Amphibians are considered reliable indicators of environmental quality. In the western United States, a general decline of frog populations parallels an apparent worldwide decline. The factors thought to be contributing to declines in frog populations include habitat loss, introduction of exotic species, overexploitation, disease, climate change, and decreasing water quality. With respect to water quality, agroecosystems use 80-90% of the water resources in the western United States, frequently resulting in highly eutrophic conditions. Recent investigations suggest that these eutrophic conditions (elevated pH, water temperature, and un-ionized ammonia) may be associated with frog embryo mortality or malformations. However, water quality criteria for frogs and other amphibians do not currently exist. Here, we briefly review data that support the need to develop water quality parameters for frogs in agroecosystems and other habitats.ImagesFigure 1.Figure 2.Figure 3.Figure 4. AFigure 4. BFigure 5.
Tetralogy of Fallot is the most common cyanotic congenital heart defect consisting of an overriding aorta, right ventricular outflow obstruction, ventricular septal defect, and right ventricular hypertrophy. Without surgical management, approximately only 3% of patients survive past the age of 40 years. Cases of unoperated patients reaching adulthood have been reported; however, few studies describe treatment guidelines for surgical or therapeutic management. In this article, we report the case of a 59-year-old Hispanic male with unoperated tetralogy of Fallot presenting to our cardiology clinic for initial workup and management.
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