Acardia
Acardia is a rare and serious malformation that occurs exclusively in monizygous twins - twins developing from a single egg. Acardia represents one of the most severe and rare congenital anomalies. It is characterized by the absence of functioning heart. Acardia results from the artery to artery connections in the placenta, thereby causing a physically normal fetus to circulate blood for itself as well as a severely malformed fetus suffering from heart regression. In other words, fetus acardius is a parasite and it receives blood supply from the donor twin. Because the pump twin heart has to pump for two, there is a high risk of going into heart failure and this would lead to the death of the normal twin.
The most common variety is the acardius acephalus where the head is lacking and so are the upper extremities. Other types are acardius anceps, acardius acormus and acardius amorphous. While in acardius anceps, the most highly developed form, a partly developed head with remnants of cranial bones and brain tissue are present with developed body and extremities, acardius acormus is the rarest form of acardia. The monster is a head without a body. Acardia amorphous is the least developed monster not recognizable as a human form, with minimally developed visceral organs. Since there is no gross human form, the name acardius amorphous.
As to the cause of acardia, the etiology of acardiac monster is still unknown. Genetic defects have been reported to be the cause. Some researchers suggest chromosomal abnormalities to be the reason. Krause and Bejdl suggest that compression of the cephalic pole of the embryo prohibiting curving and fusion of the primitive heart tube to be the basic cause of this anomaly. As a result, the dependant entodermal organs like thyroid, oesophagus, trachea, lung, liver and others are also not formed.
A pregnant woman carrying an acardiac twin is unlikely to have any unusual symptoms. An acardiac twin is often found incidentally on prenatal ultrasound. As no two acardiac twins are formed exactly alike, they may present differently. Several improved imaging techniques like 2D ultrasonography, 3D ultrasonography and transvaginal Doppler ultrasonography have made diagnosis of acardia possible even in the first trimester of pregnancy. Such early diagnosis helps to reduce the risk of complications. Fetal echocardiography is also recommended to assist in early detection of heart failure in the normal twin. Chromosome studies are also done on both fetuses.
One line of treatment is watching for the earliest signs of heart failure in the pump twin with frequent ultrasounds. If heart failure is identified and the pregnancy is also far enough, then the pump twin should simply be delivered. Physicians recommend prenatal interruption of the blood vessel connections before heart failure develops in the pump twin, thus sacrificing the acardiac twin.
Specialists use laser, electrical cauterization and electrodes, serial amniocentesis, medications and other treatments successfully. If the acardiac twin is large enough and the amount of blood flow to it can cause heart failure in the healthy twin, then blood flow is stopped with Fetal Image-Guided Surgery. The acardiac or parasitic twin never survives, as it is severely malformed and does not have a functioning heart. The normal twin is at risk for heart failure and complications associated with premature birth. The normal twin is expected to have about 10% risk for malformations.
Obsessive compulsive disorder
The exact cause of obsessive compulsive behavior is yet to be established. On the basis of some studies and research carried so far, possible causes include any one or a combination of two.
Genetics (family history): Multiple genes passed on through generations are likely to affect the sufferer whose close relative is diagnosed with OCD as well. The genetic connection proves to be higher if the onset of OCD is before age 14. Identical twins have a 70% chance of sharing the disorder.
Illness: If the person is suffering from other anxiety disorder like depression, , substance abuse disorder, a personality disorder, attention deficit disorder, he or she is most likely to experience a high level of anxiety. Certain auto immune diseases such as Sydenham's chorea, rheumatic fever, pediatric streptococcal infection may also cause obsessive compulsive disorder.
Serotonin Hypothesis: People diagnosed with OCD are believed to have abnormally low levels of brain chemical, the serotonin which helps carry messages from one nerve cell to another. This imbalance may interfere with the normal biological processes including mood, sleep, appetite, impulse control, aggression and pain.
Structural brain differences: Abnormalities in several parts of the brains including the thalamus, caudate nucleus, orbital cortex and cingulated gyrus may also be a cause for OCD.
OCD traits
The disorder is clearly visible right from early childhood. Check for one or more of the following traits which are generally associated with time, dirt, relationship and money. Unless and until the individual has trouble leading a normal life due to any or all of these traits, it is not diagnosed as a disorder.
- Keeping home perfectly organized.
- Extreme attention to details, rules, lists, orderliness even if it results in waste of time and doesn't result in completion of proposed activity.
- Exhibiting over perfectionism which interferes with task completion.
- Is a workaholic, overly devoted to work and productivity.
- Unwilling to delegate work as
- Highly rigid and stubborn.
- Leading a miserly spending style, self and others. Hoards money fearing future catastrophes.
Treating OCD
If left unattended, OCD can have devastating effects both in personal life and at the workplace. Normal life can be completely marred. Most importantly, individuals with OCD are close to acknowledging the need for help as compared to those affected with OCPD who do not conceive it as a problem, hence do not seek help until or unless someone forces the issue.
Antidepressant medications and behavior therapy are effectively used in treating OCD. Medication other than certain antidepressants is rarely prescribed. Instead individual psychotherapy or counseling helps treat OCPD. With family support and an empathetic attitude by those in contact, improvement is evident within few weeks of professional assistance.
Bibliography / Reference
|
