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Interestingly order panmycin 500mg overnight delivery length of antibiotics for sinus infection, grass allergy can also be associated with fruit pollen syndrome order cheap panmycin online antimicrobial fabric, resulting in food allergies to tomatoes buy generic panmycin from india antibiotic resistance not finishing prescription, potatoes, and peaches. Does breathing in the fresh air of a beautiful spring day trigger itchy eyes and a runny nose? During allergy season, many people mistake allergic conjunctivitis with pink eye. If you think that you may have seasonal allergies due to pollen, there are a few steps you can take to avoid exposure. Just a few pumps of the saline spray into your nose several times a day will help flush out the allergens. This time of the year, you may experience a runny nose, sneezing, itchy throat or even a persistent cough and you may be asking yourself, Is it allergies or is it a cold?”. The symptoms of seasonal allergies can be uncomfortable. Take steps to avoid seasonal allergens. Common triggers of hay fever vary from one season to another. Depending on your allergy triggers and where you live, you may experience hay fever in more than one season. Seasonal Allergies: Symptoms, Causes, and Treatment. Read how thunderstorms can exacerbate symptoms in people with hay fever at The Washington Post. Probiotics may also be helpful in stopping those itchy eyes and runny noses: After analyzing more than 20 previous, and relevant, studies, researchers found that those who suffer from hay fever may benefit from using probiotics, or "good bacteria" thought to promote a healthy gut. People can also avoid pollen by keeping their windows closed in the spring, and by using air purifiers and air conditioners at home. Both in the spring or fall allergy seasons, pollen is released mainly in the morning hours and travels best on dry, warm and breezy days. The pollen that sits on brightly colored flowers, it is interesting to note, is rarely responsible for hay fever, because it is heavier and falls to the ground rather than being borne in the air. The most common allergen is pollen, a powder released by trees, grasses and weeds that fertilize the seeds of neighboring plants. People who are allergic to weeds are more likely to get other allergies and develop asthma as they age, Josephson said. Symptoms include itchy eyes, itchy nose, itchy throat, itchy ears, sneezing, irritability, nasal congestion and hoarseness. How to identify seasonal pet allergy symptoms. You will be screened for common allergens, such as various types of pollens, cat and dog fur, dust mites, mould spores and more. Which pollens are prevalent differs from province to province but the first seasonal allergy to pop up is tree pollen which could start as early as March,” allergist Dr. David Fischer told Global News. Springtime is easily the worst season when it comes to allergies. Pollen Allergies More than 25 million Americans are allergic to pollen from trees, grass, or weeds. Winter Allergies If you have indoor allergies such as mold and dust mites, you may notice symptoms more during winter, when you spend more time inside. Doctors often call hay fever allergic rhinitis. Using an air purifier and humidifier for your home will reduce dust and mold by using Cold Evaporation to trap the allergens. Keep your indoor air free of allergens to provide relief for when you do venture outside into the high pollen count. Speaking of spring cleaning, while dusting, vacuuming, and cleaning surfaces can remove indoor allergens, the chemicals in some cleaning products may trigger allergies. Starting allergy medications early in the season can help reduce symptoms, Schreiber says. Keeping a window closed during allergy season can help reduce the amount of allergens that enter the home. In a press release announcing the study results, the American College of Allergy, Asthma and Immunology recommended several ways in which patients can reduce their stress level during allergy season, including meditating, adopting healthy lifestyle practices, and making time for fun or relaxing activities. Sufferers of spring allergies may be able to reduce their seasonal flareups by lowering their stress level, according to a study. When pollen floats through the air and reaches the nose, the body sometimes overreacts. A: People with spring allergies are usually affected by pollen from birch, elm, maple, oak or poplar trees, depending on where you live. How should I treat seasonal allergy symptoms? For example, trees that bloom in the spring will bloom the whole season and may trigger allergic reactions until summertime. Seasonal allergy symptoms, or just a cold? Rhinitis (hay fever) symptoms & diagnosis. Hay fever can worsen signs and symptoms of asthma, such as coughing and wheezing. For many people, hay fever symptoms lead to absences from work or school. The next time you come in contact with the substance, these antibodies signal your immune system to release chemicals such as histamine into your bloodstream, which cause a reaction that leads to the signs and symptoms of hay fever. Many people — especially children — get used to hay fever symptoms, so they might not seek treatment until the symptoms become severe. Grass pollen, which is common in late spring and summer. Your hay fever signs and symptoms may start or worsen at a particular time of year. Tree and grass pollen are the main allergy culprits in the spring. If you are looking to treat more than your symptoms, immunotherapy (allergy shots) can desensitize you to the allergens that are bothersome to you. Pretreating with allergy medication before symptoms begin can help prevent inflammation and help ease your stuffy nose, itchy, watery eyes and other allergy symptoms. Spring allergy symptoms are typical of respiratory allergies , these include: To help avoid allergy symptoms, you can also take precautions at home, such as staying indoors on dry and windy days when allergens are typically worse. For many people, over-the-counter and prescription medications can help relieve allergy symptoms. During the spring season, tree pollination is a major allergy trigger to many people.

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Doctors just need to go through the symptoms better — an extra 30 seconds to get more of patient history to distinguish between non-allergic rhinitis and allergies purchase 500mg panmycin overnight delivery bacteria virtual lab.” Often people are put on Claritin when they have runny nose that may be non-allergic rhinitis or even a common cold order panmycin on line amex bacteria mod 151,” says Dr buy panmycin in india antibiotics lactose intolerance. David Stempel, an allergist and researcher at Virginia Mason Medical Center in Seattle. He adds that the only way you know for sure is with allergy skin testing, where tiny amounts of potential allergens are lightly pricked or scratched into the skin to determine if a patient is allergic a substance. When you know the most likely times for a low pollen count, you can better plan your days during hay fever season. Planning your outdoor activities for times when the pollen count usually drops may help minimize hay fever symptoms. Sneezing, watery eyes, a runny nose, itchy throat - hay fever symptoms are anything but a walk in the park. The swelling of your nasal membranes may also close the sinus drainage openings, causing sinusitis Rhinitis may also be associated with nasal polyps - small, non-cancerous growths; nosebleeds can also occur during hay fever attacks. Spring is great for getting active outdoors — unless your tissues get more action than you do. Late morning is prime pollen time during spring and summer, while evenings are worst for allergy sufferers come fall, according to the American College of Allergy, Asthma & Immunology Want a closer read? "It causes hayfever , with symptoms that include sneezing, runny nose, stuffy nose, itchy nose and itchy, watery eyes." "In hay fever season, consider washing your sheets once a week to keep sheets free of pollen, as well as dust and other particles that might make symptoms worse. "Part of the problem with hay fever is it depends on when your symptoms start, pollen counts tend to be higher during the day. Used to disinfect, chlorine is highly irritating to the skin, eyes, and respiratory tract, says Prevention advisor Andrew Weil, MD. And a recent study in the journal Pediatrics found that teens who log more than 100 hours in a chlorinated pool have a 3 to 7 times higher risk of developing hay fever, compared with swimmers who dunk in chlorine-free pools. If you are unsure about the cause of your allergy symptoms, get a skin test or a blood test to identify the allergens that cause your problems. The most common allergens in bedrooms are microscopic house dust mites which live in bedding. "Many things can trigger symptoms of allergies such as nasal congestion, even nonallergic rhinitis caused by changes in temperature or weather. But Berger also suggests that a better approach to treating allergies might be the inhaled nasal steroids and intranasal antihistamines "These inhaled nasal puffs and sprays address all four allergy symptoms of sneezing, itching , runny nose and mucus formation, and nasal congestion and swelling of the mucous membranes." One common explanation from doctors—and people in forums who say they are doctors—is that we may be exposing ourselves to specific irritants at around the same time every day. Some doctors suggest the symptoms are worse during the morning and evening because the pollen is released in the morning, rises in the atmosphere during the day, but cools down and drops in the evening. Incidentally, pollen, animal hair and mould can also cause symptoms that are similar to those of a house dust mite allergy. These tests reveal an allergic disposition to certain house dust mite allergens but do not provide evidence of an actual allergy. Sure, Fido and Mittens are beloved family members, but when it comes to bedtime, they are better off in their own cozy beds, not sharing yours Not only are pets likely to disrupt your sleep, but their fur is full of allergens such as dander, dust, pollen, mold spores and bacteria. After a long, hard day, you probably let out a sigh of relief when your head hits the pillow Unfortunately, pillows quickly build up excessive amounts of health busters such as bacteria, mold spores and dust mites, leading to allergy symptoms such as sore throat, headache and congestion. In the case of rhinitis, some people will also be given a "nasal provocation" test, where a nasal spray of the potential allergen is put in your nose and your reaction is assessed. Testing for allergies can involve pricking the skin and exposing it to potential allergens to see if an immune system reaction happens, which is the most common way. Hay fever symptoms, meanwhile, tend to be worst when wind is high (meaning more pollen) and when pollens counts are at their peak, which generally hits around mid-morning and late afternoon If, however, you have a house which is open to the elements or a bedroom where pollen can turn up, this might not be a reliable guide, because pollen in your bedding can also set off hay fever. In people who are allergic to pollens, this can be a time when symptoms occur most strongly, especially if you are outdoors or around open windows. Possible allergens include food, drugs, insects, animal dander, dust mites, mold, and pollen. Castells said the most dangerous time of the day” is the early morning, so during high pollen season allergy sufferers should plan any outdoor activities or exercise for the afternoon — around 5 or 6 p.m. — when the pollen is settling. Incessant, violent sneezing for an hour or more every morning upon rising; stuffy fullness in head with profuse, hot, acrid, watery nasal discharge, worse cold air; acrid nasal discharge with salivation and shortness of breath; very tenacious mucus in nose; heavy pressure and tightness between eyes; puffy eyes; thirsty; cheerful loquacity, jesting; worse heat, dampness, pressure; better cold, open air, motion. Itching, crawling, tickling, tingling and/or painful dryness inside nose; wet sensation inside nose, but no discharge; one-sided nasal obstruction; sneezing from dust; dry, itching mouth; face feels hot; ears stopped up; itching hives, better scratching; psychogenic allergies; nervous restlessness; quarrelsome; alternating sensations of heat and cold; generally worse heat and better cold air; desires to be fanned. Profuse, acrid, hot, scalding tears from the eyes and bland nasal discharge (opposite of Allium cepa); eyes water constantly; frequent blinking which ameliorates; burning, swollen eyelids; sticky mucus on cornea; photophobia; dryness and violent itching of eyes, better from rubbing; watering eyes, worse wind, cold air; nasal discharge, better open air, dries up at night; congested headache with pressure in eyes; chilliness, cannot get warm in bed; lying down makes the nasal discharge worse as well as the watering eyes but improves the cough/asthma; worse indoors, warmth, wind, sunlight, during night, morning, after sleep; better open air, darkness. Constant sneezing; profuse nasal discharge and tearing from the eyes, worse open air, especially worse in August, as summer changes into autumn; nose totally stopped up in cold damp; wants nose kept warm; every cold settles in eyes, throat or bladder; headache from stoppage of nasal discharge; frequent urination; chilliness; thirsty; worse becoming chilled while hot, cold damp, sudden change of weather from warm to cold, before storms, exposure to newly mown grass or hay, lying on cold damp ground, cold bed; better moving about, warmth, dry weather. It may take as long as three to five seasons of ongoing professional, constitutional, homeopathic treatment to effect a cure of hay fever or allergic rhinitis. Hello you have condition called Allergic rhinitis, often called hay fever, occurs when your immune system overreacts to particles in the air that you breathe-you are allergic to them. This leaflet is about the use of loratadine to reduce the symptoms of allergy, such as in hay fever, urticaria (itchy rash) or pruritis (itchy skin). In people who are allergic to them, these particles trigger the release of a chemical in the body that causes nasal congestion, sneezing, watery eyes, and runny nose. Allergens may include dust mites, pollen, molds, or pet dander. "Allergen avoidance in the treatment of asthma and allergic rhinitis" They can trigger hay fever and asthma symptoms and reproduce by releasing spores into the air, which float around until they find a hospitable environment. Dust mites are common indoor allergens. When the allergen particles come to rest in the linings of the eyes, nose, or airway of a susceptible person, an allergic reaction can occur. Allergy symptoms can actually be worse in the winter when the windows are closed and people are shut in with the allergens. "Scientists map the worst times of day for people allergic to grass pollen." ScienceDaily. Scientists map the worst times of day for people allergic to grass pollen. Pollen food syndrome usually occurs in people who are already allergic to pollens and suffer from hayfever, although the symptoms due to hay fever can be mild. Symptoms include sore throat, fever, headache, stomach pain, nausea and vomiting. Strep throat symptoms are usually more severe than symptoms of a sore throat with a cold and may include the following: Are Strep Throat Symptoms Different From a Sore Throat With a Cold?

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Coarctation of the aorta may present in childhood or adulthood with sys- temic hypertension discount panmycin 250mg on line treatment for uti bactrim dose, usually resistant to medications purchase panmycin 500 mg without prescription antibiotics for uti chlamydia. Alternatively generic panmycin 250mg otc antibiotics jaw pain, coarctation may be diagnosed after patients are noted to have one of several heart murmurs, including a continuous murmur of the blood flow across the well-developed collaterals, a systolic murmur in the infraclavicular area that corresponds to the segment of coarctation. Headaches, chest pain, fatigue, or intracranial hemorrhage may be a less common presentation of coarctation of the aorta. On examination, severe coarctation may be suggested by the differential cyanosis as mentioned above. In less severe cases, coarctation may be detected through the identification of a delay in the femoral pulse relative to the brachial pulse 162 S. S1 first heart sound, S2 second heart sound, A aortic valve closure, P pulmonary valve closure. Constriction of the aorta causes the pressure in the ascending aorta to be higher than the poststenotic region of the aorta causing the blood flow to be turbulent producing a murmur. The murmur is mostly systolic, however, may spill over into diastole (brachiofemoral delay). Upper and lower extremity blood pressure evaluation is critical in the evaluation of as suspected coarctation. In normal individuals, the systolic blood pressure in the thigh or calf should be higher than or at least equal to that in the arm; thus the finding of a systolic pressure that is lower in the leg than in the arm may suggest the presence of a coarctation. Chest X-Ray In severe cases, chest radiographs may demonstrate cardiomegaly, pulmonary edema, and signs of congestive heart failure. In cases diagnosed later in life, chest radiographs may show cardiomegaly, a prominent aortic knob and rib notching secondary to the development of collateral vessels. Severe coarctation in newborn and children and young infants may show evidence of right ventricular hypertrophy due to pressure overload of the right ventricle which pumps blood in utero to the descending aorta through the patent ductus arte- riosus. Increased left ventricular voltage may be seen in older children and adults with coarctation of the aorta secondary to left ventricular hypertrophy. Echocardiography Transthoracic echocardiography is the gold standard diagnostic tool for coarctation of the aorta. Detailed anatomy of the aortic arch, the coarctation segment, and the ductus arteriosus patency is identified by two-dimensional echocardiography 12 Coarctation of the Aorta 163 Fig. Color Doppler is used to assess the pressure gradient across the narrow segment, although usually no signifi- cant gradient is detected if the ductus arteriosus is patent, and the direction of blood flow across the ductus arteriosus. Prenatal diagnosis can be made by fetal echocar- diography, although it is technically difficult to evaluate the fetal aortic arch for 164 S. As a result, the diagnosis is usually suspected on the basis of secondary signs that point to abnormal fetal circulation, including right ventricular dilatation, reversal of flow across the aortic arch, and left-to-right shunt across the fetal patent foramen ovale. Cardiac Catheterization Cardiac catheterization is an excellent tool for diagnosing coarctation of the aorta and identifying the extent of the narrowing. However, due to the availability of noninvasive echocardiography as a diagnostic tool, cardiac catheterization is more commonly used as an interventional tool in cases requiring balloon angioplasty of the coarctation segment, stent placement, or stent dilatation. It is also used in cases that require cardiac catheterization for further characterization of or intervention for other associated cardiac lesions. Treatment Treatment of coarctation of the aorta depends on the degree of narrowing and the severity of its presentation. Cases of coarctation that present in the newborn period typically require more invasive interventions than those that present later. Newborn children who present with shock, poor or absent pulses, or differential cyanosis should be started on prostaglandin E2 until ductal-dependent lesions are excluded. Upon confirmation of the diagnosis, prostaglandin should be continued 12 Coarctation of the Aorta 165 until the time for definitive intervention, along with continued medical management of metabolic acidosis and shock. The most common technique is resection of the coar- ctation segment and end-to-end anastomosis via a left lateral thoracotomy incision. An alternative technique is the subclavian flap, which involves using the left subclavian artery to augment the narrow aortic segment and replace resected tissue. Over time, the left upper extremity will be supplied by collateral arteries that develop in lieu of the resected subclavian artery. As a result, the left upper extremity may be smaller than the right upper extremity. Following repair of coarctation, patients may develop varying degrees of reco- arctation and will require life-long cardiology follow-up. If significant recoarcta- tion develops, patients are usually treated by balloon angioplasty with possible stent placement in the coarctation segment. Patients who present later in life with coarctation of the aorta are usually treated by balloon angioplasty with stent placement of the coarctation segment. Stent use is avoided in younger children since the stent may not be possible to dilate to adult aortic arch diameter dimensions. A 10-year-old male patient presents to his pediatrician’s office for a regu- lar checkup. His past medical history is remarkable for occasional headaches, but the patient otherwise has no complaints. Initial vital signs are notable for elevated blood pressure (154/78 mmHg) in the right upper extremity. In general, the patient is well devel- oped and well appearing, in no acute distress. On auscultation, the patient is noted to have a 3/6 systolic murmur in the left infraclavicular area. On recheck of the patient’s triage vital signs, the patient is noted to have a blood pressure of 159/79 mmHg in the upper extremity and 110/60 mmHg in the lower extremity. The differential diagnosis for hypertension includes essential hypertension, endocrine disorders, renovascular disease, or cardiac causes, such as coarctation of the aorta or conditions associated with a large stroke volume; the differential blood pressure between upper and lower extremities strongly suggests coarctation of the aorta. Associated cardiac defects, including bicuspid aortic valve and ventricular septal defect, are not found. The patient undergoes percutaneous balloon angioplasty with stent placement given in his older age at presentation and the ability to dilate implanted stent in the future to adult dimensions. A 10-day-old newborn presents to the emergency room with increased irritability and poor feeding in the last 2–3 days. He was born full term via normal vaginal delivery with no history of complications during pregnancy. He did well in the first week of life, but started to have episodes of intermittent irritability and decreased oral intake in the last 3 days with noticeable ashen discoloration. Mother denies fever, vomiting, diarrhea, or history of illnesses with other family members. However, pulses were markedly diminished in all four extremities with reduced capillary refill (4 s). This infant is demonstrating signs of acute circulatory shock, without respiratory distress.

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Large atrial communications are repaired purchase panmycin online now antibiotics klacid xl, though small atrial communica- tions are often created to allow for right atrial decompression buy cheap panmycin on-line antibiotic doxycycline hyclate, as right ventricular hypertrophy is significant and compliance is poor in the early period following complete repair cheap panmycin on line antibiotic and alcohol. If the truncal valve requires repair for regurgitation or stenosis, operative difficulty increases considerably. Following surgical repair, many infants require outpatient medical therapy for post-operative left ventricular dysfunction and varying degrees of truncal valve regurgitation. Furosemide is commonly prescribed diuretic and carries with it the risk of hypokalemia, hypocalcemia, osteopenia, and hypercalciuria with calcium oxalate urinary stones. Furosemide-associated hearing loss is more commonly associated with rapid intravenous administration of the medication. Patients with truncus arteriosus require lifelong cardiology follow-up to monitor for obstruction or stenosis of the conduit, which can be related to patient outgrowth of the conduit or to calcification. When obstruction leads to significant increases in right ventricular pressure (typically 2/3 systemic or greater), re-sternotomy and replacement are indicated. Additionally, at least yearly follow-up allows for moni- toring of truncal valve function, branch pulmonary artery stenosis, biventricular function, arterial trunk dilation, exercise tolerance, and arrhythmia surveillance. Any child with a history of truncus arteriosus repair who experiences chest pain or syncope warrants cardiology consultation. Additionally, many have small atrial level communications which put them at risk for paradoxical emboli if right-to-left flow across the atrial septum occurs. Mothers of infants with 22q11 should be offered genetic testing on future pregnancies, as the risk of a similarly affected sibling is increased. Hypocalcemia is common and can be profound, particularly in the post-operative period. Most require supplementation throughout the first year of life, which can often be discontinued in early childhood. As these infants have T cell deficiency associated with thymic hypoplasia, irra- diated blood should be selected when transfusion is planned, which will decrease future risk of graft-versus-host disease. Also related to T cell deficiency, these infants should not receive live viral vaccine, as viremia and viral sepsis can cause critical illness in these infants. Upper airway anomalies, bronchomalacia, and tracheomalacia are common, and often require otolaryngology consultation. Poor feeding and growth failure are common, even when the operative result is good. Case Scenarios Case 1 A full term infant boy born by spontaneous vaginal delivery is limp at delivery. He is vigorous, but is noted to be tachypneic, with mild subcostal retractions, so is brought to the nursery for further evaluation. On auscultation, he has mild regular tachycardia, with a normal S1, single S2, and systolic ejection click. A 3/6 systolic ejection quality (crescendo-decrescendo) murmur is present along the left sternal border, and a 2/4 diastolic decrescendo murmur is present at the left lower sternal border. Differential Diagnosis This child is presenting with tachypnea, subcostal retractions, and mild hypox- emia. The absent thymic shadow and the right aortic arch should alarm the practitioner to a possible 22q11 deletion syndrome. Echocardiography demonstrates truncus arteriosus with a single great ves- sel giving rise to a right aortic arch, the coronary arteries, and the pulmonary arter- ies. A large ventricular septal defect is present with malalignment of the ventricular sep- tum. Mild truncal valve stenosis and moderate truncal valve insufficiency is demonstrated. An echocardiogram must be performed quickly to determine whether the arch is interrupted. The infant is only mildly desaturated since pulmonary blood flow occurs throughout systole and diastole, even though 20 Truncus Arteriosus 245 pulmonary vascular resistance is likely to remain high so shortly after birth. The tachypnea and mild respiratory distress in this infant may be secondary to mild metabolic acidosis from decreased systemic perfusion secondary to diastolic flow reversal through both the regurgitant truncal valve and the branch pulmonary arter- ies originating from the ascending arterial trunk. Management Medical management initially should include diuretics and digitalis to prevent pro- gression to congestive heart failure as the pulmonary vascular resistance decreases. Case 2 A full term infant girl born by spontaneous vaginal delivery develops stridor and increased work of breathing at several minutes of life and is brought to the nursery for further evaluation. On auscultation, she has normal rate and rhythm, with a normal S1, single S2, and systolic ejection click. A 1 to 2/6 soft systolic ejection quality murmur is present along the left sternal border, and diastole is silent. Note: She required intubation prior to the arrival of the transport team, secondary to worsening stridor and respiratory distress. Differential Diagnosis The first notable physical exam finding in this neonate is her work of breathing and stridor, suggestive of an airway abnormality. Airway abnormalities that present in the newborn period include laryngomalacia, vocal cord paralysis, and vascular rings. The physical findings on cardiac exam are subtle, the murmur is non-specific and a single S2 is not always appreciated by the non-discriminating ear. The echo is indicated secondary to low pO2 in the setting of oxygen admin- istration and a chest radiograph that suggests an absent thymus. The echo demonstrates truncus arteriosus with a single great vessel giving rise to a left aortic arch, the coronary arteries, and the pulmonary arteries. A large ventricular septal defect is present with malalign- ment of the ventricular septum. The dysplastic three-leaflet truncal valve functions well, with no stenosis and no insufficiency. Assessment Though this infant has DiGeorge syndrome and truncus arteriosus, the predominant features of her presentation are consistent with airway anomalies, which are com- mon among DiGeorge patients. The suggestion of cardiac disease in this infant is more subtle, with a single S2 and systolic ejection click on physical examination, a low pO2 despite oxygen administration, and an absent thymus on chest radiograph. Management Infants who present with stridor require airway evaluation by an otolaryngologist, preferably before cardiac surgery, to allow for a better prediction of the post-operative course. This infant has significant tracheo- and bronchomalacia which will cer- tainly be expected to complicate her course in infancy. As pulmonary vascular resistance drops, pulmonary blood flow will 20 Truncus Arteriosus 247 increase and diuretics may be necessary. A genetics consult should be obtained to discuss implications of the syndrome and to counsel parents on genetic testing for future pregnancies. Awad and Ra-id Abdulla Key Facts • In single ventricle there is one ventricle receiving blood from both atria.

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