Indinavir

Generic indinavir 400 mg line

The volume of radiation and the intensity/duration of chemotherapy are determined by risk grouping based on prognostic factors at presentation, including presence of constitutional symptoms, disease stage and bulk. Bleeding from gastrointestinal tract is a common form of mucosal bleeding in the newborn due to hemorrhagic disorders. Genomics have changed the concept of antigen selection by the reverse vaccinology. Cardiac Catheterization the right ventricular pressure compared with systemic arterial pressure and the pressure gradient across the pulmonary valve are the most important measurements made at catheterization. Intractable diarrhea of infancy often begins before the age of 3 months with more than three liquid stools lasting for more than 2 weeks under 1 year of age with either weight loss or no weight gain during this period. Penicillin and the marked decrease in morbidity and mortality from rheumatic fever in the United States. Allow children to eat with their hands, even if it turns out to be a messy affair. Size, Margin, Contour and Consistency of Liver the liver is to be palpated like any routine palpation of abdomen from left iliac fossa in an anticlockwise manner. Blood transfusions are avoided for fear of exposure to infectious agents and to avoid sensitization, increasing the risk of rejection following transplantation. Iron deficiency anemia is associated with impaired condition associated with anemia. Sixty percent are nonhereditary and unilateral; 15% are hereditary and unilateral, and 25% are hereditary and bilateral. Among the most studied are weight, length/ height, arm circumference, skinfold thickness and head circumference. The eardrum may be inflamed, and bulging with loss of normal anatomy with fluid in middle ear. Endotracheal intubation and assisted ventilation are needed in patients with a modified Glasgow Coma Score less than or equal to eight, signs of respiratory distress, declining O2 saturation, irregular respiratory efforts, inadequate chest movements or central cyanosis. These include headache, blurring of vision, convulsions, papilledema, cranial nerve palsies, vomiting and altered sensorium. Mannitol (Osmitrol) Inhibits tubular reabsorption of electrolytes by increasing osmotic pressure of glomerular filtrate. From a biological perspective, puberty is the stage of physical maturation in which, an individual becomes physiologically capable of sexual reproduction. Transillumination of the skull in a dark room is useful in children below one year, to detect subdural effusion or hematoma, if translucency extends beyond 2 cm in the frontal and 1 cm in the occipital region. If fluid in an appropriate volume and composition has been given, the patient should lose 0. Drug Level Monitoring Drug levels may be estimated in certain specific situations (Table 6. The papillary muscles are poorly developed or rudimentary, with a very small left ventricular cavity. In the absence of systemic signs and symptoms, conditions like benign familial hematuria or Alport syndrome should be considered. Obstructive lesions, particularly bilateral lesions are harmful to the developing kidneys. A balance of reassurance to the survivor and vigilance in monitoring for relapse, second malignancies and other sequelae is required. The disorders are fairly benign and longterm outlook for growth and liver function are good. Patients with mild articular manifestation are usually symptom-free within a few weeks, but severe cases require months to resolve entirely. Prednisolone is given at a dose of 2 mg/kg/day until urine protein is trace or nil for three consecutive days (remission), and subsequently as a single morning dose of 1.

Buy generic indinavir line

In malignant ascites, the bowel loops do not float freely but may be tethered along the posterior abdominal wall plastered to the liver or other organs or they may be surrounded by loculated fluid collections. The results of valvar replacement are somewhat disappointing, particularly in the very young child. Chronic or recurrent diarrhea with malabsorption, abdominal pain, dysphagia, and failure to thrive are common symptoms of gastrointestinal disease. The relatively new concepts and the prevailing controversies regarding terminology, coupled with the difficulties in ascertaining diagnosis in young children whose capacities are evolving, pose challenges to epidemiological studies. Otoscopic evaluation is a must for patients with fever of unknown or known origin, as well as those with ear symptoms. Most cases occur between late autumn and early spring, with sporadic cases any time. Skeletal dysplasia: Achondroplasia, hypochondroplasia, spondyloepiphyseal dysplasia 2. These are only guidelines and should not be considered as complete and comprehensive. A battery of routine investigations should be avoided because they are unproductive in most instances, expensive, may be misleading and diverting attention. Manifestations are similar to those of cerebral malaria so it can be easily overlooked. A positive tourniquet test in this phase increases the probability of dengue diagnosis. The switch over therapy for injections of third generation cephalosporins should be either cefpodoxime (10 mg/kg/ day in two divided doses) or cefdinir (15 mg/kg/day in two divided doses) and should never be cefixime as it has no activity against Pneumococcus and poor activity against community pathogens responsible for pneumonia. Urgent complete surgical repair should relieve the compression of the tracheobronchial tree. The various forms of muscular dystrophies are distinguished by a combination of clinical, pathological features and genetic investigations. Lack of antibiotic-induced clinical improvement is an indication for repeat diagnostic paracentesis. Whether the natural history can be modified by a more aggressive interventional approach remains to be proven, but given the poor long-term prognosis for this condition, significant residual obstructions are best managed by interventional techniques. This infant most likely has a vasculopathy (no elastin mutation was identified) figure 9: Residual or recoarctation is not uncommon following surgery. Accordingly influenza vaccine was a trivalent vaccine containing circulating seasonal H1N1, H3N2 and type B strains. Clinical features, chest X-ray and electrocardiogram are suggestive of the diagnosis and echocardiogram is confirmatory. On the contrary, celiac disease is a lifelong condition and the patient (and parents) should be given a clear understanding that the gluten cannot be introduced at any stage. Antibiotics initiated during the second stage do not affect the duration and severity of illness, but can hasten the eradication of B. In the fetal and postnatal circulations, this arrangement produces a vascular sling on the right side of the trachea and esophagus. The list should be given in descending order of probability of the various likely diagnoses, based on the positive and negative points towards each. It is important to allay the anxiety and guilt of the parents and other family members in repeated sessions and to explain the available modalities and plan of treatment. Breast milk is a good source of vitamin C, and children consuming animal milk are at risk of deficiency. Others Pentoxyphylline and recombinant human activated protein C have been tried, but with no demonstrated benefits. Treatment consists of antibiotic prophylaxis and immunization (especially meningococcal vaccine). Every episode of febrile neutropenia should be treated aggressively with broadspectrum antibiotics after drawing blood cultures.

Purchase indinavir 400mg online

The product of calcium and phosphorus should not exceed 65 in older children and 55 in children less than 12 years. Management of these conditions is important both to relieve the mother and to enable successful breastfeeding. Arteriovenous malfor mations and hemangiomas, which cause episodic gross hematuria, may be difficult to diagnose even by cystoscopy or angiography. Many disorders that present in the second year of life are frequently recognizable by the obvious loss of motor abilities. This case was important because the diagnosis led to the choice of an effective treatment, hematopoietic stem cell transplant. It typically uses three to four drugs including a steroid (prednisone or dexamethasone), vincristine and daunorubicin or Lasparaginase along with weekly doses of intrathecal methotrexate. In some children, especially with moderate degree of stenosis, two measurements can differ by 30 mm Hg. Druginduced cytopenias can be suspected by a detailed history and withdrawal of the offending drug usually leads to recovery of the concerned cell lines. Defined as fluid overload that is non-responsive to restriction of dietary sodium to 88 mmol/day and maximal novel Treatments in ascites dose diuretic therapy (furosemide + spironolactone), in the absence of ingestion of prostaglandin inhibitors, such Atrial Natriuretic Peptide as non-steroidal anti-inflammatory drugs. In cases of neonatal deaths, a meeting with the parent should be arranged after a few weeks when they would be more receptive having gone through the stages of bereavement and results of all investigations are available to have a more fruitful counseling. It is easy for the media to create sense of panic and outrage about the events, which are unrelated to immunization (coincidental). The details of appearance and fusion of various centers are given in subsequent sections. Evaluation of cardiac anatomy in subcostal, apical, parasternal and suprasternal notch views provides complete assessment. It is a group of disorders of varying etiology and pathogenesis, resulting in the same metabolic syndrome. Measure head size for microcephaly, palpate fontanels, look for sutural separation and auscultate head for any bruit. Lid lag on looking downward, impairment of convergence, and retraction of upper eyelids with infrequent blinking may be noticeable. There may be inherent problems like numerical cuspal abnormalities or abnormalities of the aortic root wall. Inability to pass a catheter through nose into nasopharynx establishes the diagnosis. In practice, this is too simplistic definition to be of clinical use and coarctation is more appropriately viewed as a complex cardiovascular disorder where aortic obstruction is only one part of a generalized arteriopathy with life-long implications persisting after initial correction of the aortic obstruction. The platelet count is low and platelet size small in Wiskott Aldrich syndrome and presence of Howell Jolly bodies in the red blood cells raises the possibility of asplenia. Problem of resistance is mainly due to misuse of antibiotics in human as well as veterinary medicine and also due to genetic mutation by bacteria. Chromosomes and Cell Division At conception human cell zygote consists of a single cell. If we assemble a cohort of 1000 children, less than 2 are likely to receive treatment in a teaching hospital. Transient hypogammaglobulinemia of infancy is characterized by delay in production of immunoglobulins after disappearance of maternal immunoglobulins. Characterization and surgical ablation of atrial flutter after classic Fontan repair in acute canine model. Pursuit movements are generated in the parietaltemporal occipital junction with ipsilateral projections to the abducens nucleus. Subacute intestinal obstruction is the manifestation in stricturous or hypertrophic type along with vague lump in the abdomen.

Cheap indinavir online mastercard

In younger children in whom timed collections are difficult, spot samples of urine solute/ creatinine can be used (Table 10. When it is symptomatic in neonatal period (<5%), it presents like neonatal hepatitis/biliary atresia. However, in some marginal patients with adequate size right ventricle and adequate tricuspid valve annulus, commissurotomy or valve excision or replacement have been attempted. On an average most infants measure 50 cm in length at birth, and gain approximately 25 cm in the first year of life, 12. Thus the timing of iron deficiency during infancy and its severity have critical impact even in adult life. The liver accounts for 1/20th of body weight in neonates and 1/50th of that of the adult. Pancreatic pseudocysts larger than 5 cm in diameter may require surgical intervention. Clinically, cholestasis is recognized by the presence of jaundice, high colored urine, hypopigmented or frank acholic stools, with or without itching due to retention of pruritogenic substances that are normally excreted in bile. Poststenotic dilation may result from the high velocity jet of flow ejected through the small valve orifice. The first line of defense mechanism (non-specific) is the physical barrier (skin and mucous membrane). For the same reason if a mother has two babies, breast milk production increases accordingly. The incidence of new cases varies with geographical 828 location, being highest in Finland and Sweden (40 per 100,000 children per year) and lowest in Japan (less than 1 per 100,000 children per year). The importance of vitamin A in functioning of the retina for vision has been well established. The peripheral smear in kala-azar usually shows anemia, thrombocytopenia, leukopenia with neutropenia, marked eosinopenia and relative lymphocytosis and monocytosis. Unless supported by regular transfusions, severe and progressive anemia and retardation of growth and development are the rule. Conduction system in tricuspid atresia with and without regular (d) transposition. Genital Response in Boys In the male, the principal response is erection of the penis, due to filling of the erectile tissue with blood. To open the airway, slightly extend the neck and maintain this position by placing a folded towel (about 1 inch thick) under the shoulder. In clinics, vaccines must be stored in a refrigerator which maintains the inside temperature between 4 degrees and 8 degrees. These groups of disorders are included in newborn screening programs of developed countries. In field surveys, it helps in diagnosis of mal/undernutrition: a value more than 13. Length Until 24 or 36 months of age, length in recumbency is measured using an infantometer (see Chapters 1. These vitamins are not stored for prolonged period in the body; significant toxicities at therapeutic doses are uncommon. In free or open pulmonic regurgitation, color Doppler can miss the jet altogether due to the brisk and laminar regurgitant flow. A number of indices aid in differentiating prerenal from renal azotemia, the most useful being the fractional excretion of sodium. If persons who have received full course of pre- or post-exposure prophylaxis get an animal bite at any point of time, two doses on day 0 and 3 is recommended. However, the majority may be diagnosed in late childhood as having communication disorders, autism, specific syndromes such as Rett syndrome, etc. Mitral atresia with normal aortic valve: A study of eighteen cases and a review of the literature. This will help to differentiate between infarction and hemorrhage and rule out other diagnosis.

Buy generic indinavir 400mg on line

Accurate and definitive diagnosis is the prerequisite for the prediction of prognosis and recurrence risk. Delayed and hesitant closure of the pulmonary valve due to the slow pressure drop in the stenotic infundibular chamber, associated valvar stenosis and the overrding aorta all contribute to the single S2. Poorly managed patients may progressively pass into hypovolemia, hypotension and shock. More recently, percutaneous intervention for dysfunctional right ventricular outflow tract conduits has become available. ImmunIty, ImmunIzatIon and InfectIous dIseases treatment Regimen of uncomplicated malaria Treatment regimens are to be tailored specifically according to the resistance pattern of the region under consideration. If the patient develops pulmonary edema severe respiratory distress, extensive rales and cyanosis are seen. Instead, a slight pressure may be applied on both the cheeks, between upper and lower jaws, using the thumb and a finger. The picture on right side shows that on inferior angulation of the transducer, the aberrant right subclavian artery arises from the distal portion of descending aorta on the left side of the midline. Prevention and treatment of Vaccine reaction It is mandatory for the person administering the vaccine to have sufficient knowledge regarding vaccines and expected side effects and to inform parents thoroughly regarding such adverse effects, which may however occur very rarely. Diseases of KiDney anD Urinary TracT Extracorporeal Shock Wave Lithotripsy Extracorporeal shock wave lithotripsy focuses shock wave energy at the calculus. Diffuse tubercular encephalopathy is characterized by diffuse edema of the brain, perivascular myelin loss and hemorrhagic leukoencephalopathy. These factors may prevent intestinal attachment of enteropathogens by acting as receptor homologues resulting in the suppression of enteral colonization with harmful microorganisms. The child should be encouraged to participate in age appropriate activities and attend regular school. Adolescent boys may also be brought to medical attention for large breasts, which could be due to gynecomastia, lipomastia or both. Excessive weight loss or inadequate weight gain indicates inadequate feeding, cold stress, excessive insensible water loss or systemic illness (like anemia, sepsis, late metabolic acidosis, etc. Mobile dome-shaped pulmonary valve stenosis is characterized by chubby, round, bloated face, well developed fat deposits and erythematous digits. Frequency Absent pulmonary valve is a rare and severe disease, particularly in the newborn and the fetus. If the baby continues to suckle in this way, it damages the nipple skin and causes a crack or fissure. Hyperthyroidism Hyperthyroidism (thyrotoxicosis) is an uncommon disorder of childhood and adolescence. Dietary Management the diet aims at controlling hypertension, edema and electrolyte disturbances, and retarding progression of renal failure while promoting growth and development. Frequent small feeds are encouraged, increased gradually rather than one or two major bulky meals. It is generally assumed that the sole function of the clitoris is to provide sexual pleasure for the woman as it contains large number of nerve endings. Staging the Fontan appears to decrease overall mortality, presumably related to improving the ventricular function by correcting afterload mismatch associated with one stage Fontan. Common lesions include pontine glioma and congenital agenesis like in Moebius syndrome. The aortic arch and the proximal part of descending aorta are on opposite sides of the spine. Biliary Atresia this is a fatal progressive fibro-inflammatory cholangiopathy resulting in complete obliteration of the entire or portions of the extrahepatic and intrahepatic biliary tree within weeks of birth.

Purchase indinavir from india

These children usually become symptomatic in first year of life and present with severe anemia and splenomegaly. These organisms are of low virulence that colonize the lower tract, and no treatment is necessary. It is important to teach the parents regarding the activities of daily living such as feeding, bathing, dressing and followup of therapy that is being done by the physiotherapist and occupational therapist. Clinical features Parasitic bowel disease is associated with wide variety of clinical manifestations ranging from asymptomatic carrier stage to various intestinal and extraintestinal manifestations. The extent of aortopulmonary collaterals is inversely related to the diameters of the central pulmonary arteries. The differential diagnosis include meconium plug syndrome, small left colon syndrome (diabetic mother), distal small bowel/colonic atresia, meconium ileus-cystic fibrosis complex and other medical conditions like hypothyroidism and sepsis. Localization in the visual System Localization of visual loss to different parts of the visual pathway is difficult in children and even more in infants because of the difficulties in testing visual acuity and visual fields accurately. Here we have attempted to give salient points in clinical examination that are different in children when compared to adults. Now, a rapid diagnostic test based on latex agglutination is also available for diagnosis of streptococcal pharyngitis and can be carried out in office practice. Prevention In the field of developmental impairments, prevention includes prospective interventions to avert progression to disabilities. The choice of kidney donor is either living related from a close blood relative (usually parents) or a deceased donor. Psychogenic nee: these are seen mostly in children more than 5 years of age and are either conversion reactions or malingering. Such lack of morphologic atrialization is also a feature of Ebstein malformation of the left-sided atrioventricular valve in the setting of congenitally corrected transposition (Ebsteinoid valve). Tracheoplasty with pericardial patch for extensive tracheal stenosis in infants and children. More importantly, they should be advised not to delay treatment of a coincidental illness falsely attributed as vaccine reaction. Finally, renal insufficiency, fluid and electrolyte imbalance are caused by abnormal intake, renal hypoperfusion and hormonal factors. It not only improves quality of life by reducing pain but is also supposed to decrease risk of involvement of heart, brain and kidneys. Progressive familial intrahepatic cholestasis these are a group of disorders presenting as chronic cholestasis of variable severity, ranging from severe neonatal cholestasis with biliary cirrhosis to benign recurrent cholestasis of youth and adult. In pulmonic regurgitation due to pulmonary hypertension, P2 is accentuated; with increased right ventricular end-diastolic volume, the ejection time is increased, P2 is delayed and the S2 split is widened. The saturations improved dramatically from 48 to 82 percent some potential morbidity and mortality, many centers have reported excellent outcome with this approach. A three-month-old infant presents for follow-up following end-to-end anastomosis repair of neonatal coarctation. There is severe lymphopenia and depletion of all lymphocyte subpopulations with pan-hypogammaglobulinemia. Scanty urine, giddiness, inability to walk, unsupported and narrow pulse pressure are some of the significant clinical findings of ongoing vascular leak. Clinical examination may include features of heart failure, single S2, holosystolic murmur with thrill at the left lower sternal border and sometimes a mid-diastolic murmur may be heard at the left lower sternal border. Enzyme replacement therapy with recombinant enzyme has become available since 2003. Hence the ideal public health policy should put efforts to reach at least 90% coverage with three doses of diphtheria toxoid in children below 1 year of age. As opposed to the normal tricuspid aortic valve, the folding is not only excessive, but some folds and creases persist throughout the cardiac cycle. Increased fecal losses during many episodes of diarrhea aggravate pre-existing zinc deficiency. The capillary endothelium, basement membrane and foot processes of podocytes form the filtration barrier. Long-term follow-up for possible shunt complication like infection, block and associated neurological deficits must be done in a multidisciplinary setting.

400 mg indinavir amex

This procedure was performed with minimal Management Medical Management the management depends on severity and age at presentation. Therefore, it is imperative that genetic disorders be included as a differential diagnosis in the evaluation of all children, and they should no longer be a diagnosis of exclusion. Respiratory viruses prevailing during rainy season could also present with similar erythematous flush; however a significant catarrh differentiates them from dengue illnesses. Mitral Valve Repair Beyond the neonatal period mitral valve repair is the best option, as valvar replacement in children is still fraught with problems. Definitive repair in some patients with pulmonary atresia with intact ventricular septum. Diffuse large B-cell lymphoma occurs more frequently during the second decade of life than during the first. Ultrasonography of the abdomen is done to examine for dilatation of the upper tract, bladder wall thickness and the presence of postvoid residual urine. Silent tachypnea may be metabolic because of acidosis due to diabetic ketoacidosis, drug/toxin, uremia, etc. This group includes common diseases diabetes mellitus, hypertension, obesity and schizophrenia, etc. Sometimes, they may present with early onset respiratory distress and feeding difficulties. Blood glucose should also be tested to confirm symptoms of hypoglycemia, whenever possible. Genetic background of the patient is important for conditions like Riley-Day syndrome. Avoid diuretic therapy if there is any doubt that critical phase (vascular leak) is still on. The formal education provides little or no information or guidance on issues concerning family life. In this chapter, we have discussed about clinical features, diagnosis, management and counseling issues of common genetic disorders encountered in clinical practice. Recognizing the numerous combinations and specific features with each lesion, each patient needs to be approached according to the specifics of the lesion(s). The presence of the systolic and diastolic murmur may be misdiagnosed as a continuous murmur. It is well to remember that compassion, explanation, and reassurance are valued by patients and their families as much as a diagnosis, treatment, and cure. It is common in term and post-term babies, especially those with intrauterine growth restriction. Vitamin D Antirachitic properties of vitamin D are the result of small structural changes, under the influence of ultraviolet irradiation in a number of steroids related to cholesterol. While echocardiography allows accurate diagnosis of this congenital lesion even in fetal life, angiography remains an important imaging technique to fully describe the anatomic details. In many cases a definite diagnosis cannot be established because of negative cultures and failure to demonstrate serological titers. Normal blood pressure readings in children in the different age groups are given in Table 1. Nodular Lymphocyte-Predominant Hodgkin Lymphoma this pathologic class of Hodgkin lymphoma is characterized by large cells with multilobed nuclei, referred to as Table 12. The subsequent management of a patient with steroid sensitive nephrotic syndrome depends on the course of the illness. Gitelman syndrome Patients with Gitelman syndrome have abnormalities similar to Bartter syndrome, including hypokalemia, metabolic alkalosis and hypomagnesemia.

400 mg indinavir with mastercard

Survival may be better than in patients treated with serial large-volume paracentesis. Firstly, with the lowering of the infant mortality rate in India resulting from control of infectious and nutritional disorders, pediatricians encounter more and more children with genetic disorders. Supraventricular arrhythmias (atrial flutter or fibrillation, paroxysmal supraventricular tachycardia) may be seen, particularly with older types of Fontan operation. The aims of the surgery are to repair the cardiac defects, eradicate infection and to prevent complications. Significant re-coarctation following end-to-end anastomosis in a two-year-old child has been managed with angioplasty; D. The theory of hemodynamic moulding postulates that the failure of development of cardiac structures is caused by diminished blood flow through them. Good sex involves finding out what the partner wants to happen before, during and after love making. As a result of the displacement, there is poor coaptation of the valve leaflets leading to tricuspid regurgitation, which in turn causes right atrial enlargement of a variable degree depending upon the degree of tricuspid regurgitation. Unless there is a strong suspicion of an organic cause, one should proceed directly for a two weeks trial feeding. Waterlow suggested that weight for height can be used to distinguish between malnutrition of recent origin, i. When acute visual loss is associated with pain, diplopia, ptosis, ophthalmoplegia and/or proptosis, an orbital process like cellulitis should be considered. As the times have gone by, medical professionals are being viewed with suspicion and are being dragged into the court for genuine or frivolous reasons. This is an ingenious approach and attacks the site of obstruction rather than bypassing it. Other Complications Rarely, complications like bile duct obstruction, duodenal obstruction or stenosis and pancreatic fistula may develop. Subsequently, recombinant proteins as effective immunizing agents have been enabled by gene insertion in yeast, E. Among our 40 consecutive patients with tricuspid atresia,38,42 only two with type I anatomy required pulmonary artery banding and there are only a few cases reported in the literature that required pulmonary artery banding. Child, adolescent and youth mental health is probably a continuum from a child development perspective- normal and abnormal, evolution of problems, causative and risk factors and ultimately the outcome. Most uninfected infants lose the maternal antibody between 6 months and 12 months of age (seroreverters). If one wants to follow the terminology of congenital heart disease proposed and reemphasized by Van Praagh,21 one could include the remaining segmental subsets, namely visceroatrial situs and ventricular loop. Beta blockade may help improve resting saturation and can decrease frequency of spells. Polysaccharide antigens are T-cell-independent, directly stimulate B cells and induce only IgM secretion and fail to induce memory cells. Endoscopic drainage procedures may be done either through the papilla (transpapillary) or through the wall of stomach (cystogastrostomy) or small intestine (cystoduodenostomy or -jejunostomy). Pathology of rickets the epiphyseal plate is a narrow well-defined strip from where cartilage cells grow in parallel column towards the metaphysis. The common symptoms are seizures without associated meningeal signs or evidence of tuberculosis elsewhere in the body. Lymphopenia is usually only seen in older children or those with end-stage disease. In North India, celiac disease is the commonest cause but in South India, celiac disease is a rare entity. Majority of the transplantations are carried out for end stage heart disease due to cardiomyopathies. Important causes of hematuria and steps of evaluation are listed in Chapter "Asymptomatic Hematuria". European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 2009;36: 91-5; discussion 5. Type B and C- Treatment strategy is individualized and involves unifocalization procedures, establishing ventricle-pulmonary artery continuity and closure of ventricular septal defect.