This is the medical knowledge needed to understand GNA 3 promomaterial

1. Gynecology Medical Knowledge
Readiness
Scientific Affairs – Sylvia Aziz
Cycle Meeting December 2016
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2. By the End of this Training You should be able to :
• Explain Iron absorption physiology and regulation
• Define IDA and it’s etiology and complications
• Explain the relation between Preeclampsia and oxidative stress .
• Understand lipid peroxidation.
• Explain Preterm Delivery and what risks lead to this.
• Know Bacterial infections from E.Coli , Shigella , Salmonella , H.Pylori
• Understand Giardia Colonization
• Understand Infertility Problems and IVF
• Understand Apoptosis and breast cancer
• Explain what is Lactoferrin and what are its’ major roles
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3. Iron absorption physiology and
regulation
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4. 4
https://www.youtube.com/watch?v=ahCy97FVUpM&t=3s

5. IDA and it’s etiology and complications
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6. Iron-deficiency anemia
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• Is anemia caused by a lack of iron.
• RBCs tend to be microcytic and hypochromic, and iron
stores are low as shown by low serum ferritin and low
serum iron levels with high serum total iron binding
capacity.

7. Table 1: Recommended Dietary Allowances (RDAs) for Iron
Age Male Female Pregnancy Lactation
Birth to 6 months 0.27 mg* 0.27 mg*
7–12 months 11 mg 11 mg
1–3 years 7 mg 7 mg
4–8 years 10 mg 10 mg
9–13 years 8 mg 8 mg
14–18 years 11 mg 15 mg 27 mg 10 mg
19–50 years 8 mg 18 mg 27 mg 9 mg
51+ years 8 mg 8 mg 7

8. 1-Parasitic disease
• Helminthiasis caused by infestation with parasitic worms
(helminths) such as tapeworms, flukes, and roundworms).
• The World Health Organization estimates that
"approximately two billion people are infected with soil-
transmitted helminths worldwide.
• Parasitic worms cause both inflammation and chronic
blood loss.
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Causes of iron deficiency anemia

9. Causes of iron deficiency anemia
2-Blood loss
• Women with menorrhagia (heavy menstrual periods).
• Peptic ulcer, angiodysplasia, a colon polyp or
gastrointestinal cancer.
• Gastrointestinal bleeding can result from regular use of
some groups of medication.
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10. 3-Diet
• Examples of iron-rich foods include meat, eggs, leafy
green vegetables and iron-fortified foods.
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11. 4-Iron absorption
• Inflammatory bowel disease.
• Post surgical resection.
• If there is an insufficient production of hydrochloric acid in
the stomach, often due to chronic H. pylori infections or
long-term proton pump inhibitor therapy. Ferrous and
Ferric iron salts will precipitate out of solution in the bowel
which are poorly absorbed.
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12. 3-Iron absorption
• In cases where systemic inflammation is present, iron will
be absorbed into enterocytes, but due to the reduction in
basolateral ferroportin molecules which allow iron to pass
into the systemic circulation, iron is trapped in the
enterocytes and is lost from the body when the
enterocytes are sloughed off. Depending on the disease
state, one or more mechanisms may occur.
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13. 13

14. 5-Pregnancy
Without iron supplementation, iron deficiency anemia
occurs in many pregnant women because their iron stores
need to serve their own increased blood volume as well as
be a source of hemoglobin for the growing fetus, and for
placental development.
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15. WHO definition Of Anaemia in Pregnancy
• For diagnosis of anaemia in Pregnancy when HB concentration is < 11 gm% (
7.45mmol/ L)and a haematocrit of < 0.33.
• Mild------------ 8 – 10 gm %
• Moderate ---- 5 –< 8 gm %
• Severe---------- < 5 gm %
During Pregnancy there is increase in total blood volume (1500 ml = 30 - 40%), plasma
volume(250 ml = 40-50 %) as well as the EBC volume (350ml = 20 -30 % ) also , But
increment in plasma volume is more than the increased total hemoglobin(15-20 % ).
Hence there is dilution of blood, resulting in physiological anaemia( upper limit for normal /
100% Hb level in pregnancy is brought down to 11gm % ) .
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16. Complications in Pregnancy
• Hb < 6 g/dL may cause:
– Reduced amniotic fluid volume
– Fetal cerebral vasodilation.
– Nonreassuring FHR patterns.
– Increased risks of:
• Prematurity
• Spontaneous abortion
• Low birth weight
• Fetal death
• Maternal mortality.
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17. The relation between Preeclampsia and oxidative stress
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18. 18
Iron leads to
formation of Free
radicals

19. 19
Preeclampsia is a pregnancy complication
characterized by high blood pressure and signs of
damage to another organ system, often the kidneys.
Preeclampsia usually begins after 20 weeks of
pregnancy in a woman whose blood pressure had
been normal. Even a slight rise in blood pressure
may be a sign of preeclampsia.
Left untreated, preeclampsia can lead to serious —
even fatal — complications for both the mother and
her baby. If she has preeclampsia, the only cure is
delivery of her baby.

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21. 21
Lipid Peroxidation

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23. Preterm Delivery and what risks lead to it
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24. Preterm birth, also known as premature
birth, is the birth of a baby at fewer than
37 weeks gestational age. These
babies are known
as preemies or premmies. Symptoms
of preterm labor include uterine
contractions which occur more often
than every ten minutes or the leaking of
fluid from the vagina. Premature
infants are at greater risk for cerebral
palsy, delays in development, hearing
problems, and sight problems. `
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25. 25

26. Bacterial Infections from E.Coli , Shigella , Salmonella ,
H.Pylori
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27. 27
Salmonella species are facultative intracellular
pathogens. Many infections are due to ingestion
of contaminated food. Salmonella serovars can
be divided into two main groups—typhoidal and
non typhoidal Salmonella. Non typhoidal
serovars are more common, and usually cause
self-limiting gastrointestinal disease.
Shigella is one of the leading bacterial
causes of diarrhea worldwide
Most E. coli strains do not cause disease,
but virulent strains can
cause gastroenteritis, urinary tract
infections, and neonatal meningitis.
Helicobacter pylori found usually in the stomach. It
was present in a person with
chronic gastritis and gastric ulcers, conditions not
previously believed to have a microbial cause. It is also
linked to the development of duodenal ulcers
and stomach cancer

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Giardia Colonization

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Giardiasis is a major diarrheal disease found
throughout the world. The flagellate protozoan Giardia
intestinalis (previously known as G lamblia), its
causative agent, is the most commonly identified
intestinal parasite in the United States and the most
common protozoal intestinal parasite isolated
worldwide. Infection is more common in children than
in adults. G intestinalis can cause asymptomatic
colonization or acute or chronic diarrheal illness. It is
a common cause of chronic diarrhea and growth
retardation in children in developing countries.

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Infertility and IVF

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IVF : In vitro
Fertilization

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Sperm Capacitation

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35. 35
Apoptosis and Necrosis

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37. 37
Lactoferrin structure and roles

38. What is Lactoferrin ?
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39. 30% Fe+3 iron saturation 70% unsaturated
The most crucial part of mechanism of action
Glycoprotein similar structurally and
chemically to serum transferrin but
with affinity to iron 300 times higher
Highly abundant in colostrum and milk, but is
also present in other extracellular excretions
Lactoferrin contains 2 high
affinity binding sites for iron.
The red spheres denote
ferric ions (Fe3+).
The N-terminal moiety
of lactoferrinis of particular
affinity for the anti-
microbial and
immune-modulating actions
of lactoferrin.

41. Regulation of iron absorption in the bowel
• LF plays a key role in maintaining iron levels in the body
(demonstrated in several studies).
• Several decades ago it was shown that breast-fed infants
have no iron deficiencies.
• supporting the involvement of LF in this function is the
discovery of LF receptors in the enterocytes of various
species.

42. Gram-negative bacteria
• LF damages the external membrane of Gram -ve bacteria
through interaction with lipopolysaccharide (LPS):-
– the interaction between LPS and the bacterial cations (Ca2+ and
Mg2+) inhibited by +ve charged LF, causing a release of LPS from
the cell wall and increase the membrane permeability.
– The interaction of LF and LPS also potentiates the action of natural
antibacterials such as lysozyme,which is secreted from the mucosa
at elevated concentrations along with LF.

43. Gram positive bacteria
• LF’s mechanism of action against Gram +ve bacteria is
based on binding:-
• due to its net +ve charge to anionic molecules on the
bacterial surface, resulting in a reduction of -ve charge on
the cell wall and thus favouring contact between lysozyme
and the cell membrane.