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The first prenatal screening test was introduced in the 1970s a single second-trimester serum test for maternal serum alpha-fetoprotein, a marker of neural tube defects. Aneuploidy screening using maternal serum markers was introduced in the 1980s, and the number and complexity of offered screening tests have been on an upward trajectory ever since. Prenatal genetic screening is used to assess whether there is an increased risk of the fetus being affected by a genetic disorder. Originally, prenatal genetic testing primarily focused on trisomy 21 (Down syndrome), but now it can detect a broad range of genetic disorders. Today, prenatal genetic screening falls into four categories ultrasonography, maternal carrier status of specific genetic disorders, maternal serum assays looking for specific biochemical markers indicative of aneuploidy, and most recently, maternal plasma fetal cell-free fetal DNA (cffDNA), which has been used for aneuploidy, microdeletion, and copy number variants (CNVs). Maternal serum assays include first-trimester screening, the triple screen, the quadruple screen, and the penta screen. There is also the option of combining first-trimester and second-trimester screening with either integrated, sequential, or contingent screening protocol. This provides a higher detection rate than a one-step screening.Appropriate hand, fingers, wrist, and forearm positioning is often required to facilitate proper exposure to the surgical site and anesthesia administration with easy accessibility to the intravenous (IV) site, and American Society of Anesthesiology (ASA) monitors for the anesthesiologist. The most common surgical positioning is supine, Trendelenburg, and lithotomy position. These positions often require arms in abduction less than 90-degree rested on the armrest or tugged in the neutral position. Whereas in the lateral position, the bottom limb is padded at bony prominence and placed in front of the patient, and the top limb is placed on top with padding in between the arms or flexed at shoulder and elbow. Prone position arms are abducted, but abduction should not exceed more than 90 degrees. An axillary roll is often utilized during prone positioning to prevent compression of the brachial plexus and axillary vascular structures.Tuberculosis is the oldest reported infectious disease caused by Mycobacterium tuberculosis and is known as 'barometer of social welfare' because of its higher prevalence in less developed areas. Tuberculosis frequently affects the lungs but also affects other parts of the body. Scrofula (historically known as the king's evil) is the tuberculous cervical lymphadenitis caused by hematogenous or lymphatic dissemination of pulmonary TB or reactivation of latent TB or very rarely through primary involvement of adenoids or tonsils. It is the Latin term for Brood sow, which means the tuberculosis of neck and is the most common extrapulmonary tuberculosis. The major cause of scrofula in the immunocompromised patients is Mycobacterium tuberculosis (95%), and rest (5%) is caused by atypical and nontuberculous mycobacteria. On the other hand, atypical and nontuberculous mycobacteria are mainly responsible for scrofula in immunocompetent children.Jacob's syndrome, also known as 47,XYY syndrome, is a rare genetic condition that occurs in about 1 out of 1000 male children. It belongs to a group of conditions known as "sex chromosome trisomies", with Klinefelter's syndrome being the more common type. This condition was initially discovered in the 1960s. Early studies performed on institutionalized men found that 47,XYY males were more likely to exhibit antisocial tendencies than those without this genotype. Selitrectinib The median age of diagnosis is approximately 17 years, with many patients presenting due to infertility concerns. Patient presentations may vary greatly, and in fact, many patients have relatively few, if any, phenotypic abnormalities. Those who do, however, may display macroorchidism, tall stature, macrocephaly (abnormally large head), and hypertelorism (increased distance between two body parts, typically the eyes), among other features. These patients are also more likely than the general population to be diagnosed with asthma, autism spectrum disorder, and seizures. While some 47,XYY individuals are infertile, those who are able to reproduce often produce offspring that have normal karyotypes.Response to drugs varies considerably between person to person, and their clinical outcomes, ranging anywhere from treatment failure to adverse drug reactions, can be largely attributed to drug metabolism. The role of cytochrome P450 (CYP) has been vastly studied for years regarding its influence in drug therapy. Predominantly operating within hepatocytes, their principal function serves to metabolize hosts of xenobiotics and clearance of potentially toxic compounds, accordingly. While paramount in many aspects of human biology and essential life processes, its most significant feature rests in the field of pharmacokinetic research and drug metabolism; this is the primary area with which drug developers and researchers concern themselves as different drugs can potentially affect the activity of CYP enzymes, or conversely, be affected by CYP activity, leading to unforeseen clinical outcomes. Mechanisms underlying a drug’s action on these enzymes is essential to understand for patients to receive adequate therapy, especially if in conjunction with other CYP metabolized drugs. Other features of CYP enzymes rest in its ability to synthesize and breakdown hormones, fat-soluble vitamin metabolism, fatty acid regulation, and clearance of various toxic endogenous and exogenous compounds.Cardiac pheochromocytomas (CPs) are very rare primary neuroendocrine catecholamine-secreting tumors that arise from the sympathetic paraganglia, which is made up of (chromaffin) cells. Paraganglia are non-neuronal cells that originated from the neural crest. The incidence of primary cardiac tumors ranges from 0.01 to 0.3% by autopsy.. Thus far, CP is the rarest form of primary cardiac tumors. Nearly 98% of pheochromocytomas are found in the abdomen, with the adrenal gland being the most common site). Less than 2% of pheochromocytomas are found in the chest, with the heart being the least common site. Most of the reported cases of CP were benign. Although malignant pheochromocytomas are uncommon, the ones arising from the heart appear more aggressive and difficult to resect. In a small clinical data of 158 patients, where 137 of these patients had detailed imagings, 85% (117/137) of the patients were found to have an intra-pericardiac tumor, either arose from branchiomeric paraganglia (in the roots of the great vessels including pulmonary artery, pulmonary vein, vena cava, and aorta) or visceral autonomic paraganglia( interatrial or interventricular groove).