Pediatrics notes about "Teratogenicity". These notes were published in 2018.
You can download them also from
- Telegram: https://t.me/pediatric_notes_2018
- Mediafire: http://www.mediafire.com/folder/u5u60m184t9z7/Pediatric_Notes_2018
This document discusses infectious uveitis and evidence-based medicine in uveitis. It begins by outlining the etiology of uveitis and importance of ruling out infectious causes. Specific infectious etiologies covered include purulent uveitis, endophthalmitis, bacterial causes like syphilis and tuberculosis, parasitic causes like toxoplasmosis, and viral and fungal causes. Diagnostic testing and treatment approaches for various infectious etiologies like endophthalmitis, syphilis, and tuberculosis are discussed in detail over multiple slides.
This document contains a 35 question multiple choice exam on various topics in medicine. Each question provides 5 answer choices and asks the examinee to select the most correct diagnosis, treatment, or finding. The questions cover topics like dermatology, radiology, cardiology, neurology, and other areas of clinical medicine.
Thyroid Eye Disease (TED) is an autoimmune condition that causes inflammation of the muscles and fatty tissues around the eyes. It is often associated with Graves' disease of the thyroid gland. Common signs include bulging of the eyes, dry eyes, swelling of eyelids, and double vision. The condition progresses through active and stable phases, with the active phase characterized by worsening inflammation and swelling lasting around 1 year for non-smokers and 2-3 years for smokers. Treatment depends on the severity and includes medications, orbital radiation, or surgery to repair eye muscle damage or remove fat behind the eyes.
Graves' ophthalmopathy, also known as thyroid eye disease, is an inflammatory disorder affecting the eye muscles and surrounding tissues that is associated with Graves' disease and hyperthyroidism. Symptoms include bulging or protruding eyes, eyelid retraction, double vision, and potential vision loss if left untreated. The condition results from antibodies that cause swelling of eye muscles and tissues. Diagnosis involves examination of the eyes and imaging tests. Treatment focuses on medications and surgery to reduce swelling and pressure on the eyes.
Thyroid eye disease (TED) is a common orbital disorder caused by an autoimmune reaction. It involves inflammation and swelling of the extraocular muscles and orbital connective tissues. The main clinical manifestations include soft tissue involvement, lid retraction, proptosis, optic neuropathy, and restrictive myopathy. Treatment depends on disease severity and includes lubricants, steroids, radiation therapy, orbital decompression surgery, and in severe cases intravenous steroids to prevent sight loss from optic neuropathy. Surgical intervention may be needed for disfiguring proptosis or restrictive myopathy after the inflammatory phase subsides.
Thyroid eye disease (TED), also known as Graves' ophthalmopathy, is an autoimmune disorder affecting the eyes that is commonly associated with Graves' disease and hyperthyroidism. It causes inflammation and swelling of the muscles and fatty tissues behind the eyes. The document discusses the epidemiology, risk factors, pathogenesis, clinical features including proptosis, lid retraction, optic neuropathy, and restrictive myopathy, as well as treatments such as steroids, radiation, orbital decompression surgery, and eyelid surgery. Management involves treatment of both the eye symptoms and any underlying thyroid abnormalities.
This document discusses congenital rubella infection. It notes that rubella infection early in pregnancy carries the highest risk of fetal defects. Common manifestations of congenital rubella syndrome include deafness, eye defects like cataracts, and heart defects. Diagnosis involves virus isolation or serologic testing. Prevention relies on vaccination to eliminate rubella virus transmission.
This document discusses infectious uveitis and evidence-based medicine in uveitis. It begins by outlining the etiology of uveitis and importance of ruling out infectious causes. Specific infectious etiologies covered include purulent uveitis, endophthalmitis, bacterial causes like syphilis and tuberculosis, parasitic causes like toxoplasmosis, and viral and fungal causes. Diagnostic testing and treatment approaches for various infectious etiologies like endophthalmitis, syphilis, and tuberculosis are discussed in detail over multiple slides.
This document contains a 35 question multiple choice exam on various topics in medicine. Each question provides 5 answer choices and asks the examinee to select the most correct diagnosis, treatment, or finding. The questions cover topics like dermatology, radiology, cardiology, neurology, and other areas of clinical medicine.
Thyroid Eye Disease (TED) is an autoimmune condition that causes inflammation of the muscles and fatty tissues around the eyes. It is often associated with Graves' disease of the thyroid gland. Common signs include bulging of the eyes, dry eyes, swelling of eyelids, and double vision. The condition progresses through active and stable phases, with the active phase characterized by worsening inflammation and swelling lasting around 1 year for non-smokers and 2-3 years for smokers. Treatment depends on the severity and includes medications, orbital radiation, or surgery to repair eye muscle damage or remove fat behind the eyes.
Graves' ophthalmopathy, also known as thyroid eye disease, is an inflammatory disorder affecting the eye muscles and surrounding tissues that is associated with Graves' disease and hyperthyroidism. Symptoms include bulging or protruding eyes, eyelid retraction, double vision, and potential vision loss if left untreated. The condition results from antibodies that cause swelling of eye muscles and tissues. Diagnosis involves examination of the eyes and imaging tests. Treatment focuses on medications and surgery to reduce swelling and pressure on the eyes.
Thyroid eye disease (TED) is a common orbital disorder caused by an autoimmune reaction. It involves inflammation and swelling of the extraocular muscles and orbital connective tissues. The main clinical manifestations include soft tissue involvement, lid retraction, proptosis, optic neuropathy, and restrictive myopathy. Treatment depends on disease severity and includes lubricants, steroids, radiation therapy, orbital decompression surgery, and in severe cases intravenous steroids to prevent sight loss from optic neuropathy. Surgical intervention may be needed for disfiguring proptosis or restrictive myopathy after the inflammatory phase subsides.
Thyroid eye disease (TED), also known as Graves' ophthalmopathy, is an autoimmune disorder affecting the eyes that is commonly associated with Graves' disease and hyperthyroidism. It causes inflammation and swelling of the muscles and fatty tissues behind the eyes. The document discusses the epidemiology, risk factors, pathogenesis, clinical features including proptosis, lid retraction, optic neuropathy, and restrictive myopathy, as well as treatments such as steroids, radiation, orbital decompression surgery, and eyelid surgery. Management involves treatment of both the eye symptoms and any underlying thyroid abnormalities.
This document discusses congenital rubella infection. It notes that rubella infection early in pregnancy carries the highest risk of fetal defects. Common manifestations of congenital rubella syndrome include deafness, eye defects like cataracts, and heart defects. Diagnosis involves virus isolation or serologic testing. Prevention relies on vaccination to eliminate rubella virus transmission.
Teratogenicity,Exposure to therapeutic radiation Sensitivity to teratogens ac...AMIT KUMAR
Teratogenicity refers to the ability of environmental factors to disturb the development of an embryo or fetus and cause birth defects. Some key teratogens discussed in the document include thalidomide, which caused phocomelia in the 1960s; rubella infection, which can cause deafness, blindness and intellectual disabilities; and alcohol, which is linked to fetal alcohol syndrome. The sensitivity of the embryo or fetus to teratogens depends on the stage of development, with the embryonic stage from 3-8 weeks being the most sensitive period when major malformations are most likely to occur. Teratogens can act through various mechanisms including interference with DNA/RNA, inhibition of enzymes, deficiency of energy supply, lack of substrates,
Ocular toxoplasmosis is caused by the protozoan Toxoplasma gondii and is the leading cause of posterior uveitis worldwide. It presents as recurrent inflammation and damage to the retina and choroid that can cause visual impairment. While most infections are asymptomatic, some may experience vision loss due to complications like macular scarring. Diagnosis involves antibody tests and imaging, while treatment focuses on antibiotics, though none can eliminate the parasite permanently.
This document discusses neck masses and thyroid disorders. It provides information on evaluating neck masses, including obtaining a history and physical exam. Congenital masses and infections are more common in young adults, while neoplasms are more likely in older adults. Fine needle aspiration and CT scans can help evaluate masses. It also discusses thyroid nodules, hypothyroidism, hyperthyroidism, causes like Graves' disease and thyroiditis, and treatments like beta blockers or radioactive iodine.
This document discusses congenital anomalies (structural abnormalities present at birth) including their causes, types, and examples. It notes that around 3% of liveborn infants have major anomalies, which can be genetic, environmental, or multifactorial in origin. During the first two weeks after conception, teratogens usually have no effect, but between weeks 3-8 (organogenesis period) they can cause major anomalies, and after week 9 functional abnormalities. Causes discussed include genetic factors, infections like rubella and toxoplasmosis, radiation, chemicals/drugs, maternal diseases, and nutritional deficiencies. The document provides examples of syndromes and specific anomalies affecting various body systems. Prevention emphasizes good prenatal care, iod
1. Juvenile dermatomyositis differs from adult DM in that it lacks calcinosis cutis, malignancy, and has less sex predominance and vasculitis. Adults can develop malignancy and positive anti-synthetase antibodies.
2. Two medications that can induce dermatomyositis are statins and hydroxyurea. Two features that differ DM lesions from LE are their violaceous hue and pruritus.
3. Indications for treatment of hemangiomas include obscuring vision, compromising airway, ulceration and pain, and being in a cosmetically sensitive area. The approach for starting propranolol includes testing for contraindications and slowly
Genetic disorders are not rare and can be classified as cytogenetic, Mendelian, or multifactorial. Cytogenetic disorders involve changes in chromosome number or structure and examples include Down syndrome, Edwards syndrome, and Patau syndrome. Mendelian disorders can be autosomal dominant, autosomal recessive, or X-linked and examples are neurofibromatosis, cystic fibrosis, and retinitis pigmentosa. Multifactorial disorders are influenced by multiple genetic and environmental factors.
This document provides information on GI protozoa infections, including Giardiasis, Amoebiasis, Cryptosporidiosis, and human ectoparasites such as Pediculosis and Scabies. It describes the clinical manifestations, investigations, treatments, and prevention of these protozoal infections and parasites. Key points covered include the causative organisms, modes of transmission, presentations, diagnostic approaches, and pharmacological and non-pharmacological management options for affected individuals.
The thyroid gland develops from the fourth pharyngeal pouch and normally weighs around 20 grams. It is butterfly-shaped with two lobes connected by an isthmus. The gland produces the hormones thyroxine (T4) and triiodothyronine (T3) which regulate metabolism. Hyperthyroidism, or an overactive thyroid, can result from conditions like Graves' disease. It causes a variety of symptoms affecting many body systems. Diagnosis involves blood tests showing elevated T3 and T4 with low or undetectable TSH. Treatment options include antithyroid medications, surgery, or radioactive iodine.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
This document discusses bleeding disorders in children. It covers the main types which are platelet disorders, coagulation disorders, and vascular abnormalities. Coagulation disorders can be congenital like hemophilia A and B which are caused by clotting factor deficiencies, or acquired like those caused by vitamin K deficiency or liver disease. Hemophilia A is caused by a factor VIII deficiency while hemophilia B is a factor IX deficiency. Clinical manifestations of hemophilia include easy bruising, joint bleeding, and bleeding from minor injuries that persists. Treatment involves replacing the missing clotting factor through infusions to achieve hemostatic levels.
This document summarizes the medical records of a 32-year-old male patient admitted to the hospital with fever, headache, and altered sensorium. Brain imaging showed multiple lesions consistent with cerebral toxoplasmosis. The patient had a suppressed immune system due to HIV. He was diagnosed with HIV/AIDS complicated by cerebral toxoplasmosis based on clinical presentation, imaging and lab findings. He was started on cotrimoxazole and steroids, and showed improvement in symptoms within a week.
Microbial agents like rubella virus, cytomegalovirus, toxoplasma gondii, and Treponema pallidum can cause birth defects when a woman is exposed during pregnancy. These microbes may directly damage the fetus or disrupt the immune response. Common effects include premature birth, growth problems, neurological abnormalities, and damage to organs like the eyes, liver, heart and ears. While exposure to ionizing radiation is a potential risk, most diagnostic procedures expose the fetus to less than 50 mSv of radiation, which is a dose unlikely to increase risks. Prescription drugs are also a concern, as several classes of medications like tetracyclines, chloramphenicol, and anticonvulsants
SYPHILIS.pptx bachelors degree in medicineJosphatSiele
Syphilis is caused by the bacterium Treponema pallidum. It is usually transmitted sexually but can also be transmitted congenitally from mother to fetus. There are four stages of syphilis: primary, secondary, latent, and tertiary. Left untreated, syphilis can cause serious long term complications affecting the heart, brain, and other organs. Penicillin remains the treatment of choice and can cure syphilis if administered properly in the early stages of infection. Complications from treatment may include anaphylaxis or Jarisch-Herxheimer reaction.
This document provides an overview of hyperthyroidism and its management. It discusses that Graves' disease accounts for 60-80% of cases of hyperthyroidism. The pathogenesis involves genetic and environmental factors leading to thyroid-stimulating immunoglobulins that cause excessive thyroid hormone production. Clinical features include nervousness, tremor, palpitations, and in severe cases, eye involvement. Laboratory tests can detect thyroid antibodies. Treatment options include antithyroid medications, radioactive iodine, or surgery to restore euthyroidism.
Congenital anomalies are the leading cause of death in the first year of life. They can be malformations, disruptions, deformations, sequences, or syndromes. The causes include genetic factors like chromosomal abnormalities and Mendelian disorders, as well as environmental factors like infections, drugs, chemicals, and radiation exposure. The timing of exposure to teratogens is important, as the embryonic period from 3-9 weeks is highly susceptible. Many congenital anomalies have multifactorial etiologies from interactions between genetics and the environment. Common birth defects in the US include Down syndrome, cleft lip/palate, heart defects, spina bifida, and gastrointestinal anomalies.
This document discusses the management of craniofacial syndromes and developmental anomalies. It begins by defining syndromes and anomalies, and describes how Ibn Sina pioneered the idea of classifying syndromes. It then discusses various craniofacial development stages and factors that can affect them, including teratogens, radiation, genes, and more. Finally, it outlines different syndromes and anomalies that occur at each development stage, and how orthodontists are involved in managing craniofacial disorders through diagnostic considerations, various treatment approaches, and understanding surgical correction methods.
Basics of MRI interpretation; December 2022.pptxKareem Alnakeeb
This document provides an overview of MRI basics including:
1) How MRI scanners work by using magnetic fields and radio waves to produce images mapping proton distribution and energy.
2) The differences between T1- and T2-weighted images and how they highlight different tissues.
3) How specialized sequences like STIR, FLAIR, and DWI provide additional clinical information.
4) The use of contrast agents and their role in identifying abnormal tissues.
5) The importance of a systematic approach to MRI interpretation and relating findings to clinical information.
6) Key safety considerations for MRI scanning.
The rule of 4 of the brainstem:
A simplified method for understanding brainstem anatomy and brainstem vascular syndromes
https://onlinelibrary.wiley.com/doi/10.1111/j.1445-5994.2004.00732.x
Teratogenicity,Exposure to therapeutic radiation Sensitivity to teratogens ac...AMIT KUMAR
Teratogenicity refers to the ability of environmental factors to disturb the development of an embryo or fetus and cause birth defects. Some key teratogens discussed in the document include thalidomide, which caused phocomelia in the 1960s; rubella infection, which can cause deafness, blindness and intellectual disabilities; and alcohol, which is linked to fetal alcohol syndrome. The sensitivity of the embryo or fetus to teratogens depends on the stage of development, with the embryonic stage from 3-8 weeks being the most sensitive period when major malformations are most likely to occur. Teratogens can act through various mechanisms including interference with DNA/RNA, inhibition of enzymes, deficiency of energy supply, lack of substrates,
Ocular toxoplasmosis is caused by the protozoan Toxoplasma gondii and is the leading cause of posterior uveitis worldwide. It presents as recurrent inflammation and damage to the retina and choroid that can cause visual impairment. While most infections are asymptomatic, some may experience vision loss due to complications like macular scarring. Diagnosis involves antibody tests and imaging, while treatment focuses on antibiotics, though none can eliminate the parasite permanently.
This document discusses neck masses and thyroid disorders. It provides information on evaluating neck masses, including obtaining a history and physical exam. Congenital masses and infections are more common in young adults, while neoplasms are more likely in older adults. Fine needle aspiration and CT scans can help evaluate masses. It also discusses thyroid nodules, hypothyroidism, hyperthyroidism, causes like Graves' disease and thyroiditis, and treatments like beta blockers or radioactive iodine.
This document discusses congenital anomalies (structural abnormalities present at birth) including their causes, types, and examples. It notes that around 3% of liveborn infants have major anomalies, which can be genetic, environmental, or multifactorial in origin. During the first two weeks after conception, teratogens usually have no effect, but between weeks 3-8 (organogenesis period) they can cause major anomalies, and after week 9 functional abnormalities. Causes discussed include genetic factors, infections like rubella and toxoplasmosis, radiation, chemicals/drugs, maternal diseases, and nutritional deficiencies. The document provides examples of syndromes and specific anomalies affecting various body systems. Prevention emphasizes good prenatal care, iod
1. Juvenile dermatomyositis differs from adult DM in that it lacks calcinosis cutis, malignancy, and has less sex predominance and vasculitis. Adults can develop malignancy and positive anti-synthetase antibodies.
2. Two medications that can induce dermatomyositis are statins and hydroxyurea. Two features that differ DM lesions from LE are their violaceous hue and pruritus.
3. Indications for treatment of hemangiomas include obscuring vision, compromising airway, ulceration and pain, and being in a cosmetically sensitive area. The approach for starting propranolol includes testing for contraindications and slowly
Genetic disorders are not rare and can be classified as cytogenetic, Mendelian, or multifactorial. Cytogenetic disorders involve changes in chromosome number or structure and examples include Down syndrome, Edwards syndrome, and Patau syndrome. Mendelian disorders can be autosomal dominant, autosomal recessive, or X-linked and examples are neurofibromatosis, cystic fibrosis, and retinitis pigmentosa. Multifactorial disorders are influenced by multiple genetic and environmental factors.
This document provides information on GI protozoa infections, including Giardiasis, Amoebiasis, Cryptosporidiosis, and human ectoparasites such as Pediculosis and Scabies. It describes the clinical manifestations, investigations, treatments, and prevention of these protozoal infections and parasites. Key points covered include the causative organisms, modes of transmission, presentations, diagnostic approaches, and pharmacological and non-pharmacological management options for affected individuals.
The thyroid gland develops from the fourth pharyngeal pouch and normally weighs around 20 grams. It is butterfly-shaped with two lobes connected by an isthmus. The gland produces the hormones thyroxine (T4) and triiodothyronine (T3) which regulate metabolism. Hyperthyroidism, or an overactive thyroid, can result from conditions like Graves' disease. It causes a variety of symptoms affecting many body systems. Diagnosis involves blood tests showing elevated T3 and T4 with low or undetectable TSH. Treatment options include antithyroid medications, surgery, or radioactive iodine.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
This document discusses bleeding disorders in children. It covers the main types which are platelet disorders, coagulation disorders, and vascular abnormalities. Coagulation disorders can be congenital like hemophilia A and B which are caused by clotting factor deficiencies, or acquired like those caused by vitamin K deficiency or liver disease. Hemophilia A is caused by a factor VIII deficiency while hemophilia B is a factor IX deficiency. Clinical manifestations of hemophilia include easy bruising, joint bleeding, and bleeding from minor injuries that persists. Treatment involves replacing the missing clotting factor through infusions to achieve hemostatic levels.
This document summarizes the medical records of a 32-year-old male patient admitted to the hospital with fever, headache, and altered sensorium. Brain imaging showed multiple lesions consistent with cerebral toxoplasmosis. The patient had a suppressed immune system due to HIV. He was diagnosed with HIV/AIDS complicated by cerebral toxoplasmosis based on clinical presentation, imaging and lab findings. He was started on cotrimoxazole and steroids, and showed improvement in symptoms within a week.
Microbial agents like rubella virus, cytomegalovirus, toxoplasma gondii, and Treponema pallidum can cause birth defects when a woman is exposed during pregnancy. These microbes may directly damage the fetus or disrupt the immune response. Common effects include premature birth, growth problems, neurological abnormalities, and damage to organs like the eyes, liver, heart and ears. While exposure to ionizing radiation is a potential risk, most diagnostic procedures expose the fetus to less than 50 mSv of radiation, which is a dose unlikely to increase risks. Prescription drugs are also a concern, as several classes of medications like tetracyclines, chloramphenicol, and anticonvulsants
SYPHILIS.pptx bachelors degree in medicineJosphatSiele
Syphilis is caused by the bacterium Treponema pallidum. It is usually transmitted sexually but can also be transmitted congenitally from mother to fetus. There are four stages of syphilis: primary, secondary, latent, and tertiary. Left untreated, syphilis can cause serious long term complications affecting the heart, brain, and other organs. Penicillin remains the treatment of choice and can cure syphilis if administered properly in the early stages of infection. Complications from treatment may include anaphylaxis or Jarisch-Herxheimer reaction.
This document provides an overview of hyperthyroidism and its management. It discusses that Graves' disease accounts for 60-80% of cases of hyperthyroidism. The pathogenesis involves genetic and environmental factors leading to thyroid-stimulating immunoglobulins that cause excessive thyroid hormone production. Clinical features include nervousness, tremor, palpitations, and in severe cases, eye involvement. Laboratory tests can detect thyroid antibodies. Treatment options include antithyroid medications, radioactive iodine, or surgery to restore euthyroidism.
Congenital anomalies are the leading cause of death in the first year of life. They can be malformations, disruptions, deformations, sequences, or syndromes. The causes include genetic factors like chromosomal abnormalities and Mendelian disorders, as well as environmental factors like infections, drugs, chemicals, and radiation exposure. The timing of exposure to teratogens is important, as the embryonic period from 3-9 weeks is highly susceptible. Many congenital anomalies have multifactorial etiologies from interactions between genetics and the environment. Common birth defects in the US include Down syndrome, cleft lip/palate, heart defects, spina bifida, and gastrointestinal anomalies.
This document discusses the management of craniofacial syndromes and developmental anomalies. It begins by defining syndromes and anomalies, and describes how Ibn Sina pioneered the idea of classifying syndromes. It then discusses various craniofacial development stages and factors that can affect them, including teratogens, radiation, genes, and more. Finally, it outlines different syndromes and anomalies that occur at each development stage, and how orthodontists are involved in managing craniofacial disorders through diagnostic considerations, various treatment approaches, and understanding surgical correction methods.
Basics of MRI interpretation; December 2022.pptxKareem Alnakeeb
This document provides an overview of MRI basics including:
1) How MRI scanners work by using magnetic fields and radio waves to produce images mapping proton distribution and energy.
2) The differences between T1- and T2-weighted images and how they highlight different tissues.
3) How specialized sequences like STIR, FLAIR, and DWI provide additional clinical information.
4) The use of contrast agents and their role in identifying abnormal tissues.
5) The importance of a systematic approach to MRI interpretation and relating findings to clinical information.
6) Key safety considerations for MRI scanning.
The rule of 4 of the brainstem:
A simplified method for understanding brainstem anatomy and brainstem vascular syndromes
https://onlinelibrary.wiley.com/doi/10.1111/j.1445-5994.2004.00732.x
How to Read a Research Article? By Dr. Nizar Saleh Abdelfattah, 2017Kareem Alnakeeb
This presentation is created by Dr. Nizar Saleh Abdelfattah in 2017. He used it in his episodes of "Research Fundamentals For Dummies" on YouTube.
https://www.youtube.com/playlist?list=PLuDFktFSWZ_XVufo7h9bDIerKoo7s3ouA
* The original presentation on Mediafire:
http://www.mediafire.com/file/mu5dml695g5r8qf/How-to-Research-by-Nizar-Abdelfattah.pptx/file
Some notes in Cardiothoracic surgery. These notes were published in 2019.
You can download the file from:
- Mediafire: http://www.mediafire.com/file/zrxenwq4tjdnhsj/file
Refractive procedures; Ophthalmology - April 2017Kareem Alnakeeb
This document summarizes various refractive procedures for correcting vision problems. It discusses procedures for myopia, hyperopia, astigmatism, and presbyopia, including surface ablation, LASIK, phakic implants, clear lens extraction, and conductive keratoplasty. For presbyopia, multifocal lenses, monovision, and intracorneal inlays are addressed. The document was prepared by Kareem Fisal Alnakeeb for the Ophthalmology Department at Mansoura University in Egypt.
Management of twin pregnancy with single fetal demise; Obstetrics - October 2019Kareem Alnakeeb
This document summarizes the current management of single fetal demise (sIUFD) in twin pregnancies. It discusses that sIUFD occurs in 3.7-6.8% of twin pregnancies and increases risks for the surviving twin. The management approach depends on chorionicity, gestational age, and whether the demise occurred in the first, second, or third trimester. For monochorionic twins after the first trimester, the surviving twin has increased risks of death, neurological issues, and preterm birth due to shared blood flow between twins. Conservative monitoring is recommended when possible to allow further fetal development, though delivery may be considered if the in utero environment is deemed hostile.
Addisonian crisis; pharmacology - 25 March 2016Kareem Alnakeeb
An Addisonian crisis is a medical emergency caused by severe adrenal insufficiency and insufficient levels of the hormone cortisol. It can occur in patients with undiagnosed or untreated Addison's disease when they are under stress. Signs and symptoms include confusion, vomiting, diarrhea, fever, and electrolyte imbalances that can cause hypoglycemia, hyponatremia, and hyperkalemia. Treatment involves aggressive fluid resuscitation, glucose supplementation, electrolyte correction, glucocorticoid replacement, and treating any underlying infections. Prevention relies on patient education, carrying medical identification, and maintaining treatment during stressful periods. With prompt treatment, prognosis is good, but lack of treatment can lead to shock,
Referred pain, also known as reflective pain, is pain perceived in a location other than where the painful stimulus originates. There are several proposed mechanisms to explain referred pain, with the convergence-projection theory being the most widely accepted. This theory suggests that afferent nerve fibers from different structures converge on the same spinal cord neurons, resulting in pain being perceived elsewhere. Other mechanisms like central sensitization may also play a role in referred pain. Certain organs have characteristic referred pain patterns, such as cardiac pain often radiating to the left arm, helping clinicians diagnose conditions.
This document discusses the structure and development of ovarian follicles. It begins by describing the basic components of follicles: the oocyte, granulosa cells, and theca layers. It then explains the development of follicles from primordial to Graafian stage, including the roles of FSH and LH. Finally, it discusses ovulation and the formation and function of the corpus luteum, as well as clinical significance regarding cysts and ultrasound imaging of follicles.
The document summarizes the structure and development of ovarian follicles. It describes the four stages of follicular development: primordial, primary, secondary (antral), and tertiary (Graafian). Key points include that ovarian follicles contain a single oocyte and support cells, develop in response to FSH and LH, and either ovulate during each menstrual cycle or become atretic. The dominant follicle develops into a corpus luteum which secretes progesterone to support early pregnancy.
Metabolic basis of Atherosclerosis; Biochemistry - February 2015Kareem Alnakeeb
This document defines atherosclerosis and its causes and risk factors. It discusses how atherosclerosis is initiated by inflammation in artery walls in response to LDL particles. As LDL particles accumulate in arteries, they can become oxidized, attracting macrophages. If macrophages cannot process the oxidized LDL, foam cells form, which can rupture and further narrow arteries. Risk factors include older age, male sex, diabetes, high LDL and low HDL cholesterol levels, smoking, and genetic factors. Diagnosis involves medical tests, and treatment includes medications, surgery, lifestyle changes, and managing underlying conditions like high blood pressure and cholesterol.
Anatomy of the cerebrum; Anatomy - January 2015Kareem Alnakeeb
The document provides detailed information about the structure and functions of the cerebrum. It describes the lobes, sulci, gyri, poles and borders of each cerebral hemisphere. It then outlines the primary motor, sensory and association cortices and their functions. Specifically, it discusses the primary motor cortex, premotor cortex, supplementary motor cortex, frontal eye field, Broca's area, primary somatosensory cortex, primary auditory cortex, primary visual cortex, Wernicke's area and their roles in movement, speech, senses and language.
This document provides information on lung cancer, including non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). It discusses risk factors like smoking, symptoms, diagnosis, staging, pathology, and treatment approaches. The main types of lung cancer - NSCLC subtypes like adenocarcinoma and squamous cell carcinoma, as well as SCLC - are described in terms of characteristics, histology, and prognosis. Diagnostic tests include imaging, biopsy procedures, and staging evaluations. Treatment depends on cancer type and extent of disease, and may involve surgery, radiation, chemotherapy, or a combination.
Summary notes of Anesthesia. These notes were published in 2020.
You can download them from:
-Mediafire: http://www.mediafire.com/file/wkey81yff7kv3j1/Anesthesia_Q%2526A_2020.pdf/file
Pediatrics notes about "Wheezy chest". These notes were published in 2018.
You can download them also from
- Telegram: https://t.me/pediatric_notes_2018
- Mediafire: http://www.mediafire.com/folder/u5u60m184t9z7/Pediatric_Notes_2018
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
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
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
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
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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1. Teratogenicity
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Teratogenicity
Agent can produce permanent alteration of structure or function by
interfering with normal embryonic or fetal development.
Teratogen
(monster or ugly animal)
Capability of producing fetal malformation.Teratogenicity
Science that studies causes, mechanisms and patterns of abnormal
development.
Teratology
1- Multifactorial (42%) → Most common
2- Unknown (37%)
3- Teratogen (10%)
4- Monogenic "single gene" (8%)
5- Chromosomal (3%)
(5 points)
1- Individual differences in susceptible to teratogen exist.
2- There are no absolute teratogens
( depend on: dose, duration, single or multiple exposure, period "trimester")
3- Teratogens act at vulnerable periods of embryogenesis and fetal development
4- Teratogenic exposures tend to produce characteristic patterns of multiple anomalies
rather than single defects
5- Combination of exposures to teratogenic agents → may increase or decrease defect
Definitions:
Incidence of birth defects in childhood:
Principles of clinical teratology
Multifactorial
42%
Unknown
37%
Teratogen
10%
Monogenic
8%
Chromosomal
3%
N.B:
- Exposure to Teratogens in 1st
2 weeks → abortion
- Most vulnerable period to Teratogens: (2: 8 or 10 weeks)
2. Teratogenicity
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Stage of exposures Outcome
A. pre-implantation
(1st
2 weeks)
• Embryonic lethality
B. Implantation to time of organogenesis
(2: 8 or 10 weeks)
• Morphological defects.
C. Fetal stage to neonatal stage • Functional disorders
• Growth retardation
• carcinogenesis
Critical periods:
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(6 points)
1- Chromosomal aberration.
2- Interference with nucleic acids: (replication, transcription or RNA translation).
3- Genetic mutation:
X-ray, atomic explosion & radiations→ DNA damage→ Mutation →Congenital abnormalities
4- Inhibition of enzymes
e.g. Methotrexate Inhibits Dihydrofolate Reductase enzyme
& prevent conversion of folic acid to folinic acid which is essential for embryo
5- Lack of substrates:
- Decrease of vitamins or minerals intake
- Failure of absorption from GIT as in GIT infection e.g. Diarrhea or bile acid deficiency
6- Deficiency of energy supply needed to build organs:
a) Glucose deficiency:
* Glucose in diet
* G6PD inhibitors e.g. 6-Aminonicotinamide (6-AN)
* Drugs affecting Krebs cycle e.g. Fluoroacetate
b) Interference with internal respiration
* CO toxicity → inhibits Cytochrome oxidase
c) Hypoxia:
* CO toxicity → O2 delivery + osmotic pressure to fetus
* Drug induced e.g. phenytoin
Mechanism of action of teratogens
DHFR DHFR
Folic acid (−)
methotrexate
�⎯⎯⎯⎯⎯⎯⎯⎯⎯� Dihydrofolate (−)
methotrexate
�⎯⎯⎯⎯⎯⎯⎯⎯⎯� Tetrahydrofolate → Folinic acid
4. Teratogenicity
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( 4 categories )
1- Infectious agents ( sTORCH )
2- Drugs & pharmaceutical
( ACEIs, Antibiotics, Anticoagulants, Anticonvulsants, Thalidomide, vitamin A,
corticosteroid, Hormones, Aspirin, Chemotherapy, metronidazole)
3- physical, chemical & Environmental agents
* Physical: Ionizing radiation – Hyperthermia
* Chemical: Alcohol – Tobacco “ Nicotine “ – Cocaine
* Environmental: Lead – Mercury – CO - pesticides - Toluene
4- Maternal disorders
( DM – Hyper/Hypo thyroidism – SLE - PKU – Malnutrition)
1-Infectious agents (sTORCH)
- Syphilis – Toxoplasma – Rubella – CMV - Herpes simplex –
- Others: Varicella Zoster, HIV, TB, … etc.
Mainly affect CNS - Eye - Ear & others
I. Congenital Syphilis: (Treponema pallidum)
Early:
1. Rhinorrhea “snuffles” and conjunctival discharge → At birth
2. maculopapular eruption (involving palms and soles - desquamating)
Late:
1. Hutchinson teeth → late at age 10ys
2. perforated palate → late at age 10ys
3. Rhagades (thickening and fissures of corners of mouth)
4. Saddle nose
5. Saber shins
Teratogenic agents
6. Teratogenicity
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V. Congenital Herpes simplex:
1. CNS : Seizures
2. Eye : Microphthalmia
3. CHD : PDA
4. GIT : Hepatomegaly, HSM
5. Skin : scarring vesicular rash
6. Bone : Osteitis + characteristic hypoplasia of distal phalanges.
7. Adrenal failure
VI. Congenital varicella zoster: ( Chicken pox )
1. CNS : Microcephaly , Hydrocephalus , cortical atrophy , intracranial calcification ,
Seizures , deafness , Sensory & motor deficits , psychomotor retardation
2. Eye : “ Chorioretinitis , cataract , microphthalmia , optic atrophy , anisocoria “
3. gastrointestinal & genitourinary anomalies
4. Skin : Scarring (cicatricial) lesions with characteristic "zigzag” pattern in a dermatome
distribution
5. Bone : Hypoplasia & paresis of an extremity “limb malformations and deformations “
VII. HIV/AIDS
1. CNS : Microcephaly
2. Abnormal facies (expression or appearance of face).
3. growth retardation
VIII. TB
1. Weight loss , Refusal to suckle
2. GIT : Hepatosplenomegaly
Q: What is the congenital infections cause brain calcification?
- most frequently observed in Toxoplasma (diffuse), CMV ( periventricular )
- occasionally in patients with congenital HSV infection
- rarely in patients with congenital rubella infection or congenital varicella
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Many of the findings of the TORCH infections are very similar,
so note the most likely presentations:
• Syphilis: osteochondritis and periostitis; skin rash involving palms and soles and is
desquamating; snuffles (mucopurulent rhinitis)
• Toxoplasmosis: hydrocephalus with generalized calcifications and chorioretinitis
• Rubella: the classic findings of cataracts, deafness, and heart defects
• CMV: microcephaly with periventricular calcifications; petechiae with thrombocytopenia
• Herpes: skin vesicles, keratoconjunctivitis, acute meningoencephalitis
• varicella Zoster: Scarring (cicatricial) Zigzag skin lesions
8. Teratogenicity
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2-Drugs & pharmaceuticals:
Classification based on teratogenic potential :
Category Animal
studies
Human
Data
Examples
A folic acid, thyroxin
B ? acetaminophen, erythromycin
C ? Rifampicin, morphine
D antiepileptics
X thalidomide, retinoid
(ACEIs, Antibiotics, Anticoagulants, Anticonvulsants, Thalidomide, vitamin A, corticosteroid,
Hormones, Aspirin, Chemotherapy, metronidazole)
- Theoretically, All drugs should be considered as possible teratogens during pregnancy, So
they should be limited to treat important maternal health conditions
: NO risk : risk ? : No adequate studies
Common teratogenic DRUGS :
Benefits > Risk
Risk > Benefit
Benefits > Risk
9. Teratogenicity
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I. ACE inhibitors: “ captopril , enalapril “
- If used during 2nd
and 3rd
trimester will Lead to:
1. PDA
2. Neonatal hypotension
3. Prematurity, IUGR
4. Renal failure
5. Oligohydramnios
6. Hypoplasia of skull
7. Deformation sequence
II. Antibiotics: (Streptomycin, Tetracycline, Trimethoprim)
a. Streptomycin & closely related aminoglycosides
- 10-15% SNHL “Ototoxicity”
b. Tetracycline
- Related to dose and duration of exposure
If exposure after 4th
month gestation :
1. brown staining on deciduous teeth
2. increased caries
3. diminished growth of long bones
if exposure later in pregnancy :
- may affect permanent teeth
c. Trimethoprim (folate antagonist)
Used alone OR in combination with sulfonamides
1. Cardiovascular defects
2. Neural tube defects
3. Structural defects
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III. Anticoagulant: Warfarin “Coumadin“
1. Eye: Microphthalmia , hypertelorism , cataract , optic atrophy , blindness
2. Dysplastic ear
3. Characteristic Hypoplastic nose with deformed nasal cartilage & anteverted nares
4. Macroglossia
5. Hypoplasia of distal & proximal phalanx of index finger
6. Stippling of epiphysis of lumbosacral area & trochanters of femur
7. Short neck
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IV. Anticonvulsant: (phenytoin, Diazepam, Phenobarbital, Carbamazepine, valproic acid)
a. phenytoin “
"phenyl-hydantoin, Dilantin"
Fetal hydantoin syndrome ( FHS )
1. Profuse coarse hair + hirsutism
2. Eye: Hypertelorism, strabismus, ptosis
3. Low set ear
4. Depressed nasal bridge
5. Wide mouth
6. Short neck
7. Small, widely spaced nipple
8. hypoplasia of nails & terminal digits
b. Diazepam "valium" “
- 1st
trimester exposure → ↑risk for cleft lip + palate
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c. Phenobarbital
- Probably low risk
- Very rarely features similar to FHS reported
All anticonvulsants are teratogenic
but the anticonvulsant with least Teratogenicity is phenobarbitone
d. Carbamazepine "Tegretol"
Phenotype similar to FHS
- CNS: Microcephaly
- Psychomotor delay
- Cardiac defects
- Eye: Upward slanting palpebral fissure, epicanthal folds
- Short nose
- Long philtrum
- Nail hypoplasia
- Prenatal & postnatal growth deficiency
e. valproic acid
"Depakene, Depakote" “
29% Fetal valproic syndrome ( FVS ) :
1. CNS: neural tube defect
2. High forehead , Narrow bifrontal diameter head
“prominent metopic ridge “
3. Eye: Shallow orbits, Epicanthal folds , telecanthus
4. Ear: Minor ear anomalies
5. Flat nasal bridge, short anteverted nares
6. Long thin philtrum, thin upper lip
7. Small mouth “micrognathia“
8. IUGR
Phenytoin has Similar features with carbamazepine and phenobarbital
hypoplasia of distal phalanx Caused by :
( Diazepam, phenobarbitone, carbamazepine, phenytoin, Warfarin )
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V. Tranquilizer, psychotropics “thalidomide “→ Historical
► Effect only between 20-40 days after conception
1. Hydrocephalus
2. Renal & Cardiac anomalies “Tetralogy of Fallot”
3. Eye & ear defects
4. Facial capillary hemangioma
5. Phocomelia “Arms more affected than legs “
6. syndactyly, polydactyly
7. Esophageal or duodenal atresia
8. Normal psychomotor development
VI. Vitamin A
• Maximum Recommended dose during pregnancy : 8000 units per day.
• If used with megadose: > 15,000 units per day will cause:
1. Sirenomelia “anomalies of the lower spine and the lower limbs “
2. Genitourinary malformations.
3. Oculo-auriculo-vertebral sequences
VII. Corticosteroid
- 1% risk for cleft palate or adrenal atrophy
VIII. Hormones
a. oral contraceptive (combined progestogen and estrogens)
- 2 to 4 folds increase in VATER association.
V = Vertebral defects
A = Anal atresia (imperforate anus)
TE = Tracheoesophageal fistula
R = Renal & Radial defects “Limb defects“
b. Androgenic agents: "synthetic progestin"
- Used to establish pregnancy e.g. Ethisterone - Norethisterone
- But can lead to masculinization of female genitalia (virilization).
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IX. Acetyl salicylic acids : “ Aspirin “
- If used in 1st
trimester → cleft palate “ In a few percentages “
X. Chemotherapy
Methotrexate → Craniofacial and limb anomalies
XI. Antiparasitic agents & Antimalarials: “metronidazole”
- If used in 1st
trimester → may cause fetal malformations
- If used in 2nd
& 3rd
trimester → safe “acceptable “
XII. Lithium
- Ebstein Anomaly;
(Atrialization of the right ventricle → Huge Right atrium; tricuspid regurge)
3- physical, chemical & Environmental agents:
* Physical : Ionizing radiation – Hyperthermia
* Chemical : Alcohol – Tobacco “ Nicotine “ – Cocaine
* Environmental : Lead – Mercury – CO - pesticides - Toluene
a. Physical Agents
I. Ionizing Radiation
With large doses for treating malignancy OR dose >10 rem
- Early loss of pregnancy
- Microcephaly
- spina bifida cystica
- Psychomotor retardation
- Eye anomalies, cataract
- Cleft palate
- Skeletal & visceral malformation
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II. Maternal hyperthermia
► Temperature: 38.9o
c or more; usually over 24 h period or more with inter-current
illness
► as minimal as 30-45 minutes in sauna or hot tub.
► Exposure between 4 and 14 weeks (1st
trimester) :
- IUGR
- psychomotor retardation
- Hypotonia, Seizures
- Microcephaly
- Neural tube defects “Encephalocele “
- Microphthalmia
- malformed ear
- micrognathia
- cleft lip + palate
- midfacial hypoplasia
b. Chemical Agents
III. Tobacco “Nicotine “
- passive or active → lapsing effect
- Dose-related IUGR
- Prematurity
- Fetal loss
- Neonatal death
IV. Cocaine
- Exposure occurs in up to 10% of all pregnancies
- Spontaneous abortions, prematurity
- Abruption placenta
- Exposure in 1st
trimester: 15.7 % Vascular disruption with associated porencephaly
- Gastrointestinal, Genitourinary, limb reduction defect
- Psychomotor retardation, Behavioral difficulties
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V. Alcohol (Ethyl alcohol )
Fetal alcohol syndrome ( FAS ):
a. Growth
- prenatal and/or postnatal growth retardation
b. Facial deformities “ Midface hypoplasia “ (from abnormal frontal lobe development)
- Smooth philtrum
- Thin, smooth vermilion border of the upper lip
- Short palpebral fissures
- ptosis of eyelid
- microphthalmia
- Epicanthic folds
- flattened nasal bridge, Short upturned nose
- cleft lip ( + palate)
- Micrognathia in adolescence,
retrognathia in infancy
- protruding ears
c. CNS deformities
- Developmental delay
- Irritability in infancy
- Hyperactivity in childhood (ADHD)
- Mental retardation
- microcephaly
- meningomyelocele
- hydrocephalus
d. Cardiac deformities
- tetralogy of Fallot
- coarctation of aorta
e. Skeletal abnormalities (Neck deformities)
- cervical vertebral & rib abnormalities
- mild neck webbing
Characteristic
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c. Environmental Agents
VI. Toluene → glue sniffing
Similar to Fetal alcohol syndrome with :
- prenatal and/or postnatal growth retardation
- Craniofacial deformities
- Microcephaly
- Psychomotor retardation
- Caudal regression sequence
“congenital defect of the lower spinal segments and the neural tube”
VII. Lead → “In old paints, water pipes “
- ↑ Abortion
- Anemia
- Neurological disorders: “encephalopathy, Abnormal development of brain, MR “
VIII. Mercury → “ In fish , seed corn sprayed with mercury containing fungicide “
- Multiple neurological Symptoms
IX. CO → “ Cigarette smoking , car exhaust , incomplete consumption of coal “
- Bind to Hb → O2 supply to fetus → Hypoxia →
• Spontaneous abortion
• Still birth
• Growth retardation
• prematurity
X. Pesticides → used in parental agricultural work
- ↑ risk of fetal death
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4- Maternal disorders:
( DM – Hyper/Hypo thyroidism – SLE - PKU – Malnutrition)
• The outcomes depends on degree of control & severity of maternal disease
I. Diabetes mellitus
• Outcome varies with degree of control of maternal DM
• Type 1 “IDDM “ is higher at risk than type 2 “NIDDM “ or gestational
- ↑ risk for Early loss of pregnancy
- CHD : TGA ( 8% ) , hypertrophic cardiomyopathy
- Neural tube defect : anencephaly , spina bifida
- Hydrocephalus, holoprosencephaly
- Renal disorders: double ureter, renal vein thrombosis, renal agenesis
- Small left colon syndrome
- VATER association like findings
- Caudal regression sequence similar to sirenomelia sequence
II. Hyperthyroidism
- ↑ risk of loss of pregnancy especially with grave’s disease
- If Thyroid stimulating immunoglobulins (TSI) are present → fetal & neonatal
hyperthyroidism
N.B. TSI bind with TSH receptors in thyroid glands → continuous ++ thyroid
hormone secretion “outside normal -ve feedback“→ Hyperthyroidism
- Treatment with Antithyroid drugs → fetal hypothyroidism
III. Hypothyroidism
- ↑ risk for loss of pregnancy
- N.B. fetal thyroid development independent of maternal thyroxin levels → Fetal &
neonatal thyroid development & function are NOT affected
IV. SLE
- Early loss of pregnancy
- Congenital heart block
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V. Phenylketonuria
• Outcome varies with degree of control of maternal phenylalanine levels in pregnancy
• High level of phenylalanine ( >20 mg/dl ) → serious damage to the fetus:
- Mental retardation (the most common finding)
- Psychomotor retardation
- Microcephaly
- CHD
- Spontaneous early miscarriage
- Prenatal onset growth deficiency
- Abnormal facies similar to FAS
VI. Malnutrition
a. vitamin A deficiency
- Anophthalmia
b. folic acid deficiency
- Neural tube defect
► Recommended dose to prevent it : 400 micrograms daily
c. Vitamin D deficiency
- Bone and teeth malformation
d. Calcium Ca
- Bone malformations
e. Potassium K
- Preterm labor
f. Iron
- Anemia
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Causes of neural tube defect :
1. Trimethoprim (folate antagonist)
2. Sodium valproate
3. prolonged Maternal hyperthermia ( >38.9o
c )
4. Uncontrolled DM
5. Folic acid deficiency
Treatable causes of mental retardation :
1. PKU
2. Galactosemia
3. Hypothyroidism
4. Craniostenosis
5. Congenital hydrocephalus
Preventable causes of mental retardation :
1. Hypoglycemia
2. Hyperbilirubinemia
3. CP
What about Father ?
- When toxic substances affect sperm cells, the damaged sperm usually does Not survive
the journey to the egg
- Cocaine may disrupt the development of zygote
- Most birth defects result from mother’s exposure to toxins
- Men should consider how they contribute to prenatal hazards
- Healthy pregnancy is the responsibility of both men & women
Home message
- Birth defects due to exposure to teratogens are preventable
- And their prevention is an important public health problem