Different anomalies related to the inappropriate development of the ductus arteriosus or the aortic arch have been described, in some cases accompanied with chromosomal or morphological anomalies, and also being able to form a vascular ring that can compromise the postnatal life.
Generally occurs secondary to pulmonary atresia with intact IVS .
Pathophysiology- it develops because of a reduction in the blood flow secondary to inflow impedence from tricuspid atresia or outflow impedence from pulmonary arterial atresia .
Typical findings- a small , hypertrophic RV and a small or absent pulmonary artery
The term “complete transposition of the great
arteries” (TGA) is traditionally used to name congenital
heart defects (CHDs) that are characterized by discordant
ventriculo-arterial connections. In such a situation, the
morphologically right ventricle is abnormally connected
to the ascending aorta while the morphologically left
ventricle is abnormally connected to the pulmonary trunk.
In the majority of cases, discordant ventriculo-arterial
connections are associated with parallel (non-spiraling)
arrangement of the arterial trunks, suggesting that the
condition may have resulted from abnormal development
of the outflow tract of the embryonic heart.[1,2] Parallel
arrangement (non-spiraling) of the great arterial trunks,
however, does not necessarily indicate the presence of
TGA. For example, a few cases have been reported in
which TGA occurred with normal spiraling of the arterial
trunks. Furthermore, in cases of CHDs with a solitary
ventricle of indeterminate morphology (“univentricular”
hearts), parallel great arterial trunks cannot be connected
in a discordant fashion to the ventricle since neither a
morphologically right nor a morphologically left ventricle
exists. Parallel arrangement (non-spiraling) of the great
arterial trunks, thus, should not be named TGA but
rather “malposition of the great arterial trunks”
Transposition of Great Arteries;TGA,Firas Aljanadi,MDFIRAS ALJANADI
presentation about the Transposition of great arteries.Definition,Epidemiology,History,Embryology,Classification,Anatomy,Coronary arteries,Physiology,natural history,clinical presentation,doagnosis,management.palliative and definitive treatment,Arterial switch operation,atrial switch,senning,mustard,special cases,with VSD ,with PS.
Generally occurs secondary to pulmonary atresia with intact IVS .
Pathophysiology- it develops because of a reduction in the blood flow secondary to inflow impedence from tricuspid atresia or outflow impedence from pulmonary arterial atresia .
Typical findings- a small , hypertrophic RV and a small or absent pulmonary artery
The term “complete transposition of the great
arteries” (TGA) is traditionally used to name congenital
heart defects (CHDs) that are characterized by discordant
ventriculo-arterial connections. In such a situation, the
morphologically right ventricle is abnormally connected
to the ascending aorta while the morphologically left
ventricle is abnormally connected to the pulmonary trunk.
In the majority of cases, discordant ventriculo-arterial
connections are associated with parallel (non-spiraling)
arrangement of the arterial trunks, suggesting that the
condition may have resulted from abnormal development
of the outflow tract of the embryonic heart.[1,2] Parallel
arrangement (non-spiraling) of the great arterial trunks,
however, does not necessarily indicate the presence of
TGA. For example, a few cases have been reported in
which TGA occurred with normal spiraling of the arterial
trunks. Furthermore, in cases of CHDs with a solitary
ventricle of indeterminate morphology (“univentricular”
hearts), parallel great arterial trunks cannot be connected
in a discordant fashion to the ventricle since neither a
morphologically right nor a morphologically left ventricle
exists. Parallel arrangement (non-spiraling) of the great
arterial trunks, thus, should not be named TGA but
rather “malposition of the great arterial trunks”
Transposition of Great Arteries;TGA,Firas Aljanadi,MDFIRAS ALJANADI
presentation about the Transposition of great arteries.Definition,Epidemiology,History,Embryology,Classification,Anatomy,Coronary arteries,Physiology,natural history,clinical presentation,doagnosis,management.palliative and definitive treatment,Arterial switch operation,atrial switch,senning,mustard,special cases,with VSD ,with PS.
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Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Its association with Pulmonary Atresia is considered to be the most severe form, the diagnosis of which plays an important role in determination of the treatment protocol. In such cases, systemic vascular channels called Major Aortopulmonary Collateral Arteries (MAPCA’s) develop from aorta and its major branches to supply and maintain the pulmonary circulation. Such patients commonly undergo a Cardiac CT as an imperative pre-operative investigation for detailed information of these collaterals which helps plan further management. Here, we present a Case Report of an adult female patient with Pentalogy of Fallot wherein, a Cardiac CT showed the presence of dilated coronary-to-pulmonary collateral circulation. i.e. CAPA apart from the normally visualized MAPCA’s, an extremely rare occurrence.
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Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Its association with Pulmonary Atresia is considered to be the most severe form, the diagnosis of which plays an important role in determination of the treatment protocol. In such cases, systemic vascular channels called Major Aortopulmonary Collateral Arteries (MAPCA’s) develop from aorta and its major branches to supply and maintain the pulmonary circulation. Such patients commonly undergo a Cardiac CT as an imperative pre-operative investigation for detailed information of these collaterals which helps plan further management. Here, we present a Case Report of an adult female patient with Pentalogy of Fallot wherein, a Cardiac CT showed the presence of dilated coronary-to-pulmonary collateral circulation. i.e. CAPA apart from the normally visualized MAPCA’s, an extremely rare occurrence.
A Road From Coronary To Pulmonary: A Rare Imaging Presentationkomalicarol
Tetralogy of Fallot (TOF) is the most common cyanotic congenital
heart disease. Its association with Pulmonary Atresia is considered
to be the most severe form, the diagnosis of which plays an important role in determination of the treatment protocol. In such cases,
systemic vascular channels called Major Aortopulmonary Collateral Arteries (MAPCA’s) develop from aorta and its major branches to supply and maintain the pulmonary circulation. Such patients
commonly undergo a Cardiac CT as an imperative pre-operative
investigation for detailed information of these collaterals which
helps plan further management. Here, we present a Case Report of
an adult female patient with Pentalogy of Fallot wherein, a Cardiac CT showed the presence of dilated coronary-to-pulmonary collateral circulation. i.e. CAPA apart from the normally visualized
MAPCA’s, an extremely rare occurrence.
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Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Its association with Pulmonary Atresia is considered to be the most severe form, the diagnosis of which plays an important role in determination of the treatment protocol. In such cases, systemic vascular channels called Major Aortopulmonary Collateral Arteries (MAPCA’s) develop from aorta and its major branches to supply and maintain the pulmonary circulation.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
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14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
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Fetal Vascular Rings: Beyond The Anomalies of The Aortic Arch
1. Annals of Clinical and Medical
Case Reports
Case Report
Fetal Vascular Rings: Beyond The Anomalies of The Aortic Arch
Vila J1
, Ferrer Q1, 2
, Albaiges G1
, Rodriguez MA1
, Rodriguez-Melcon A3
, Serra B3
, Prats P1, 3, *
1
Department of Obstetrics, Gynaecology and Reproduction, Instituto Universitario Dexeus, Barcelona
2
Department of Paediatric Cardiology, Hospital Vall d’Hebron, Barcelona
3
Department of Obstetrics, Gynaecology and Reproduction, Instituto Universitario Dexeus, Barcelona.
Volume 3 Issue 2- 2020
Received Date: 27 Feb 2020
Accepted Date: 18 Mar 2020
Published Date: 24 Mar 2020
2. Key words
Ductus Arteriosus (DA), Right Duc-
tus Arteriosus (RDA), Aberrant Right
Subclavian Artery (ARSA), Left Aortic
Arch (LAA), Sd.Di George.
1. Abstract
Different anomalies related to the inappropriate development of the ductus arteriosus or the
aortic arch have been described, in some cases accompanied with chromosomal or morpho-
logical anomalies, and also being able to form a vascular ring that can compromise the post-
natal life. For this reason, a complete fetal anatomy examination and cardiovascular study is
needed to discard possible other malformations or ultrasound markers for fetal syndromes. A
detailed prenatal diagnosis of the type of ductal arch anomaly and possible vascular ring can
give us a postnatal prognosis and help pediatricians with the management of symptomatic
neonates.
The abnormalities related to the position or branching of the ductal arch (ductus arteriosus)
are very uncommon. We describe the first case reported of prenatal diagnosis of right ductus
arteriosus, left aortic arch and aberrant right subclavian artery associated with 22q11 deletion.
3. Introduction
The fetalductus arteriosus (DA)is a vascular structure with func-
tional importance in the fetal circulation. It connects the Main
Pulmonary Artery (MPA) or its left branch to the aorta, diverting
blood flow apart from the pulmonary vascular bed to the systemic
circulation.
In the model of embryonic vascular development, six pairs of aor-
tic arches communicate the ventral and dorsal aortas. The ductus
arteriosus arisesfrom the sixth aortic arch. In a normally developed
heart, the normal branching of the left aortic arch is, from right to
left: brachiocephalic trunk (rising right common carotid and right
subclavian), left common carotid and left subclavian artery [1]. In
normal cardiac development, both right aortic and ductal arches
regress at 4-7 gestational weeks [2] (Figure 1).
Different anomalies related to theinappropriate development of the
aortic and ductal arches have been described, with a prevalence of
1-2% [3,4]. Arch anomalies refer to a variety of congenital abnor-
malities that are related to the position or branching of the aortic
and/or ductal arches. Aortic arch anomalies are most common.
However, other uncommon abnormalities of position/branching
of the ductal arch may occur (right or double DA, unusual, tortu-
ous or S-shaped ductus). Scarce data is published in the literature
about right ductus arteriosus (RDA)[2-15]. Most of the papers de-
scribe RDA associated to Right Aortic Arch (RAA) or in the con-
text of Congenital Heart Disease (CHD)[2]. The aim of this study is
to report a new case of an uncommon type of RDA with Left Aortic
Arch (LAA) without a major CHD and to review the literature.
Figure 1: Hypothetical double aortic arch model of Jesse E.Edwards. Ao,
ascending (ventral) aorta; DA, descending (dorsal)aorta; T, trachea; E, esophagus;
LAA, left aortic arch; LC, left commoncarotid artery; LPA, left pulmonary artery;
LS, left subclavianartery; P, main pulmonary artery; RAA, right aortic arch; RC,
rightcommon carotid artery; RPA, right pulmonary artery; RS, rightsubclavian
artery.
*Corresponding Author (s): Pilar Prats Rodríguez, Department of Obstetrics, Instituto Universi-
tario Dexeus, Barcelona, E-mail: pilpra@dexeus.com
http://www.acmcasereport.com/
Citation: Prats P, Fetal Vascular Rings: Beyond The Anomalies of The Aortic Arch. Annals of Clinical and
Medical Case Reports. 2020; 3(1): 1-5.
3. ferent combinations might occur: RAA with left ductus arteriosus
(LDA), RAA with RDA, double aortic arch or LAA with RDA, as
in our case. In the cases of RDA with LAA, 3VT view is completely
abnormal. RDA with RAA, however, needs more attention and it
could be easily overlooked: RAA with RDA form a V-shaped con-
figuration like the normal fetal anatomy, but on the right side of
the trachea [13].
3D/4D ultrasound can be very useful for a more precise diagnosis
in case of vascular rings. In this case, 4D clarified the relationship
between the vascular structures (Figures 4, Figures 5).
In addition, a complete fetal anatomy examination is needed to
discard other malformations or ultrasound markers for fetal syn-
dromes.
RDA with LAA is a very uncommon anomaly. We could find no
reference to it in the main prenatal diagnosis textbooks and we
found only 3 reports about RDA and LAA in the on line literature
(Table 1). The lack of literature might be due to the rarity of this
anomaly and also to the difficulty of its diagnose. A few more re-
ports describe the association of RDA with RAA [2,13] diagnosed
prenatally. All cases of RDA in pediatric literature are associated
to other cardiac malformations [5, 8]. Despite of the limited liter-
ature, we would suspect that most cases of RDA are isolated, and
remain undetected. We believe this because RDA is diagnosed after
delivery only when it remains patent, and this occurs manly in as-
sociation with CHD or other pathologic states.
To our knowledge this is the first case of prenatal diagnosis of RDA,
LAA and ARSA associated with 22q11 deletion. DiGeorge Syn-
drome is associated with anomalies of the cardiac outflow tracts.
In this case, DA was displaced to the right. Classically the anoma-
lies of the aortic arch are associated with congenital heart defects,
chromosomal anomalies, especially trisomy 21 or deletion 22q11
[20,21], but DA abnormalities are seldom mentioned.
In our case, the child had mild symptoms of compression after de-
livery but surgery was no needed. There isno consensus between
pediatricians an obstetricianregardingesophagus or trachea com-
pression symptoms. According to prenatal series most of the vas-
cular rings are asymptomatic after delivery, with the exception of
DAA and some cases of RAA with ARSA [22,23]. However, pe-
diatricians report that between 30 and 60% of cases of anomalies
in aortic arch and ARSA can cause obstructive symptoms due to
an extrinsic compression of the esophagus and trachea [24,25].
It is described significant tracheal compression in asymptomatic
infants with a RAA and left DA, considering an early airway in-
vestigation even in this type of patients[26]. Another sign recently
described that should be taken into account is the high incidence
of progressive stenos is in aberrant left sub clavian artery (ALSA)
with RAA in asymptomatic newborns [27]. In our case, the RDA
was associated to an ARSA that might worsen the prognosis.
6. Conclusion
In conclusion, ductal abnormalities are uncommon in prenatal life.
Prenatal diagnosis of RDA is feasible and its diagnosis provides
several benefits. Making a detailed prenatal diagnosis of the type
of ductal arch anomaly and possible vascular ring can give us a
postnatal prognosis and help pediatricians with the management
of symptomatic neonates. Arch anomalies, aortic or ductal, can be
either isolated or associated to other anomalies, commonly con-
genital heart diseases, and chromosomal abnormalities, including
Figure 3: Transversal thoracic view, upper mediastinum using STIC technique:
left aortic arch forming a complete vascular ring with the right ductal arch (cross
ribbon sign). Ao, aorta; t, trachea; da, descending aorta; rda, right ductus arteriosus.
Figure 5: Transversal thoracic view, upper mediastinum: Bifurcation of the
pulmonary artery, with the formation of the right DA originating in the right
pulmonary artery and ending in the aortic isthmus. DA, descending aorta; RDA,
right ductus arteriosus; PA-rt, right pulmonary artery; lt-PA, left pulmonary artery;
r, right; l, left.
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4. 22q11 deletion, as in our case. Based on this association invasive
testing should be highly considered prenatally.
7. Aknowledgements
Under the auspices of the Càtedra d’ Investigacióen Obstetríciai
Ginecologia de la Universitat Autònoma de Barcelona.
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