🔄 Flowchart Migration Preview

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["📊 Interim Analysis
Mid-study data review
Evaluate trial progress"] Penalty["⚖️ Statistical Penalty
Alpha-spending method
Preserve Type I error"] Decision{"🛑 Stop Study?
Assess for efficacy
Assess for futility"} Terminate["🏁 Terminate Trial
Early study closure
Report final findings"] Continue["🏃 Continue Trial
Maintain recruitment
Follow study protocol"] Adjust["⚙️ Trial Adjustments
Sample size estimation
Adaptive design changes"] Start --> Decision Start --> Penalty Decision -- Yes --> Terminate Decision -- No --> Continue Continue --> Adjust style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Penalty fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Decision fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Terminate fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Continue fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Adjust fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["☁️ Hypoxia
Low tissue oxygen
Primary physiological trigger"] HIF["🧬 HIF-1alpha Stabilization
Inducible factor buildup
Reduced protein degradation"] EPO["🧪 Renal EPO Transcription
Increased kidney mRNA
Erythropoietin production"] Marrow["🦴 Bone Marrow Response
Erythropoiesis stimulation
RBC precursor proliferation"] Outcome["✅ Increased Capacity
⬆️ Hematocrit level
⬆️ O2 carrying capacity"] Start --> HIF HIF --> EPO EPO --> Marrow Marrow --> Outcome style Start fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style HIF fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style EPO fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Marrow fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Outcome fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD StartNode["💉 Lanosterol
Initial lipid precursor
Substrate for demethylase"] AzoleBlock["🚫 Azole Inhibition
Blocks 14-alpha demethylase
Stops fungal growth"] EndNode["🍄 Ergosterol
Fungal membrane sterol
Target for antifungals"] StartNode --> AzoleBlock AzoleBlock -- "X" --> EndNode style StartNode fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style AzoleBlock fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style EndNode fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🔍 Thyroid Nodule
Initial presentation
Perform FNAC procedure"] Bethesda{"📋 Bethesda Result
Classification category
Determine management"} Cat1["⚠️ Category I
Non-Diagnostic result
Insufficient specimen"] Cat2["✅ Category II
Benign finding
Low malignancy risk"] Cat34["🔬 Category III & IV
AUS / FLUS / FN / SFN
Indeterminate cytology"] Cat56["🚨 Category V & VI
Suspicious / Malignant
High malignancy risk"] Action1["🔄 Repeat FNAC
Re-evaluate nodule
Improve sampling"] Action2["📅 Follow-up USG
Monitor in 12-24 mo
Assess size changes"] Action34["🧬 Further Testing
Molecular markers
Diagnostic lobectomy"] Action56["🔪 Surgery
Thyroidectomy plan
Definitive treatment"] Start --> Bethesda Bethesda --> Cat1 Bethesda --> Cat2 Bethesda --> Cat34 Bethesda --> Cat56 Cat1 --> Action1 Cat2 --> Action2 Cat34 --> Action34 Cat56 --> Action56 style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Bethesda fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Cat1 fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Cat2 fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Cat34 fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Cat56 fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Action1 fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Action2 fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Action34 fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Action56 fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🍄 Terbinafine Action
Antifungal mechanism overview
Inhibits ergosterol synthesis"] Terb["💊 Terbinafine Drug
Allylamine class medication
Blocks enzyme function"] Squalene["🧪 Squalene
Initial precursor molecule
Accumulates during inhibition"] Enzyme["🚫 Squalene Epoxidase
Key biosynthetic enzyme
Target of drug inhibition"] Lanosterol["🧬 Lanosterol
Intermediate sterol product
⬇️ Levels when blocked"] Ergosterol["✨ Ergosterol
Final fungal cell membrane
⬇️ Membrane structural integrity"] Start --> Terb Terb -- INHIBITION --- Enzyme Squalene --> Enzyme Enzyme --> Lanosterol Lanosterol --> Ergosterol style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Terb fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Squalene fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Enzyme fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Lanosterol fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Ergosterol fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD DRUG_ACTION["💊 Drug Action
Antifungal medications
Target cell synthesis"] TERBINAFINE["🧪 Terbinafine
Inhibits epoxidase
Prevents conversion"] AZOLES["🧪 Azoles
Inhibits demethylase
Blocks ergosterol"] NYSTATIN["🧪 Nystatin
Binds to sterols
Creates cell pores"] SQUALENE["🧬 Squalene
Initial precursor
Membrane building block"] LANOSTEROL["🧬 Lanosterol
Intermediate sterol
Biosynthesis pathway"] ERGOSTEROL["🧬 Ergosterol
Vital component
Fungal sterol marker"] MEMBRANE["🛡️ Cell Membrane
Maintains integrity
Final cell structure"] DRUG_ACTION --> TERBINAFINE DRUG_ACTION --> AZOLES DRUG_ACTION --> NYSTATIN SQUALENE -- "Squalene Epoxidase" --> LANOSTEROL LANOSTEROL -- "14-alpha-demethylase" --> ERGOSTEROL ERGOSTEROL -- "Forms" --> MEMBRANE TERBINAFINE -- "X Inhibits" --- SQUALENE AZOLES -- "X Inhibits" --- LANOSTEROL NYSTATIN -- "X Disrupts" --- MEMBRANE style DRUG_ACTION fill:#E3E5E5,stroke:#5F747D,stroke-width:1px,rx:10,ry:10,color:#435A64 style TERBINAFINE fill:#89D5F7,stroke:#5886E0,stroke-width:1px,rx:10,ry:10,color:#1961b4 style AZOLES fill:#89D5F7,stroke:#5886E0,stroke-width:1px,rx:10,ry:10,color:#1961b4 style NYSTATIN fill:#89D5F7,stroke:#5886E0,stroke-width:1px,rx:10,ry:10,color:#1961b4 style SQUALENE fill:#F7C398,stroke:#AE6B35,stroke-width:1px,rx:10,ry:10,color:#9C5D29 style LANOSTEROL fill:#F7C398,stroke:#AE6B35,stroke-width:1px,rx:10,ry:10,color:#9C5D29 style ERGOSTEROL fill:#F7C398,stroke:#AE6B35,stroke-width:1px,rx:10,ry:10,color:#9C5D29 style MEMBRANE fill:#A5C9C2,stroke:#41645D,stroke-width:1px,rx:10,ry:10,color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD START["🩸 Hyperglycemia
Sustained glucose levels
Excessive oxidation"] METABOLIC["🧬 Metabolic Changes
Mitochondrial dysfunction
Cellular nerve damage"] NEURO["🧠 Diabetic Neuropathy
Impaired myelin formation
Peripheral nerve impact"] ANGIO["🫀 Angiopathy
Microvascular damage
Vessel wall changes"] ROS["⚡ Reactive Oxygen Species
Rise in free radicals
Uncoupled NO levels"] SENSORY["🤚 Sensory Deficit
Impaired proprioception
Loss of pain sensation"] MOTOR["🦿 Motor Deficit
Muscular atrophy
Deformed foot shape"] AUTO["💧 Autonomic Deficit
Damaged sweat glands
Epidermal skin fissures"] MICRO["🔬 Microvascular
A/V shunt opening
Tissue ischemia"] MACRO["🥩 Macrovascular
Atherosclerosis
Cold and pale foot"] IMMUNE["🛡️ Immune Dysfunction
Neutrophil dysfunction
Chronic inflammation"] HEALING["⏳ Delayed Healing
Fibroblast dysfunction
⬇️ Angiogenesis"] ULCER["🦶 Diabetic Foot Ulcer
Infection and gangrene
Complex wound state"] START --> METABOLIC START --> ROS METABOLIC --> NEURO METABOLIC --> ANGIO ROS --> IMMUNE ROS --> HEALING NEURO --> SENSORY NEURO --> MOTOR NEURO --> AUTO ANGIO --> MICRO ANGIO --> MACRO SENSORY --> ULCER MOTOR --> ULCER AUTO --> ULCER MICRO --> ULCER MACRO --> ULCER IMMUNE --> ULCER HEALING --> ULCER style START fill:#CFBFF7,stroke:#8560C1,stroke-width:1px,rx:10,ry:10,color:#613C9D style METABOLIC fill:#A5C9C2,stroke:#41645D,stroke-width:1px,rx:10,ry:10,color:#274F47 style NEURO fill:#FFCBE1,stroke:#E34E79,stroke-width:1px,rx:10,ry:10,color:#B0294B style ANGIO fill:#FCC4B7,stroke:#D4655F,stroke-width:1px,rx:10,ry:10,color:#A44540 style ROS fill:#E3E5E5,stroke:#5F747D,stroke-width:1px,rx:10,ry:10,color:#435A64 style SENSORY fill:#F7C398,stroke:#AE6B35,stroke-width:1px,rx:10,ry:10,color:#9C5D29 style MOTOR fill:#F7C398,stroke:#AE6B35,stroke-width:1px,rx:10,ry:10,color:#9C5D29 style AUTO fill:#F7C398,stroke:#AE6B35,stroke-width:1px,rx:10,ry:10,color:#9C5D29 style MICRO fill:#FFDAB4,stroke:#BF814A,stroke-width:1px,rx:10,ry:10,color:#5D3A00 style MACRO fill:#FFDAB4,stroke:#BF814A,stroke-width:1px,rx:10,ry:10,color:#5D3A00 style IMMUNE fill:#E3E5E5,stroke:#5F747D,stroke-width:1px,rx:10,ry:10,color:#435A64 style HEALING fill:#E3E5E5,stroke:#5F747D,stroke-width:1px,rx:10,ry:10,color:#435A64 style ULCER fill:#89D5F7,stroke:#5886E0,stroke-width:1px,rx:10,ry:10,color:#1961b4

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["💧 Initial Stimulus
⬆️ Plasma Osmolality
⬇️ Blood Volume"] Senses["🧠 Hypothalamus Sensor
Osmoreceptor activation
Senses fluid change"] Pituitary["🩸 Hormone Release
Posterior Pituitary gland
Releases ADH hormone"] Duct["🔬 Renal Action
ADH acts on kidney
Targeting Collecting Duct"] AQP2["🧬 AQP2 Insertion
⬆️ Aquaporin-2 channels
Apical membrane insertion"] Reabsorb["🌊 Water Recovery
⬆️ Water Reabsorption
Passive water movement"] Outcome["✅ Final Outcome
Concentrated urine output
⬇️ Plasma Osmolality"] Start --> Senses Senses --> Pituitary Pituitary --> Duct Duct --> AQP2 AQP2 --> Reabsorb Reabsorb --> Outcome style Start fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Senses fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Pituitary fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Duct fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style AQP2 fill:#FFCBE1, stroke:#E34E79, stroke-width:1px, rx:10, ry:10, color:#B0294B style Reabsorb fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Outcome fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🍎 Pyruvate
End of glycolysis
3-carbon substrate"] PDC["⚙️ Acetyl-CoA
Active acetate form
Mitochondrial entry"] Krebs["🌀 Krebs Cycle
TCA central hub
Citric Acid Cycle"] NADH["🔋 3 NADH
Electron carrier
High energy yield"] FADH2["⚡ 1 FADH2
Electron carrier
Lower energy yield"] GTP["💎 1 GTP
Energy currency
ATP equivalent"] CO2["☁️ 2 CO2
Carbon byproduct
Released via exhalation"] Start -->|PDC enzyme| PDC PDC --> Krebs Krebs --> NADH Krebs --> FADH2 Krebs --> GTP Krebs --> CO2 style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style PDC fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Krebs fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style NADH fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style FADH2 fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style GTP fill:#FFCBE1, stroke:#E34E79, stroke-width:1px, rx:10, ry:10, color:#B0294B style CO2 fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Plan["📝 Plan Content
Define objectives and audience
Craft central core message"] Create["🎨 Create Material
Maintain high credibility
Focus on visual engagement"] Share["📤 Share Content
Select optimal platforms
Use timing and hashtags"] Engage["💬 Engage Audience
Open dialogue and Q&A
Encourage user content"] Monitor["📊 Monitor Results
Track analytics and feedback
Assess audience sentiment"] Adapt["🔄 Adapt Strategy
Refine based on data
Improve overall ROI"] Plan --> Create Create --> Share Share --> Engage Engage --> Monitor Monitor --> Adapt style Plan fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Create fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Share fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Engage fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Monitor fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Adapt fill:#FFCBE1, stroke:#E34E79, stroke-width:1px, rx:10, ry:10, color:#B0294B

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["⚠️ ADR Occurs
Adverse drug reaction
Patient side effect"] Detect["🔍 Detection
Identify clinical symptoms
Recognize drug link"] Report["📝 Reporting (PvPI)
Pharmacovigilance Program
Submit official form"] Assess["⚖️ Assessment
Analyze causality link
Evaluate risk level"] Understand["💡 Understanding
Identify risk factors
Clarify mechanism"] Prevent["🛡️ Prevention
Avoid future events
Improve patient safety"] Start --> Detect Detect --> Report Report --> Assess Assess --> Understand Understand --> Prevent style Start fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Detect fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Report fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Assess fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Understand fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Prevent fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["💊 Drug Administration
Initial drug entry
Systemic circulation"] Appr["📍 Cellular Approach
Reaches cell surface
Passive diffusion path"] Interact["🧬 P-gp Interaction
Binds at membrane
Active transport site"] Efflux["📤 ATP-Driven Efflux
Energy used: ATP
Drug pumped outward"] Concen["📉 Intracellular Levels
⬇️ Drug concentration
Reduced availability"] Outcome["⚖️ Clinical Impact
⬇️ Absorption and distribution
⬆️ Drug elimination"] Start --> Appr Appr --> Interact Interact -- ATP --> Efflux Efflux --> Concen Concen --> Outcome style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Appr fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Interact fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Efflux fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Concen fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Outcome fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🚨 Chest Pain
Suspected ACS presentation
Assess clinical symptoms"] ECG["📊 12-Lead ECG
Perform within 10 minutes
Identify cardiac rhythm"] Decision["❓ ST-Elevation?
Check for ⬆️ ST-segments
Assess new LBBB"] STEMI["🛑 STEMI
Immediate reperfusion needed
Activate Cath Lab"] NSTEMI["🔍 NSTEMI / UA
Stable vs unstable angina
Check cardiac Troponins"] Start --> ECG ECG --> Decision Decision -- "Yes" --> STEMI Decision -- "No" --> NSTEMI style Start fill:#E3E5E5,stroke:#5F747D,stroke-width:1px,rx:10,ry:10,color:#435A64 style ECG fill:#F7C398,stroke:#AE6B35,stroke-width:1px,rx:10,ry:10,color:#9C5D29 style Decision fill:#FFDAB4,stroke:#BF814A,stroke-width:1px,rx:10,ry:10,color:#5D3A00 style STEMI fill:#FCC4B7,stroke:#D4655F,stroke-width:1px,rx:10,ry:10,color:#A44540 style NSTEMI fill:#CFBFF7,stroke:#8560C1,stroke-width:1px,rx:10,ry:10,color:#613C9D

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🩺 ECG Analysis
Check PR interval
Look for P waves"] PRCheck{"⏲️ PR > 0.20s?
Measure interval
Check for delay"} Normal["✅ Normal
Normal sinus rhythm
Stable conduction"] QRSCheck{"📉 Dropped QRS?
Missing beats
P without QRS"} FirstDegree["1️⃣ 1st Degree Block
Constant prolonged PR
Every P has QRS"] ProgCheck{"📈 Progressive PR?
PR getting longer
Compare intervals"} Mobitz1["2️⃣ Mobitz I
Wenckebach pattern
Long-longer-dropped"] Mobitz2["3️⃣ Mobitz II
Constant PR interval
Unexpected drop"] ThirdDegree["🚫 3rd Degree
AV Dissociation
No P-QRS relation"] Start --> PRCheck PRCheck -- No --> Normal PRCheck -- Yes --> QRSCheck QRSCheck -- No --> FirstDegree QRSCheck -- Yes --> ProgCheck ProgCheck -- Yes --> Mobitz1 ProgCheck -- No --> Mobitz2 Mobitz2 --> ThirdDegree style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style PRCheck fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Normal fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style QRSCheck fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style FirstDegree fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style ProgCheck fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Mobitz1 fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Mobitz2 fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style ThirdDegree fill:#FFCBE1, stroke:#E34E79, stroke-width:1px, rx:10, ry:10, color:#B0294B

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["👤 High-Risk Patient
Identify immune status
Determine prophylaxis needs"] Defect{"❓ Immune Defect?
Assess primary condition
Check specific lab values"} Neutro["🩸 Neutropenia
AML or MDS patients
Risk of fungal infection"] Yeast["🍄 Yeast Coverage
Standard prophylaxis
Use Fluconazole"] Mold["🛡️ Yeast and Mold
Broad spectrum needed
Use Posaconazole"] HSCT["🧬 Allogeneic HSCT
Post-transplant phase
High mold risk"] Posac["💊 Posaconazole
Primary mold agent
Standard HSCT protocol"] HIV["🎗️ HIV/AIDS
Monitor CD4 counts
Assess endemic risks"] PJP["🫁 PJP Prophylaxis
CD4 count < 200
Use TMP-SMX"] Flucon["👅 Fluconazole
CD4 count < 100
Prevent Esophageal Candidiasis"] Itrac["🌎 Itraconazole
Endemic and CD4 < 150
Prevent Histoplasmosis"] SOT["🫀 Solid Organ Transplant
Varies by organ type
Assess surgical risk"] SOTMed["🧪 Targeted Therapy
Fluconazole or Echinocandin
Risk-based selection"] Start --> Defect Defect --- Neutro Defect --- HSCT Defect --- HIV Defect --- SOT Neutro --> Yeast Neutro --> Mold HSCT --> Posac HIV -- "CD4 < 200" --> PJP HIV -- "CD4 < 100" --> Flucon HIV -- "CD4 < 150" --> Itrac SOT --> SOTMed style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Defect fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Neutro fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Yeast fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Mold fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style HSCT fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Posac fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style HIV fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style PJP fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Flucon fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Itrac fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style SOT fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style SOTMed fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Azoles["💊 AZOLES
Inhibit ergosterol synthesis
Lanosterol 14-alpha-demethylase"] AzMut["🧬 TARGET MUTATION
ERG11 gene mutations
Altered binding affinity"] AzEf["⚡ EFFLUX PUMPS
⬆️ CDR and MDR pumps
Expulsion of drug from cell"] Echino["💊 ECHINOCANDINS
Inhibit beta-1,3-D-glucan
Blocks cell wall synthesis"] EchMut["🧬 TARGET MUTATION
FKS1 gene mutations
Reduced drug sensitivity"] Polyene["💊 POLYENES
Binds to cell membrane
Creates pores/ion leakage"] PolMut["🧬 TARGET MUTATION
ERG3 gene mutations
⬇️ Ergosterol content"] Flucy["💊 FLUCYTOSINE
Inhibits DNA/RNA synthesis
Pyrimidine analog antimetabolite"] FluRed["📉 REDUCED ACTIVITY
⬇️ Cellular uptake
⬇️ Metabolism (deaminase)"] Azoles --> AzMut Azoles --> AzEf Echino --> EchMut Polyene --> PolMut Flucy --> FluRed style Azoles fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Echino fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Polyene fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Flucy fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style AzMut fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style AzEf fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style EchMut fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style PolMut fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style FluRed fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🔍 Suspected Candidemia
Identify clinical symptoms
Obtain blood cultures"] HemoDecide{"⚖️ Hemodynamic Stability?
Assess vitals
Evaluate severity"} Unstable["⚠️ Echinocandins
For unstable patients
Or critically ill"] Stable["💊 Oral / IV Therapy
Fluconazole or
Echinocandin therapy"] IsolateDecide{"🧪 Azole Susceptibility?
Review microbiology
Check sensitivities"} StepDown["✅ Step-down Therapy
Switch to Fluconazole
Oral transition option"] Continue["🛡️ Continue Therapy
Maintain Echinocandins
For resistant strains"] Duration["🗓️ 14-Day Course
Complete treatment
Time post-clearance"] Start --> HemoDecide HemoDecide -- Unstable / Critically Ill --> Unstable HemoDecide -- Stable --> Stable Unstable --> IsolateDecide Stable --> IsolateDecide IsolateDecide -- Yes --> StepDown IsolateDecide -- No --> Continue StepDown --> Duration Continue --> Duration style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style HemoDecide fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Unstable fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Stable fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style IsolateDecide fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style StepDown fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Continue fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Duration fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🦠 Suspected Infection
Clinical signs present
Initial assessment done"] Query["❓ Cultures Drawn?
Check recent orders
Confirm sample timing"] NoCultures["🚨 GET CULTURES FIRST!
Collect before antibiotics
Avoid result masking"] BroadSpec["💊 Empiric Therapy
Start broad spectrum
Cover likely pathogens"] Results["🧪 C&S Available
Review microbiology
Check sensitivities"] NarrowSpec["✅ Definitive Therapy
De-escalate treatment
Narrow the spectrum"] Start --> Query Query -- "NO" --> NoCultures Query -- "YES" --> BroadSpec BroadSpec --> Results Results --> NarrowSpec style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Query fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style NoCultures fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style BroadSpec fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Results fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style NarrowSpec fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD StartNode["🚀 Start Process
Begin data workflow
Initialize telematic analysis"] SelectVar["📊 Select Variable
Choose telematic data
Deceleration or acceleration"] Preprocess["🧹 Preprocess Data
Handle missing values
Normalize dataset parameters"] ApplyNSPCA1["🧬 Apply NSPCA 1
Process Variable 1
Analyze deceleration data"] Decision1["❓ Var. Exp. > Thresh?
Check variance explained
Compare vs threshold"] SelectPC1["📉 Select PCs 1
Select components
Reduce Var 1 dimensions"] ApplyNSPCA2["🧬 Apply NSPCA 2
Process Variable 2
Right turn speed analysis"] Decision2["❓ Var. Exp. > Thresh?
Check variance explained
Final threshold check"] SelectPC2["📉 Select PCs 2
Select components
Reduce Var 2 dimensions"] FeatureSet["🏗️ Form Feature Set
Combine n reduced variables
Create input feature set"] BuildModel["📈 Build Pricing Model
Regression or GLM model
Structure predictive tool"] RiskMetrics["📋 Output Risk Metrics
Calculate claim frequency
Export final risk data"] StopNode["🏁 Stop Process
Analysis complete
Results generated"] StartNode --> SelectVar SelectVar --> Preprocess Preprocess --> ApplyNSPCA1 ApplyNSPCA1 --> Decision1 Decision1 -- "Yes" --> ApplyNSPCA2 Decision1 -- "No" --> SelectPC1 SelectPC1 --> ApplyNSPCA2 ApplyNSPCA2 --> Decision2 Decision2 -- "Yes" --> FeatureSet Decision2 -- "No" --> SelectPC2 SelectPC2 --> FeatureSet FeatureSet --> BuildModel BuildModel --> RiskMetrics RiskMetrics --> StopNode style StartNode fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style SelectVar fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Preprocess fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style ApplyNSPCA1 fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Decision1 fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style SelectPC1 fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style ApplyNSPCA2 fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Decision2 fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style SelectPC2 fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style FeatureSet fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style BuildModel fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style RiskMetrics fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style StopNode fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["💊 Antibiotic Process
Analyze clinical data
Review patient data"] Decision{"⚖️ Therapy Type
Single therapy?
Combined therapy?"} SortSingle["📊 Sort Efficiency
Rank agents ⬆️ efficay
Identify best drug"] SelectSingle["✅ Select Single
Choose top agent
Finalize prescription"] OutcomeSingle["💊 Single Therapy
Administer capsule
Monitor response"] Criteria["🎯 Define Criteria
Coverage and activity
Toxicity and protection"] Constraints["🧬 Define Constraints
Min dose increments
Limit drug overlap"] Create["⚙️ Create Combos
Generate pairings
Assess synergy"] SortCombos["🌡️ Rank Combos
Patient ⬆️⬇️ status
Match clinical need"] CheckSuitable{"❓ Suitable?
Meets all criteria?
Patient tolerant?"} SelectCombo["🤝 Select Combo
Finalize drug pair
Coordinate dosing"] OutcomeCombo["💊💊 Dual Therapy
Administer agents
Clinical follow-up"] Start --> Decision Decision -- Single --> SortSingle SortSingle --> SelectSingle SelectSingle --> OutcomeSingle Decision -- Combined --> Criteria Criteria --> Constraints Constraints --> Create Create --> SortCombos SortCombos --> CheckSuitable CheckSuitable -- No --> Criteria CheckSuitable -- Yes --> SelectCombo SelectCombo --> OutcomeCombo style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Decision fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style SortSingle fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style SelectSingle fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style OutcomeSingle fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Criteria fill:#FFCBE1, stroke:#E34E79, stroke-width:1px, rx:10, ry:10, color:#B0294B style Constraints fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Create fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style SortCombos fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style CheckSuitable fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style SelectCombo fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style OutcomeCombo fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD subgraph HumanHost ["👤 HUMAN HOST"] direction TB Start["💉 Sporozoites Injected
Inoculated via bite
Travel to the liver"] Liver["🏠 Liver Stage
Exo-erythrocytic cycle
Schizont development"] Hypno["💤 Hypnozoites
Dormant liver forms
P. vivax and P. ovale"] Fever["🌡️ Fever Spikes
Erythrocytic cycle
RBC lysis events"] Gametocytes["🧬 Gametocytes
Sexual stage forms
Ready for ingestion"] end subgraph MosquitoHost ["🦟 MOSQUITO HOST"] direction TB Ingestion["🍽️ Gametocyte Ingestion
Mosquito blood meal
Enters insect midgut"] SexualRepro["💖 Sexual Reproduction
Formation of zygote
Oocyst maturation"] Salivary["👄 Salivary Glands
Sporozoites migrate
Infectious for next host"] end %% Connections Start --> Liver Liver --> Fever Liver -- "P. vivax/ovale" --> Hypno Fever -- "Cycles" --> Fever Fever --> Gametocytes Gametocytes --> Ingestion Ingestion --> SexualRepro SexualRepro --> Salivary Salivary --> Start %% Styling style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Liver fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Hypno fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Fever fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Gametocytes fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Ingestion fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style SexualRepro fill:#FFCBE1, stroke:#E34E79, stroke-width:1px, rx:10, ry:10, color:#B0294B style Salivary fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD StartWards["🏥 General Wards
Standard patient care units
Lower acuity floor patients"] StartICU["⚕️ Intensive Care Units
High acuity critical care
Urgent clinical monitoring"] Path1["📝 Path 1: Pre-Prescription
ID Specialist pre-approval
Authorization prior to drug"] Path2["🔍 Path 2: Post-Prescription
Review and feedback audit
Empirical or urgent status"] Drug1["💻 Computer Entry *
Enter antibiotic order
Electronic system logging"] IDContact["📞 ID Specialty Contact
Telephone approval process
Direct specialist consult"] Pharmacy1["💊 Pharmacy Release
Clinical pharmacist review
Medication dispensing"] Drug2["💻 Computer Entry #
Initial urgent prescription
Electronic system logging"] Pharmacy2["💊 Pharmacy Release
Clinical pharmacist review
Immediate drug dispensing"] Audit["🧪 Post-Review Audit
By ID specialist team
Evaluate therapy duration"] StartWards --> Path1 StartICU --> Path1 StartICU --> Path2 Path1 --> Drug1 Drug1 --> IDContact IDContact --> Pharmacy1 Path2 --> Drug2 Drug2 --> Pharmacy2 Pharmacy2 --> Audit Audit -- "If necessary" --> Path1 style StartWards fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style StartICU fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Path1 fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Path2 fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Drug1 fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style IDContact fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Pharmacy1 fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Drug2 fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Pharmacy2 fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Audit fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD START["💊 Drug Concentration
Monitor levels over time
Optimize clinical dosing"] CMAX["🔝 Cmax
Maximum peak concentration
Dose-dependent killing"] AUC["📉 AUC
Area under the curve
Total drug exposure"] TMIC["⏳ Time > MIC
Percentage of dosing interval
Duration of efficacy"] MIC(("🔬 MIC
Minimum Inhibitory
Concentration")) START --> CMAX START --> AUC START --> TMIC CMAX -- Peak Level --> MIC AUC -- Total Exposure --> MIC TMIC -- Duration Above --> MIC style START fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style CMAX fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style AUC fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style TMIC fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style MIC fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["💊 Empiric Therapy
Broad-spectrum started
Initial infection control"] Decision{"🧫 Culture Results
Sensitivity available?
Check lab data"} Deescalate["🎯 De-escalate
Narrowest effective agent
Reduce resistance risk"] Reevaluate["🔎 Re-evaluate
Review at 48-72 hours
Confirm initial diagnosis"] Complete["✅ Complete Course
Optimized treatment plan
Ensure clinical cure"] Start --> Decision Decision -- "Yes" --> Deescalate Decision -- "No" --> Reevaluate Deescalate --> Complete Reevaluate --> Complete style Start fill:#E3E5E5,stroke:#5F747D,stroke-width:1px,rx:10,ry:10,color:#435A64 style Decision fill:#FFDAB4,stroke:#BF814A,stroke-width:1px,rx:10,ry:10,color:#5D3A00 style Deescalate fill:#89D5F7,stroke:#5886E0,stroke-width:1px,rx:10,ry:10,color:#1961b4 style Reevaluate fill:#CFBFF7,stroke:#8560C1,stroke-width:1px,rx:10,ry:10,color:#613C9D style Complete fill:#A5C9C2,stroke:#41645D,stroke-width:1px,rx:10,ry:10,color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🔍 Patient Assessment
Check renal history
Screen for impairment"] Calc["🧮 Calculate CrCl
Use Cockcroft-Gault
Check serum creatinine"] Decision1{"🔬 Evaluate CrCl
Is CrCl > 50-60?
mL per min threshold"} Standard["✅ Standard Dosing
Apply normal regimen
No adjustment needed"] Adjust["⚖️ Adjust Therapy
Modify dose amount
Change dose interval"] Monitor["📈 Clinical Monitoring
Check drug levels
Track renal function"] Start --> Calc Calc --> Decision1 Decision1 -- Yes --> Standard Decision1 -- No --> Adjust Adjust --> Monitor style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Calc fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Decision1 fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Standard fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Adjust fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Monitor fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD HF["❤️ Heart Failure
Structural heart disease
Functional impairment"] DT["⚙️ Dysfunction Type
Mechanism of failure
Classification of pumping"] AS["📍 Affected Side
Anatomical involvement
Congestive symptoms"] SYS["🟦 Systolic
Reduced pump power
⬇️ Ejection Fraction"] DIA["🟨 Diastolic
Impaired filling
Stiff ventricles"] LHF["🫁 Left HF
Pulmonary congestion
Dyspnea and crackles"] RHF["💧 Right HF
Systemic congestion
JVD and edema"] HF --> DT HF --> AS DT --> SYS DT --> DIA AS --> LHF AS --> RHF style HF fill:#FCC4B7,stroke:#D4655F,stroke-width:1px,rx:10,ry:10,color:#A44540 style DT fill:#89D5F7,stroke:#5886E0,stroke-width:1px,rx:10,ry:10,color:#1961b4 style AS fill:#89D5F7,stroke:#5886E0,stroke-width:1px,rx:10,ry:10,color:#1961b4 style SYS fill:#A5C9C2,stroke:#41645D,stroke-width:1px,rx:10,ry:10,color:#274F47 style DIA fill:#FFDAB4,stroke:#BF814A,stroke-width:1px,rx:10,ry:10,color:#5D3A00 style LHF fill:#CFBFF7,stroke:#8560C1,stroke-width:1px,rx:10,ry:10,color:#613C9D style RHF fill:#F7C398,stroke:#AE6B35,stroke-width:1px,rx:10,ry:10,color:#9C5D29

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🧪 Test Strategy
Interpretation of results
Improving diagnostic accuracy"] Sub1["⬆️ High Sensitivity Test
SnNout principle used
Good for initial screening"] Sub2["⬆️ High Specificity Test
SpPin principle used
Good for confirmatory testing"] Neg["➖ Negative Result
Test shows no disease
Highly reliable if sensitive"] Pos["➕ Positive Result
Test indicates disease
Highly reliable if specific"] RuleOut["✅ Rule Out - SNOUT
SeNsitivity Negative
Rules OUT the disease"] RuleIn["🚩 Rule In - SPIN
SPecificity Positive
Rules IN the disease"] Start --> Sub1 Start --> Sub2 Sub1 --> Neg Sub2 --> Pos Neg --> RuleOut Pos --> RuleIn style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Sub1 fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Sub2 fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Neg fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Pos fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style RuleOut fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style RuleIn fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🔍 CL Diagnosis Confirmed
Cutaneous Leishmaniasis
Clinical and lab proof"] Assess["⚖️ Assess Severity/Species
Evaluate lesion count
Identify species type"] Simple["🛡️ Local Therapy Options
OWCL Simple or few lesions
Minor clinical involvement"] Complex["💊 Systemic Therapy
NWCL or Complex OWCL
Multiple or resistant lesions"] Local1["💉 Intralesional SSG
Direct lesion injection
Sodium stibogluconate"] Local2["❄️ Cryo/Thermotherapy
Physical destruction
Heat or cold cycles"] Local3["🧴 Topical Paromomycin
Aminoglycoside cream
Non-invasive application"] Local4["👀 Observation
Self-healing case
OWCL likely to resolve"] Sys1["☣️ Pentavalent Antimonials
IV or IM delivery
SSG 20 mg/kg/d for 20-28d"] Sys2["🧪 Amphotericin B
Intravenous route
For resistant or severe cases"] Sys3["💊 Miltefosine
Oral administration
2.5 mg/kg/d for 28 days"] Sys4["💉 Pentamidine
Alternate therapy
Systemic antiprotozoal"] Start --> Assess Assess -- OWCL Simple/Few --> Simple Assess -- NWCL or Complex/Resistant --> Complex Simple --> Local1 Simple --> Local2 Simple --> Local3 Simple --> Local4 Complex --> Sys1 Complex --> Sys2 Complex --> Sys3 Complex --> Sys4 style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Assess fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Simple fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Complex fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Local1 fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Local2 fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Local3 fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Local4 fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Sys1 fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Sys2 fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Sys3 fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Sys4 fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🔍 Suspected Infection
Identify clinical signs
Assess patient risk"] Empiric["💊 Empiric Therapy
Start broad spectrum
Cover likely pathogens"] Cultures["🧫 Obtain Cultures
Collect blood samples
Tissue and fluid tests"] Review["📊 Review Data
Check results 48-72h
Assess clinical response"] Deescalate["📉 De-escalate or Stop
Narrow the spectrum
Discontinue if negative"] Duration["⏱️ Shortest Duration
Limit therapy days
Target effective course"] Start --> Empiric Empiric --> Cultures Cultures --> Review Review --> Deescalate Deescalate --> Duration style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Empiric fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Cultures fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Review fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Deescalate fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Duration fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["👤 Patient History
Reported Penicillin Allergy
Verify official history"] Assess{"🔍 Assess Reaction
Determine reaction type
Evaluate IgE mediation"} Severe["🚨 Severe Reaction
Anaphylaxis or Urticaria
High risk IgE response"] Mild["⚠️ Mild Reaction
Isolated non-IgE rash
Low risk for shock"] Avoid["🚫 Strict Avoidance
Avoid PCN and Cephalosporins
Use Aztreonam or non-bl"] Cautions["💊 Cautious Use
Can use Cephalosporins
Consider Carbapenems"] Start --> Assess Assess -- "Anaphylaxis/Urticaria" --> Severe Assess -- "Mild Rash (Non-IgE)" --> Mild Severe --> Avoid Mild --> Cautions style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Assess fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Severe fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Mild fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Avoid fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Cautions fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Title["🧫 Bacterial Resistance
Key mechanisms and strategies
used by resistant pathogens"] Enz["🧪 Enzymatic Degradation
Beta-lactamases hydrolyze rings
Inactivates antibiotic molecules"] Target["🎯 Target Modification
Alteration of drug targets
mecA modifying PBPs in MRSA"] Efflux["📤 Active Efflux Pumps
Pumps actively expel drugs
Effective against tetracyclines"] Permeable["🛡️ Low Permeability
Loss of porin channels
Prevents entry of carbapenems"] Title --> Enz Title --> Target Title --> Efflux Title --> Permeable style Title fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Enz fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Target fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Efflux fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Permeable fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["💊 Nicotinic Antagonists
Acetylcholine receptor blockers
Competitive and non-competitive"] Ganglion["🧠 Ganglionic Blockers
Autonomous nervous system
Hexamethonium and Mecamylamine"] NMB["💪 Neuromuscular Blockers
Skeletal muscle relaxation
Used in surgical anesthesia"] NonDepol["⏹️ Non-Depolarizing
Competitive ACh inhibition
Reversible via AChE inhibitors"] Depol["⚡ Depolarizing
Persistent depolarization
Initial fasciculations occur"] Curium["🧪 -curonium / -curium
Rocuronium and Vecuronium
Pancuronium and Atracurium"] Succi["💉 Succinylcholine
Rapid onset of action
Short duration of effect"] Start --> Ganglion Start --> NMB NMB --> NonDepol NMB --> Depol NonDepol --> Curium Depol --> Succi style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Ganglion fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style NMB fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style NonDepol fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Depol fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Curium fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Succi fill:#FFCBE1, stroke:#E34E79, stroke-width:1px, rx:10, ry:10, color:#B0294B

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["💉 Initial Treatment
Empiric broad spectrum
Intravenous IV meds"] DecideImprove{"📈 Improving?
Patient is stable
Symptoms resolve"} DecideGI{"🍴 GI Tract?
Gut is functioning
Oral intake ok"} DecideCulture{"🔬 Labs Ready?
Culture results back
Sensitivity known"} SwitchPO["💊 Switch to PO
Oral antibiotic meds
Equivalent dosage"] Deescalate["🎯 De-escalate
Narrow spectrum meds
Targeted therapy"] Final["✅ Optimized Care
Cost-effective plan
Therapy success"] Start --> DecideImprove Start --> DecideCulture DecideImprove -- Yes --> DecideGI DecideGI -- Yes --> SwitchPO DecideCulture -- Yes --> Deescalate SwitchPO --> Final Deescalate --> Final style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style DecideImprove fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style DecideGI fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style DecideCulture fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style SwitchPO fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Deescalate fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Final fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["💊 Atropine Overdose
Toxic dose ingestion
Muscarinic antagonist"] Antidote["🧪 Physostigmine
Acetylcholinesterase inhibitor
Crosses blood-brain barrier"] Blockade["⚠️ Muscarinic Blockade
Widespread receptor inhibition
Anticholinergic syndrome"] CNS["🧠 CNS Effects
Delirium and agitation
Visual hallucinations"] Peripheral["💓 Peripheral Effects
Tachycardia and fever
Mydriasis and dry skin"] Start --> Blockade Antidote -- Reverses --> Blockade Blockade --> CNS Blockade --> Peripheral style Start fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Antidote fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Blockade fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style CNS fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Peripheral fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD CHOL["🧪 Choline
Essential precursor
Extracellular source"] ACOA["⚡ Acetyl-CoA
Mitochondrial source
Metabolic substrate"] SYNT["🏗️ Synthesis
ChAT mediated process
ACh formation"] ACH1["🟢 ACh
Neurotransmitter pool
Cytoplasmic stage"] VESI["📦 Vesicle
VAT storage transporter
Protected compartment"] RELE["🚀 Release
Ca2+ influx triggered
Exocytosis to cleft"] ACH2["🟢 ACh
Active transmitter
Synaptic cleft signal"] DEGR["♻️ Degradation
AChE activity
Choline and Acetate"] CHOL --> SYNT ACOA --> SYNT SYNT --> ACH1 ACH1 --> VESI VESI --> RELE RELE --> ACH2 ACH2 --> DEGR DEGR -- "Reuptake" --> CHOL style CHOL fill:#F7C398,stroke:#AE6B35,stroke-width:1px,rx:10,ry:10,color:#9C5D29 style ACOA fill:#F7C398,stroke:#AE6B35,stroke-width:1px,rx:10,ry:10,color:#9C5D29 style SYNT fill:#89D5F7,stroke:#5886E0,stroke-width:1px,rx:10,ry:10,color:#1961b4 style ACH1 fill:#A5C9C2,stroke:#41645D,stroke-width:1px,rx:10,ry:10,color:#274F47 style VESI fill:#FFDAB4,stroke:#BF814A,stroke-width:1px,rx:10,ry:10,color:#5D3A00 style RELE fill:#FCC4B7,stroke:#D4655F,stroke-width:1px,rx:10,ry:10,color:#A44540 style ACH2 fill:#A5C9C2,stroke:#41645D,stroke-width:1px,rx:10,ry:10,color:#274F47 style DEGR fill:#E3E5E5,stroke:#5F747D,stroke-width:1px,rx:10,ry:10,color:#435A64

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD START["💊 Neuromuscular Blockers
Muscle relaxant agents
Anesthesia adjuncts"] NON_DEP["🚫 Non-Depolarizing
Competitive antagonist
ACh receptor block"] DEP["⚡ Depolarizing
ACh receptor agonist
Persistent activation"] CURON["💉 -curoniums
Steroid structure
Roc/Vecuronium"] CURIUM["💉 -curiums
Isoquinoline type
Atra/Mivacurium"] SUX["🧪 Succinylcholine
Short-acting agent
Rapid sequence use"] TOF_FADE["📉 TOF: Fade
Progressive ⬇️ twitch
Non-depol profile"] PHASE_1["⏹️ Phase I Block
Constant diminished
No fade present"] PHASE_2["📉 Phase II Block
Fade seen later
Desensitization"] %% Connections START --> NON_DEP START --> DEP NON_DEP --> CURON NON_DEP --> CURIUM NON_DEP --> TOF_FADE DEP --> SUX DEP --> PHASE_1 DEP --> PHASE_2 %% Styling style START fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style NON_DEP fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style DEP fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style CURON fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style CURIUM fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style SUX fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style TOF_FADE fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style PHASE_1 fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style PHASE_2 fill:#FFCBE1, stroke:#E34E79, stroke-width:1px, rx:10, ry:10, color:#B0294B

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["⚠️ OP Exposure
Organophosphate entry
Toxic pesticide contact"] AChE["⚙️ AChE Inhibition
Acetylcholinesterase blocked
Enzyme function stops"] HighACh["⬆️⬆️ Acetylcholine
Excess neurotransmitter
Synaptic accumulation"] Overload["⚡ Receptor Overload
Muscarinic activation
Nicotinic stimulation"] DUMBBELSS["🤮 Muscarinic Effects
DUMBBELSS mnemonic
Secretions and bradycardia"] Nicotinic["💪 Nicotinic Effects
Muscle fasciculations
Eventual paralysis"] Rx["💊 Treatment
Emergency stabilization
Antidote administration"] Atropine["💉 Atropine
Muscarinic antagonist
Reverses secretions"] Pralidoxime["💉 Pralidoxime
AChE regenerator
Targets nicotinic signs"] Start --> AChE --> HighACh --> Overload Overload -- Muscarinic --> DUMBBELSS Overload -- Nicotinic --> Nicotinic Rx --> Atropine Rx --> Pralidoxime style Start fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style AChE fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style HighACh fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Overload fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style DUMBBELSS fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Nicotinic fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Rx fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Atropine fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Pralidoxime fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD StartNode["💧 Filtrate Entry
Enters Descending Limb
Flows toward medulla"] DescLimb["🌊 Descending Limb
Passive H2O reabsorption
Concentrates the filtrate"] AscLimb["🧂 Ascending Limb
Active NaCl reabsorption
Dilutes the filtrate"] Medulla["📈 Interstitium
⬆️ Medullary Osmolality
High salt concentration"] StartNode --> DescLimb DescLimb --> AscLimb AscLimb -- "pumps ions into" --> Medulla Medulla -- "draws water from" --> DescLimb style StartNode fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style DescLimb fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style AscLimb fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Medulla fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["Kidney Nephron
Basic functional unit
Filters blood plasma"] Loop["🔄 Loop of Henle
Creates osmotic gradient
Countercurrent multiplier"] Vasa["🩸 Vasa Recta
Maintains the gradient
Countercurrent exchanger"] Urine["💧 Urine Concentration
Enables final dilution
Water reabsorption occurs"] Start --> Loop Loop --> Vasa Vasa --> Urine style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Loop fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Vasa fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Urine fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

flowchart TD subgraph TALCell["TAL Cell & Interstitium"] direction TB Lumen["💧 Lumen Fluid
Source of tubular ions
Enters through NKCC2"] ATPase["⚡ Na+/K+ ATPase
Basolateral active pump
Maintains Na+ gradient"] Ionic["🔋 Cellular Entry
Na+, K+, and 2Cl-
Transported into cell"] Medullary["⬆️ Medullary Solutes
Interstitial concentration ⬆️
Basolateral transport"] Potential["➕ Lumen Potential
Lumen-positive charge
K+ backleak movement"] end Cations["💎 Cation Absorption
Paracellular Ca2+, Mg2+
Driven by charge gradient"] Lumen -->|NKCC2| Ionic ATPase -->|Maintains Na+ Gradient| Ionic Ionic -->|Basolateral Transporters| Medullary Ionic -->|K+ Leak Channel| Potential Potential -->|Drives| Cations %% Node Styling style TALCell fill:#f9f9f9,stroke:#5F747D,stroke-width:2px,color:#435A64 style Lumen fill:#E3E5E5,stroke:#5F747D,stroke-width:1px,rx:10,ry:10,color:#435A64 style ATPase fill:#F7C398,stroke:#AE6B35,stroke-width:1px,rx:10,ry:10,color:#9C5D29 style Ionic fill:#89D5F7,stroke:#5886E0,stroke-width:1px,rx:10,ry:10,color:#1961b4 style Medullary fill:#FCC4B7,stroke:#D4655F,stroke-width:1px,rx:10,ry:10,color:#A44540 style Potential fill:#CFBFF7,stroke:#8560C1,stroke-width:1px,rx:10,ry:10,color:#613C9D style Cations fill:#A5C9C2,stroke:#41645D,stroke-width:1px,rx:10,ry:10,color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🧠 ADH Dysregulation
Impaired water balance
Pituitary or renal cause"] SIADH["💧 SIADH
⬆️ ADH hormone levels
Excessive hormone release"] DI["🏜️ Diabetes Insipidus
⬇️ ADH or response
Inadequate hormone action"] SIADH_Effect["📉 Hyponatremia
⬆️ H2O reabsorption
Dilutional sodium drop"] DI_Effect["📈 Hypernatremia
⬇️ H2O reabsorption
Concentrated sodium rise"] Start --> SIADH Start --> DI SIADH --> SIADH_Effect DI --> DI_Effect style Start fill:#E3E5E5,stroke:#5F747D,stroke-width:1px,rx:10,ry:10,color:#435A64 style SIADH fill:#FFCBE1,stroke:#E34E79,stroke-width:1px,rx:10,ry:10,color:#B0294B style DI fill:#FFDAB4,stroke:#BF814A,stroke-width:1px,rx:10,ry:10,color:#5D3A00 style SIADH_Effect fill:#FCC4B7,stroke:#D4655F,stroke-width:1px,rx:10,ry:10,color:#A44540 style DI_Effect fill:#89D5F7,stroke:#5886E0,stroke-width:1px,rx:10,ry:10,color:#1961b4

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["👥 Population
Cohort without disease
Initial study assembly"] Step1{"🔍 Exposure Status
Identify risk factors
Categorize participants"} Exposed["⚠️ Exposed Group
Presence of factor
Follow over time"] Unexposed["✅ Unexposed Group
Absence of factor
Follow over time"] Outcome["🏁 Outcome?
Incidence of disease
Measure relative risk"] Start --> Step1 Step1 -- Exposed --> Exposed Step1 -- Unexposed --> Unexposed Exposed --> Outcome Unexposed --> Outcome style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Step1 fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Exposed fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Unexposed fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Outcome fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🔍 Investigator Choice
Determines exposure assignment
Controlled vs natural"] Exp["🧪 Experimental Design
Randomized trials included
Active intervention used"] Obs["👀 Observational Design
Exposure is not assigned
Natural exposure observed"] Follow["⏳ Follow-up Check
Participants followed over time
Temporal sequence assessed"] Other["📊 Alternative Studies
Cross-sectional or Case-control
Ecological study designs"] Cohort["📈 Cohort Study
Primary longitudinal design
Tracking group outcomes"] Pros["⏩ Prospective Cohort
Followed into the future
Real-time data collection"] Retros["⏪ Retrospective Cohort
Looking back at records
Exposure happened in past"] Mixed["🔁 Mixed Cohort
Combined past and future
Hybrid data collection"] Start -- Yes --> Exp Start -- No --> Obs Obs --> Follow Follow -- No --> Other Follow -- Yes --> Cohort Cohort -.-> Pros Cohort -.-> Retros Cohort -.-> Mixed style Start fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Exp fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Obs fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Follow fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Other fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Cohort fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Pros fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Retros fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Mixed fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🧠 Hypothalamic Dysfunction
Impaired GnRH secretion
Low FSH and LH levels"] Ovaries["🥚 Secondary Ovarian Failure
⬇️ Estrogen production
Amenorrhea and infertility"] Thyroid["🦋 Secondary Thyroid Failure
Low TSH production
⬇️ Metabolic rate"] Adrenal["⚡ Secondary Adrenal Failure
Low ACTH production
⬇️ Serum cortisol"] Finish["🏥 Panhypopituitarism
Global hormone deficiency
End-stage endocrine failure"] Start --> Ovaries Ovaries --> Thyroid Thyroid --> Adrenal Adrenal --> Finish style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Ovaries fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Thyroid fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Adrenal fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Finish fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D

flowchart TD Start["📉 Hypocalcemia
⬇️ Low Serum Ca2+
Initial trigger state"] PTH["⬆️ PTH Release
Parathyroid response
Hormone levels rise"] subgraph Kidney["Kidney Effects"] ReabsorpCa["⬆️ Ca2+ Reabsorption
Distal convoluted tubule
Conserve serum calcium"] ReabsorpPO["⬇️ PO4 3- Reabsorption
Proximal tubule site
Increases PO4 excretion"] Calcitriol["⬆️ Calcitriol
Vitamin D activation
1-alpha-hydroxylase activity"] end Start --> PTH PTH --> Kidney style Start fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style PTH fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Kidney fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style ReabsorpCa fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style ReabsorpPO fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Calcitriol fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD subgraph KeyRegs ["Key Regulators"] direction TB HighK["🩸 High Plasma K+
Elevated serum potassium
Primary trigger factor"] Aldo["🧪 ⬆️ Aldosterone
Adrenal cortex release
Hormonal signal sent"] end subgraph PCell ["Principal Cell Response"] direction TB Baso["🧫 ⬆️ Na+/K+ Pump
Basolateral upregulation
K+ entry from blood"] Apical["🧪 ⬆️ Ion Channels
Apical ENaC activity
Open K+ channels"] end Secret["💧 ⬆️ K+ Secretion
Increased urinary loss
Restores homeostasis"] %% Connections HighK --> Aldo HighK --> Baso Aldo --> Baso Aldo --> Apical Baso --> Secret Apical --> Secret %% Styling style HighK fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Aldo fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Baso fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Apical fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Secret fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style KeyRegs fill:#f9f9f9, stroke:#5F747D, stroke-dasharray: 5 5 style PCell fill:#f9f9f9, stroke:#5F747D, stroke-dasharray: 5 5

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD subgraph Triggers ["⚡ JGA TRIGGERS"] direction TB T1["⬇️ Renal Perfusion
Low blood pressure
Reduced renal flow"] T2["⬇️ NaCl Delivery
Macula densa sense
Low distal salt"] T3["⬆️ Sympathetic Tone
Beta 1 activation
Stress response"] end JGA["🏢 JGA Cells
Juxtaglomerular apparatus
Sensory integration"] ReninRel{"🔑 Renin Release
Enzyme secretion
Proteolytic action"} AngioGen["🧪 Angiotensinogen
Produced by liver
Circulating substrate"] AngioI["💉 Angiotensin I
Decapeptide product
Mild vasoconstrictor"] AngioII["🔥 Angiotensin II
Potent vasoconstrictor
Main RAAS effector"] T1 & T2 & T3 --> JGA JGA --> ReninRel ReninRel --> AngioGen AngioGen -- "Renin enzyme" --> AngioI AngioI -- "ACE (in lungs)" --> AngioII style Triggers fill:#E3E5E5,stroke:#5F747D,stroke-width:1px,rx:10,ry:10,color:#435A64 style T1 fill:#FCC4B7,stroke:#D4655F,stroke-width:1px,rx:10,ry:10,color:#A44540 style T2 fill:#FCC4B7,stroke:#D4655F,stroke-width:1px,rx:10,ry:10,color:#A44540 style T3 fill:#FCC4B7,stroke:#D4655F,stroke-width:1px,rx:10,ry:10,color:#A44540 style JGA fill:#89D5F7,stroke:#5886E0,stroke-width:1px,rx:10,ry:10,color:#1961b4 style ReninRel fill:#FFDAB4,stroke:#BF814A,stroke-width:1px,rx:10,ry:10,color:#5D3A00 style AngioGen fill:#F7C398,stroke:#AE6B35,stroke-width:1px,rx:10,ry:10,color:#9C5D29 style AngioI fill:#CFBFF7,stroke:#8560C1,stroke-width:1px,rx:10,ry:10,color:#613C9D style AngioII fill:#A5C9C2,stroke:#41645D,stroke-width:1px,rx:10,ry:10,color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD PT["🧪 Proximal Tubule
15-25% reabsorption
Initial Mg2+ transport"] TAL["⚡ Thick Ascending Limb
60-70% reabsorption
Major transport site"] DT["💧 Distal Tubule
5-10% reabsorption
Final fine tuning"] PT --> TAL TAL --> DT style PT fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style TAL fill:#FFCBE1, stroke:#E34E79, stroke-width:1px, rx:10, ry:10, color:#B0294B style DT fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🌱 Fresh Stage
Initial autolysis process
Timeline: 0-24 hours"] Bloat["🎈 Bloat Stage
Putrefaction gas buildup
Timeline: 24-72 hours"] Active["🔬 Active Decay
Colliquative liquefaction
Timeline: 1-3 weeks"] Advanced["🧀 Advanced Decay
Butyric fermentation
Timeline: 3 weeks-2 months"] Dry["🦴 Dry Remains
Complete skeletalization
Timeline: > 2 months"] Start --> Bloat Bloat --> Active Active --> Advanced Advanced --> Dry style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Bloat fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Active fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Advanced fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Dry fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🩺 Cutaneous Symptoms
Assess skin manifestations
Determine clinical severity"] Decide{"⚖️ Treatment Strategy
Select path based on
patient clinical phenotype"} Mild["🧴 Lifestyle & Topical
Xerosis and pruritus care
Emollients and antihistamines"] Moderate["🎯 Targeted Therapy
Annular erythema and purpura
Topical steroids or HCQ"] Severe["💊 Systemic Modulation
Severe or refractory disease
Systemic steroids and biologics"] Start --> Decide Decide -- Xerosis or Pruritus --> Mild Decide -- Mild-Mod Vasculitis --> Moderate Decide -- Severe or Refractory --> Severe style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Decide fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Mild fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Moderate fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Severe fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD RP["📉 Renal Perfusion
⬇️ Blood flow detected
Occurs in Kidney"] RR["⚙️ Renin Release
Secreted by JG cells
Enzymatic trigger"] ATN["🥩 Angiotensinogen
Plasma protein alpha 2
Produced by Liver"] AT1["🧪 Angiotensin I
Inactive decapeptide
Primary precursor"] ACE["🫁 ACE Enzyme
Converting enzyme
Found in Lungs"] AT2["🔥 Angiotensin II
Potent vasoconstrictor
Main RAAS effector"] VC["⚡ Vasoconstriction
⬆️ Peripheral resistance
⬆️ Blood pressure"] AR["💧 Aldosterone
Adrenal cortex release
⬆️ Na+ and H2O"] RP --> RR RR --> AT1 ATN --> AT1 AT1 -- ACE Enzyme --> AT2 AT2 --> VC AT2 --> AR style RP fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style RR fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style ATN fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style AT1 fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style ACE fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style AT2 fill:#FFCBE1, stroke:#E34E79, stroke-width:1px, rx:10, ry:10, color:#B0294B style VC fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style AR fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD RPP["⬇️ Renal Perfusion
Low perfusion pressure
Detected by baroreceptors"] NaCl["⬇️ NaCl Levels
Low NaCl at macula densa
Sensed in distal tubule"] Symp["🧠 Sympathetic Input
Activation via beta1 receptors
Stress or baroreceptor reflex"] JG["🧬 Juxtaglomerular Cells
Primary site of synthesis
Integration of triggers"] Renin["⬆️ Renin Secretion
Renin released into blood
Starts RAAS cascade"] RPP --> JG NaCl --> JG Symp --> JG JG --> Renin style RPP fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style NaCl fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Symp fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style JG fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Renin fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD ALDO["🧬 Aldosterone
Steroid hormone binds
Intracellular receptor"] NUC["🏢 Nucleus
Gene transcription occurs
Protein synthesis begins"] SYN["🛠️ Channel Synthesis
⬆️ ENaC channel count
⬆️ ROMK channel count"] ION["⚡ Ion Transport
⬆️ Na+ Influx Reabsorption
⬆️ K+ Efflux Secretion"] ADH["💧 ADH / Vasopressin
Antidiuretic hormone
Regulates water balance"] V2R["🛰️ V2 Receptor
G-protein coupled
Basolateral membrane"] CAMP["🧪 ⬆️ cAMP Levels
Second messenger signaling
Activates protein kinase A"] AQP["🚪 AQP2 Insertion
Aquaporin water channels
Apical membrane docking"] H2O["🌊 H2O Reabsorption
⬆️ Free water uptake
Concentrates the urine"] ALDO --> NUC NUC --> SYN SYN --> ION ADH --> V2R V2R --> CAMP CAMP --> AQP AQP --> H2O style ALDO fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style NUC fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style SYN fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style ION fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style ADH fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style V2R fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style CAMP fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style AQP fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style H2O fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

flowchart TD Start["🧬 Angiotensin II
Potent vasoconstrictor peptide
Primary effector of RAAS"] AT1["🎯 AT1 Receptor
G-protein coupled receptor
Mediates physiological actions"] Vaso["⚡ Squeeze
Systemic vasoconstriction
⬆️ Blood Pressure (BP)"] Salt["🧂 Salt Retention
Aldosterone hormone release
⬆️ Na+ and H2O retention"] Sip["💧 Sip Activity
ADH and thirst activation
⬆️ H2O total retention"] Symp["🔥 Sympathetic Activity
Norepinephrine stimulation
⬆️ HR and Contractility"] Scar["🏗️ Scarring
Cardiac and vascular growth
Tissue remodeling process"] GFR["🛡️ Save GFR
Efferent arteriole constriction
Maintains glomerular filtration"] Start --> AT1 AT1 --> Vaso AT1 --> Salt AT1 --> Sip AT1 --> Symp AT1 --> Scar AT1 --> GFR style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style AT1 fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Vaso fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Salt fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Sip fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Symp fill:#FFCBE1, stroke:#E34E79, stroke-width:1px, rx:10, ry:10, color:#B0294B style Scar fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style GFR fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🧬 Angiotensinogen
Produced by liver
Plasma globulin substrate"] End["🩸 Angiotensin I
Decapeptide hormone
Cleaved by renin"] Start -- "Renin" --> End style Start fill:#E3E5E5,stroke:#5F747D,stroke-width:1px,rx:10,ry:10,color:#435A64 style End fill:#E3E5E5,stroke:#5F747D,stroke-width:1px,rx:10,ry:10,color:#435A64

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🔍 Suspected RMS
Rhabdomyosarcoma suspicion
Initial clinical workup"] Biopsy["🔬 Biopsy + IHC
Tissue sampling required
Immunohistochemistry tests"] Imaging["🖼️ Imaging Evaluation
Site specific imaging
Radiological assessment"] Staging["📊 Staging Workup
Disease extent evaluation
Systemic involvement check"] Markers["🧬 Key Markers
Myogenin expression
MyoD1 nuclear staining"] Confirm["✅ Confirm & Stage
IRS group assignment
TNM staging system"] Primary["📍 Primary Site
Local MRI assessment
Anatomical CT imaging"] Metastasis["✈️ Metastasis
PET-CT systemic scan
CT Chest evaluation"] Special["🦴 Special Studies
Bone Marrow biopsy
CSF for parameningeal"] Start --> Biopsy Start --> Imaging Start --> Staging Biopsy --> Markers Biopsy --> Confirm Imaging --> Confirm Imaging --> Primary Imaging --> Metastasis Staging --> Confirm Staging --> Special style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Biopsy fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Imaging fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Staging fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Markers fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Confirm fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Primary fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Metastasis fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Special fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["👶 Suspect EA/TEF
Choking/Frothy Saliva
Cyanosis with feeds"] NGTube["🩺 NG Tube Attempt
Insert nasogastric tube
Check for resistance"] Xray["📸 Chest & Abdominal X-ray
Assess tube position
Check bowel gas pattern"] Confirm["✅ Confirm Diagnosis
Coiled NG tube seen
+/- Gas in bowel"] InitialRx["🏥 Initial Management
NPO and IV Fluids
Pouch Suction and Head Up"] SurgConsult["👨‍⚕️ Surgical Consult
Urgent evaluation needed
Definitive repair planning"] Start --> NGTube NGTube -- "Fails to pass / Coils" --> Xray Xray --> Confirm Confirm --> InitialRx InitialRx --> SurgConsult style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style NGTube fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Xray fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Confirm fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style InitialRx fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style SurgConsult fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🧒 Precocious Puberty
Early secondary sex traits
Initial clinical evaluation"] Assess["📊 Initial Workup
Assess Bone Age study
Check basal LH/FSH levels"] CPP["🧠 Central PP
GnRH-dependent type
Pubertal LH response"] PPP["🩸 Peripheral PP
GnRH-independent type
Prepubertal LH response"] GnRH_Test["🧪 GnRH Stim Test
Differentiate PP types
Monitor LH peak levels"] MRI["🖥️ Brain MRI
Evaluate pituitary gland
Search for CNS lesions"] Investigate["🩻 Imaging & bloods
USG Adrenals and Gonads
Specific hormone panels"] Rx_Central["💊 Treat Central PP
GnRH Agonist therapy
Regular clinical follow-up"] Rx_Periph["🩺 Treat Cause
Address underlying source
Example: Tumor resection"] Start --> Assess Assess -- "Advanced Bone Age
Pubertal LH" --> CPP Assess -- "Advanced Bone Age
Prepubertal LH" --> GnRH_Test GnRH_Test -- "Pubertal LH Response" --> CPP GnRH_Test -- "Prepubertal LH Response" --> PPP CPP --> MRI MRI --> Rx_Central PPP --> Investigate Investigate --> Rx_Periph style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Assess fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style CPP fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style PPP fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style GnRH_Test fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style MRI fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Investigate fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Rx_Central fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Rx_Periph fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["👶 Suspected HIV
Evaluation in child
Clinical suspicion"] Age{"📅 Age Check
Determine child age
Choose test pathway"} VirTest["🧬 Virological Tests
HIV DNA/RNA PCR
Required for infants"] Res1{"⚖️ PCR Result
Analyze PCR data
Determine status"} Repeat["🔄 Repeat PCR
Confirm first positive
Ensure accuracy"] AbTest["🧪 Antibody Test
ELISA or Rapid test
Standard screen"] Res2{"⚖️ Ab Result
Analyze Ab screen
Determine status"} Confirm["🔬 Confirmatory Lab
Western Blot test
Final verification"] NegPCR["🧐 Clinical Follow-up
Monitor if high risk
Re-test if symptomatic"] NegAb["✅ HIV Unlikely
Review recent exposure
End of pathway"] Confirmed["🚨 HIV Confirmed
Initiate ART therapy
Refer for specialist care"] Start --> Age Age -- "< 18 months" --> VirTest Age -- ">= 18 months" --> AbTest VirTest --> Res1 Res1 -- "Positive" --> Repeat Res1 -- "Negative" --> NegPCR Repeat -- "Positive" --> Confirmed AbTest --> Res2 Res2 -- "Positive" --> Confirm Res2 -- "Negative" --> NegAb Confirm -- "Positive" --> Confirmed style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Age fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style VirTest fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Res1 fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Repeat fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style AbTest fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Res2 fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Confirm fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style NegPCR fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style NegAb fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Confirmed fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["📋 Initial Evaluation
History and Physical Exam
CBC BMP Urinalysis and US"] Obstructing["❓ Obstructing Stone?
Check Ultrasound findings
Review renal bladder imaging"] CompFactors1["⚠️ Complicating Factors?
Fever or hemodynamic instability
AKI or intractable pain"] Intervention["⚡ Interventional Route
Proceed to Interventional Guidelines
Urgent urology consultation"] Conservative1["💊 Conservative Management
Pain control and anti-emetics
Strain urine and fetal monitor"] Discharge1["✅ Discharge and Referral
Discharge when criteria met
Referral to Endourology"] CompFactors2["⚠️ Complicating Factors?
Fetal distress or obstruction
Immunocompromised status"] SecondImaging["🔍 Second Line Imaging
Proceed to Imaging Guidelines
Further diagnostic workup"] Conservative2["💊 Conservative Management
Pain control and anti-emetics
Close clinical observation"] Discharge2["✅ Discharge and Referral
Discharge when criteria met
Referral to Endourology"] Start --> Obstructing Obstructing -- "Yes" --> CompFactors1 CompFactors1 -- "Yes" --> Intervention CompFactors1 -- "No" --> Conservative1 Conservative1 --> Discharge1 Conservative1 -- "Re-evaluate" --> CompFactors1 Obstructing -- "No" --> CompFactors2 CompFactors2 -- "Yes" --> SecondImaging CompFactors2 -- "No" --> Conservative2 Conservative2 --> Discharge2 Conservative2 -- "Re-evaluate" --> CompFactors2 style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Obstructing fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style CompFactors1 fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Intervention fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Conservative1 fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Discharge1 fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style CompFactors2 fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style SecondImaging fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Conservative2 fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Discharge2 fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Root["💊 Beta-Agonists
Sympathomimetic agents
Receptor stimulation"] NonSel["⚖️ Non-Selective
Isoproterenol medication
Beta1 = Beta2 activity"] B1Sel["❤️ Beta1-Selective
Dobutamine medication
Beta1 > Beta2 activity"] B2Sel["🫁 Beta2-Selective
Albuterol and Salmeterol
Terbutaline medication"] Root --> NonSel Root --> B1Sel Root --> B2Sel style Root fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style NonSel fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style B1Sel fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style B2Sel fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["肿瘤儿茶酚胺突增
极高循环儿茶酚胺
导致高血压危象"] Decision["控制血压
术前核心目标
维持循环稳定"] Alpha["第一步：Alpha阻断剂
酚苄明或哌唑嗪
防止过度血管收缩"] Beta["第二步：Beta阻断剂
仅在Alpha阻断后用
控制心率失常"] Surgery["手术切除
择期肾上腺切除
术中严密监测"] Start --> Decision Decision --> Alpha Alpha --> Beta Beta --> Surgery style Start fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Decision fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Alpha fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Beta fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Surgery fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["💊 Beta-Agonist
Binds to receptor
Initiates cascade"] Receptor["🧬 Beta-Receptor
GPCR activation
Conformational change"] GsProtein["⚡ Gs protein
⬆️ protein activity
GDP to GTP exchange"] Adenyl["🧪 Adenylyl cyclase
⬆️ cyclase activity
Membrane bound enzyme"] cAMP["🔋 cAMP levels
⬆️ intracellular cAMP
ATP conversion"] PKA["🔑 Protein Kinase A
⬆️ PKA activity
Regulatory subunit release"] Phospho["✨ Phosphorylation
Intracellular proteins
Covalent modification"] Response["🎯 Cellular Response
Downstream effect
Physiological change"] Start --> Receptor Receptor --> GsProtein GsProtein --> Adenyl Adenyl -- ATP --> cAMP cAMP --> PKA PKA --> Phospho Phospho --> Response style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Receptor fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style GsProtein fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Adenyl fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style cAMP fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style PKA fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Phospho fill:#FFCBE1, stroke:#E34E79, stroke-width:1px, rx:10, ry:10, color:#B0294B style Response fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD subgraph Action ["Alpha Antagonist Action"] A["💊 Alpha Antagonist
Binds to receptors
Initiates blockade"] B["🚫 Alpha-1 Blockade
Blocks alpha-1 receptor
Prevents catecholamines"] end subgraph Effect ["Physiological Effect"] C["⬇️ Muscle Contraction
Relaxes smooth muscle
Vascular wall relaxation"] D["💨 Vasodilation
Wider blood vessels
Reduced resistance"] E["⬇️ Blood Pressure
Reduces systemic BP
Antihypertensive effect"] end A --> B B --> C C --> D D --> E style A fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style B fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style C fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style D fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style E fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["💊 Phenylephrine
Selective alpha1 agonist
Systemic administration"] BP["💪 ⬆️ Blood Pressure
Alpha1 vasoconstriction
Increased TPR"] Baro["⚖️ Baroreceptors
Aortic arch activation
Carotid sinus firing"] Vagal["🧠 ⬆️ Vagal Firing
Parasympathetic output
Nerve activation"] HR["💓 ⬇️ Heart Rate
Reflex bradycardia
Compensatory response"] Start --> BP BP --> Baro Baro --> Vagal Vagal --> HR style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style BP fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Baro fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Vagal fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style HR fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["💊 Sympathomimetic Overdose
Tachycardia and agitation
Identify toxic substance"] HTN{"❓ Severe Hypertension?
Monitor blood pressure
Assess end-organ damage"} Labetalol["🧪 Alpha/Beta-blocker
Give drug like Labetalol
Control ⬆️ blood pressure"] Supportive["🏥 Supportive Care
Administer Benzodiazepines
Monitor vital signs"] Start --> HTN HTN -- Yes --> Labetalol HTN -- No --> Supportive style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style HTN fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Labetalol fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Supportive fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD A["📝 Preamble and Consent
Define procedural scope
Obtain written consent"] B["👤 History Taking
Record incident timeline
Document patient symptoms"] C["🔍 Clinical Examination
Physical status assessment
Injury documentation"] D["🔬 Investigations
Order necessary labs
Radiology and imaging"] E["💡 Opinion Formulation
Analyze clinical findings
Synthesize medical expert view"] F["✍️ Report and Signature
Finalize documentation
Official sign-off"] A --> B B --> C C --> D D --> E E --> F style A fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style B fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style C fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style D fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style E fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style F fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🔬 Glomerular Insult
Initial kidney trigger
Glomerular damage onset"] Decide{"📍 Primary Site
Identify injury zone
Select central pathway"} Nephrotic1["🧪 Podocyte Injury
Podocyte effacement
Charge barrier loss"] Nephrotic2["💧 Nephrotic Syndrome
Massive proteinuria
> 3.5 g/day loss"] Nephritic1["🔥 Inflammation
Cellular infiltration
Glomerular wall breach"] Nephritic2["🩸 Nephritic Syndrome
Hematuria findings
RBC cast formation"] Start --> Decide Decide --> Nephrotic1 Nephrotic1 --> Nephrotic2 Decide --> Nephritic1 Nephritic1 --> Nephritic2 style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Decide fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Nephrotic1 fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Nephrotic2 fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Nephritic1 fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Nephritic2 fill:#FFCBE1, stroke:#E34E79, stroke-width:1px, rx:10, ry:10, color:#B0294B

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Root["💊 Antagonists
Receptor blocking agents
Sympatholytic effects"] Alpha["⚡ Alpha-Blockers
Inhibit alpha receptors
Vascular smooth muscle"] Beta["❤️ Beta-Blockers
Inhibit beta receptors
Cardiac and lung tissue"] Phenoxy["🧬 Phenoxybenzamine
Irreversible inhibition
Pheochromocytoma use"] Osins["📉 Prazosin, -osins
Selective alpha-1 blockade
Treats hypertension"] Prop["🧠 Propranolol
Non-selective blocker
Beta-1 and Beta-2"] Metop["🫀 Metoprolol, Atenolol
Selective Beta-1 blocker
Cardioselective agents"] Root --> Alpha Root --> Beta Alpha --> Phenoxy Alpha --> Osins Beta --> Prop Beta --> Metop style Root fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Alpha fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Beta fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Phenoxy fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Osins fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Prop fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Metop fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD ANS["🧠 Autonomic Nervous System
Involuntary motor system
Visceral organ control"] SYM["🔥 Sympathetic Division
Thoracolumbar Outflow
Fight or flight response"] PARA["🧊 Parasympathetic Division
Craniosacral Outflow
Rest and digest state"] ANS --> SYM ANS --> PARA style ANS fill:#E3E5E5,stroke:#5F747D,stroke-width:1px,rx:10,ry:10,color:#435A64 style SYM fill:#FCC4B7,stroke:#D4655F,stroke-width:1px,rx:10,ry:10,color:#A44540 style PARA fill:#89D5F7,stroke:#5886E0,stroke-width:1px,rx:10,ry:10,color:#1961b4

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD subgraph SG1 ["Epinephrine + Alpha-Blocker"] Start1["💉 Epinephrine
Administered with blocker
Non-selective agonist"] AlphaB["🚫 Alpha-Blocker
Blocks alpha-1 receptors
Prevents vasoconstriction"] A1B["📉 alpha-1: Blocked
No alpha-1 activation
Resistance cannot ⬆️"] B2U["📉 beta-2: Unopposed
Vasodilation dominance
Significant ⬇️ TPR"] Net1["⚠️ Net Effect: ⬇️ MAP
Epinephrine Reversal
Pressure falls overall"] end subgraph SG2 ["Epinephrine Alone"] Start2["💉 Epinephrine
Isolated administration
High dose effects"] A1V["📈 alpha-1: Vasoconstrict
Significant ⬆️⬆️ TPR
Primary vascular effect"] B2V["📉 beta-2: Vasodilation
Minor ⬇️ resistance
Opposed by alpha-1"] Net2["✅ Net Effect: ⬆️ MAP
Systolic pressure rises
Overall ⬆️ Pressure"] end %% Connections SG1 Start1 --> AlphaB AlphaB --> A1B Start1 --> B2U A1B --> Net1 B2U --> Net1 %% Connections SG2 Start2 --> A1V Start2 --> B2V A1V --> Net2 B2V --> Net2 %% Styles style Start1 fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style AlphaB fill:#FFCBE1, stroke:#E34E79, stroke-width:1px, rx:10, ry:10, color:#B0294B style A1B fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style B2U fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Net1 fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Start2 fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style A1V fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style B2V fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Net2 fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🌱 Primordial Germ Cell
Origin of gamete line
Early embryonic stage"] Mitosis1["🔄 Mitosis
Cellular proliferation
Daughter cell formation"] Gametogonium["🧬 Gametogonium
Diploid state 2N, 2C
Pre-replication phase"] Mitosis2["🔄 Mitosis
Preparation for meiosis
DNA replication occurs"] Primary["🔬 Primary Gametocyte
Diploid state 2N, 4C
Homologous pairs ready"] Meiosis1["✂️ Meiosis I
Reductional division
Separates homologues"] Secondary["🌓 Secondary Gametocyte
Haploid state 1N, 2C
Sister chromatids stay"] Meiosis2["⚡ Meiosis II
Equational division
Separates chromatids"] Gamete["🎯 Gamete
Haploid state 1N, 1C
Mature functional cell"] Start --> Mitosis1 Mitosis1 --> Gametogonium Gametogonium --> Mitosis2 Mitosis2 --> Primary Primary --> Meiosis1 Meiosis1 --> Secondary Secondary --> Meiosis2 Meiosis2 --> Gamete style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Mitosis1 fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Gametogonium fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Mitosis2 fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Primary fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Meiosis1 fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Secondary fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Meiosis2 fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Gamete fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🧬 Spermatogonium
Diploid cell 2n, 2d
Initial germ cell"] Primary["🔬 Primary Spermatocyte
Diploid cell 2n, 4d
Post DNA replication"] Secondary["🌓 Secondary Spermatocyte
Haploid cell 1n, 2d
End of Meiosis I"] Spermatid["🌑 Spermatid
Haploid cell 1n, 1d
End of Meiosis II"] Spermatozoon["🎓 Spermatozoon
Mature cell 1n, 1d
Functional motile gamete"] Start -- Mitosis --> Primary Primary -- Meiosis I --> Secondary Secondary -- Meiosis II --> Spermatid Spermatid -- Spermiogenesis --> Spermatozoon style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Primary fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Secondary fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Spermatid fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Spermatozoon fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🏥 Acute Appendicitis
Initial presentation assessment
Diagnostic confirmation required"] Type{"❓ Disease Type
Evaluate clinical severity
Imaging findings scan"} Uncomp["✅ Uncomplicated
Inflammation only present
No signs of rupture"] CompAbs["💊 Complicated
Abscess or phlegmon focus
Localized inflammatory mass"] CompPerf["⚠️ Complicated
Free perforation present
Evidence of peritonitis"] LapApp["🔪 Laparoscopic Surgery
Standard appendectomy procedure
Minimally invasive approach"] PostOpAbx["💊 Post-op Antibiotics
Duration <= 24 hours
Limited prophylactic use"] InitialTx["💉 Initial Management
IV Abx +/- drainage
Stabilize inflammatory mass"] IntervalApp["📅 Interval Surgery
Wait 6-8 weeks total
Elective appendectomy later"] UrgentApp["🚨 Urgent Surgery
Immediate appendectomy needed
IV Abx for 3-7 days"] Start --> Type Type --> Uncomp Type --> CompAbs Type --> CompPerf Uncomp --> LapApp LapApp --> PostOpAbx CompAbs --> InitialTx InitialTx --> IntervalApp CompPerf --> UrgentApp style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Type fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Uncomp fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style CompAbs fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style CompPerf fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style LapApp fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style PostOpAbx fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style InitialTx fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style IntervalApp fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style UrgentApp fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🚨 Hypertensive Emergency
Severe HTN present
End-organ damage seen"] Goal["🎯 Management Goal
Controlled BP reduction
Prevent further damage"] Initial["📉 Initial Phase
⬇️ MAP by <= 25 percent
Target within first 8 hrs"] Subsequent["⏱️ Subsequent Phase
Normalize BP safely
Target over 24-48 hrs"] Meds["💊 IV Medications
Administer Labetalol
Administer Nicardipine"] Monitor["👁️ Close Monitoring
Avoid rapid BP drops
Continuous observation"] Start --> Goal Goal --> Initial Initial --> Subsequent Subsequent --> Meds Meds --> Monitor style Start fill:#FCC4B7,stroke:#D4655F,stroke-width:1px,rx:10,ry:10,color:#A44540 style Goal fill:#FFDAB4,stroke:#BF814A,stroke-width:1px,rx:10,ry:10,color:#5D3A00 style Initial fill:#89D5F7,stroke:#5886E0,stroke-width:1px,rx:10,ry:10,color:#1961b4 style Subsequent fill:#89D5F7,stroke:#5886E0,stroke-width:1px,rx:10,ry:10,color:#1961b4 style Meds fill:#CFBFF7,stroke:#8560C1,stroke-width:1px,rx:10,ry:10,color:#613C9D style Monitor fill:#A5C9C2,stroke:#41645D,stroke-width:1px,rx:10,ry:10,color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🚨 Hypercalcemic Crisis
Severe calcium elevation
Emergency medical management"] Step1["💧 Step 1: IV Hydration
Normal Saline (NS)
Restore intravascular volume"] Step2["💊 Step 2: Furosemide
Give after repletion
Promote urinary excretion"] Step3["🦴 Step 3: Bisphosphonates
Inhibit bone resorption
Long-term calcium control"] Step4["⚡ Step 4: Calcitonin
Rapid effect onset
Immediate calcium lowering"] End["🏥 Consider Dialysis
Severe or Refractory
Renal failure management"] Start --> Step1 Step1 --> Step2 Step2 --> Step3 Step3 --> Step4 Step4 -.->|"Severe/Refractory"| End style Start fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Step1 fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Step2 fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Step3 fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Step4 fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style End fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🧬 Oogonium 2n
Diploid germ cell
Early fetal life"] Div1["🔄 Meiosis I
Initial division begins
Genetic recombination"] Prim["🥚 Primary Oocyte 2n
Developed from oogonium
Ready for arrest"] Arr1["🛑 Prophase I
Arrested until puberty
Diplotene stage"] Sec["🌙 Secondary Oocyte n
Occurs after puberty
Haploid cell formed"] Arr2["🛑 Metaphase II
Second arrest phase
Awaiting fertilization"] Final["👶 Ovum n + 2nd PB
Meiosis II complete
Fertilization required"] Start --> Div1 Div1 --> Prim Prim -- "Arrested in" --> Arr1 Arr1 -- "Puberty" --> Sec Sec -- "Arrested in" --> Arr2 Arr2 -- "Fertilization" --> Final style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Div1 fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Prim fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Arr1 fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Sec fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Arr2 fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Final fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD subgraph M1S ["🧬 Meiosis I Error"] M1Parent["🧫 Parent Cell
Diploid germ cell
Initial replication"] M1NDJ["⚠️ Nondisjunction
Homologous failure
Occurs in Meiosis I"] M1NP["➕ Result (n+1)
Extra chromosome
Gametes affected"] M1NM["➖ Result (n-1)
Missing chromosome
Gametes affected"] M1Parent --> M1NDJ M1NDJ --> M1NP M1NDJ --> M1NM end subgraph M2S ["🧬 Meiosis II Error"] M2Parent["🧫 Parent Cell
Diploid germ cell
Initial replication"] M2Norm1["✅ Normal Meiosis I
Homologues separate
Secondary gametes"] M2NDJ["⚠️ Nondisjunction
Sister chromatids
Fail in Meiosis II"] M2Normal["✅ Normal (n)
Euploid gamete
Typical count"] M2NP["➕ Result (n+1)
Extra chromosome
Aneuploid result"] M2NM["➖ Result (n-1)
Missing chromosome
Aneuploid result"] M2Parent --> M2Norm1 M2Norm1 --> M2NDJ M2Norm1 --> M2Normal M2NDJ --> M2NP M2NDJ --> M2NM end style M1Parent fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style M1NDJ fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style M1NP fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style M1NM fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style M2Parent fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style M2Norm1 fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style M2NDJ fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style M2Normal fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style M2NP fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style M2NM fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🐣 Zygote
Single totipotent cell
Fertilization product"] TwoCell["🧬 2-Cell Stage
Initial mitotic cleavage
30 hours post-fertilization"] FourCell["🧬 4-Cell Stage
Continued blastomere division
40 to 50 hours post-sperm"] Morula["🍇 Morula
16 to 32 cell cluster
Compaction phase begins"] Start --> TwoCell TwoCell --> FourCell FourCell --> Morula style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style TwoCell fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style FourCell fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Morula fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🐣 Uterine Entry
Morula enters uterus
Day 4 post-fertilization"] Fluid["🧪 Fluid Influx
Fluid penetrates Zona Pellucida
Pressure increases inside"] Blastocoel["💧 Blastocoel Formation
Cavity space appears
Blastocoel fluid fills center"] Diff["🧬 Differentiation
Trophectoderm forms outer layer
Embryoblast forms inner mass"] Hatch["🥚 Hatching
Zona Pellucida degenerates
Blastocyst emerges from shell"] Ready["🎯 Implantation Ready
Trophoblast exposure complete
Prepared for uterine attachment"] Start --> Fluid Fluid --> Blastocoel Blastocoel --> Diff Diff --> Hatch Hatch --> Ready style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Fluid fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Blastocoel fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Diff fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Hatch fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Ready fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD START["🧬 Sperm Binding
Sperm binds ZP3 glycoprotein
Initial contact with zona"] ACRO["⚡ Acrosome Reaction
Reaction is triggered
Calcium signaling begins"] ENZ["🧪 Enzyme Release
Acrosin enzymes released
Proteolytic activity starts"] DIGEST["🕳️ ZP Digestion
Sperm digests path thru ZP
Progresses to membrane"] FUSE["🤝 Membrane Fusion
Sperm fuses with oocyte
Membrane integration"] CORT["🛡️ Cortical Reaction
Prevents polyspermy entry
Fast and slow blocks"] CALC["🌊 Ca2+ Influx
Cortical granule release
Intracellular calcium rise"] BLOCK["🧱 ZP Hardening
Zona Pellucida hardens
Permanent block to sperm"] MEI["⏳ Meiosis II
Oocyte completes division
Second polar body forms"] PRO["Kernels Nuclei
Male and female pronuclei
Genetic material prepares"] ZYG["🐣 Zygote Formation
Pronuclear fusion occurs
Diploid embryo created"] START --> ACRO ACRO --> ENZ ENZ --> DIGEST DIGEST --> FUSE FUSE --> CORT CORT --> CALC CALC --> BLOCK FUSE --> MEI MEI --> PRO PRO --> ZYG style START fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style ACRO fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style ENZ fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style DIGEST fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style FUSE fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style CORT fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style CALC fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style BLOCK fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style MEI fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style PRO fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style ZYG fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🔬 Testicular GCT
Germ cell origin
Male malignancy"] Seminoma["🟡 Seminoma
Slow growing tumor
Radiosensitive type"] NonSeminoma["🔵 Non-Seminoma
Mixed cell types
Aggressive growth"] Embryonal["🔴 Embryonal Carcinoma
Hemorrhagic mass
Painful lesion"] YolkSac["🟡 Yolk Sac Tumor
⬆️ AFP marker
Schiller Duval bodies"] Chorio["🔴 Choriocarcinoma
⬆️ hCG levels
Early hematogenous spread"] Teratoma["🟣 Teratoma
Multiple germ layers
Mature or immature"] Start --> Seminoma Start --> NonSeminoma NonSeminoma --> Embryonal NonSeminoma --> YolkSac NonSeminoma --> Chorio NonSeminoma --> Teratoma style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Seminoma fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style NonSeminoma fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Embryonal fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style YolkSac fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style Chorio fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Teratoma fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🌱 Epiblast Cells
Pluripotent progenitor layer
Source of all germ layers"] Invag["⚡ Invagination
Primitive streak formation
Cells migrate inward"] Remain["🧬 Remaining Epiblast
Non-migrating cell layer
Differentiates at surface"] Wave1["🌊 First Wave
Cells displace hypoblast
Formation of deep layer"] Wave2["🌊 Second Wave
Cells fill middle space
Formation of central layer"] Endo["🟢 Endoderm
Internal lining formation
Gut and respiratory tubes"] Meso["🔴 Mesoderm
Middle layer development
Muscles and bones"] Ecto["🔵 Ectoderm
External layer formation
Skin and nervous system"] Start --> Invag Start --> Remain Invag --> Wave1 Invag --> Wave2 Wave1 --> Endo Wave2 --> Meso Remain --> Ecto style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Invag fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Remain fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Wave1 fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Wave2 fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Endo fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Meso fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Ecto fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🫀 Advanced HF Diagnosis
Severe heart failure state
NYHA Class III or IV"] Assess{"❓ Refractory Symptoms?
Persistent despite therapy
Reduced functional capacity"} Palliative["⚖️ Palliative Care Consult
Expert symptom assessment
Multidisciplinary support"] Management["💊 Symptom Management & ACP
Aggressive comfort focus
Advance Care Planning"] Success["✨ Improved QoL
Better quality of life
Alignment with goals"] Standard["🏥 Standard HF Care
Continue GDMT therapy
Monitor clinical status"] Start --> Assess Assess -- Yes --> Palliative Assess -- No --> Standard Palliative --> Management Management --> Success style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Assess fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Palliative fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Management fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Success fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Standard fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Node1["📍 Apposition
Initial blastocyst contact
Loose tissue alignment"] Node2["🤝 Adhesion
Firm physical attachment
Integrin mediated binding"] Node3["⚔️ Invasion
Trophoblast penetration
Endometrial remodeling"] Node1 --> Node2 Node2 --> Node3 style Node1 fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Node2 fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Node3 fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🥚 Morula
16-cell stage ball
Solid mass formation"] Compaction["🧬 Compaction
Cell-to-cell adhesion
Outer cell sealing"] Blastocyst["✨ Blastocyst Formation
Cavitation process begins
Fluid filled cavity"] Hatching["🐣 Hatching
Exits Zona Pellucida
Ready for implantation"] DiffBlast["🔍 Differentiated blastocyst
Distinct cell lineages
Polarized structure"] ICM["👶 Inner Cell Mass
Embryoblast cells
Forms the embryo"] Trophoblast["🛡️ Trophoblast
Outer cell layer
Forms the placenta"] Start --> Compaction Compaction --> Blastocyst Blastocyst --> Hatching Blastocyst --> DiffBlast DiffBlast -->|gives rise to| ICM DiffBlast -->|gives rise to| Trophoblast style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Compaction fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Blastocyst fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Hatching fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style DiffBlast fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style ICM fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Trophoblast fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🌱 Notochord
Primary embryonic inducer
Derived from mesoderm"] Induce["⚡ Ectoderm Induction
Signaling to overlying layer
Triggers neuroectoderm"] Plate["🧠 Neural Plate
Thickening of ectoderm
Basis of nervous system"] Groove["➰ Groove and Folds
Invagination of plate
Lateral edges elevate"] Tube["🧬 Tube and Crest
Closure of neural tube
Migration of crest cells"] Start --> Induce Induce --> Plate Plate --> Groove Groove --> Tube style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Induce fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Plate fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Groove fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Tube fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🩺 Initial Findings
⬆️ PSA level detected
Abnormal DRE exam"] Biopsy["💉 TRUS Biopsy
Transrectal ultrasound
Guided tissue sampling"] Gleason["🔬 Gleason Score
Histological grading
Cancer aggressiveness"] Staging["📋 Management
Clinical staging plan
Treatment selection"] Start --> Biopsy Biopsy --> Gleason Gleason --> Staging style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Biopsy fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Gleason fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Staging fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🦴 Notochord
Primary inductor signaling
Mesodermal origin structure"] Induction["⚡ Induction
Induces overlying ectoderm
Signals neural differentiation"] Plate["🧠 Neural Plate
Thickening of ectoderm
Early CNS precursor"] Groove["🔄 Invagination
Formation of Neural Groove
Neural plate begins folding"] Fusion["🧬 Neural Folds
Folds elevate and fuse
Closing the dorsal gap"] Tube["🧪 Neural Tube
Final primitive tube
Forms Brain and Cord"] Start --> Induction Induction --> Plate Plate --> Groove Groove --> Fusion Fusion --> Tube style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Induction fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Plate fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Groove fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Fusion fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Tube fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🐣 Blastocyst
Early embryonic stage
Implantation occurs"] Epi["🧬 Epiblast
Primary germ layer
Forms embryonic disc"] Streak["〰️ Primitive Streak
Established symmetry
Begins gastrulation"] Gas["🔄 Gastrulation
Cell migration phase
Three layer formation"] Ecto["🧠 Ectoderm
Nervous system origin
Skin and hair"] Meso["🫀 Mesoderm
Muscles and bones
Circulatory system"] Endo["🫁 Endoderm
Digestive tract lining
Respiratory system"] Start --> Epi Epi --> Streak Streak --> Gas Gas --> Ecto Gas --> Meso Gas --> Endo style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Epi fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Streak fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Gas fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style Ecto fill:#FFCBE1, stroke:#E34E79, stroke-width:1px, rx:10, ry:10, color:#B0294B style Meso fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Endo fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🧠 Neural Plate
Initial ectoderm thickening
Provides neural blueprint"] MHP["📐 Folding at MHP
Medial hinge point induction
Forms the ventral furrow"] Elevate["⬆️ Folds Elevate
Lateral edges move upward
Converging toward midline"] DLHP["📐 Folding at DLHPs
Dorsolateral hinge points
Facilitates apical closure"] Fusion["🔗 Midline Fusion
Adhesion of fold edges
Seamless tissue integration"] End["⭕ Neural Tube
Primary neurulation complete
CNS precursor established"] Start --> MHP MHP --> Elevate Elevate --> DLHP DLHP --> Fusion Fusion --> End style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style MHP fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Elevate fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style DLHP fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Fusion fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style End fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🌱 Somite
Paraxial mesoderm origin
Segmented body blocks"] Sclero["🦴 Sclerotome
Forms the vertebrae
Forms the ribs"] DermoM["🧬 Dermomyotome
Dorsolateral somite part
Bipotential precursor"] Derma["🖐️ Dermatome
Dermis of the back
Connective tissues"] Myo["💪 Myotome
Skeletal muscle cells
Epimeres and hypomeres"] Start --> Sclero Start --> DermoM DermoM --> Derma DermoM --> Myo style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Sclero fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style DermoM fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D style Derma fill:#FFCBE1, stroke:#E34E79, stroke-width:1px, rx:10, ry:10, color:#B0294B style Myo fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🧬 Paraxial Mesoderm
Primary germ layer
Bilateral tissue bands"] Somites["📦 Somites
Segmented blocks
Form along neural tube"] Sclero["🦴 Sclerotome
Ventral-medial part
Mesenchymal cells"] Derma["🧤 Dermatome
Dorsal-lateral part
Skin precursors"] Myo["💪 Myotome
Intermediary part
Muscle progenitor cells"] Vert["🏛️ Vertebrae and Ribs
Axial skeleton
Cartilage and bone"] Dermis["🧥 Dermis of Back
Connective tissue
Posterior skin layer"] Muscle["🏃 Skeletal Muscle
Body wall muscles
Limb musculature"] Start --> Somites Somites --> Sclero Somites --> Derma Somites --> Myo Sclero --> Vert Derma --> Dermis Myo --> Muscle style Start fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style Somites fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Sclero fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Derma fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Myo fill:#FFDAB4, stroke:#BF814A, stroke-width:1px, rx:10, ry:10, color:#5D3A00 style Vert fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Dermis fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Muscle fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD START["🌱 Limb Bud Development
Initial outgrowth stage
Basic mesoderm structure"] AER["📏 Apical Ectodermal Ridge
Distal limb tip ectoderm
Signals limb elongation"] ZPA["🧭 Zone of Polarizing Activity
Posterior limb margin
Determines digital identity"] DO["🤚 Dorsal-Ventral Control
Wnt7a and En1 signals
Positions nails and palms"] PD["⬆️ Proximo-distal Lengthening
FGF gene expression
Longitudinal bone growth"] AP["↔️ Antero-posterior Patterning
SHH protein secretion
Thumb vs little finger"] DV["🦶 Dorso-ventral Axis
Upper vs lower surfaces
Skin and muscle layout"] START --- AER START --- ZPA AER -- "FGFs" --> PD ZPA -- "SHH" --> AP DO --> DV style START fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style AER fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style ZPA fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style DO fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style PD fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style AP fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style DV fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD START["🧬 Paraxial Mesoderm
Primary germ layer
Embryonic segment source"] SOMITE["📦 Somite
Segmented tissue block
Paired axial structures"] SCLERO["🦴 Sclerotome
Forms axial skeleton
Vertebrae and ribs"] DERMA["🩹 Dermatome
Dermis of back skin
Subcutaneous tissues"] MYO["💪 Myotome
Skeletal muscle cells
Trunk and limb muscles"] START --> SOMITE SOMITE --> SCLERO SOMITE --> DERMA SOMITE --> MYO style START fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style SOMITE fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style SCLERO fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style DERMA fill:#FFCBE1, stroke:#E34E79, stroke-width:1px, rx:10, ry:10, color:#B0294B style MYO fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD subgraph SpinalCord["脊髓 SPINAL CORD"] N1["🧠 1st Order Neuron
Dorsal root ganglion
Peripheral sensory input"] N2["🧬 2nd Order Neuron
Posterior horn site
Synapse with primary"] Cross["🔄 Decussation
Ant. white commissure
Cross to other side"] Ascend["⬆️ Ascends Contralateral
Spinothalamic tract
Travels up spinal cord"] end subgraph Brain["脑 BRAIN"] N3["🔬 3rd Order Neuron
VPL of Thalamus
Relay to cortex"] Cortex["🎯 Somatosensory Cortex
Final sensory target
Postcentral gyrus site"] end N1 --> N2 N2 --> Cross Cross --> Ascend Ascend --> N3 N3 --> Cortex style SpinalCord fill:#F2F2F2,stroke:#5F747D,stroke-width:2px,color:#435A64 style Brain fill:#F2F2F2,stroke:#5F747D,stroke-width:2px,color:#435A64 style N1 fill:#89D5F7,stroke:#5886E0,stroke-width:1px,rx:10,ry:10,color:#1961b4 style N2 fill:#89D5F7,stroke:#5886E0,stroke-width:1px,rx:10,ry:10,color:#1961b4 style Cross fill:#FCC4B7,stroke:#D4655F,stroke-width:1px,rx:10,ry:10,color:#A44540 style Ascend fill:#CFBFF7,stroke:#8560C1,stroke-width:1px,rx:10,ry:10,color:#613C9D style N3 fill:#89D5F7,stroke:#5886E0,stroke-width:1px,rx:10,ry:10,color:#1961b4 style Cortex fill:#A5C9C2,stroke:#41645D,stroke-width:1px,rx:10,ry:10,color:#274F47

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Root["🩹 Classic Psoriasis Agents
Non-biologic topical options
Traditional clinical regimens"] Coal["🖤 Coal Tar
Goeckerman Regimen use
Suppresses DNA synthesis"] SalAcid["🧪 Salicylic Acid
Keratolytic action 2-10%
Removes scales effectively"] Anthralin["🟡 Anthralin (Dithranol)
SCAT or Ingram Regimen
Reduces cell proliferation"] Root --> Coal Root --> SalAcid Root --> Anthralin style Root fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Coal fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style SalAcid fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Anthralin fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD START["🌱 Metanephros
Permanent kidney precursor
Embryonic development"] UB["🧬 Ureteric Bud
Dorsal outgrowth duct
Derived from Wolffian duct"] MM["🧪 Metanephric Mesenchyme
Induces bud branching
Undifferentiated blastema"] COLL["💧 Collecting System
Forms ureter and pelvis
Calyces and collecting ducts"] NEPH["🔬 Nephron Formation
Glomerulus and Bowman capsule
Proximal and distal tubules"] %% Connections START --> UB UB -- Induces differentiation --> MM MM -- Induces branching --> UB UB --> COLL MM --> NEPH %% Stylings style START fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style UB fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style MM fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style COLL fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style NEPH fill:#CFBFF7, stroke:#8560C1, stroke-width:1px, rx:10, ry:10, color:#613C9D

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🧬 Bipotential Gonad
Undifferentiated state
Primary sex organ precursor"] Testis["♂️ Testis
Male gonad development
SRY gene expression"] Ovary["♀️ Ovary
Female gonad development
Absence of SRY gene"] MullDeg["🚫 Mullerian Duct
Sertoli cell AMH action
Duct system degenerates"] WolfDev["💪 Wolffian Duct
Leydig cell testosterone
Duct system develops"] MullDev["🌸 Mullerian Duct
Absence of AMH
Duct system develops"] WolfDeg["🚫 Wolffian Duct
Absence of testosterone
Duct system degenerates"] Start -- "SRY gene present" --> Testis Start -- "No SRY gene" --> Ovary Testis -- "Sertoli: AMH" --> MullDeg Testis -- "Leydig: Testosterone" --> WolfDev Ovary -- "No AMH" --> MullDev Ovary -- "No Testosterone" --> WolfDeg style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Testis fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Ovary fill:#FFCBE1, stroke:#E34E79, stroke-width:1px, rx:10, ry:10, color:#B0294B style MullDeg fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style WolfDev fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style MullDev fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style WolfDeg fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540

%%{init: {'theme': 'base', 'themeVariables': { 'fontFamily': 'Nunito, sans-serif'}}}%% flowchart TD Start["🧪 Syphilis Serology
Diagnostic testing pathways
Standard screening options"] Trad["📜 Traditional Algorithm
Initial screening method
Nontreponemal first approach"] Rev["🔄 Reverse Algorithm
Alternative screening method
Treponemal first approach"] TradStep1["🔍 Nontreponemal Test
RPR or VDRL screening
Checks for active infection"] RevStep1["🧬 Treponemal Test
EIA or CIA screening
Checks for specific antibodies"] TradPos["➕ Treponemal Test
Confirmatory testing done
Specific antibody detection"] TradNeg["❌ Syphilis Unlikely
Negative screening result
Retest if suspicion high"] RevPos["➕ Nontreponemal Test
RPR or VDRL titration
Determines disease activity"] RevNeg["❌ Syphilis Unlikely
Negative screening result
Retest if suspicion high"] Start --> Trad Start --> Rev Trad --> TradStep1 TradStep1 -- Reactive --> TradPos TradStep1 -- Non-Reactive --> TradNeg Rev --> RevStep1 RevStep1 -- Reactive --> RevPos RevStep1 -- Non-Reactive --> RevNeg style Start fill:#E3E5E5, stroke:#5F747D, stroke-width:1px, rx:10, ry:10, color:#435A64 style Trad fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style Rev fill:#89D5F7, stroke:#5886E0, stroke-width:1px, rx:10, ry:10, color:#1961b4 style TradStep1 fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style RevStep1 fill:#F7C398, stroke:#AE6B35, stroke-width:1px, rx:10, ry:10, color:#9C5D29 style TradPos fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style TradNeg fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540 style RevPos fill:#A5C9C2, stroke:#41645D, stroke-width:1px, rx:10, ry:10, color:#274F47 style RevNeg fill:#FCC4B7, stroke:#D4655F, stroke-width:1px, rx:10, ry:10, color:#A44540