three or a two is probably good. Really satisfying to have those big chunks of hair come off. Yeah. So this is something that is kind of really interesting because I always felt like my head was very square. And I'm really seeing it now. You really don't have an idea what your head shape is like, at least I didn't.  It's been interesting. Whatever, nobody's perfect.  I don't have any regrets. I thought I might. I thought I might feel bad choice. I had honestly a moment when I was cutting off the ponytail. I was really unsure. This was something I should be doing. She can't stop touching it. I'm really happy with it. And we'll see if I'm still happy tomorrow in a few days, but I'm pretty excited. You're gonna be very happy with that decision. It's gonna be so much easier for you.  Wow, your hair went from so long to so short in such a quick amount of time. All right, let's move on. All right, and one last video. This is by Iseth Mendoza and this is shaping my head going bald. Show us how it's done. In honor of every person in my family who has suffered from cancer, every kid going through this hard moment and every person dealing with hair loss. You angel! Oh my gosh, she's just going for it. She's not even putting anything in. Ponytail's not cutting anything. Just shaving it. I hope she's donating it, though. You do it slow because you're doing it too fast at a pull. There's this long hair. So, holy, this is... I'm so excited. I've said that a hundred times in this video, but I am so excited. Dude, oh, this is so satisfying. This is so satisfying. I want to do it. I want to do it for her. Give me the thing.  Yes. I love these husbands and boyfriends supporting and doing it with them and doing it for them. It's so awesome. It's so fun. He's shaving it. He's going, he's going. And that is a big-ass ponytail of a lot of hair. That's a lot of hair. Very, very heavy hair. And I'm so happy she's going to donate it. Thank you. Yeah, she does. I was afraid that I have an ugly hair today. I just can't baffle going from having that much hair to having absolutely none. It just must be so exciting and just such a huge change and just a huge sense of relief. I know. It feels so nice. My God. Oh, she's fully shaving it. She is going fully. This is awesome. What a badass. Yes. I feel amazing. I'm not nervous anymore. I'm excited to start growing my hair. I'm going to remind you I'm doing this with St. Baldrick's. Rock the ball. Yes.  Bald is beautiful. Yes, thank you for that. That was such an amazing video. I'm so happy for her. I'm so happy for all these girls. So my favorite part about these videos wasn't even the actual transformation. It was the amazing reasons why these girls were shaving their heads. And I don't know, it was just so powerful and exciting. All of them seemed like they had a weight lifted off of them. I'm so glad all of them loved it so much and had such a great experience. It really had a deeper meaning than just shaving their head. It was everything. You don't have to have long hair to be feminine. I swear these women are a prime example of it. Beautiful, very feminine and just fabulous and powerful with a shaved head. All right, you guys. That is all for today. Don't forget to give this video a like, share it with your friends. Don't forget to follow me on Instagram, TikTok, Facebook, Twitter, everything. I have Brad Mondo NYC and follow my hair care brand X Mondo Hair for Fabulous Beautiful Amazing Hair Products that will just make you feel fabulous, beautiful and amazing and confident. And that is all for today. Thank you guys so much for watching. Don't forget to stay safe and live your extra life and I'll see you next time. Bye guys. Hi, beautiful. This is Project X, our everyday shampoo. Project X shampoo is perfect for those of you with normal hair who need a normal cleanse. This is not a heavy duty cleanser. This is not a lightweight one. It is perfectly right in the middle. It is going to get rid of all the dirt and debris in your hair. Without over drying it, she is gonna be your best friend.


Alright, so we're going to be pretty quick about this because I have an hour, you have an hour, and I need to get to clinic and so do you guys, but I'm going to give you if there are any questions if there are any pictures and stuff that I want you guys to interpret, then I'll give you about three seconds before I take over. So the purpose of this lecture is not to not to make you guys struggle. So I want this work. So it's the first few things that they do ask and the hookups is about the basic immunology of the eye. Just remember a few things that there are two blood ocular barriers, there's the tight junctions in the blood vessels in the anterior chamber and also in the retina, but there's also tight junctions in the arc between the RPE cells and those are the those comprised of blood ocular barrier. Remember, there's a concept of immune privilege, which is partially mediated by the fact that there is a blood ocular barrier but also mediated by the fact that there are suppressor T cells, such as D h 17 cells, which mediate this immune privilege or so called immune privilege. One common question for some reason is, where is antigen in the anterior chamber process by macrophages this is a concept that stems back to experimental UV it is in in mice antigen is processed by macrophages in the iris that leave the, the eye through the tobacco to mesh work and present to the reticular endosclerial system. And do you get is what is the most common cause of vision loss remember that that is macular edema. What are the causes of reversible vision loss. The most common is cataract. Abigail what's going on here. And so I think we're looking at x-ray of a heel, and there's a fracture there. That's like anterior to the calcaneus I think that there's actually if you can see my mouse is fusion of the of the calcaneal joint here and there's a calcaneal spur. And there is kind of this, like anification of the posterior aspect of the calcaneus, you see this spur over here. This is actually a process, something called anthocytus. And axial arthritis that you see in each of the B 27 associated UVA is so first they like to give you a little twist, so rather than showing you a spine, they can show you a heel. And just remember that the heel and the Achilles tendon insertion and the the calcaneus can, they can all be inflamed in HLAB 27 disease. So remember that overall worldwide less than 5% of the population is HLAB 27 positive 7 to 11% of Caucasians 18 to 32% of all anterior uveitis in Western countries, less so elsewhere. 50% of patients with non-granulometous anterior uveitis HLAB 27 positives or recurrent disease you're talking about. It's associated with seronegative spondyloarthropathies. 50% of patients with acute non-granulometous anterior uveitis will develop seronegative spondylopathy. On the reverse 25% of patients who are HLAB 27 positive and have seronegative spondyloarthropathy will develop non-granulometous anterior uveitis. So those numbers are important. Four syndromes to know when it comes to HLAB 27 positivity. No and closing spondylitis. No writers now known as inflammatory arthritis. Certain aspects of inflammatory bowel disease can in fact have HLAB 27 positive anterior uveitis. Know that uveitis in an isolated fashion with inflammatory bowel disease is likely to be HLAB 27 positive but scleritis anterior uveitis anterior scleritis and scleritis are not associated with HLAB 27 positivity in the setting of inflammatory bowel disease. Does that make sense? And then of course the psoriatic arthritis which tends to be HLAB 27 positive. So this is kind of the more conventional picture that they'll show for spondyloarthropathies. Specifically there's no ankylosis per se but focus here, does everybody see my mouse here? But can you guys see this sclerosis along the sacroiliac joint? See how there's kind of this radio opacity along the joint line and also narrowing of the joint space. So this is sacroiliitis which is something that you can see most commonly in HLAB 27 disease. But more of course you know and this is from your BCSE textbook but kind of more unmanaged. You see less and less of this now but more unmanaged and closing spondylitis. You can see sclerosis along the joint lines, complete fusion of the vertebra, complete fusion of the sacroiliac joint and this stooped posture which you don't tend to see anymore, at least in the developed world because it's treated. There is sclerosis and narrowing of the joint spaces, 90% of patients with AS are HLAB 27 positive. My guess is that a lot of these negative HLAB 27 negative patients are actually false negatives but there's your statistic. 5% will get recurred anterior non-granulometous anterior uveitis. So remember that that is the majority of patients with HLAB 27 disease of course in the minority you can get chronic disease about 3% of patients with HLAB 27 positive anterior uveitis actually get chronic anterior uveitis and those patients are more likely to get intermediate uveitis. Remember also this is another question that I'll ask you on your board, 5% will get erotitis and valvular insufficiency or pulmonary fibrosis. So remember that they can't ask you about cardiac manifestations and manifestations of disease that can kill you. Remember also what inflammatory pattern back pain is the stiffness off the back that lasts for at least 45 minutes after the cessation of sleep after waking up. But of course it can also apply to patients who go on long car rides etc. Who can tell me what the top picture is? It's a foot, it's two feet. It's a carotidermoblenoragium. I can't pronounce it correctly. So this is a carotidermoblenoragium and this is you can see a calcaneal spur in conjunction with enthesitis which can manifest as calcification of the achilles tendon but more commonly just carosis along the insertion of the achilles tendon with the spur. What disease do you think this might be? Reactive arthritis. That's right, so reactive arthritis. Just remember the can't see, can't be, can't have a tree. So arthritis, uveitis and or conjunctivitis and urethritis. Knees, ankles, feet and hands, calcaneal spur formation. Just remember this one, this buzzword carotidermoblenoragium which is a desquimiting rash of the souls which can also be seen in syphilis. Exactly. It's not called the same but it looks very similar. Most common eye manifestation is actually not uveitis, it's conjunctivitis so remember that. 90% of patients with writers are HLAB 27 positive, mostly male. And this is another thing they love to ask is which bacteria can be associated with chlamydia, salmonella, shigella, ureoplasma, urolyticum and eusinia. Not Pestis but enter colitica. So basically just think of some of the sexually transmitted diseases but most commonly actually it's these bowel pathogens. What is this lesion? Tony. Wake up Tony. Never mind. Anybody. Actually I'm not sure. Pyoderma. It's gangrenosome. That's right. So, pyoderma gangrenosome. Is this painful? Looks painful. Generally not. So this is a painless, very, very geographic bunched out through the dermis skin lesion usually in the extensor surfaces of the arm or the leg. This is seen in inflammatory bowel disease. 5 to 10% Crohn's disease 2% to ask about GIS symptoms if you see that.  You get skin lesions, pyoderma gangrenosome, aftus ulcers which are also painless, IBD, and anterior uveitis as I mentioned before. HLAB 27 positive but if there's inflammatory bowel disease and scleroid uveitis or anterior scleritis it's generally not HLAB 27 disease of course there is a spectrum. What do you see here? Name the disease. Sausage fingers. Yes. The dactylitis. And you also see nail pitting and destruction of the nails, the dactylitis. Exactly. This is a patient with psoriatic arthritis. Remember that psoriatic arthritis but not psoriasis per se are related to anterior uveitis so you have to have the arthritis component. So it's a symmetrical polyarthritis. There is asymmetric oligoarthritis, this DIP joint involvement. There is resorption of the phalanges. So you have shortening of the fingers and lysis of the nails as axial arthritis as well so you can see neck and thoracic spine and lumbar spine. And ankle arthritis is unequalysis, nail pitting, and the sausage disease, the dactylitis and anthocytus as well, which is once again information of the insertion of Achilles tendon. And these are just some findings, you can see the dactylitis here, the nail pitting, the sausage digits, and the unequalysis. These are, let's see. Tyler, what do you see here? So it looks like we have some, I don't know if that's Dan carrying out the earplug information on my sound. So there is band. So I would think about GIA. That's right, so GIA specifically. I'm not exactly right Tyler, but if you look at the conjunctiva, most people you see on call who have anterior uveitis have red painful eyes. This is a quiet anterior uveitis. So then the conjunctiva is white and quiet, but you see evidence of a lot of information. So there's cataract and synechia and band care top and then you'd think this I would be explicitly painful but it's not. Exactly, this is GIA. It's the most common cause of childhood uveitis. Chronic area cyclitis occurs in 10 to 20% of all patients with GIA. It's chronic bilateral smoldering and asymptomatic until complications occur. So once you do get angle closure or, you know, synecule glaucoma. Of course, it does hurt or band starts to erode or the eye starts to get ticycle and hurts. But before then, in its earlier phases, not painful. Loss of vision due to band care top of the posterior synechia CME hypoteny is a very common and unfortunately quite devastating complication and cataract. Cataract can be more serious here than in other uveities, because it occurs in an amylogenic age group. So just remember the highest risk of uveitis is female bossy articular, so oligo articular and a positive but I would advise you guys to go back and read basically risk stratification in GIA and screening guidelines I haven't gone through it here but just know that if you have a female young age of onset with three or less joints involved and in a positive then you have to see her every two to three months in screening. And then of course your risk stratification does dictate your screening. So do things that you need to know about in uveitis when it comes to screening read up GIA screening and read up HIV screening which patients with HIV do you screen and how often. I won't make you guys suffer through this but this is inflammatory. It's a vasculitis. You can see kind of a mixed arterial and venous vasculitis and you can see over here that there's an occlusive vasculitis where there's an area of non perfusion before the, you know after the front of vasculitis. This is actually the chest disease now there are two big manifestations in the eye of the chest disease one is an anti uveitis which is a high, high-po-peon uveitis. But secondly, don't forget that it also causes kind of disseminated systemic occlusive vasculitis not just in the eye but also the brain and the bowel. 25% of patients with just disease of CNS involvement. Do remember also that ischemic necrosis of the bowel is not uncommon patients may also have occlusive retinal vasculitis ban uveitis and ischemic optic neuropathy as a CNS manifestation remember that the Asian variant but not so much the European variant. Sorry, the other way around the European variant but not so much the Asian variant of this disease will have HLAB 51 and HLAB 5 association. And of course there is the benzene reaction of pathogy that they can also ask you about in your boards. And you can see here this is an example of pathogy where 30 gauge needle was was used to make these this linear pattern of punctures and 24 hours later you have these basic this vesicular eruption at the site of off the puncture and this is this is a phenomenon on this pathogy where you get these vesicular eruptions at the site of any skin trauma and this is a hallmark of the chest disease. Sarcoidosis. It's another disease that I could question you about 30 to 60% of patients have eye involvement. What is the most common eye involvement in sarcoidosis abigale sleep. So, most common involvement of the eyes of sarcoidosis is actually lacrimal gland or dry eye. And the UVA is the second most common. Sorry, this was an error in my part. Sorry, this was not supposed to be a trick question. And it's the most common cause of intermediate UVA. It's the most common females, African American origin and Scandinavians. And in Utah most of the patients sarcoidosis you see will have Scandinavian origin. This is another slide that they like to show. These are two non-caseating granulomas within tissue and also a lot of little lymphocytes everywhere. So, very different from the tuberculosis granulomas because they don't have a clear or caseous center. Clinical science suggestive of sarcoidosis.  Cappy nodules. You can also get inferior, inferiorly kind of situated carotid precipitates that are not granulometers, although these are less suggestive. You can also see granules or nodules on the anterior surface of the iris known as basacas nodules. Cappy nodules as you can see can evolve into synechium. Other signs of sarcoidosis you can have macroaneurysms associated with inflammation along the blood vessels, optic nerve head granuloma, as you can see here. These little punched out coroidal, retinocoroidal lesions and also coroidal lesions along the retinal vasculature. Classically the vasculitis is very vanilla. So you see kind of this candle wax dripping or touch the bougie. Very vascular infiltrates denoting very phlebitis in sarcoid. 30% of patients will have lacrimal gland enlargement and 30% will have increased gallium optic in the lacrimal gland. So it does most commonly affect the lacrimal gland, even in asymptomatic patients. Okay, anybody? Abigail? You there? I would think, sorry, Maya. I would think fuchs. Yes, right. So heterochromia, these little periodic precipitates and what's going on here? It's really hard to see on my small screen. I think that's the T. So that's the T. You can see these bridging vessels in fuchs disease. And so, you know, commonly when you depressurize the anterior chamber during cataract surgery, one of the things complications of cataract surgery during fuchs, in a patient with fuchs is getting high fema. And because of the rupture of these bridging blood vessels. Remember, 10% of fuchs heterochromic iracyclitis are bilateral, in which case, of course, they do not have heterochromia. There's iris atrophy, there's fine stellate, periodic precipitates with these little connecting legs, minimal cell and flare. It's an achia, almost never formed. That's an important distinction. Cataract and glaucoma are common. And remember that there are fine vessels that cross the TM on gonioscopy, which makes cataract surgery complicated and can increase your risk. It's often difficult to treat. So you often have to just tolerate a little bit of cell. And that it makes sense then that it's there's a possible association with an infectious agent. And this hasn't been identified in certain PCR studies to be rubella. Remember, there are many differential diagnoses of heterochromia. Fuchs is one of them, but then you have to think about neoplastic disease, ciderosis, herpetic disease can often cause a heterochromia. And that can be CMV, HSV and various other astro virus. And of course, congenital horners. Okay. What's going on here? So Asian kid with strawberry tongue. And yeah, so Kawasaki's disease. So. Why did the cycle? That's weird. Oh, there you go. So it's mucus detenus. The blood syndrome. Remember mortality is related to coronary artery aneurysm and thrombosis. Avoid steroids. That's one question that they'll ask because that can increase your risk. Coronary death. Two thirds have uveitis, 97% bilateral, five days of fever. Conjunctivitis. It spares the limbis. So there's no discharge as well. Strawberry tongue or oral mucosal involvement as a rash of the palms and soles. And there's generalized lymph adenopathy. This is one. Complex that they like to test you for. Was the Schlossman syndrome, which I don't think really exists, but they'll test you in your boards. So it's bilateral glaucoma. It's a unilateral glaucoma, cyclitis crisis. It's a diagnosis of exclusion. Always think HSV, VZV and CNP first. Now, actually the thing, having done that, having done that, taking HSV, VZV and CNP first now, actually the think having done the CR, patients with so-called Bosner Schlossman syndrome, the founders actually, in many cases associated with CMV, my guess is that it's often associated with any of the her rico welding viruses. It's associated with a very high IOB cornial edema fine. KP very. Scanned cell. and flare and you treat with steroids and glaucoma medicines. Often in fact, if the pressure is not too high, if you just treat day one with steroids, only the pressure will come down because it's purely due to trabeculitis. The differential diagnosis of hypertensive uveitis is herpetic, so HSB, VZV, CMV, fuchs, sarcoid, syphilis, and toxoplasma. Lebanese friend of mine says his grandmother used to admonish him by saying psst and SKT. I don't know if this helps anybody, for some reason it helped me, but think about fuchs, syphilis, sarcoid, carotero-uveitis, and toxoplasma. All of these can cause a hypertensive anterior uveitis, but most commonly it's herpetic. Think Lebanese grandmas. Necrotizing retinitis, acute retinal necrosis, progressive outer retinal necrosis, and CMV retinitis. These are things that you need to know about. Viral retinitis may occur in immunocompromised or immunocompromising patients. Retinal detachment occurs in up to 75% of patients and there has been more than one-third involvement of the retina. There are, you'll often have multiple breaks and early, early proliferative vitro retinopathy. You always need oil and the retina tries to crunch even once you have it completely attached.  You treat with IV or oral antivirals and intravitrials. You cannot treat with intravitrials in isolation. And in fact, the role of intravitrials and antivirals is controversial, except perhaps in porn. You can treat with oral valve acyclovir to obtain IV level, IV levels of acyclovir in the blood you treat with two grams, three times a day rather than two grams. The usual one gram, three times a day, we can do that for up to a week and it's safe. You can use IV acyclovir, which would be 10 milligrams per kilogram, three times a day, so every eight hours. You can get intravitrials acyclovir in Europe. You do not get intravitrials acyclovir in the United States. You can use FAMCYCLAVIR, IV or oral, although it's harder to reach the appropriate plasma levels with this drug. You can inject GANCYCLAVIR, you can do IV, Intravitral Orbitricert, which is no longer available, but it was manufactured by Bausch & Lohm. I think I implanted the very last one because it was expired by six months and then we had no more. This was in San Francisco. FOSCARNET can be IV or Intravitrally. The good thing about FOSCARNET is that you use it in the same concentration as what you get in the vial, which is 2,400 milligrams in 0.1 milliliters, so you don't have to re-compound it. Of course, the only oral treatment for... If you want to use something for CMV and if you want to get GANCYCLAVIR in an oral formulation, you have to use VALGANCYCLAVIR. Now, of course, there are three other new antiviral agents that are active against CMV and take an orally. One of them is the DOMOVIR, which is approved for peripheral CMV, but not approved for organ-specific CMV, but we have used it and it has got a much better side effect profile. Remember also that CMV can get resistance to GANCYCLAVIR and by extension to VALGANCYCLAVIR, there is a specific viral mutation that you can actually sequence for, which I forgot. Look it up. Steroids may be added, laser is controversial for necrocritizing retinitis. This is a... Oh, wait a minute, I aren't very critical. So yeah, this is ARN, so you can see GANCYCLAVIR is a rapidly progressive peripheral retinitis, usually multiple foci that starts to come together and move centripetally. It's very fast, it moves about a disc diameter or two disc diameters per day. Notice also that when you look at the blood vessels and in ARN, there is some very vascular apparent clearing. This is not really clearing, it's just kind of an absence of necrosis because washed away through the capillaries around the major blood vessels. So you'll see clearing, although it's not actually clearing, it's just the appearance of very vascular clearing of disease. This is... The difference between this and the previous picture is simply that you have a better view, you have a clearer picture, and that means that there is less necritis. This is as rapidly progressive, if not more, and it's actually harder to treat. This is progressive outer retinone necrosis, which what is the difference between ARN and foreign? ARN is generally seen in immunocompetent patients and foreign is seen exclusively in immunocompromised patients. That does not always mean HIV, that you can see it in organ transplant patients, bone marrow transplant patients, or even patients that you've locally immunosuppressed that have actually been reports of patients who get progressive outer retinal necrosis after an ozioidex injection or a subtenone scandal. So local immunosuppression, obviously can have the same effect as systemic immunosuppression. Foreign needs to be treated more aggressively, is treated with high dose plus garnet and gans like covariant alternating fashion, and treated with IV or very, very high dose. Valtrex in this situation, I prefer IV. So you most commonly, it's very little zoster, as I said, rapid and relentless progression. It involves immaculate early, and there is no too little bit right. Anybody, what's going on here? It's more like CMV retinitis. Right, so this is pretty classic CMV retinitis. So you see kind of this progression along the arcade. How fast does CMV retinitis progress? Not very fast, about this diameter per week. So even if you saw this, you don't have to panic. Obviously, this one is very close to the macular, so maybe you should panic. And you should treat this with integrals, but if you see peripheral CMV retinitis, you don't have to treat with integrals or go to IVs immediately. In the HIV era, you would often treat peripheral CMV with careful observation and just trying to get patients under control with antivirals and treat the immune suppression first. And then start treating the eye with intrabitural gun cycle where once it starts to show evidence of progression, that's how slow it is. But equally devastating, because it's hard to stop. It's not as devastating now that we have good treatments for HIV. But with CMV, you can see peripheral vascular occlusion and occlusive vascularitis is actually very common in these patients. I have patients with armed to artery time of about a minute with CMV retinitis. So immunocompromised patients, not just HIV, CD4 counts of less than 50, retinitis with hemorrhage, all the layers of the retina tend to be affected in a granular fashion in the periphery. Usually starts along the arcades, but can occur anywhere. And there's a segmental vascularitis that's occlusive. What's this? This is HIV retinopathy. You can see multiple cotton wool spots. It looks a lot like diabetic retinopathy. Kind of a hybrid of diabetic and hypertensive retinopathy. This is a microvascular disease that's induced by immune complex disease in patients with HIV. It is not an infectious retinitis. Remember that it does not, it just means that the patient has uncontrolled or poorly controlled HIV. So it's a microvascular retinopathy along the arcades, not infectious as cotton wool spots and hemorrhages. It resembles very much interferon retinopathy. That's an entity that you will see less and less off because we're using less and less interferon in the treatment of hepatitis. But it does resolve with heart. What's this? Toxin. Yeah, exactly. So you have retinocoriditis adjacent to a scar. With, usually there's overlaying with arthritis, which it's unusual to see such a clear picture, but this is toxoplasma. Remember that it's an obligate intracellular parasite. The cat is the definitive host. I don't know if anybody read the Nature article, but it actually makes mice less afraid of cats as an evolutionary adaptation where a toxoplasma infected mouse will be unafraid of a cat and then go up to the cat, get eaten and perpetuate the life cycle of toxoplasma, which I thought was pretty cool. You can also get it and most commonly you get it from undercooked meat, soil and cat poop. As you can see is number three. In Brazil, the most common, which is the place with the highest incidence of toxoplasma, the main culprit is undercooked meat. Remember that the bradyzoid is the latent system, the tachyzoid is the phase of the organism that causes retinocoriditis. Remember that there's a white yellow lesion with retritis, overlying it. Active lesions occur at the edge of old scars. Inutrious infection is as common as acquired infection. And if you have a patient with de novo toxoplasma as not associated with the scar, think about HIV. And if a patient is HIV positive and has toxoplasma in the eye, always obtain a CT off the brain because you'll see these ring-enhancing lesions. Treatment options do include triple therapy, pyromethymine, subpoenomy, pyromethymine, is that's from isentrovercone and prednisone after 24 hours. This is an example of toxocara, which is an intestinal parasite. So remember if they ask you what it is, it's a nematode. So this is a larval form, insisted larval form of a nematode. Children and young adults, usually, you know, lateral, it is one cause of glucocorrhea, but when the cyst does erupt, there is the endothelitis phase. It's usually peripheral granuloma. You can treat with albendazol and the steroid. You can actually resect the cyst as well, but do that with caution. White dot syndromes, this is something they love to ask about. Here's a 67-year-old with nictalopia and vitritis. This is birdshot. You can see some of these bicep form lesions, which you can actually enumerate better with ICG and geography. More than patients tend to be greater than 40 years of age. Median age is 57. There's blurring of vision, loss of color vision, nictalopia, contrast, sensitivity problems. Vitritis, vascular attenuation, late discadema is actually a fairly common presentation, CME and significant risk of CNBM. Not as high as PICC or multifocal corridors, but still exists between 50 and 30%. Multiple cream-colored radially-oriented lesions in the post-ecritorial fundus. And then remember, of course, the HLA-A29 association, which is actually one of two HLA associations that I ever looked for in my clinic, because if a patient is HLA-A29 negative, I rethink my diagnosis of birdshot. What is this? Mr. Ali here. Serpigenous. That's right. So Ali and I were seeing a patient that we were suspicious for serpigenous and it was actually just AMD. But this is a patient with true serpigenous. And you can see that there's it's blurring of this area here over the fovea and then the macular is obliterated in this situation. And it's usually older patients over 40 geographic pattern. It used to be called helicoid cororectal atrophy. It's most commonly peripapillary, but it can in about 10% start in the macular. And then it can also start in a multifocal fashion, in which case it's called Ampigenous or Lentus Blackoid. Block early stain late, like most inflammatory couridopathies, there's a transmission defect. It's progressive with multiple crops of recurrence and it can often result in CNBM up to 40%. It often needs treatment with alkylating agents, although I'm more likely to go to Rituximab now before I do an alkylating agent. And geography. This is actually a really good distinguishing test, but number, if you look on the left side of the slide, you can see that there's this early blockage with late staining. So this was the area that I was pointing out to you that stains late and it's central macular progression. And then on the other side, you don't see so much of this early blockage in this staining because it's less active, but one way to differentiate this from other geographic forms of retinal, or geographic retinal disease such as GA and AMD is in the mid and late phases of the angiogram. You see this kind of brush fire type staining at the edge of the lesion. This does not imply involved, actually this does not imply activity. Mudes. Another disease I'd like to ask about young to middle age, women 90%, 90% unilateral, but remember it can also be 10% bilateral. You see granular or puncture changes in the macular if you look really closely. The spots are small about 100 to 200 microns about the size of, between the size of an artery and a vein leaving the upper nerve. There's reeds like staining and this has always confused me. Is it the whole thing? Is it the entire distribution of the spots that are reeds or is it the spots themselves that are reeds? Turns out that the reeds like staining is actually those little spots in themselves that have this little reeds like pattern. You'll see in a large blind spot. And if you do a multifocal ERG or in the peripapillary zone, you'll see why there's an enlarge blind spot you see of the iteration of ERG aptitudes along in the peripapillary zone. So, and geographically you can see these little reeds like spots, these little dots kind of arranged in these little reeds. ICG will show you more numerous lesions, but once again, you can see punctured hyper fluorescence and staining late of these lesions and of the optic nerve. Sometimes you get a little bit of vitritus and a little bit of dyskidema as well. The rate of recurrence of mutes is 10%. Just remember that. This is a case of very classic ampy. So apmopopy, acute placoid multifocal pigment, apitheliopathy. Posterior pigment apitheliopathy. Acute posterior multifocal placoid pigment apitheliopathy, yeah. So this is, has a viral prodrome most common days. Usually young adults, cream colored plaques, approximately one disc diameter is much larger, much, much larger than what you see in mutes. They disappear over several weeks. The FA will remain abnormal, usually bilateral most do well, but many end up with a little bit of scarring. I tend to treat with steroids, but as far as your own caps are concerned, you can just say that it's a self-limiting disease. Yeah, and just also remember that a lot of these patients have headache. And if you do have patients with headache, always do at the very least an MRA, M-R-B because about five to 10% in literature patients with MPR do have cerebral vasculitis as well. And I've seen, you know, fleeting cases of cerebral vasculitis in MP, and but I've also seen bilateral pontine in parts in Amphigenus. So it's important to screen for cerebral vasculitis. This is a case of PIC, or punctate inner choridopathy, where you see these little spots, most classically in the macula, but you can have extra macular spots. The difference between PIC and multifocal choriditis is that PIC does not have vitritus. That was the dogma, however, it's more now recognized to be a spectrum between PIC and multifocal choriditis, where you do in fact see a little bit of a difference in a little bit of posterior vitreous cell if you were to do a swap source imaging or OCT of the premacular vitreous. This is a case of multifocal choriditis where you can see more vitritus, discodema, kind of a more blood and thunder type appearance. And more with the pan-UVI, I just can kind of appearance rather than PIC, which is more quiet looking. So remember in multifocal versus PIC, there's vitritus versus no vitritus, the lesions are smaller in PIC, whereas in multifocal choriditis, they're up to 200 microns. The course is chronic in multifocal choriditis and often the majority of patients will need immunomodulatory therapy, whereas in PIC, needing immunomodulatory therapy is the exception of the rule. It's self-limited. And the most common manifestation of PIC is CNBM. Ciflis, this is something we're seeing more and more often in our clinics. You remember there's a difference between congenital and secondary Ciflis. Congenital Ciflis usually presents with, it can present with UVA's, but most commonly presents with interstitial keratitis and peripheral congenital looking retinopathy and deafness and all that stuff. Secondary Ciflis will present with rash and arthritis, iridus, retinitis, choriditis, basically it can do anything. In testing previously, you would do a trapanemial and non-trapanemial test. So you do an FDA and an RPR or you do an MHATP and a BRDL. But now we tend to do something called reverse sequence testing. This is that will not be tested in your OCAPs because it's very new, but in reverse sequence testing, you start with IDG testing in the blood.  That's a pretty good way of going about it. If the patient has UVIS, you always need to do a lumbar puncture to rule out neurociflis. And despite what some of your ID friends may say, all patients with Ciflitic UVIS need to be treated as if it is neurociflis. So CDC guidelines are to do a lumbar puncture at day zero before treatment and then in six months to check for CSF, VDRL. You can use penicillin G, IV, or IM for two weeks, but you have to make sure that you use IV if there is neurociflis. Lyme is also a spirochete related to, at least morphologically, and in size to Ciflis. They always ask you the name of the tick. It's Ixides or the deer tick. It also has stages very similar to Ciflis, where there's a primary stage one month after infection with erythema chronicum migrans and follicular conjunctivitis. Stage two, one to four months after infection with neurocardiac abnormalities and arthritis. And in this stage, you start to get ocular involvement with iritis, keratitis, and intermediate ubiitis. Stage three, chronic arthritis, meningitis and keratitis. And you treat with tetracycline or Ib-CEF-triaxone if CNS involvement is present. Over here in the West, people laugh about Lyme diagnosis and that's true because your pre-test probability is very, very low because it's not transmitted here. However, we had several cases of Lyme keratitis and Lyme ubiitis in Long Island, New York. So if you end up practicing out East, then doing a test for Lyme is not foolish. But if you're practicing out West, doing a test for Lyme is not particularly a good idea because you get false positives. Sympathetic oftalmia, you get bilateral granulometous banubiitis, remember it is bilateral. So even if you were to take the, of course, you don't really look at the inciting eye because it's often ticycle or there's no view. But if you were to take this eye out and do a pathological examination of this eye, just remember that it is still a bilateral disease. It happens due to 50 weeks or longer after injury to the inciting eye. There's diffuse granulometous coroidal information that's bilateral, exudative RD. Previously, they would say that it spares a coriocapularis. Sympathetic is sympathetic to the coriocapularis. This is not true. This is a histological artifact. It does in fact involve the coriocapularis. But depending on how your OCAP question is asked, sometimes you do have to give false information. Remember the Dallons-Fupe nodule is a pathological lesion. There was some controversy about whether or not you should inoculate the inciting eye before one to two weeks have evolved. But that becomes for two reasons. Number one, we can treat sympathetic ophthalmia really well with immunomodulation. And secondly, now the number one inciting factor is actually surgery, especially vitroretinal surgery. So you wouldn't be able to think about removing the inciting eye when the inciting event is surgery. So not pretty relevant to do that anymore. That's not an eye, it's an eye. God. So this is an example of sympathetic ophthalmia, granulometers and vanuviitis with an exudative retinal detachment. You can see that this is somewhat multi-lobulated. And if you were to turn the patient to the side, this retinal detachment would shift. So kind of a hallmark of exudative retinitis, or exudative retinal detachment. This is what a Dallons-Fupe nodule looks like under the RPE at the level of the cordial capillaris with overlying elevation of the outer retina. VKH is basically just sympathetic ophthalmia without trauma. That's all it is. It's an histologically indistinguishable disease. However, there are systemic manifestations of chronic diffuse bile for granulometers, uveitis, exudative RD. No prior history of trauma and it's in certain populations such as indigenous American populations, the Inuit and in Japan, but I've seen it in India, Pakistan and Iran as well, and in the Middle Eastern or Saudi populations as well. So remember this vitiligo, poliosis. Poliosis is a whitening of eyelashes. You'll have headache, meningismus, loss of consciousness, paralysis, deafness and tenitis. Those are the main neurological manifestations. Know also that interestingly, you can see these manifestations also in sympathetic. I've had patients with sympathetic with hearing loss and ringing in their ears and whatnot. But here's an example. So you see this multi-lobed neurosensory RG with kind of these corrugations and dyscypremia. The angiogram is very telling this kind of this, this punctate hyperfluorescence that then pools into the sub-retinal space given this initial starry sky pattern followed by this pooling everywhere. You can see a good example of pooling here. This is, I'm moving on. This is, these are examples of intraocular lymphoma where you see atypical vitrious cells in sheets. You see kind of an iris and ciliary body mass in a patient with B-cell lymphoma. See how the mass is pushing the IOL backwards. And then you see this patient who was sent in as Arne, who I looked at and said, this does not look like Arne. This was actually lymphoma as well. One reason you can tell is that there's these different ages of lesions which you don't see so much in Arne. So large B-cell lymphoma is the most common presentation in the eye. It may be primary, ocular or CNS. Bilateral is more likely to be CNS. If you see unusual cells in clumps, think about lymphoma. If it's partially responsive to steroids, think about lymphoma, but even lymphoma can respond partially to steroids because there is some pericellular inflammation, something called Desmoplasia. So treat with intravitral rituximab and methotrexate if ocular only, but if it's bilateral, do consider systemic treatment in fact, a lot of centers do that for bilateral disease without CNS involvement. Coroidal lymphoma is a different animal. Remember small B-cell lymphoma, not large B-cell lymphoma. CNS involvement is almost unheard of. Systemic involvement at presentation is common. So you see this retroperitneal or hiler or mediastinal involvement without CNS involvement. But ongoing screening is not often necessary because if there is no systemic involvement in presentation, that tends not to be a future systemic involvement. This is a patient with, you can see this tiny hypopion and some exudate along the IOL. This is the chronic endophthalmitis. B-acne, but it can also be others. I've seen clostridium. I've seen corinibacterial. I've even seen strep chronic endophthalmitis, which was weird. But you can get inflammation in the eyes up to two years after any kind of surgery. You'll see AC cell, geriatric precipitates in a small hypopion. You see plaques on the intraocular lens, vitritis. And actually sometimes when you see these plaques on the IOL and you do a YAG, you can actually liberate these organisms into the pictures precipitating an attack of B-acne endophthalmitis. So always think of endophthalmitis when the patient has a history of surgery. And also I'm going to give you guys this presentation to look at, but these are all the various HLA associations. And I don't know about you guys right now, but back in my day, the OCAPs would love to ask what HLA associations, which are totally useless, except for HLA B-27 and HLA A-29. That's the only two HLA associations that in practice you know about, but unfortunately for your OCAPs, it's nice to know some of these others just because they love to ask. And that's it. Any questions?


Well a very big thank you to our support partners and on that note I'd like to invite chairman and editor in chief exchange for Media group none other than Anurag Bhattra Thank you.  Can you do a really big round of applause for her? There are cameras there whoever applaud loudly will get extra beer and drinks, right? So do it for yourself on a serious note. It's my honor and privilege to welcome you to the Neons, I'd like to specially acknowledge the presence of our jury chair and an industry leader mr. Kamal Jeet Bawa who's the MD and CEO of dyke in there so please Give a big round of applause because our awards are all about the jury You know I have me or novel would not even if novel was at the jury He wouldn't have influenced the jury, but he can tell you that we really jury is central to what we do I can see some other leaders from the industry mr. Bandula is there mr. Jalan is there But I'd like to acknowledge jury members if I forget someone because I can't see them. Please. Pardon me. I See my friend DJ here somewhere. Yes, the orisa oria association, right Sanjay. They're forming an oria association Every other jury member mr. Sujit Sudhakaran Vivek Malhotra, Yuggesh Tiwari Subha Shubha Iyer Kaushik Prasad Neil Pandia Ashish Bajaj Anuja Mishra and my friend Abdul Khan who's not here if he was there I would know he's here. He's based in Bombay as I said in the morning this year. We got 360 plus entries We pruned it down pruned it down to 120 shortlist and about 30 of them are 30 order getting awards as I said in the morning the two people winners are Winners that I if I were in the jury, I would award them. So I'm very happy that those two gentlemen are being awarded As I said, this is the most honest and credible awards Nobody including me can have a say in that and we cut off our hands because we believe that Only way to do something is to do it with honesty and passion So tonight if you win mr. Java and the jury members are the reason you won and your work We at exchange for media are only a custodian of the process So we hope tonight when we celebrate the great advertising that happens in outer form We celebrate your talent and your future. Thank you.


You can be a Christian and find truth and value in other world views and religions Let's make this clear Jesus didn't leave holes for other religions to fill He didn't intentionally leave us with questions that only Islam Buddhism or Judaism could fill Jesus is the truth And yet Judaism says that he was merely a teacher Islam says that he was a prophet and Buddhism says that he could be one of many Gods, how could you find truth in a belief system that rejects the ultimate foundation for truth? It doesn't make any sense while other religions may promote the idea of loving each other We need to understand that that is a distorted love without a true understanding of God We won't have a knowledge of love because God is love follow for more Christ-centered content