Cristiana A. Costa, DO
 https://medicine.duke.edu/faculty/cristiana-costa-do It is the bowel wall anxiety 7 year old proven anafranil 10 mg, leading to infection in the abdomiusually caused by viruses but sometimes by bactenal cavity (peritonitis) and in adjacent organs anxiety 7dfps discount anafranil 25mg otc. Treatments concern with croup is difficulty breathing as the air include medications that reduce inflammation bipolar depression 35 generic 10mg anafranil with mastercard, suppassages narrow anxiety zone blood in stool buy anafranil from india. Dietary tration of moist air (as from a humidifier), saltwachanges can reduce symptoms. Also known as regional suppressants, pain medication, fluids, and, if the enteritis. Crossing over is cryoglobulinemia the presence in blood of a way to recombine the genetic material so that each abnormal proteins called cryoglobulins that have person (except for identical twins) is genetically the unusual property of precipitating from the blood unique. Cryoglobulins can increase the risk of crossover study A type of clinical trial in which blood clots forming in the brain (stroke), eyes, and the study participants receive each treatment in a heart. With this type of study, every patient blood vessels (vasculitis), which increases the risk serves as his or her own control. Cryoglobulinemia can also are often used when researchers feel it would be accompany another disease, such as multiple difficult to recruit participants willing to risk going myeloma, dermatomyositis, or lymphoma. Cultural evolution shows a rapid rate of crypt In anatomy, variously a blind alley, a tube change, is usually purposeful and often beneficial, is with no exit, a depression, or a pit in an otherwise widely disseminated by diverse means, is frequently fairly flat surface. For example, the tonsillar crypts transmitted in complex ways, and is enriched by the are little pitlike depressions in the tonsils. Cultural evolution is unique to humans among cryptorchidism A condition in which one or all forms of life. Any body tisrected in early childhood are at increased risk for sue or fluid can be evaluated in the laboratory by developing cancer of the testicles. Also known as using culture techniques to detect and identify infecundescended testicles. It also has a joint in the front that permits it to articulate anteriorly with the Curie A unit of radioactivity. Specifically, a Curie fourth and fifth metatarsals (the bones just behind is the quantity of any radioactive nuclide in which the fourth and fifth toes). It is important to tion (brand names: Neoral, Sandimmune) that is wash a cut with soap and water, and keep it clean prescribed chiefly for organ transplant recipients and dry, but avoid putting alcohol, hydrogen peroxand people with autoimmune disorders. Delay in getting medical care can increase the rate cyclothymia A form of bipolar disorder in which of wound infection. If a cut results from a puncture the mood swings are less severe than manic depreswound through a shoe, there is a high risk of infecsion. Redness, swelling, increased pain, and pus draining from the wound also indicate an infection cyst A closed sac or capsule, usually filled with that requires professional care. Also known as chalazion or cutaneous syndactyly See syndactyly, cutatarsal cyst. Still other types of ovarian cysts are called dermoid cysts, or ovarian cyanosis A bluish color of the skin and the teratomas. These bizarre but usually benign tumors mucous membranes due to insufficient oxygen in can contain many different body tissues, such as the blood. Pain from an with a malformation of the heart that permits into ovarian cyst can be caused by rupture of the cyst, the arterial system blood that is not fully oxygenated. If a cyst is causing severe pain, is not resolving, or is suspicious in any cycle, menstrual the monthly progression of way, it can be removed through laparoscopy or, changes in the endometrium (the lining of the if necessary, through an open laparotomy (bikini. When cysticerci are found in the cyst, synovial, of the popliteal space See brain, the condition is called neurocysticercosis. When the tapeworm eggs are inside the stomach, cyst, thyroglossal A fluid-filled sac that is presthey hatch, penetrate the intestine, travel through ent at birth and located in the midline of the neck. It results from incomplete closure of often in rural, developing countries where hygiene a segment of the thyroglossal duct, a tube-like strucis poor and pigs are allowed to roam freely and eat ture that normally closes as the embryo develops. Cysticercosis is not spread from perAlso called a thyroglossal duct cyst or a thyrolingual son to person. Tapeworm eggs that are accidentally swallowed by another person can cause infection. A follicular cyst is the most common type cystine An amino acid that is particularly notable of ovarian cyst. It results from the overgrowth of a because it is the least soluble of all naturally occurfollicle, the fluid-filled cyst that contains an egg, that ring amino acids and because it precipitates out of does not rupture to release the egg. Cystine ian cysts resolve with no intervention over the tends to precipitate out of urine and form stones course of days to months. Treatment includes avoiding irritants on the face, including many cleansers and cosmetics, and stones can make their way from the kidney into the ureter and lodge there, further blocking the flow of in some severe cases, use of steroid or antibiotic medication. Cystinuria is the most to mucus buildup that impairs the pancreas and, common defect in the transport of amino acids. Mucus buildup in lungs Signs and symptoms of cystinuria include blood in can impair respiration. There are several genetic types are the visible carriers of the hereditary material. Cytogenetics is a fusion science, joining cytology (the study of cells) with genetics (the study of inhercystitis Inflammation of the bladder. Infection with human ing of the bladder, and even to ulcerations and cytomegalovirus can also cause viral hepatitis and bleeding. Another cause of dandruff is fungus, especially an abundance of the fungus Pitrosporum ovale. He blood pressure, and so helps to prevent and control injected the blood vessels and cerebral ventricles high blood pressure. His drawings of the human anatomy It is low in saturated and total fat and cholesterol, have long been considered to be unrivaled. See its (fingers or toes), as in dactylitis (inflammation of congenital hip dislocation. These tendons include the extensor pollicis brevis and dactylomegaly Enlargement of a finger or toe. Acquired epileptiform opercular syngate the biological bases of language and its development 3 types of mood disorder discount anafranil online amex. Frequently depression definition apa safe anafranil 50 mg, the cognitive profile in sparked much debate in the scientific community depression keeps coming back cheap anafranil uk. The cognitive this syndrome continues to be broadly described as strikprofile in this genetic condition is usually described as strikingly ingly uneven depression unspecified icd 9 generic anafranil 25mg fast delivery, where language, music, and face processing uneven, where language is relatively proficient but visuospatial are areas of strength but visuospatial processing is an area processing is impaired. Others have lar architecture of the human mind, where different domains challenged this view, pointing to the contribution of interactions can be fractionated. Some have even argued that this profile between genes and the environment over development. Instead of supports a genetically prespecified language faculty (Pinker, describing the end products of development in terms of patterns 1999). The underlying assumption of such theoretical modof proficiency and impairment in higher-level domains, the study els is that developmental disorders provide us with a unique of Williams Syndrome can reveal how these complex interactions opportunity to directly link genes, the brain, and behavioral unfold over time giving rise to the phenotype characteristic of this outcomes. Handbook of the Neuroscience of Language 367 All rights of reproduction in any form reserved. In fact, rather strong theoretical claims have been made with In view of this variability in physical and physiological groups as small as three or four individuals. Although its origins are poorly understood, been diagnosed using genetic criteria. Rethinking innateness: A connectionist perfacial features and heart abnormalities, there is substantial spective on development. Cognitive heterogeneity in cardiac abnormalities appear to be expressed on a continuum Williams syndrome. And yet, several lines of evidence also refer to a more of overall mental age (Brock, 2007) and performance within complex picture, occasionally reporting serious difficulties individuals across various domains is highly correlated in areas that are generally described as proficient. Do these generalizations hold in the face of experithese considerations suggest that language is strictly speakmental evidencefi For instance, on tests of vocabulary comto be less clear-cut than these sweeping claims suggest. These nevertheless successfully capture the interest and attenpatterns suggest that proficiency in the language domain tion of their interlocutor. Therefore, Language and Communication in Williams Syndrome 369 Such claims are usually based on taskand populationBox 36. Extending approaches of adult neuropsychology can be attributed to the disorder itself. Control groups can be normal individuals or individuals focused on seeking selective patterns of impairment and with other disorders that are matched on chronological age sparing, mostly in late childhood and adulthood. Traditionally, these matching procedures terns are used like double dissociations that can then reveal have been used to assess questions regarding delay or deviwhether two skills are separable, not only functionally, but ance in the behavior of the experimental group relative to also developmentally, neuroanatomically, and genetically. However, these procedures are associIn these models, the original claim of dissociation between ated with certain limitations. In more strict applications of modular young children with far less world experience. Even further refinements of dissociations snapshots captured at different moments in time and averaged over the group. For instance, non-spatial which patterns of developmental change and developmenlanguage has been found to be more proficient relative to tal stability emerge more clearly. Development itself is the key to outcomes, deeming the developmental process itself to be a understanding developmental disorders. Instead of dema multitude of difficult questions: What exactly is the nature onstrating a prespecified brain architecture, it seems more of these domain-relevant developmental mechanismsfi Exactly how and when do Considering some of these links clearly illustrates these domain-relevant mechanisms give rise to the specialthis point. The underbehavioral and cognitive profile in this neurodevelopmental lying assumption is that if domain-relevant processes prodisorder. Hence, elucidating alterations in these domain-relevant ments have challenged this view. The domain-relevant mechanisms described and environmental interactions give rise over developmennext include alterations in basic sensory and perceptual tal time to uneven behavioral profiles in the phenotypic outinputs (hearing and hyperacusis, auditory processing), atypcome, via alternative trajectories (Karmiloff-Smith, 1998). What tions (statistical learning), alterations in the environmental alterations in perception or in processing of input drive context of language acquisition (social communication), these trajectories and what constrains themfi Hypersensitivity to sound is one of the most over developmental time (Elman et al. Hyperacusis is very At first blush, these propositions of the developmental rarely seen in the general population and is usually linked Language and Communication in Williams Syndrome 371 to hearing loss. In another functions, it is unclear what effects of this symptom might study using functional brain imaging when listening to have on auditory functioning, in general, and on language, music versus noise, patterns of activation were less disin particular. It is possible that higher-order with abnormally high levels of activation in the amygdala executive functions. Could processing and language given that these impairments are fine-grained methods reveal subtle abnormalities in auditory not found in all or in most cases. Statistical Learning in all or some participants mostly tested in late childhood and adulthood. This is because differences in perceptual While different domains vary substantially in the nature processing need not exist throughout the entire life span. A couple of studies of brain neuroanatlearning capacities both infants and adults employ in disomy and neurophysiology examined the neural correlates covering patterns and regularities not only in linguistic input of auditory skills. In the auditory cortex, abnormalities are but also in the general auditory and visuospatial domains 372 Clinical Neuroscience of Language (Newport & Aslin, 2000). We still have little understanding show the typical left hemisphere asymmetry for grammatiof how processes which structure or make use of structured cal words which indexes the integration of the elements of input are used in the development and processing of higherthe sentence nor did they show the typical processing diflevel domains such as language, and importantly of the conference between content words and structure words (Mills straints on this type of learning. This raises the possifor example, pitch versus contour cues, has been discussed bility that similar underlying strategies have different impliin detail in several developmental models concerned with cations for the emergence of higher-level abilities such as language acquisition and on-line processing. Further investigation emphasize that while a modular organization of language of these cross-domain patterns can be incredibly revealing may be plausible in adulthood, shared developmental mechin relation to the role of shared underlying mechanisms anisms are very likely to come into play, including mechaacross domains. The Social Context marking syntactic boundaries since these contours correlate probabilistically with syntactic structures in language. In this is likely to contribute to the significant delay in language infancy, sharing eye gaze, establishing joint attention with acquisition in this population. For instance, infants acquire various object names clinical group a lack of sensitivity to these prosodic contour through following the eye gaze or pointing of the caregiver cues requires a more extended period of exposure to linguiswho then names the object. This seemingly inborn desire tic input for the discovery of structure to get off the ground. Consistent from communication-rich environments makes important with some hypotheses in research on language processing contributions to language development. An alterperspective taking, is weak (Tager-Flusberg & Sullivan, native possibility is that problems in phonology are subtle, 2000). Interestingly, their deficits pensation for difficulties is bidirectional between different result from excessive interest in looking at the adult withaspects of language in this clinical group. Purchase anafranil 75 mg on-line. Bipolar Depression Across the Life Span: Enhancing Diagnosis and Management From Youth to Older Age.
It can last for months or longer downstait separation anxiety order anafranil 50 mg without prescription, and it can the gums after a dental procedure depression test dr oz cheap anafranil 10mg with visa, heavy menstrual vanish as suddenly as it started depression symptoms during period anafranil 10 mg overnight delivery. The cause of vulvobleeding in women anxiety during pregnancy buy 75mg anafranil amex, blood in the stool and urine, dynia is unknown. Many women with vulvodynia and excessive bleeding after a cut or other accident or after surgery. Von Willebrand disease is usually have a history of treatment for recurrent vaginal funmild and often does not require treatment. Treatments can include the use of Treatment may be needed only after surgery, a tooth drugs, use of nerve blocks to numb the vulvar nerves, and biofeedback therapy to relax pelvic extraction, or an accident. Plantar warts may attack blood vessels deep in the skin, and they can be quite painful. Waardenburg syndrome A genetic syndrome Avoidance and prompt treatment are essential. In that features varying degrees of hearing loss and some cases, allergy injection therapy is highly effecpigmentation changes in the skin and hair. Warfarin works by separates the gluteus maximus muscle of the butsuppressing production of some clotting factors. Wegener granulomatosis See granulomatosis, wart A local growth on the outer layer of the skin Wegener. Papillomavirus is transmitted by contact, either with a wart on somewelt See hive. Warts that occur on the hands or feet are called Werner syndrome A premature aging disease common warts. A wart on the sole of the foot is a that begins in adolescence or early adulthood and plantar wart. See also ture graying, early baldness, wizened face, beaked genital warts; human papillomavirus. Plantar warts are different from most other autosomal recessive manner and is due to mutation warts. It can affect any part of the body, leading to arthritis and then weight loss, Werner-His disease See trench fever. Whipple disease has mitted from birds to mosquitoes and then to people been discovered to be due to a type of bacteria by mosquito bites. Some patients relapse and virus occurs in parts of Africa and Asia and, infreneed long-term, even life-long, treatment. West Nile virus had never been seen in birds Whipple procedure A type of surgery that is or people in the Western Hemisphere prior to an used to treat pancreatic cancer and was devised by outbreak in summer 1999 in New York City. Most affected creas, the duodenum, a portion of the stomach, and people have no symptoms or minor symptoms, but other nearby tissues are removed. The whipworm is infants and small children under age 5, the aged, found worldwide, and whipworm infections are and people with impaired immune systems. Heavy infections, especially in small children, can cause gastrointestinal problems (such as Western blot A technique in molecular biology abdominal pain, diarrhea, and rectal prolapse) and that is used to separate and identify particular possibly growth retardation. It can be expressed in international units wheezing A whistling noise in the chest during as (4. Ideally, people so affected should do thought to be as follows: the victim may be first their best to relax when in the medical office. The white matter is white ments in and around the spine may be stretched or because it is the color of myelin, the insulation that torn. This may rock the head violently white subungual onychomycosis, proximal forward, stretching and tearing more muscles and See onychomycosis, proximal white subungual. A closed comedo may rupture and cause a low-grade skin inflammawinter depression See seasonal affective distory reaction in the area. Wilms tumor A childhood form of kidney cancer with a peak age of occurrence at 3 years of age. Symptoms can include abdominal pain, swelling, Wolff-Parkinson-White syndrome A condition and blood in the urine. Diagnosis is made by biopsy, that is caused by an abnormality in the electrical which can classify the tumors as having a favorable system of the heart, which normally tells the heart histology (microscopic appearance) or an unfavormuscle when to contract. The outcome is also reflected by the stage of cal connection inside the heart that acts as a short the tumor (extent of spread) at the time of diagnocircuit, causing the heart to beat too rapidly and sis. Wilson disease An inherited disorder of copper metabolism that results in an abnormal accumulaWolhynia fever See trench fever. Although the accumulation of copper begins at birth, symptoms of the womb See uterus. A diagnostic feature of the disthe muscles of the hand and sometimes the forearm ease is a Kayser-Fleischer ring, a deep copperand that occurs only during typing or use of a comcolored ring around the edge of the cornea that puter. Similar focal dystonias have also been called represents copper deposits in the eye. If treatment is begun early enough, symptomatic wormwood the plant whose essence forms the recovery is usually complete, and a life of normal basis of absinthe, a dangerous emerald-green length and quality can be expected. Another row of carpal bones meets the hand at the five metacarpal bones that make up the palm. Xx xanthoma, planar A type of xanthoma that is characterized by flat yellow-to-orange patches or pimples that cluster together on the skin. Xanthelasma is a harmless growth of tissue caused by tiny deposits of fat in the skin, and it is xanthomatosis An accumulation of excess lipids often associated with abnormal blood fat levels in the body that is due to disturbance of lipid metab(hyperlipidemia). Dermatologists can remove the xanthopsia A form of chromatopsia, a visual abnormal plaques. In xanthinuria A rare metabolic disorder that is xanthopsia, that color is yellow. Classic xanthinuria is inherited in an autosomal recessive manner and involves a defect in the xenotransplantation Transplantation from one enzyme xanthine dehydrogenase. Although xanthomas themselves are harmless, they frequently indicate underxeroderma Abnormally dry skin. They are composed of lipid-laden foam drome), overexposure to sunlight, and medication. Treatment is directed toward Xeroderma can usually be addressed with the use any underlying disorder when present. Xanthoma is distinguished from xanthelasma by xeroderma pigmentosum A genetic disease that being a large nodule deep in the tissues as opposed is characterized by such extraordinary sensitivity to to a plaque on the skin surface, but both can occur sunlight that it results in the development of skin from lipid disorders. This means that X-linked traits are expressed in males and in females who are homozyxerophagia Having a tendency to eat a dry diet. See also function of the lacrimal glands, which produce autosomal recessive trait; X-linked dominant. When xerophthalmia is due to vitamin A deficiency, the condition begins with night blindness X-ray High-energy radiation with waves shorter and conjunctival xerosis (dryness of the eye memthan those of visible light. X-ray is used in low doses branes), progresses to corneal xerosis (dryness of to make images that help to diagnose diseases and the cornea), and in its late stages develops into kerin high doses to treat cancer. The xiphoid process has no particular functhe condition is associated with increased height tion and ranges in size from miniscule to several but no malformations. Xylitol is called a affects about 1 in 1,000 males caused by the presnutritive sweetener because it provides calories, just ence of an extra Y chromosome. However, it is less likely than sugar to include increased height, speech delays, learning contribute to dental caries. The mother yaw is followed by recurring (secondary) crops of bumps and more swollen lymph nodes.
One popular theory associates the presence of ductal tissue encircling the aorta at the site of the coarctation suggesting a constrictive effect of the ductile tissue (2) depression symptoms shortness of breath buy anafranil master card. Although present at birth mood disorders kingston discount anafranil 10mg amex, coarctation of the aorta may not cause symptoms until early childhood and sometimes not until late childhood bipolar depression bipolar medications safe anafranil 75mg, depending on the severity of the coarctation anxiety 1st trimester generic 10mg anafranil otc, and the presence of associated cardiac lesions. If a ventricular septal defect is also present and is large, the coarctation of the aorta will cause increased left to right shunting across the defect, producing congestive heart failure within the first few months of life as the pulmonary resistance decreases after birth. A patent ductus arteriosus located proximal to Page 273 the coarctation would likewise increase pulmonary shunting through the ductus resulting in congestive heart failure. If the ductus is located distal to the coarctation, signs and symptoms may be delayed. Other anomalies associated with aortic coarctation include a bicuspid aortic valve (85%) (3) that may obstruct left ventricular output, and an aberrant origin of the right subclavian artery distal to the coarctation (1%) (4). The latter will cause the blood pressure of the right arm to be equal to the leg, and may mislead one from the correct diagnosis. It is important to measure the blood pressure in both arms and at least one leg in order to detect the blood pressure differential caused by an aortic coarctation. If coarctation of the aorta is an isolated lesion, the typical symptoms may include: shortness of breath with exertion, leg pain with exercise, and rarely, chest pain with exercise. A chest x-ray may display cardiomegaly with a left ventricular hypertrophy configuration. In long standing cases, rib notching due to erosion of the lower anterior portion of the rib by dilated collateral arteries can be appreciated. The echocardiogram demonstrates narrowing of the distal aortic arch with increased velocities on pulsed and color Doppler. The pulsed Doppler waveform has a typical prolonged systolic phase extending throughout systole. If the coarcted segment is short and discrete, resection and end to end anastomosis of the proximal and distal ends is possible. If the coarctation is a long tubular obstruction, resection with interposition of a tube graft would be necessary. Some surgeons favor a longitudinal incision with insertion of a synthetic graft to enlarge the diameter. In the young infant, sacrificing the left subclavian artery, and using the transected blood vessel as a graft by turning it down and sewing it into the aortic wall was popular at one time (5). Catheter balloon dilatation of native coarctations has not been as successful as dilatation of postoperative restenosis of a coarctation. The use of stents to reinforce the arterial wall is now preferred to balloon dilation alone. A postoperative complication that is now rare is the syndrome of mesenteric arteritis (6), caused by reflex spasm of mesenteric arteries that are suddenly exposed to higher pressures after the coarctation is removed. Patients are being operated on at a younger age now so that the mesenteric arteries do not have as long a period of exposure to low pressures and are therefore less reactive. These defects represent abnormal communications between the high pressure left side of the heart and the low pressure right side of the heart. The pressure differential results in a left-to-right shunting of blood through the defect. The consequences of this shunting of blood are: turbulence of abnormal blood flow producing a heart murmur in systole and sometimes in diastole; excessive blood flow into the lungs causing shortness of breath and increased pulmonary vascularity on a chest x-ray; and increased volume overload of the myocardium resulting in hypertrophy of myocardium and chamber dilatation. The high pressure turbulence of the shunted blood produces a harsh quality to the murmur. When the pulmonic flow exceeds the systemic flow by a ratio of 2:1, an apical diastolic murmur is produced due to excessive flow during recirculation across the mitral valve. The machinery quality of the murmur results from the rhythmic variation of the pressure differentiation during the cardiac cycle. With increasing defect size and pulmonary flow, signs and symptoms of congestive heart failure occur: shortness of breath with exertion and in severe cases, also at rest; cough and susceptibility to pulmonary infections; hepatomegaly, splenomegaly, and lower extremity edema result from retrograde extension of the systemic venous congestion into the liver, spleen and legs. The chest x-ray in a left-to-right shunt lesion will demonstrate congested pulmonary vessels. Untreated defects with large shunts will eventually result in injury to the pulmonary arterioles, vascular obstruction, and pulmonary hypertension. The intracardiac defects can be closed by primary suturing of the edges of the defect if small, or by covering with a patch material if large. The knowledge of the location of the conduction system in relationship to the defect now makes this a rare complication. The mortality rate in experienced hands should be less than 5% if all ages are considered, with infants carrying a higher mortality rate especially if pulmonary hypertension is present. True/False: Equal blood pressures in the right arm and left leg rule out the diagnosis of coarctation of the aorta. True/False: the presence of palpable femoral pulses rules out the diagnosis of aortic coarctation. Anomalous origin of the right subclavian artery and its relation to coarctation of the aorta. Other congenital heart disease lesions may remain occult for longer period of time. An aberrant right subclavian artery originating below a coarctation will produce equal pressures in the right arm and leg. Development of collateral vessels to the lower body can produce palpable femoral pulses. If the hypoxia is severe enough, visible cyanosis will result, although this can be overcome with oxygen and other treatments for pulmonary edema and congestive heart failure. He was born at 41 weeks of gestation by C-section because of failure to progress to a 23 year old mother G1P0. He was discharged from the hospital and followed in the office until this episode. He subsequently undergoes palliative surgery with improved oxygenation and appearance of a continuous murmur. He is discharged in stable condition to be followed on an outpatient basis and to undergo further corrective surgery at a later date. Cyanosis can be secondary to cardiac, respiratory, hematologic and metabolic causes. Methemoglobinemia, decreased alveolar hypoventilation secondary to depressed respiratory center or obstruction of the respiratory passages, polycythemia, and hypoglycemia, shock, and sepsis may also cause cyanosis, or at least something that resembles cyanosis. Peripheral cyanosis is secondary to low cardiac output, in which acrocyanosis usually occurs with cool extremities and small pulse volume with bluish discoloration at the tip of the nose and fingers, and less in the mucous membranes. It is often difficult to differentiate pulmonary from cardiac causes of cyanosis in the newborn. A hyperoxy test may be helpful, whereby an arterial pO2 is measured in room air, which is then compared to a arterial pO2 measured in an FiO2 of about 90%-100% for about 10-15 minutes. Respiratory problems with alveolar hypoventilation usually improve with paO2 measurements well above 100-150 mmHg, whereas in right-to-left shunt cardiac lesions, the improvement in arterial pO2 is very minimal. Classifying cyanotic congenital heart defects into those with increased vascularity with an accentuated second heart sound and those with decreased blood flow with a diminished second heart sound, can simplify the differential diagnosis to an extent. Lesions with increased or normal blood flow with accentuated second heart sounds include transposition of the great vessels, truncus arteriosis, total anomalous pulmonary venous return, single ventricle, single atrium, and hypoplastic left heart. Transposition of the great vessels is the most common cyanotic congenital heart disease in the newborn infant (tetralogy of Fallot is more common overall, but many tetralogy of Fallot cases present after the newborn period). The aorta arises from the right ventricle and pulmonary artery from the left ventricle, with the aorta positioned anterior and to the right of the pulmonary artery. It is incompatible with life unless a communication exists between systemic and pulmonary circulation, as the two circulations are in parallel (and independent). On auscultation, the second heart sound is greater in intensity, as the aortic valve is anterior. Chest x-ray shows increased pulmonary vascular markings and a narrow mediastinal shadow secondary to a small thymus, sometimes giving the appearance of "egg on side" or "apple on a string" appearance. Echocardiography confirms the diagnosis and delineates the other associated lesions. Inadequate mixing between systemic and pulmonary circuits represents a medical emergency and a prostaglandin E1 infusion which maintains ductus arteriosus patency (to preserve mixing) may be lifesaving, followed by balloon atrial septostomy (Rashkind procedure). Surgical management consists of an arterial switch procedure (aorta and pulmonary artery are anastomosed to the correct ventricle), which is the operation of choice. The atrial switch (atrial baffling) such as Senning or Mustard procedures are no longer done because of the development of later complications. The arterial switch procedure offers the best prognosis with a mortality of about 5%. Potential links between ToM deficits and central coherence bias have also been considered by Frith (1989b); Happe (1994b); Happefi and Frith (2006) definition depression in elderly buy anafranil from india, but these domains are typically viewed as separate from one another (see Jarrold et al mood disorders kingston buy 25 mg anafranil. Coleman (2003) cited several scholars who consider the view of the Brain Dysconnectivity Hypothesis bipolar depression relationship cheap anafranil 25 mg on-line, such as McAlonan et al depression symptoms graves disease anafranil 50 mg free shipping. For example, cases of Wernickefis aphasia or Brocafis aphasia were originally based on reports of the effect of lesions in a localised brain area. However, different lesion sites produce differential language breakdowns that reinforced the search for localised areas of the brain and led to the construction of diagrams and models representing anatomical and functional centres and connections between them (Fromkin 1997). Information might therefore travel between these last two areas either directly, via the arcuate fasciculus, or by a second parallel route that passes through the inferior parietal lobule (Dick & Tremblay, 2012). For example, Fridriksson (2010) found that the Parietal lobe is the epicentre of anomic aphasia. The data suggest close correlations between abnormalities 60 in neuronal synchronisation and cognitive dysfunctions emphasising the importance of temporal coordination. On the contrary, Connectionism, as an interdisciplinary approach integrating raw anatomic brain knowledge with new neurolinguistics discoveries, focuses on learning from experience gained in relation to onefis environment and then storing what is learned in a form of weighted connections between neurons Elman (1998; Jagota, 1998; Christiansen, 1999, in Al-Sibai, 2004). According to Bishop (1988), the majority of children suffering left hemidecortication or brain damage within the first years of life do not develop aphasia. The ability to recover rapidly decreases with age and chances are best before the age of ten. Bates (1999) also confirmed that children are never aphasic and recovery was at as normal a rate as typical children when she studied patterns of unilateral lesions and their impact on language outcomes. To conclude, children are prone to develop coping strategies to overcome difficulties in attention, learning, memorising, and social adaptation although effective progresses depend on integrated efforts of personal intelligence, parental reinforcement, familial scaffolding, social understanding, pedagogical atmosphere, and literacy knowledge. Therefore, it is significant to the idea of early assessment and identification of speech and language impairments to plan suitable intervention that will help a child catch up with absent skills and his/her first language acquisition. From another point of view, Fay and Schuler (1980); McLean and Snyder-McLean (1978) stated that Communicative Competence is built upon the acquisition of several prerequisite skills, such as attending to and interacting with the physical environment; actively participating in social interactions with other individuals; and understanding and using expression forms. Speech and language problems are more serious when emerging in middle childhood having long-lasting effects, especially when both expressive and receptive skills are affected (see Beitchman et al. Linguistic Competence is to know how to use the grammar, syntax, and vocabulary of a language. Sociolinguistic Competence is to use and respond to language appropriately, and the relationships among the people communicating. Discourse Competence is how to interpret the larger context and construct longer stretches of language to make up a coherent whole. Finally, Strategic Competence is to recognise and repair communication breakdowns, how to work around gaps in onefis knowledge of the language, and to learn more about the language in context. Learners should be able to make themselves understood using their current proficiency to the fullest, try to avoid confusion in the message or offense to communication partners, and to use strategies for recognising and managing communication breakdowns. Fern-Pollak (2008) stated several factors that have to be taken into account to be considered proficient in a language. Among these are the linguistic properties of the languages that may influence the occurrence of impairments, and the function of cortical structures associated with language processing in cases of language impairments associated with brain damage. Based on the above, the development of Metalinguistic awareness is a crucial component that allows a child to be able to competently select and use communication 64 compensatory strategies appropriate to his needs, which the literature confirms can cooccur in some developmental expressive disorders (Schwartz & Solot, 1980) and in dyspraxia (Purcell, 2006). For example in social situations, listeners use vocabulary, variable intonation, tone, volume, and pace. In addition, they consider when to ask questions and when not to , and have the awareness of who talks first and who has the final say during a conversation, debate or perhaps an argument. Metalinguistic awareness also uses language behaviour that is opportune to the situation, as body language, facial expressions, eye contact, gesture, or touching. This methodology assisted in capturing deficiencies and incompetence in this challenging case of comorbidity. Very few reviewed studies focusing on topics related to this study are conducted on Arab school-aged children. Thus, this study assisted in understanding aspects in child language acquisition and learning when neurological and psychological comorbidity is occurring in an Arab child speaking in Aleppine Arabic dialect. In addition to some linguistic aspects of Standard Arabic and features of Syrian Aleppine dialect specifically; child-specific communication strategies and difficulties backed by theories on the typical and atypical language acquisition and learning processes are presented. Finally, fundamental linguistic concepts on communicative competence, performance, proficiency and metalinguistic awareness, and their implementations on the model under study are covered as well. The detailed observation provides in-depth insight into the communicative competence of the subject in different areas of language and speech. The analysis will focus on the subjectfis communication abilities and strategies, and will also take into consideration Arabic cultural aspects. Field notes of the subjectfis verbal and non-verbal communication will be recorded by the researcher (the mother) in various home-contexts. For this purpose semi-structured tasks and activities will be prepared by the researcher in advance to elicit daily communication, which will be audio taped, transcribed and analysed according to the research objectives set. Audio-taped recordings of the childfis linguistic and communicative abilities will also be documented. Since no one methodology is considered the best when dealing with developmental disorders in general and autistic children specifically, experts in developmental language studies. Brown (1973); Kelly and Rice (1986); Tager-Flusburg (2008) recommend the use of a combination of methods, protocols, and a variety of tasks as the most effective way to obtain data for describing the communicative ability of such children. These methods and types of data gathered in this study can be illustrated in Figure 3. The medical and psychological diagnoses and prognoses of the subject confirmed by several paediatric professionals are presented in Figure 3. Each of these instruments is designed to gather data that will answer the research questions presented in Chapter 1. Different types of observation are carried out by the researcher over a period of six months. The second observation involves getting the child to participate in a range of pre-set activities and tasks to obtain the following communication data from the child, elicited and task-oriented. The subjectfis spontanous participations in conversations and the researcherfis comments on changes in the subjectfis communication ability are documented using paper and pencil after they occur. Two sub-scales assess aspects of language structure (syntax and speech); two assess aspects of autistic behaviour (social relationships and interests); and five assess aspects of pragmatic communication (inappropriate initiation, coherence, stereotyped conversation, use of context, and rapport) which can be combined into a pragmatic composite (subscales C-G). The 70-item rating scales can be scored automatically for investigating language and communication impairments, each item is scored 0 (does not apply), 1 (applies somewhat), 2 (definitely applies) or missing value (unable to 70 judge). Bishopfis original criterion for interpreting the results is obtained directly from the toolfis author for providing the standard scores and percentiles for interpretation. Subscales No of Domain Theme of Behaviour Making up Subscale Items Item A Speech 11 Structural Phonological & speech abilities. Making sense in C Inappropriate 6 Structural conversation through proper referencing & Initiation sequencing of people & events. E Stereotyped 8 Pragmatics Versatility of conversational topics & use of Conversation different words. Use & understanding of social rules governing F Use of Context 8 Pragmatics communication. She included the studies that contrast these groups on potential etiological factors. Additional information: |
