this slide share will provide the information about orphan diseases and its management . this will give the introduction of orphan disease , what are drugs used for these diseases and how the diseases can be managed.
Recent advances of alzheimer's disease boc sciencesBOC-Sciences
Alzheimer's is a type of dementia that causes problems with memory, thinking and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks. Here, we sort out the recent advences of Alzheimer's Disease.
Disorders of amino acid metabolism
Disorders of renal amino acid transport
Disorders of carbohydrate metabolism and transport
Carbohydrate-deficient protein syndromes
carbohydrate metabolism and transport
Disorders of fatty acid oxidation
Disorders of purine and pyrimidine metabolism
Disorders of lipid and lipoprotein metabolism
Ceroid lipofuscinosis and other lipidoses.
Disorders of serum lipoproteins
Lysosomal disorders
Peroxisomal disorders
Disorders of metal metabolism
Porphyrias
Alzheimer's is the most common form of dementia, a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Alzheimer's disease accounts for 60 to 80 percent of dementia cases.
The word "myopathy" means disease of the muscle tissue. As the term implies, mitochondrial myopathy (MM) is a neuromuscular disease caused by damage to the mitochondria. Many patients with mitochondrial disease have a mitochondrial myopathy, either as their sole diagnosis or as an additional, descriptive co-diagnosis as part of their mitochondrial disorder. Mitochondrial myopathy may be present in adults and children, and may occur with or without a genetic mitochondrial disease diagnosis. Further, several clinical trials are currently examining the impact of various therapies or potential treatments for people with mitochondrial myopathy.
Recent advances of alzheimer's disease boc sciencesBOC-Sciences
Alzheimer's is a type of dementia that causes problems with memory, thinking and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks. Here, we sort out the recent advences of Alzheimer's Disease.
Disorders of amino acid metabolism
Disorders of renal amino acid transport
Disorders of carbohydrate metabolism and transport
Carbohydrate-deficient protein syndromes
carbohydrate metabolism and transport
Disorders of fatty acid oxidation
Disorders of purine and pyrimidine metabolism
Disorders of lipid and lipoprotein metabolism
Ceroid lipofuscinosis and other lipidoses.
Disorders of serum lipoproteins
Lysosomal disorders
Peroxisomal disorders
Disorders of metal metabolism
Porphyrias
Alzheimer's is the most common form of dementia, a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Alzheimer's disease accounts for 60 to 80 percent of dementia cases.
The word "myopathy" means disease of the muscle tissue. As the term implies, mitochondrial myopathy (MM) is a neuromuscular disease caused by damage to the mitochondria. Many patients with mitochondrial disease have a mitochondrial myopathy, either as their sole diagnosis or as an additional, descriptive co-diagnosis as part of their mitochondrial disorder. Mitochondrial myopathy may be present in adults and children, and may occur with or without a genetic mitochondrial disease diagnosis. Further, several clinical trials are currently examining the impact of various therapies or potential treatments for people with mitochondrial myopathy.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
1. ORPHAN DISEASES AND ITS
MANAGEMENT
K.VISHNUPRIYA,
M.Pharm(pharmacology),
Ratnam institute of pharmacy,
Nellore.
2. INTRODUCTION
WHO Defines Orphan/ rare disease are “ All pathogenic conditions are
affected by 0.65 – 1% out of every 1000 inhabitants”.
The European organization – defines Orphan is one with prevalence of
5:10,000 Europeans.
USA defines it is an aliment affecting fewer than 2,00,000 Americans.
Australia defines it is an aliment affecting fewer than 2,000.
India defines it is an aliment affecting fewer than 50,000 Indian patients.
Orphan drugs :
The drugs which used to treat Orphan diseases are called as Orphan
drugs.
Eg: Haem arginate – acute
Intermittent porphyria
Ibuprofen – dutus arteriosus
3. INTRODUCTION
Orphan drug law :
In 1984 United states promulgated the 1st law which is specially
designed to encourage R&D investments in areas usually neglected by
pharmaceutical companies.
Subsequently other countries like Japan(1993), Australia(1998) and
European union(2000) have adopted similar laws.
India follows the European laws
The Orphan drug law depends on 2 criteria
1. Epidemiological criterion:
The product is aimed to cure or treat the disease with low prevalence
2. Economic criterion: Irrespective of disease prevalence, there is no
reasonable expectation R&D production cost will be recovered by sale
revenues in countries where the Orphan status is granted.
4. INTRODUCTION
Incentives of pharmaceutical companies:
1. Push mechanisms: these are incentives that operates upstream during
R&D process and involve costs to the public sector, such as tax credits and
research grants.
2. Pull mechanisms: these are incentives that operates downstream reward
the research output and offers public incentives for development of product.
5. Various orphan diseases
Name of Pathophysiology Age of % of Symptoms Management
the disease occurrence occurrence
1.Handigodu It is an inherited 10 yrs to 0.01% sever joint & hip no cure but
syndrome degenerative adult pains, dwarfism, pain manage-
osteoarthropathy deformation of - ment is
limbs available
2. Acromegaly it is characterized Adults 0.02% skeletal & soft tissue Octreotide,
by exaggerated growth deformities, Lanreotide,
somatic growth due teeth separation, wt Cabergoline,
to increased growth gain, fatigue & heat Pegvisomant
hormone secretion intolerance
in an adult after
the epiphysis
6. Various orphan diseases
Name of the Pathophysiology Age of % of Symptoms Management
Disease occurrence occurrence
3. Muscular it is rare inborn copper Weakness, muscle Glucocorticiods,
dystrophy storage disorder which All 0.02% atrophy& elevated physiotherapy
is characterized by levels of serum & gene therapy
progressive skeletal enzyme creatinine
muscle weakness. kinase
4. Grave
disease it is an autoimmune Adult 0.03% Hyper thyroidism, Anti thyroid
disease which affect Anti thyroid unusual drugs
affect thyroid gland intolerance to heat,
fatigue, wt loss &
protrusion of eye
balls
7. Various orphan diseases
Name of the Pathophysiology Age of % of Symptoms Management
disease occurrence occurrence
5.
osteopetrosis it is characterized All 0.04% in infants- life No cure is availa-
by increased bone threatening bone -ble but hemato-
mass, failure of marrow failure -poitic stem cell
osteoclats function in adults- bone transplantation,
as a result of fractures vit-D &
mutation in multi- erythropoietin for
-ple genes human symptomatic
relief
6. Porphyria it is most common All 0.04% Blisters, bullae, Antibiotics, 4-
cutenia tarda human porphyria increased fragility, aminoquinolines,
due to acquired scaring, hyper-hypo Iron chelating
deficient activity pigmentation of agents &
of hepatic UROD. Sun exposed areas erythropoietin
it catalyzes copro
porphyrinogen &
causes tissue
damage
8. Various orphan diseases
Name of Pathophysiology Age of % of Symptoms Management
the disease occurrence occurrence
7.
Myasthenia it is an autoimmune All 0.06% Diplopia, eye Cholinesterase
gravis neuromuscular lid moment, inhibitors,
junction disorder swallowing, corticosteroids
which is caused due fatigue & facial with immuno
to problems in trans expression modulators
-mission of nerve
signals to muscles
8.
Parkinson’s it is an progressive Elderly 0.5% tremors, brady Levodopa,
disease neuro-degenerative kinesia, gait & Carbidopa,
moment disorder muscular rigidity Dopamine
that impairs speech, Pramipexole
moment & others
9. Various orphan diseases
Name of Pathophyisiology Age of % of Symptoms Management
the disease occurrence occurrence
9. Rabies it is an infectious All 0.06% pains, parasthesia, cell culture
viral disease which fever, encephalitis, rabies
affects human, hydrophobia, vaccine
domestic & wild Aerophobia, photo
animals phobia & paralysis
10.
Alkaptonuria it is an autosomal Congenital 2% joint pains, black Nitisinone
recessive genetic sports appears in
disease. In which the whites of eyes,
patients inherit 2 pigmentation in
defective copies of ligament & tendons
a gene one from cardio vascular
each parent problems
10. Various orphan diseases
Name of the Pathophysiology Age of % of Symptoms Management
disease occurrence occurrence
11. Gaucher’s it causes due to Congenital 2% Hepatospleeno- enzyme
disease deficiency of - megaly replacement
glucocerebrosidase therapy &
enzyme which is surgical removal
responsible for of spleen&/liver
break down of part to improve
fatty substances affected person
called Gluco - comfort
- cerebrosides
12. Kyasanur it is an infectious Adult 5% chills, frontal no treatment
forest disease bleeding disease head ache, high is available
in monkey’s & fever, vomiting,
human caused by diarrhea, cough,
pathogenic virus sever pain in
called KFD virus neck & low back
11. Various orphan diseases
Name of the Pathophysiology Age of % of Symptoms Management
disease occurrence occurrence
13. Alpha-1- affected people Congenital 5% chronic obstructive Lung
antitrypsin have lack of alpha- pulmonary disease transplant
deficiency 1 antitrypsin protein less commonly
in their blood due cause liver damage
mutation of SERPINA-1 rarely skin disease
gene. It causes
uncontrolled neu-
-trophil elastage
activity.
14. Madras it is an molecular Adult NA patient look slender no treatment
motor neuron disease, in which facial & bulbar, is available,
disease the pathogenesis hearing loss due to IV Ig is
is unknown nerve defect & available
muscle bilateral
optic atrophy
12. Various orphan diseases
Name of the Pathophysiology Age of % of Symptoms Management
disease occurrence occurrence
15. Ebstein’s there is an Congenital 5% Dyspnea, atypical ACE inhibitors
anomaly embryological chest pain, fatigue, Ca2+ channel
malformation of anorexia, decreased blockers,
of tricuspid valve energy from cardiac beta-blockers
leaflets. So, that failure causes venous Diuretics,
there is incomplete congestion in stomach Digoxin
alignment of leaf
lets at AV junction
16. Ehler’s it is an inherited Congenital 8% hyper extensibility no drug is
danlos connective tissue of joints & skin, available but
syndrome disorder which vascular changes, life style
results impaired dental abnormalities modifications
formation & & pulmonary & surgery
integrity of alterations
collagen
13. Various orphan diseases
Name of the Pathophysiology Age of % of Symptoms Management
disease occurrence occurrence
17.Wilson’s it is an rare inborn Congenital 6% yellowing of skin & copper chelators,
disease copper storage eyes, loss of D-penicillamine
disorder which is appetite, fatigue,
characterized by the trembling, mood
presence of excess swings, difficulty
copper in liver, brain, in walking & speech
kidney & cornea problems
18.Tetralogy TOF arises from Congenital 8% hyperpnea, Nacortic
of fallot single genetic cyanosis, analgesics, PGs,
defect involving the syncope diuretics & beta
TBx gene, which blockers
encodes transcri-
-ption factor
14. Various orphan diseases
Name of Pathophysiology Age of % of Symptoms Management
the disease occurrence occurrence
19. Lupus it is an inflammatory All NA it can affect Anti-malarial
autoimmune disease any organ like drugs, NSAIDs
in which body’s heart, kidney’s, like Ibuprofen,
immune system attack blood vessels, steroids,
its own healthy tissues joints/skin, immuno -
& causes inflammation skin rashes, supressives
joint pains
20. Pulmonic it narrow the pulmonic Congenital NA difficult to
valvular valve & the group of 3 breath, chest valvuloplasty
stenosis leaflets separates right pain, fatigue,
ventricle from the right ventricular
pulmonary trunk hypertrophy &
hypoxemia