#conditions costales

[lichenaday]

Pertusaria californica

OMG you guys, there is now this AI plant care app (Greg App), for anyone curious) that is getting top-billing in Google searches when looking up info for plant care, but has apparently has now moved into lichen care? I have never seen more evidence for the uselessness of certain AI products than using generic advice to describe how to care for Pertusaria californica, a rare lichen only found in very particular habitats along the Pacific North American coastline.

The phrase "Thanks, I hate it," has never applied so thoroughly to something in my life. It uses very technically the correct information to come to the completely wrong conclusions, and I fear that this is the future of information distribution as we know it (OK I am being dramatic but I am a little day-drunk and this has me really wound up). What I can actually tell you about this lichen from a reputable source is that P. californica is a crustose lichen that grows on siliceous rocks in costal and montane habitats along the west coast on North America. It has an areolate (tile-like), verrucose (wart-like) thallus that is whitish-gray in coloration. It produces 1 to 10 small, black disked apothecia in its verrucae (the wart-like protuberances in the thallus) which produce large (relatively) spores. And you can't cultivate it at home. Why? Because lichens are slow-growing habitat specialists that require hyper-specific conditions to thrive and like to thwart our every effort to cultivate them. I think out of spite.

images: source | source

info: source | and the Greg App but I refuse to cite them because they have made me mad and it is clearly AI generated anyway so screw them

[wildwinterlunas]

Just watched a playthrough of Rot in Paradise and holy shit. People have started coming to me for critiques on Australian characters (mainly overwatch), their writing and designs, and that is Australian rep done right!

Starting with the character designs, I have seen variations of all of those outfits on people here, not only that but the designs all communicate where the characters are actually from;

Carmen, McCoy and Vonnie are all from an urban area, likely a city. The characters never change clothes during the game so I'm going to assume these are their swimming clothes. All three of them are actively wearing swimwear covered by things you would typically wear to the beach if you aren't planning to immediately change clothes afterwards. Not only that but they are wearing a lot nicer clothes then June and Ryan, they are clothes specifically bought for swimming. Not only that but you can tell the they are from different cities or at least different parts of the same city, Carmen is more inland, her coat is think and the way it falls communicates that it's not really made from beach safe material, it's also very obvious that her swimmers are underneath her clothes and are not just her outfit. Meanwhile with McCoy and Vonnie they live more costal, they're outfits are made for the beach, McCoy's actively being just his swimmers. Vonnie is a little more complicated but though she is wearing clothes over her swimmers, they aren't the same as Carmen's. Vonnie is wearing loose fitting clothes specifically designed for the beach something that can easily be tied on and off again.

Meanwhile Ryan and June are dressed more rurally. Ryan can't swim and is implied to be afraid of the ocean, which communicates to me that he's from somewhere that is pretty land locked. That and his clothes are something I've seen worn by Aussie farmers (Aka my dad) wear on their days off, that and his tan lines indicate that he's in the sun a lot, possibly in an old button up considering where his tan lines are. Not only that but his drinking habits and taste in beer are very rural Australian coded. While June is dressed more as a person who grew up rural but has moved into a city later in life, she's wearing old looking shorts with a belt on them which signifies that they're not going to be taken off to get in the water, while her top is an actual swimming top and she's wearing a beach top over that, both look in good condition and fairly new. There's also June's dyed hair which is honestly common for people who grew up rurally to do once that move to a city. Also Ryan still living in a more rural area would also explain why his hair does seemed dyed but is a lot more faded and less maintained. In all honesty it wouldn't surprise me if June and Ryan grew together considering the similar dye jobs and the way June greets Ryan at the beginning of the game.

Also THANK YOU studio investigrave for not making all the characters white, it's such a common problem when people are writing Australians or Australia in general that they make everyone white. It feels so gross to me when I see that.

Next up in the language used and holy shit was the dialogue well written, "mate" was used in the correct context, "bloody hell" and "dickhead" where the most used slang and that is fully correct, Ryan bringing an esky (cooler, as everyone else says) full of beer on a vacation is such a relatable experience to me. In general I felt seen by the way that characters talked and acted, which is rare when looking at Australian characters.

Also the story involving the environment as the horror, and the environment explored being the water is so important to me. Australia is dangerous, but when that is explored in media it's usually just the outback. Meanwhile the bush and our oceans are usually never touched on, despite them being just as dangerous. Not only that but they used the theme of isolation without using the outback too, which again, is very rare for me to see.

Anyway this game was great and is going up there as one of my favorite games.

[15-lizards]

What are your thoughts on Northern fashion? You mentioned in an early post that it would be different depending on the location, can you elaborate on that? I also feel like the style changed soon after Catelyn married Ned, since she would bring styles from the Riverlands and Winterfell is the King's Landing of the North when it comes to fashion

Let’s goooo 🏃🏻‍♀️

Starting in the Neck, they would definitely be more like the riverlanders in terms of clothing. It’s a fairly similar wet and muggy climate. Everything is mostly made of wool and hemp and linen. Thinner clothes for the muggy summers and warmer, thicker ones for when winter comes. Leather/animal skin shoes to keep the mud off. Also whenever I imagine the Crannogmen I imagine cloaks and hoods to stay dry in the swamps. So lots of those.

To the East and a bit father to the north, that costal area around White Harbor is colder than the Neck. So theres a lot more layers, and clothing it way thicker. Also the Manderlys are dripped tf out they got that White Harbor money. Wyman has fur lined EVERYTHING his damask coats could put Cerseis to shame. Wylla and Wynafred pull up to the Sept with lace and silk and jewels eating all the other bitches up. Also since they follow the Faith and are originally southern, this area probably follows more southern customs (fabrics, headpieces, etc)

And we finally make it to winterfell 🤸🏻‍♀️At this point everyone’s freezing their tits off, so fur lined everything. Indoors, I think they can wear lighter stuff bc of those hot springs. Even in the spring months, you can catch Cat wearing at least one shift, underdress, overdress, AND a jacket bc I feel like she never acclimated to the cold. Lots of leather and wool for everyday wear, but when Ned throws a feast or something they get to wear more fur and velvet (even Jon gets to wear a nice velvet surcoat, as a treat). Since the Starks are bordering on ascetic sometimes, there isn’t a ton of ornamentation, but Sansa likes to wear southern-ish styles as much as she can, so you can frequently find her wearing clothes from white harbor (aka I want to see Sansa in a kokoshnik)

And then even farther north we start to see Bolton and Umber territory. The conditions are even more brutal than at Winterfell and they don’t even have hot springs :/ like Sansa and Arya could probably get away with not having to cover their ears during warmer days, but the girls of last hearth and the dreadfort have no warm days. At this point clothing becomes a bit bulky and harder to move around in. Dresses are lined stiffly and almost drag the floor, and everyone is always bundled up to the neck. However materials and fabrics are cohesive and nice atp.

And by the time we nearly reach the wall, conditions are almost unbearable during the winter. Even during spring, all the villagers in the gift are wearing at least four layers (bc I hate hate hate how the show made the people at and around the wall just chill in a thin jacket when they were near a gargantuan frozen block of ice). Clothing is a lot less structured here, resources are getting sparse so most people stitch together a patchwork of whatever furs they can get their hands on. You will rarely see a person without a big hood or thick gloves on. And even though they aren’t wildlings, you can probably see a lot of animal head hoods, bc these people do NOT waste any part of the animal

[tempestuous-tempest]

A Semi-Relevant Guide To Tieflings

Most of these are headcannons and are based on my own ideas and beliefs even if not 50% close to cannon. I also used added commonly known headcannons. This is a part one. Also looking for feedback. Part two, Part three.

Inspiried by posts by @yeetmeoutthewindowdaddy @lolliputian @ominous-potato96 @drizztdohurtin @crowsyart @threerattsinatrenchcoat @pikapeppa @tealfling

Tiefling Bio[?] (Sect. 1)

Spinal, Sternal, Costal Ridges:

Points are made of cartilage covered in skin like ears

Some individuals may develope slight ossification in these ridges as they age, adding to durability

Wingtips:

Superstition leads to some thinking that bigger/more prominent wingtips are good luck

More developed wingtips can indicate a stronger lineage of flight-capable ancestors

Some individuals experience minor sensitivity in their wingtips due to a high concentration of nerve endings

Upper Tail/Tail Root/Tail Base:

Off-limits to those who aren't romantically involved with specimen

Very sensitive, often causing reflexive movement when touched

Tieflings with damaged tail bases can experience difficulty balancing properly

Lower Tail:

Okay for friends/close family to touch

Partially Prehensile and can grab/pull/push things

Babies often cuddle with their tails for comfort

Often used for balance as well, especially with younglings learning to walk

Specimens may involuntarily teitch their tails when startled or excited

Tail Tip/Tail Barb:

Babies may chew on the flats of these tails and parents are recomended to put coverings over them for protection

Becomes pointier by the age of 5-6

Some individuals develope hooked or blunted tail tip rather than a sharp point

Tails May Convey Emotions: (Very Often A Subconscious Behavior)

Happy/Ecited: Tail is often upright and wags (different levels of wagging exist)

Angry/Agitated: Tail is often low and lashing side to side

Nervous/Anxious: Tail is often tucked or wrapped around the specimen's leg

Possessive/Protective: Tail is often wrapped around the s/o's waist (Very intimate)

Affectionate: Tail may wrap around a s/o's wrist or (If they have one) link with their tail

"Presenting": Tail may curve into an 'S' shape, base raises a bit (Often called "F*ck Me Tail")

Horns:

Often cut at a certain point to keep them healthy and from over-growing (Like sheep horns)

Grow rapidly

A male specimen's pride, bigger is better (More attractive)

Horns may be covered or slightly dulled at the points for infants so they don't hurt themselves/others

Cutting the horns past a certain point will stunt growth

At a certain age, they stop growing back (Often much much older which is unlike sheep horns)

Certain horn shapes and patterns can be indicative of ancestry

Claws:

Stronger, thicker and sharper than human nails

Grow quickly, like horns

Often end in tips

Can be filed down for younglings to prevent harm to themselves/others

Fangs:

First set of teeth are blunt

Get their fangs around the same time their tail gains it's point

Four canines that are strong, sharp and elongated

Sharper and stronger fangs are considered more attractive

Some may have additional ridges along their molars, aiding in the consumption of tougher food

Tongue:

Can be forked or single point

Usually longer than the average human's

Some specimen's tongues have a rougher texture similar to a felines

Eyes:

Sclera can be black or white

Irises can be almost any color and often have a bit of a glow to them

Pupils can be normal, goat-like or slits (Cat like)

Can adjust to low-light conditions, allowing for night-vision

Ears:

Pointy and elongated

Sensitive to stimulations (Sound, touch, etc)

Some specimen have the ability to move their ears to better detect sound

[darkmaga-returns]

Scientists at the world-renowned Stanford University School of Medicine have confirmed that a measles vaccine caused a previously healthy baby to develop a fatal case of leukemia.

The team of researchers, led by Dr. Christina Costales, revealed that the infant received dose 1 of Merck’s MMR ProQuad vaccine.

The vaccine was administered during the baby girl’s 1-year well-child visit.

Just a few days later, the child was diagnosed with acute myeloid leukemia.

Tragically, the baby’s condition deteriorated so aggressively that she did not survive.

The study’s paper was published in the PubMed journal.

In the “Abstract” section of the study’s paper, the researchers write:

“We report a fatal case of vaccine-associated measles encephalitis in an immunocompromised child in California, USA.

“The infection was confirmed by whole-genome RNA sequencing of the measles virus from brain tissue.

[reckoning1187]

Creature design is one of my favorite art exercises.

Anyway, lol, have this guy. I don’t know what he is or what his name is, but he exists now. Him and all the unnecessarily detailed information I created about him. First draft anyway.

The idea was for him to be mammal-like, but avian-accented. He has exposed bone on his forelegs, lower ribcage, skull and lower spine. His diaphragm acts like a layer of skin, not only keeping his guts from spilling out everywhere lol, but as protective casing (skin) also. When he breathes, you can actually see that layer lift up from his ribs slightly. The feathers don’t serve much purpose except to cover his joints and parts of vital organs (heart/lungs) and spinal cord.

His stomach is placed lower than most of his organs, just below his costal arch, for him to be able to eat his fill and not press against the ribs almost at all. Note that his head is quite small compared to the rest of his body. He pulls and tears at food, similar to a vulture, but needs to chew before swallowing. This makes eating a long and taxing process. To make up for this, he can eat ridiculous quantities of food and digest it over a long period of time, storing excess for when it’s ready to be used. He’s typically a fasting creature, eating only three or four times every month, unless food is scarce.

He has a three-part jaw system, split in the middle of the mandible, set with omnivorous teeth. This helps him tear the flesh from large meals, though makes his necessity to chew a bit complex. His maxilla is hooked and beak-like, while still being wide enough to hold two sets of teeth on the top. He can tear with one set or grind with the other, or if the food is tough enough, lower a blade-like shield over those sets to sever and cut ligaments or bone without damaging his teeth. This shield also acts as his foremost offensive weapon against predators.

Though omnivorous, he finds it difficult to find a big enough meal of fruit and vegetables to satisfy his near-constant cravings. Instead he scavenges roots or fruit in between hunting.

Like avian species, he preens his feathers regularly, smoothing and oiling them with the collected fats from his latest meal. He constantly sheds and regrows feathers, often leaving behind small piles of multicolored plumage in his den or preferred resting spots. Color of feathers can vary by season/location or his condition of health: cream or grey in winter, moss green or mold grey in spring, warm brown or grey-brown in summer, warm gold/orange or sickly yellow in fall. He typically eats a hefty final meal before sleeping through most of winter, as the color of his plumage makes difficult camouflage for hunting until the spring pigment comes in.

Typically dwelling in marshes or rainforests, he is four meters (about thirteen feet) tall. His eyes are pink-gold, and sunken into his head, making anything but limited monocular vision almost impossible. He is practically blind directly in front and behind him, but makes up for this with a strong sense of smell and hearing.

While his vocal cords are not unlike humanoid design, he has never made effort to learn language besides animalistic body language.

He is, in fact, sentient, but doesn’t care for much company or interaction with other sentient species. Being reclusive in his mannerisms, he keeps to himself and defends a small territory around his den or nest, before moving on to another area as a perpetual nomad.

[styxbugg]

I learned today that one of the factors of sinkholes is the existence of limestone caves and tunnels under the ground, and that costal areas with those conditions are more likely to get sinkholes than non costal areas

Now who lives in limestone caves and tunnels under the ground? And who lives in a coastal area? The fraggles.

Anyway this is my pitch for a fraggle story based around sinkholes, whether it be a season of the reboot or a movie (👀 i really want a movie)

[melmedarda]

@meljaymicrofics ⸻ heatwave ⸻ wc: 975 ⸻ rated G

It’s insufferable.

Air too thick in her lungs, her throat and nose close around every inhale. Rebel with every exhale. Perhaps this is how she’ll die.

The woman on the television has a pretty, plastic smile on her face, make up perfect. Face without the sheen of sweat as she announces the weather report in her perfect, near robotic voice. Mel has never hated a woman more.

Hot winds blowing up towards the isthmus from the deserts of Shurima threaten to make this summer the hottest we’ve seen. With record breaking temperatures of 311K and above, the costal cities of Krexor, Holdrum, Piltover, Rokund, Trannit, and Zaun are facing several heatwaves in the summer season. This is Lady Sempescu with PNN, live from—”

The tele blinks off, Mel’s hand tight on the remote. Held like a spear, handled like a weapon within her grip.

There’s no one she can go to. Mel has few friends enough as it is, and the few she has are busy. Elora’s gone to some convention in Noxus. She hasn’t heard from Samira for upwards of two months, which means she’s on assignment. Shoola’s gone to Camavor on vacation, and she’d jump into the Pilt before ever asking Salo for a favor. And then, there is the manor.

She entertains the idea, stripped down to the barest of clothing. Reclined on the cool tile of the apartment, she relishes the feel of it against her heated skin. Stares at the ceiling and thinks of her childhood room in her too quiet apartment. Thinks of a place that has not been home for a long while now.

They have working AC there, no doubt. Ambessa would not tolerate anything otherwise. But if Mel was to leave Midtown Heights and return home, her mother would give her the look. The look which communicated that Ambessa was right, and that Mel should have never moved out in the first place.

Mel had left home to escape her mother’s controlling hand in her life. Tolerating Ambessa was much like this heatwave. Oppressive. Suffocating and smothering. Mel had worked hard to escape; to return for any would be humiliating. Not when she worked so hard to escape her mother’s world.

Mel would never live it down.

She calls the Midtown Heights office again, bare foot tapping impatiently as the line rings. Her skin is cooler after standing in front of her open freezer for some relief. But her core temperature is rising now, and her temper with it. Finally, she gets someone.

“Good morning, Midtown Heights Luxury Apartments, how may I help you?” the operator says. The cheeriness in her voice makes Mel want to reach through the phone and strangle her.

“Hello, this is Ms. Medarda, from the penthouse suite 1004. I’m calling to inform you of a issue with the air conditioning… yes, I left a message two days ago and have not heard back. Is the maintenance man available to come up today? Yes, please do. Thank you. You too.”

She’s near peeling her skin off her body by the time she hears the doorbell. The sky is too blue outside the large floor to ceiling windows, not a cloud on the horizon. The sun blinds, unrepentant. Beside her, the box of ice cream she’d picked up from the mart is half finished, containing a pool of melted Noxian citrus ice cream.

Mel opens the door and immediately, heat swirls and builds beneath her skin. The handyman is a vision. Smoking hot, as Samira would say. He smiles at her, and she feels his eyes rove over her as well. They leave a trail of new heat in their wake.

And Mel’s not one to feel embarrassed or self-conscious, but she cannot help her acute awareness of the too short night slip she wears, and the near sheerness of the material. Of how sweaty she is. Of how far from appropriate this situation is. Of how deeply the heat has addled her brain, because she realizes she hasn’t said anything as yet.

“Jayce Talis, Miss Medarda. Admin sent me to fix the HVAC?” Golden eyes flit back to her. Mel swallows thickly and nods, something bitter in her throat. Steps back. Opens the door wider to let him enter. Keeps her eyes on the deep blue of his henley as he walks past. She nearly swoons when he removes his work boots before stepping further into the house. Thoughtful.

He turns to face her, and Mel realizes she is simply standing. Watching. “Please, call me Mel.” Miss Medarda reminds too much of Ambessa. “And yes, the unit has been out for about two days. She gestures towards the hall, and he falls her through on near silent feet.

“It really is hot. Did you not want to go to a hotel until everything was fixed?” His curiosity betrays his real question. Why are you courting heatstroke by roasting in this glorified oven, no doubt.

“I have fish to feed,” is all she says as they pass her assortment of fans lining the hallway. “It’s just in here.” Her penthouse comes with a rooftop garden, within which the body of her problem lies. Jayce nods, and wordlessly gets to work.

She checks on him about 30 minutes later. Better clothes and bearing a glass filled with water and ice cubes. His broad back is the first thing the greet her, blue henley discarded. Then the toned muscles of his arms. Her eyes drink him in, greedy. A desire to paint overwhelms her. She says nothing, leaving the glass near enough that he might see it, and retreats into the house.

Perhaps she might see if there is anything else in the penthouse that needs…fixing.

[arcanarubinaito]

Headcanon Post (1)

“Leech Barometer”

Okay so we all know about the Leech Barometer right? No? Okay well if you don’t, it’s a contraption that utilizes leeches to create a storm warning system. You heard me right: leeches.

The Leech Barometer—originally named the “Tempest Prognosticator”—used natural leech behavior as a warning system for incoming storms. When atmospheric pressure falls and the oxygen content in the water drops, the leeches instinctively try to move to the surface. It’s a neat little trick to predict bad weather, so George Merryweather (talk about names reflecting one’s job lmao) created a device that took advantage of that fun little fact. The Leech Barometer essentially consists of twelve bottles in a circle under a bell. Small hammers would strike the bell once the leech climbed high enough. I’ll link the Wikipedia article below, it goes into more detail about the mechanics.

The leeches used were presumably medicinal leeches since that’s what Merryweather refers to when talking about their sensitivity to weather conditions, and the device was more or less inspired by poetry. (“The leech, disturbed, is newly risen, / Quite to the summit of his prison.” Edward Jenner, Signs of Rain) It was fairly accurate but couldn’t actually tell you when the potential storm would hit. The more rings from the bell, however, the more likely it was for a storm to show up.

I have such a strong mental image of Julian kicking down Nadia’s door one evening, as a storm is brewing on the horizon, and aggressively pointing at a jar he’s holding. It takes Nadia a minute or so to realize what Julian is saying, but once she does he has her full attention. The leeches climb when a storm is approaching? What a fascinating concept.

The two of them immediately start discussing how they could create a storm warning system with the leeches. One could always look at the jar, but when you’re as prone to getting lost in one’s work or thoughts like Julian and Nadia are? They’d completely forget.

Julian is the one to suggest bells. The actual logistics on how to get the leeches to ring said bells, however, was Nadia’s idea. They spend an entire night working on a prototype, but by the time it’s finished the storm had passed and the leeches had settled. It isn’t until the next storm rolls along—they don’t have to wait long, it is a costal city after all—that they get the chance to test it out.

By the Gods, it worked! Only… well now there are pieces of whalebone floating in the water, and it is difficult to set back up again. Far more of a hassle than it needs to be. Once they fish out the whalebone and realign everything, Julian makes sure to tie the whalebone up with a string so that they can easily place it again after the next storm.

For areas like Nopal, it would make a great signal for when rain water would come. And Vesuvians in areas prone to flooding could use it as a signal to prepare. It was a brilliant invention!

Just, ah… perhaps not very streamlined. It takes up quite a bit of space and producing the prototype alone wasn’t cheap. They have the device moved into the new research laboratory Nadia had commissioned a while back, and now the question they both share was why the leeches behave this way.

(Asra and Portia frequently stop by to make sure they’re both eating, drinking, and taking breaks whenever they have the time to go on a research binge.)

Links & Inspiration

Wikipedia - Tempest Prognosticator

Australian Museum - Leeches

Atlas Obscura - The Rise and Fall of the Leeches Who Could Predict the Weather

Here’s the inspiration for this post. I couldn’t find the original, so here’s the crappy cropped version from Reddit. If you can find the original, please send me the link!

[sierraschool]

Vertebrates 2/24

today in verts we talked about turtles. apparently, turtles have a lot going on that make them super freaky when it comes to their sister taxa.

Lets start with this question: What exactly ARE turtles?

Order Testundies

Sauropsida

Only 361 alive species across 14 families

Instantly recognizeable because of shell

What is so weird about them?

Turtles have anapsid skulls, and are the only amniotes (vertebrates that lay amniotic eggs) with this condition

What is an anapsid skull?

Anapsid skull is a type of Temporal Fenestration.

Temporal fenestrae are openings in the skull that are behind the eyes which allow movement of the lower jaw.

Anapsid means no fenestra, so the only opening are the orbits (eye holes) and nostrils. (turtles)

Synapsid means single fenestra, which is the lower fenestra. (this is what humans have, including mammals and mammal like reptiles)

Diapsid means two fenestrae, which are upper and lower. (lepidosaurs and archosaurs [lizards/snakes, crocodiles/dinosaurs/birds, respectively])

The big question with turtles anapsid skulls is: were they always this way, or did they lose their synapsid/diapsid condition?

The answer comes from the fossil record. In the past we can see that the synapsid condition appears in turtles once in the synapsid lineage, and the diapsid condition appears once in the sauropsid lineage. This proves that turtles evolved to have the anapsid condition in their skull, making it a secondary condition.

2. Modern turtles lack teeth

Jaws of turtles are surrounded by a hard keratinous sheath. Keratin is the same thing our fingernails are made of, but this is a much thicker and denser makeup of it. It has a very sharp beaklike shape that is good for cutting plant and animal material. This is good, because most turtles are omnivores or carnivores.

There are some turtles that are herbivores, but these are usually stenophagous (specific diet) and only eat a certain food in general.

3. Modern turtles are divided into two groups

Cryptodira

262/361 species belong here

head retracts as a vertical S-bend

known as "S-necked" turtles

found in fresh water, marine, and terrestrial

Pleurodira

99/361 species belong here

head retracts by bending horizontally into shell

known as "side-necked" turtles

All freshwater

4. Turtle Shells

Formed by 3 elements

Endoskeleton (spine, ribs, clavical)

Exoskeleton (dermis)

Epidermis (keratinous scutes)

Two halves of shell are:

carapace (top)

plastron (bottom)

The carapace is covered in scutes, which are the individual outlined shapes on top. Under the carapace is bone, dermal and endochondral. Dermal bone is the lower layer and endochondral is the upper layer.

Now lets talk about the types of shells:

Hinged shell

Hinge in the middle that allows the plastron to close the front and back opening of the shell

OR

Double hinge on either end

Weird shells

Lack keratinous scutes and bony plates are reduced

OR

Lack keratinous scutes and the bony plates are replaced by thousands of dermal bone

Evidence of turtles date back to the triassic period

5. How do turtles breathe?

Before getting into this, it is important to note that during development, turtles ribs fuse to their shell, which is good because it reinforces their shell, but it also changes how they breathe in comparison to other amniotes.

Amniotes use a process called costal ventilation, which is where when the lungs expand with air, the ribcage moves with it, and then when the lungs exhale, the ribcage goes back to normal. Because turtles cannot move their fused ribcage, they had to adapt a new way of breathing.

Instead of moving their lungs, turtles move their guts!

when the turtle inhales, the lungs expand. a few muscles and membranes surrounding the guts stretch and allow the lungs to push their gut downward

when the turtle exhales, the muscles and membranes push the guts back up towards the deflating lungs

This causes problems for many turtles functions.

when a turtle is fully retracted inside of its shell, it cannot breathe and must hold its breath

Sea turtles cannot breathe when they walk. they must walk, then take a break to breathe

Most turtles can breathe when they walk due to their diagonal gait. They walk with their left back foot and right front foot, and then right back foot and left front foot.

Aquatic turtles must come up for air, which makes them vulnerable to predators. Luckily, they can hold their breath for a very long time.

There is another way for turtles to breathe which is honestly pretty funny. I'm being completely serious when I tell you, some of them can breathe through their buttholes. They literally open their butthole over and over and pump water in and out and are able to diffuse oxygen from the water. This is really good for them to not have to surface, especially for turtles who get trapped under ice in colder months.

6. Turtle reproduction!

Lay on average 4-5 eggs, or even up to 100 eggs!

Almost no parental care, layed egg and then you are on your own!

Temperature dependent sex determination (TSD):

temperature determines sex of turtle. (Humans are the organism with gender, everything else is sorted by sex)

changes of even 3-4 degrees can determine sex

Lower temps mean males while higher temps mean females

Challenges of reproduction:

Few eggs and slow maturity mean turtles do not reproduce fast enough to combat endangerment

Pet trading, food collection, medicine, habitat destruction, and pollution all affect turtles

Global warming effects TSD and creates a disproportionate ratio of sexes which affects future reproduction as well

Over half of the 361 species are endangered

In conclusion, turtles are funky. We need to protect them to ensure they stay on our earth!

[evil-jennifer-hamilton-wb]

My OC Worm cluster I talked about a few months back. The cluster is designed around powers that have unsettling or stranger-y aspects, the story set in a low-income immigrant area of Detroit being gentrified after damage to costal cities by endbringers revitalizes the city economy. From left to right (primary powers only), Descry/Brooke (15, she/they demigirl) has the power to hunt down anyone who thinks about her, and teleport to their location if her name (any name she uses to refer to herself, not just her civilian name) is directly mentioned. Aria/Penelope (13, she/her cis girl) Has the power to manipulate, still, and sense vibrations within a medium. Aria's power automatically and uncontrollably bends light and sound around her body, rendering her blind, deaf, and invisible. She interacts with the world through her vibration sense ability, and mobility aids. Micah/Myopia (15, he/him cis man) has the power to manipulate attention. People within myopia's range are forced to look at him and direct their emotions, positive or negative, towards him. Once people's focus has been forced his way, he can redistribute it to some extent. Cordyceps/Hayden (19, he/him trans man) Has the power to grow fungus on any organic material, and feel through the senses of the fungi. His range is seemingly infinite, but only applies to fungus he has grown or interacted with. The fungus grows at a rate standard for the external conditions, and he can only create spores for fungus he has ingested and then grown in his own body I'd love help with a name for the cluster if anyone has any ideas (mostly for tagging reasons), and any thoughts, criticism, or questions are appreciated!

[aspiringwarriorlibrarian]

I still fell so weird thinking back at people that took Blake being daughter of menagerie chief to mean she was actually some privileged rich girl. Like, they were still living in a small costal town on a island that is half unhabitable. They might, possibly, have more that other people on the island but that still won't amount to much in those conditions.

I think people are forgetting that Ghira got that position by being an activist for most of his life and that he got it fairly recently. I don't think the Belladonnas are independently wealthy by any means, I think that's just "the house the Chief stays in".

[nursingwriter]

Injury (Chest) Athletes to perform effectively need all their body parts at optimum working condition. It is therefore essential that optimum body mechanics are to be ensured guaranteeing maximum performance whilst conserving energy. However, athletes are susceptible to injuries and accidents often as a result of "poor co-ordination, lack of balance, contact in sports, excessive loading, repetitive jolting or jarring and insufficient preparation." (Athletic & Sports Injury Treatment) Massive recovery from injury is crucial for the athlete. The ribcage has a supporting role to the upper body; it safeguards the internal organs like heart and lungs and helps in the breathing process. The ribcage is constituted by 24 curved ribs organized in 12 pairs; each pair is connecting to the vertebra in the spine. The first seven pairs are connected at the front of the body directly to the sternum by cartilage regarded as costal cartilage. Such ribs are sometimes known as true ribs. The last tow pairs are not connected to the body at all and are therefore regarded as floating ribs. The ligaments and muscles inclusive of the muscles between the ribs support the ribcage. Such muscles make it possible to expand at the time of breathing in and drop at the time of breathing out. Rib injuries involve bruises, torn cartilage and bone fractures. (Rib injuries) Rib injuries result when the chest is being directly hit upon. The blunt injuries to ribcage is caused normally by Motor Vehicle Accidents involving slamming of the chest against that of the steering wheel; Crush injuries like heavy object which lands directly on the chest; Sports related injuries to illustrate - a heavy tackle; falling down from a considerably reasonable height; assault-being hit by a baseball bat etc. The symptoms of the injury mostly relies on the type and severity of the injury, however, involves pain at the location of the injury; occurrence of pain with flexes of the ribcage when breathing, coughing, sneezing or laughing, crunching or grinding sounds with the touching or movement of the injury site, Muscle spasms of the ribcage, appearing deformed and difficulties in breathing. (Rib injuries) Chest injury involves Soft tissue injuries, Rib fracture, Flail Chest etc. The soft tissue of the ribcage incorporates the intercostals muscles and the coastal cartilage. The common injuries in this respect involve Bruising that is the rupturing of blood vessels and leaking of blood into the surrounding tissues. The intercostals muscles facilitate the ribcage to move up and down. Straining of such muscles results in by any activity that associates with extreme or forceful twisting of the body or swinging of the arms. The sports activity such as golf and tennis generally results in such type of injury. Costochondral Separation involves torn loosing of the rib from the costal cartilage and its detachment from sternum. The second form of chest injury is Rib Fracture. Normally the curvature of the ribs prevents them to common fractures. Its flexibility assists the bones to absorb some amount of strength of a blow. However, bone breaks with stronger exertion of force against it than that it can resist. A rib is prone to break at its out curve since it is the weakest point. Older people are more vulnerable to rib fractures with thin bones and children are less vulnerable due to the flexibility. The common serious injury to the ribs is Flail Chest. It normally results when three or more ribs are fractured in at least two places, front and back. This occurs with exertion of a great deal of blunt force. The primary symptom of flail chest is 'paradoxical movement' that implies the natural movement of the ribcage during breathing is in reverse. To illustrate, the injured location of ribcage sinks in when the person inhales rather than lifting outwards. The reversal is generated by variation to air pressure in the ribcage resulted by the injury. (Rib injuries) It is not the broken rib cage but its simultaneous injury to the lungs that normally results in complications. Intubating i.e. putting oxygen into the lungs via a tube placed down the trachea will normally generate a pressure in the lungs. As the ribs encompass vital organs like hearts, lungs, the chest trauma may give rise to life-threatening and fatal injuries such as Pneumothorax, Cardiac and associated blood vessel, and Splenic rupture. Pneumothorax is symbolized by collapsed lung as a result of the variations in pressure within the chest. This results in due to a broken rib tearing the lung or a puncture in the chest wall giving rise to breathing problems, chest pain and coughing up blood. This may also result in cardiac and associated blood vessel injury to illustrate, trauma to the blood vessel servicing the heart or a tear in the main artery of the body. The spleen is found at the left side of the abdomen. It assists in filtration of the blood to remove abnormal cells, and the creation of some immune system cells inclusive of antibodies and lymphocytes. Splenic rupture implies that the outer capsule has split and the spleen bleeds into the abdominal cavity. The diagnosis of the rib injuries involves use of a number of tests inclusive of physical examination and Chest X-ray. The treatment of fractures in ribs is somewhat different than that of the arms and legs. It is not possible to set the broken ribs in a cast. Treatment of rib fractures involves relieving of pain while the injury heals, that can up to six weeks. It may take 12 weeks or more when the rib has torn from the cartilage. The treatment options include rest; providing pain killing drugs, non-steroidal anti-inflammatory drugs; not having sports activities that worsen the injury; administering icepacks that may assist to reduce inflammation in the early stages. (Rib injuries) Pulmonary contusion results in when high velocity blunt force is applied to the chest and a person as an illustration is struck with a bat. The blow upsets the microvasculature in the lung parenchyma and blood and several other inflammatory mediators attack the tissue. Normally, the patients are asymptomatic at the first instance. While the pulmonary contusion advances crackles are noted during chest auscultation and particularly dyspnea, tachypnea and tachycardia also. The diagnosis of pulmonary contusion is made with a chest X-ray that reveals opacity in the peripheral lung near the injured chest wall. Such revelations may not be possible up to 12 to 24 hours after the injury. When the contusion is small, supplemental oxygen by nasal cannula is necessary. In case of serious pulmonary contusion intubation and mechanical ventilation is required to facilitate lung time to recover. (Trauma nursing: Blunt chest injuries) Myocardial contusion or bruising of the heart results due to direct force to the chest to illustrate an unrestrained driver that hits the steering wheel during MVC. The force upsets the vasculature in the heart, giving rise to accumulation of blood and inflammatory mediators in the myocardium. Myocardial contusion in its severe form leads to cardiac dysrhythmia. Blunt chest trauma can also lead to pericardial tamponade which is a life threatening situation. Also known as cardiac tamponade, it exists when blood fills the pericardial sac, whereby it compresses the heart. While the pressure on the heart enhances, the heart does not refill adequately and cardiac output rapidly drops. When the pericardial sac fills quickly, it may need about 100 to 200 ml of blood to result in death. Blunt chest trauma may also cause another type of cardiac injury known as aortic tear. The heart moves towards the front of the chest during rapid deceleration, however, its movement is obstructed to some extend by ligamentum arteriosum that tethers the aorta to the heart. (Trauma nursing: Blunt chest injuries) About 20% of trauma cases per annum in the United States are inclusive of important chest trauma as an element. About two thirds of major chest trauma cases are associated with motor vehicle accidents. About 25% of injuries from motor vehicle accident related to chest trauma. The outcome out of the study made by the North American Major Trauma Outcome Study indicated that about 70% of trauma cases are blunt in nature. About 50% of chest trauma injuries are associated with chest wall. The initial recovery from chest trauma concentrates on the ABCs-airway, breathing, and circulation- subject to all major trauma resuscitation instances. After completion of initial resuscitation and stabilization a concurrent evaluation of a patient is done with suspected chest trauma. Normally chest injuries are diagnosed by chest radiograph alone. The recognition of treatment of chest trauma mostly relies upon a high index of suspicion mixed with the appropriate diagnostic tests. (Lesson 18: Blunt Chest Trauma) The rate of recovery varies from person to person at various rates. The return to normal activities depends upon the recovery of ribs and not by the days of the occurrence of its injury. The objective is to rehabilitate the patient not sooner but in a safer condition. The return to the normal activities with out complete recovery may aggravate the injury. The health care provider takes out an x-ray to ascertain the healing of the bone before recommending taking part in the normal activities. Participation in non-contact activities without pain in the ribs and without pain while breathing may be permitted. (Rib Injury) References Athletic & Sports Injury Treatment" Retrieved at http://www.scotiachiropractic.co.uk/treatment/sporting-injury.html. Accessed 26 October, 2005 Rib injuries" Retrieved at http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Rib_injuries-open. Accessed 26 October, 2005 Rib Injury" Retrieved from http://www.fairview.org/healthlibrary/content/sma_ribinjur_sma.htm. Accessed 26 October, 2005 Sako, Edward Y. "Lesson 18: Blunt Chest Trauma" PCCU Update. Vol: 15. Retrieved at http://www.chestnet.org/education/online/pccu/vol15/lessons17_18/lesson18.php. Accessed 26 October, 2005 Veronsei, James. F. (1 March 2004) "Trauma nursing: Blunt chest injuries" Retrieved at http://www.rnweb.com/rnweb/article/articleDetail.jsp?id=110082. Accessed 26 October, 2005 Read the full article

[myrawjcsmicasereports]

 Clinical Case Reports – 1970 by P. Syamasundar Rao in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

In this paper five case reports were presented and include congenital pulmonary cyst, Wilson-Mikity syndrome, diaphragmatic eventration; foreign body in the bronchus, and cor pulmonale that developed after implantation of a ventriculo-atrial shunt with a Pudenz-Heyer valve for treatment of hydrocephalus. For each case report, clinical, chest x-ray, electrocardiogram and other pertinent findings were presented. This was followed by discussion of etiology, diagnosis, and treatment options, as appropriate.

Keywords: congenital pulmonary cyst; diaphragmatic eventration; Wilson-Mikity syndrome; foreign body in the bronchus; cor pulmonale

Introduction

During the academic clinical practice for over five decades, the author had the unique opportunity to observe and document many interesting clinical case scenarios. The purpose of this review is to revisit these interesting cases. Because of the voluminous amount of this material, the material may be divided into a five-part series. Each of these case reports, while rare and important clinical observations, do demonstrate a clinical point that is useful to the pediatricians, pediatric cardiologists and/or other physicians.

Congenital Pulmonary Cyst

Case Report

A female infant with a birth weight of  6 lb 7 oz, born after a full-term, normal pregnancy and delivery with an Apgar score of 9 presented at three weeks of age with a two-week history of tachypnea. There were no other symptoms and the infant’s physical examination was normal except for tachypnea (respiratory rate of 50 per minute) and mild inter-costal and sub costal retractions. A chest roentgenogram was obtained (Figure 1) which was interpreted as pulmonary cyst. The heart was pushed to the right by the cyst (dextroposition of the heart). At thoracotomy, a huge lung cyst, involving the lower lobe of the left lung, was found, and was resected and the patient made an uneventful recovery.

Chest x-ray in posterio-anterior (A) and lateral (B) views demonstrating a large pulmonary cyst, marked with arrows. Note that the heart is pushed to the right, dextroposition of the heart. Reproduced from Rao PS. Amer J Dis Child 1970; 119:341-2.

Discussion

Congenital pulmonary cysts in the neonate are uncommon and are considered as errors in embryological development. They are of several categories namely, bronchogenic cell, alveolar cell, and combined cell types, based on the cellular component of the cell wall of the cyst. The symptoms depend largely upon the size of the cyst. These patients may not be discovered until a chest x-ray is performed for other reasons or may present with symptoms of tachypnea, dyspnea, and cyanosis in the neonatal period secondary to compression of lung tissue. The findings depend upon the size and location of the cyst. Dextroposition of the heart or tracheal shift and hyper-resonance, diminished breath sounds, and rales may be detected on physical examination. The chest x-ray findings may demonstrate a cyst, as in our case (Figure 1) or may be misinterpreted as pneumothorax. Other conditions simulating the cyst are staphylococcal pneumonia, diaphragmatic hernia, congenital lobar emphysema, sequestrated lobe, and hydro-pneumothorax or pyo-pneumothorax. In symptomatic cases, cystectomy, segmentectomy, lobectomy, or pneumonectomy, depending upon the size and location of the cyst is suggested. Percutaneous aspiration of the cyst is not recommended except as an emergency measure to relieve the tension. Some authorities advocate no surgical intervention because of the possibility of spontaneous regression of the pulmonary cysts, but most authorities recommend surgical excision of the cysts [1].

Late Respiratory Distress in a Premature Infant

Case Report

A premature male infant was born at 25 weeks of gestation and weighed 2 lb 12 oz at birth. Abruptio placenta and prolapse of the umbilical cord complicated the delivery and required resuscitation with oxygen. The chest x-ray was normal at that time. The baby was placed in an incubator in 35 percent oxygen, which was discontinued within 24 hours. At the age of 31 days, tachypnea and recurrent apnea with cyanosis developed. Auscultation revealed bilateral rales in the chest, again necessitating resuscitation with O2, administered by bag and mask. Chest x-ray (Figure 2) revealed a diffuse parenchymal reticular pattern with multifocal areas of radiolucency. This roentgenographic pattern, along with the clinical findings, is essentially diagnostic of the Wilson-Mikity syndrome.

Discussion

Wilson an Mikity originally described this condition in 1960, and is now called Wilson-Mikity syndrome.2 The etiology is not clearly understood but is considered to be due to pulmonary dysmaturity with uneven postnatal development of pulmonary alveoli in the premature infants.2 No consistent relationship with O2 therapy has been established. Bronchopulmonary dysplasia is another condition seen in the neonatal period and should be distinguished from Wilson-Mikity syndrome. The cystic appearance on the chest x-ray in the third stage of bronchopulmonary dysplasia resemble those of Wilson-Mikity syndrome; however, it follows treatment of severe hyaline membrane disease with high concentrations of O2 and artificial ventilation.2 The clinical presentation of Wilson-Mikity syndrome is characteristic in that the infant is premature with minimal or no respiratory distress at birth but, develops progressive respiratory distress, with dyspnea, tachypnea, cough, cyanosis, and rales in a few days to weeks. Diffuse reticular pattern of both lungs with areas of multifocal radiolucency are usually seen, similar to those seen in figure 2. Progressive pulmonary insufficiency with signs of right heart failure develop in patients with fatal outcome. But, about half of the patients eventually recover from their pulmonary disease. Pulmonary function studies are abnormal with decreased lung compliance, increased expiratory flow resistance, and increased breathing effort. Respiratory acidosis develops in spite of increased minute volume. Arterial O2 desaturation is thought to be secondary to intrapulmonary right-to-left shunting.2 The treatment is largely supportive [2].

Fever, Vomiting and Dome-Shaped Density in Right Thorax

Case Report

A four-month-old boy presented with a history of fever, poor feeding, vomiting, and slight cough for two days. Past history is essentially normal except for an Apgar score of 6 at birth. Breath sounds were diminished at the right base. Laboratory studies were normal. Chest x-ray (Figure 3) was performed which revealed a dome-shaped density in the right thorax which did not coincide with any pulmonary lobe or segment. The elevation of the inferior liver margin in the abdomen indicated that the abnormal shadow was liver. Based on these findings eventration of the right hemi-diaphragm was suspected. To confirm the diagnosis, a diagnostic pneumoperitonium was performed (Figure 4) which confirmed the diagnosis.

 Chest x-ray in posterio-anterior (A) and lateral (B) views showing a dome-shaped density in the right thorax (the x-ray was reversed by the printer). The distribution of the density did not coincide with any pulmonary lobe or segment. The elevation of the inferior hepatic margin in the abdomen indicated that the abnormal shadow was liver. Reproduced from Rao PS and Patel JK. Chest 1970; 58:89-90.

 Diagnostic pneumoperitonium with chest x-ray in lateral view. This demonstrated air below the diaphragm suggesting eventration of the diaphragm instead of pneumonia or other lung pathology. Modified from Rao PS and Patel JK. Chest 1970; 58:89-90.

Discussion

Eventration of the diaphragm is classified into adult and infantile types [3]. It is generally thought to be the result of congenital mal-development of the diaphragmatic musculature. However, such an abnormality may occasionally be caused by phrenic nerve injury during birth. The true incidence of eventration is not known, but in mass x-ray surveys of adults, it was found to be one in 10,000 [3]. Total eventration is thought to be more common on the left side and partial eventration on the right [3].

Clinical findings largely depend on the extent of eventration. There may be no symptoms or the patient may present with dyspnea, tachypnea, and cyanosis in the newborn period, requiring immediate treatment. Seesaw cyclic motions of the epigastrium with respiration and Hoover's sign (uninhibited divergence of costal margin from midline on inspiration), if present, are helpful in making the diagnosis. Percussion on the affected side may be dull or tympanic depending on the organs migrated under the diaphragm.

Fluoroscopy and chest x-rays are generally useful in arriving at the diagnosis. In right-sided eventrations, the lesser amount of liver shadow in the abdomen, i.e., elevation of the inferior margin of the liver helps to distinguish eventration from the other conditions [3]. Diagnostic pneumoperitonium is likely to establish the diagnosis, but the current availability of ultrasound technology, diagnostic pneumoperitoneum may not be necessary at the present time.

Symptomatic newborns with diaphragmatic eventration should be treated surgically; plication of the eventrated diaphragm is successful in relieving the symptoms with good long-term results. Some authorities suggest that asymptomatic patients also should be addressed surgically [3].

Foreign Body (Peanut) in The Left Main Stem Bronchus

Case Report

A 13-month-old girl with a history of poor appetite, loss of weight, cough, and intermittent low grade fever was admitted to the hospital for evaluation and treatment. No history of choking episodes was elicited. History revealed that a relative who had active pulmonary tuberculosis lived with the infant's family for a short period of time four months prior to the current admission. Because of this reason, the local health department performed tuberculin skin test which was positive and treatment with isoniazid was initiated. On examination her weight and height were between the third and tenth percentile. Decreased breath sounds on auscultation and hyper tympanic note on percussion were noted over the left side of the chest.

Intermediate strength purified protein derivative (PPD) was positive. Chest roentgenograms were obtained (Figure 5). Based on the history, physical examination, and chest x-ray findings, a diagnosis of endobronchial tuberculosis was entertained. However, prior to beginning treatment, bronchoscopy was performed to appraise the extent of airway encroachment.

Discussion

Autoimmune encephalitis is a condition that can be easily missed as it is not commonly considered in the differential diagnosis of various medical presentations. However, such diagnosis should be always taken into consideration when a person, particularly a child, presents with a new onset of refractory status epilepticus (NORSE) and/or new behavioral or psychiatric conditions. An early diagnosis of AE is essential, as the treatment is different from other conditions. With correct timely interventions the outcome is frequently favorable.

Though SARS-Cov-2 virus rarely invades the nervous system, Covid-19 infection frequently causes neurological symptoms like headache, delirium, anosmia, and dysgeusia [14]. One of the mechanisms of indirect nervous system involvement is through inflammatory response and immune dysregulation. There are few recorded cases of indirect involvement of CNS by auto-antibodies that are directed against the surface and synaptic protein. This case is one of the rare cases of Anti NMDA antibody autoimmune encephalitis that is associated with Covid-19 infection [15]. It indicates that in the era of COVID-19, high vigilance is required as a possible association may increase AE incidence.

A recent systemic review that analyzed 16 studies, including a total of 161 patients with NORSE [16], showed that the most frequent cause was AE. In addition to the well-known association with teratoma and cancer, AE, and specifically Anti-NMDA receptor Ab encephalitis, could be associated with a SARS‑CoV‑2 infection, either concomitantly or as post-infection manifestation. In this reported case, immunotherapy, in addition to anti-seizure medication, showed to be effective.

The main limitation of this report is the relatively short follow-up period. Observation of the child is ongoing to detect possible medium- or long-term consequences.

 Chest x-ray in posterio-anterior (A) and lateral (B) views showing hyper-aeration of the left lung and a slight shift of the heart and mediastinum to the right. The left diaphragm is also flattened. There are no areas of infiltration or consolidation in the lung, but prominent densities (arrows in A and B) suggestive of enlarged lymph nodes were also seen. Modified from Rao PS, et al. Amer J Dis Child 1970; 120:51-52.

Positive PPD in an infant with poor appetite, loss of weight, and fever is suggestive of primary tuberculosis. This is particularly so given the patient's exposure to a subject with active pulmonary tuberculosis. The x-rays show hyper aeration of the left lung with a shift of the heart and mediastinum to the right. The left leaf of the diaphragm is also flattened. While there are no areas of infiltration or consolidation were seen, prominent shadows suggesting enlarged lymph nodes were seen (arrows in figure 5). Endobronchial tuberculosis with compression of the bronchus by adenopathy may produce changes seen figure 5.

Discussion

Even though there was no history of choking or aspiration, the possibility of foreign body aspiration should be considered in this age group. Consequently, bronchoscopy was performed which revealed a peanut in the left main stem bronchus and was extracted during bronchoscopy. The peanut and the adjacent edema of the bronchus caused partial bronchial obstruction and acted as a check valve, so the air entered the left lung but, unable to leave the left lung since the bronchus becomes smaller during expiration, producing the roentgenographic appearance shown in figure 5. The baby improved and the treatment with isoniazid was continued because of the positive PPD.

Cor Pulmonale as a Complication of Ventriculoatrial Shunts

Introduction

Cerebral ventricle-to-right atrial shunts with Pudenz-Heyer or Spitz-Holter valves were widely used to treat hydrocephalus in the 1960s. Development of pulmonary hypertension with chronic cor pulmonale is rare with these shunts. We reported a patient who developed such a complication along with description of specialized pulmonary function studies in the early detection of such complication [5].

Case Report

An 11-year-old white boy was hospitalized in April 1969 with a history of progressive weakness, dyspnea, and pedal edema. He was diagnosed to have hydrocephalus and had a ventriculo-atrial shunt with a Pudenz-Heyer valve implanted at the age of 6 months. The shunt was thought to be functioning well when he was evaluated at the age of 2 years. He was asymptomatic until he was 9.5 years old, when he developed signs of congestive heart failure (CHF) and was treated at another hospital with digitalis and diuretics with some improvement. Right heart catheterization at the same institution revealed a mean right atrial pressure of 35 mmHg and right atrial angiography revealed slow emptying of the contrast, filling defects on the right lateral atrial wall and in the right and left pulmonary arteries. The ventriculo-atrial shunt was removed shortly thereafter. The patient was referred to our group for further evaluation and management [5].

Pertinent findings on examination included height and weight below the third percentile, head circumference above the 97th percentile, pretibial edema, prominent “a” wave in the left side of the neck, no venous pulsations on the right side, palpable right ventricular heave, markedly accentuated single second heart sound, an audible fourth heart sound at left lower sternal border, a Grade I/VI ejection systolic murmur at the mid-left sternal border, liver edge palpable 5 cm below the right costal margin, clear lung fields on auscultation, and normal neurological examination.

Electrocardiogram (ECG) (Figure 6) and the vectorcardiogram (not shown) revealed right atrial and ventricular hypertrophy. Chest roentgenogram (Figure 7) showed moderate cardiomegaly and prominent main pulmonary artery (PA) segment and clear lung fields. Lung scan with 131I-labeled macro-aggregated albumin was suggestive of multiple pulmonary emboli. Blood gas analysis showed pH 7.56; PaO2 80 mmHg, PaCO2 23 mmHg and bicarbonate 24 mEq/liter. Routine pulmonary function studies revealed restrictive lung disease. The ratio of wasted ventilatory volume (physiological dead space) to tidal volume (VD:VT) using Bohr's equation was 0.58 (normal 0.3 or less).

Electrocardiogram shows right axis deviation with right atrial hypertrophy and marked right ventricular hypertrophy. Reproduced from Rao PS, et al. J Neurosurg 1970; 33:221-225.

Chest x-ray in posteroanterior view demonstrating cardiomegaly and prominent main pulmonary artery segment (arrow). The peripheral pulmonary vasculature is diminished. Modified from Rao PS, et al. J Neurosurg 1970; 33:221-225.

Vigorous treatment with digitalis and diuretics resulted in only temporary relief. During the next year, he continued to deteriorate and died of intractable right ventricular failure. Postmortem revealed right atrial thrombosis, severe right ventricular hypertrophy, multiple thrombo-emboli in the large and medium-sized pulmonary arteries, and intimal proliferation of the pulmonary arterioles.

Discussion

The case presented demonstrated development of cor pulmonale secondary to pulmonary thrombo-embolism which was produced by thrombi that arose following a ventriculo-atrial shunt with a Pudenz-Heyer valve for treatment of hydrocephalus. The causes of thrombo-embolic complications were not well understood, but the hypotheses, as reviewed by us [5], include infection, periarteritis due to autoimmune reaction of the pulmonary vessels to protein of cerebrospinal fluid, release of brain thromboplastin resulting in thrombosis at the point of contact with plasma coagulation factors, and simply the presence of a foreign body in the cardiovascular system for prolonged periods of time.

Early detection of pulmonary hypertension by periodic (every six months) evaluation by chest x-ray and ECG studies was suggested by some investigators, but early detection of pulmonary hypertension is of limited value since obstruction of 60% of the pulmonary vascular bed occurs by the time pulmonary hypertension develops [5]. Detection of multiple filling defects on radioisotope scanning in a child with a ventriculo-atrial shunt would be suggestive of pulmonary embolization and might be useful in early identification. Based on the observations of Nadel and associates [6] and those of ours [5], we suggested that specialized pulmonary function studies such as VD:VT, pulmonary diffusing capacity, pulmonary capillary blood volume, blood gas, and pH be performed periodically to detect obstruction of pulmonary vasculature prior to the development of pulmonary hypertension and cor pulmonale [5]. However, it should be noted that ventriculo-atrial shunts are no longer performed to treat hydrocephalus, but instead ventriculo-peritoneal shunts are used at the present time.

In summary, a rare case of pulmonary thrombo-embolism with resultant pulmonary hypertension and cor pulmonale following ventriculo-atrial shunt for hydrocephalus was presented with the recommendation to use of special pulmonary function studies for early detection and if found to be positive, immediate removal of the shunt system may eliminate further embolization into the lungs and prevent irreversible pulmonary vascular disease.

[theonlinechroniclesofaladybug]

Today is my mothers birthday,

I woke up with the disastrous desire to got back to sleep. It was only 10:30 but then I remembered my mom would’ve wanted a good breakfast to start her day. I love sleeping, i just cant sleep sometimes (majority of the time,) and I would’ve slept until 2 in the afternoon if it was up to me. But alas, I love my mother too much. She was already up before me, and the dogs were very happy to see me (—I had just came back home last night from my boyfriends place; I only left for three days but in dog years I’m sure that has to be a millennium—)

But none the less they were happy to see me (as always, usually they’re the only two who do.) but I made cinnamon rolls from scratch. (I had froze them to preserve them and simply bake them the day of.) I plan ahead too much, I’m overly cautious and I like contingency plans due to my narcissistic ex-father and his unplanned outbursts. Thank god he no longer lives with us though.

Anyways, after providing sustenance to the whole house (my three big-little brothers, my mom, her girlfriend and me,) I hurried upstairs to change into the outfit I planned before i went to bed last night.

I always have trouble sleeping, I’ve taken everything and nothing helps so I’ve decided to come to terms with the title insomniac. Somehow though my boyfriend seems to be the only thing keeping me asleep, and I love naps more than living life and going out with friends or being social.

I donned a white brandy melville dress I bought off of depop, (stupidly overpriced, per usual. Thanks depop.) that was loose, flown, the absolute perfect summer dress for a dainty sprite like myself (sorta) but the problem was you could see my nipples. (I refuse to wear a bra because, idk it ruins your outfit by being so bulky, and I’m like a 32-34 DD, but I can fit into 5/6 children’s tees no problem, I think not wearing a bra for my entire life has helped with that. Not to say I don’t have any, I do, but my dad was a big pervert and he refused to let me get bras when i was younger so I would always have my moms old and tattered ones that were far to big on my prepubescent 11 year old chest or she would make them for me. It’s fucked up, and maybe that’s why I don’t wear a bra? To save the trouble? But in all fairness my mother did the same thing her age, the no-bra part. She grew up in Miami with a Chelsea cut if that helps.)

Back on subject, I decided to wear this 70s button up, with blue and green dainty stripes and tying it at my waist and it created a gorgeous and almost costal grandma kinda look. I debated wearing my dainty kitten heels with it but chose a blister free ailment with my brown converse and white socks. (that the thrift gods had bestows upon me, in my size, in perfect condition might I add.)

We went to Starbucks, obvi the best you’ll get; Venti Iced Matcha Latte with oat milk and vanilla cold cream!!! It’s so good, and hen we went to the bookstore which i had IMMENSE self control. It’s my mom’s birthday, but her girlfriend was kind enough to let us each get one book. I got Lady Macbeth. Which, fuck yeah i want a semi-traditional historical fantasy romance. With magic and Scotsmen.

(I’m a ginger, very Irish and Scottish along with German and Norwegian. I have the burden of being mystical and fantastical at all times. Not a pick me moment, just for reference.)

There was. Guy following me, tall, long greasy looking hair, I couldnt tell if he was homeless (by the layers and the backpack he wore), but he did have a lot of magazines in his hands. Anyways, afterwords we went to the mall, where my mom got a build-a-bear with all of us shouting ‘happy birthday!’ Her name is Thumbellina Glitter Sparkles for those curious.

Then we ate Mexican, i gorged. Sizzling enchiladas and tamales. Ugh yummy.

Though im still kind of recovering from my eating disorder.

I go through periods of starving myself, obsessing over my weight and counting calories which I did way back in the 7th grade. (I’m like, 5’3, 112 lbs.) my brain wont let me stop until im 85 lbs. why is that?

The heaviest i weighed was 128lbs at 17, which im sure is plenty normal but that feels so gross to me.

Then i feel like i dont have enough, or that im huge and bigger than i think. Like im 5’7 and 170lbs. Like my mirror convinces me my face is covered in acne and my face is fat and VERY unsymmetrical.

But when im with my boyfriend he forces me to eat, buying me any and all snacks i didn even ask for but i drink a sip of after and im full.

But regardless, im trying to fix it, but im in the inbetween where i can fall into it at any moment. Just chilling on the edge lol.

Anyways, we came home and now im here, in m bed on my computer writing to you, dear reader.

I’ll be back again tomorrow or later, maybe.

Happy birthday momma.

[darkmaga-returns]

By Peter A. McCullough, MD, MPH

I am sure when parents take their children to the pediatrician for routine vaccinations, they could not possibly consider that a few days or weeks later their child could develop a condition where immunosuppressive therapy would be warranted.Costales C, Sahoo MK, Huang C, Guimaraes CV, Born D, Kushner L, Gans HA, Doan TA, Pinsky BA. Vaccine-Associated Measles Encephalitis in Immunocompromised Child, California, USA. Emerg Infect Dis. 2022 Apr;28(4):906-908. doi: 10.3201/eid2804.212357. PMID: 35318930; PMCID: PMC8962891.

Researchers at Stanford University led by Costales et al reported a tragic case.

A previously healthy infant received dose 1 of the MMR ProQuad vaccine (Merck, https://www.merck.com) at her 1-year well-child visit. Over the following week, the patient experienced fevers, and acute myeloid leukemia was diagnosed. During induction chemotherapy, a diffuse morbilliform rash developed. A nasopharyngeal swab sample was positive for MV RNA by a laboratory-developed multiplex quantitative reverse transcription PCR (7). We detected all 3 genomic targets: the nucleoprotein, hemagglutinin, and large protein genes.

The measles vaccine is a live attenuated vaccine. In this case, the vaccine measles virus hypermutated to a fatal strain that invaded the brain and killed the child. Chances are if the child was unvaccinated, the AML would have been treated in the usual fashion with a good chance at survival. The 5-year survival rate for children with acute myeloid leukemia (AML) diagnosed before age 2 is around 60-70%, with some subtypes having higher survival rates, according to the American Cancer Society and other sources.

Very rare deaths with measles must be weighed with equally rare cases of vaccine deaths. It is exceeding difficult for the human mind to factor in any event occurring less than one percent of the time. As a result, parents and doctors should have a complete free choice on the issue of vaccination with no pressure, coercion, or threat of reprisal for whatever decision is made.