This document provides an overview of metabolic pathways and inborn errors of metabolism. It discusses the major metabolic pathways for carbohydrates, proteins, and lipids and how genetic defects can disrupt these pathways. It also describes the three main types of inborn errors of metabolism and provides examples. The document then goes into more detail about carbohydrate metabolism, including glycolysis, pyruvate metabolism, and the tricarboxylic acid cycle. It also discusses glycogen metabolism, protein metabolism, fat metabolism, and approaches to investigating metabolic cases.
Maple syrup urine disease (MSUD) is caused by a defect in the branched-chain alpha-ketoacid dehydrogenase complex, leading to a buildup of the branched-chain amino acids leucine, isoleucine, and valine. Left untreated, this can cause neurological issues such as developmental delays. Jakob was diagnosed with MSUD as an infant after presenting with irritability and poor feeding. His family found dietary management stressful and he underwent a successful liver transplant at age 4 to provide an alternative source of the defective enzyme, allowing him to discontinue treatment.
This document discusses Leber's hereditary optic neuropathy (LHON), a maternally inherited mitochondrial disease affecting vision. Key points include:
- LHON is caused by mutations in mitochondrial DNA and results in degeneration of retinal ganglion cells and optic nerve atrophy, leading to legal blindness.
- The most common mutations occur at positions 11778, 3460, and 14484 of mitochondrial DNA and decrease ATP production in retinal ganglion cells.
- LHON typically begins in young adults and males are more commonly affected, developing vision loss in 40% of cases compared to 10% for females.
- While mutations are necessary, additional genetic and environmental factors like smoking are thought to trigger
This document discusses sphingolipidoses, a class of rare genetic disorders caused by the accumulation of metabolites from complex lipids within neurons. Sphingolipidoses are characterized by progressive nervous system degeneration leading to symptoms like blindness, dementia, and paralysis. A cherry-red spot in the macula is a common sign seen during ophthalmologic examination, which can provide an important clue to diagnosis. Gangliosidoses are a type of sphingolipidosis caused by deficiencies in lysosomal enzymes involved in ganglioside metabolism, resulting in the storage of certain gangliosides in neurons and neurological deterioration. These disorders are ultimately fatal as there are currently no effective treatments available.
The Story of Phenylketonuria and the Path to TreatmentCHC Connecticut
This document summarizes the history and treatment of phenylketonuria (PKU). It describes the discovery of PKU in the 1930s and milestones that led to newborn screening starting in the 1960s. Untreated PKU causes intellectual disability, but treatment involving a phenylalanine-restricted diet or medications can prevent disability. Current treatments include dietary therapy, cofactor therapy with sapropterin, and enzyme therapy with phenylalanine ammonia lyase. Gene therapy is also being explored. Newborn screening programs have helped identify thousands of cases annually to facilitate early treatment and prevention of intellectual disability.
Homocystinuria is a disorder of methionine metabolism, leading to an abnormal accumulation of homocysteine and its metabolites (homocystine, homocysteine-cysteine complex, and others) in blood and urine. Normally, these metabolites are not found in appreciable quantities in blood or urine.
Electrophoresis of LDH Isoenzymes and Activity StainingASHIKH SEETHY
The slides prepared for MD(Biochemistry) and MSc (Biochemistry) teaching comprehensively covers isoenzymes, isoforms, clinical utility of Lactate Dehydrogenase (LDH), LDH isoenzymes and basics of zymography.
Download and view in presenter mode for better visual experience.
Mitochondrial diseases are caused by defects in mitochondrial structure or enzymes that result in deficient energy production. They can affect multiple organ systems and occur across all age groups. Mitochondrial DNA mutations can be inherited from the mother and nuclear DNA mutations can affect mitochondrial proteins or DNA maintenance. Common mitochondrial diseases include MELAS, MERRF, and Leigh syndrome. Mitochondrial dysfunction has also been implicated in aging and common diseases like heart disease and Parkinson's.
The document provides information on various mitochondrial disorders including Kearns-Sayre syndrome, MELAS syndrome, and Mitochondrial Neurogastrointestinal Encephalopathy Syndrome (MNGIE). It describes the symptoms, causes, and diagnosis of each disorder. Kearns-Sayre syndrome is characterized by progressive paralysis of the eye muscles and can affect multiple systems. MELAS syndrome causes seizures, headaches, and muscle weakness and is caused by mitochondrial DNA mutations. MNGIE is a rare multisystem disorder causing gastrointestinal problems and is caused by mutations in the TYMP gene encoding thymidine phosphorylase.
Maple syrup urine disease (MSUD) is caused by a defect in the branched-chain alpha-ketoacid dehydrogenase complex, leading to a buildup of the branched-chain amino acids leucine, isoleucine, and valine. Left untreated, this can cause neurological issues such as developmental delays. Jakob was diagnosed with MSUD as an infant after presenting with irritability and poor feeding. His family found dietary management stressful and he underwent a successful liver transplant at age 4 to provide an alternative source of the defective enzyme, allowing him to discontinue treatment.
This document discusses Leber's hereditary optic neuropathy (LHON), a maternally inherited mitochondrial disease affecting vision. Key points include:
- LHON is caused by mutations in mitochondrial DNA and results in degeneration of retinal ganglion cells and optic nerve atrophy, leading to legal blindness.
- The most common mutations occur at positions 11778, 3460, and 14484 of mitochondrial DNA and decrease ATP production in retinal ganglion cells.
- LHON typically begins in young adults and males are more commonly affected, developing vision loss in 40% of cases compared to 10% for females.
- While mutations are necessary, additional genetic and environmental factors like smoking are thought to trigger
This document discusses sphingolipidoses, a class of rare genetic disorders caused by the accumulation of metabolites from complex lipids within neurons. Sphingolipidoses are characterized by progressive nervous system degeneration leading to symptoms like blindness, dementia, and paralysis. A cherry-red spot in the macula is a common sign seen during ophthalmologic examination, which can provide an important clue to diagnosis. Gangliosidoses are a type of sphingolipidosis caused by deficiencies in lysosomal enzymes involved in ganglioside metabolism, resulting in the storage of certain gangliosides in neurons and neurological deterioration. These disorders are ultimately fatal as there are currently no effective treatments available.
The Story of Phenylketonuria and the Path to TreatmentCHC Connecticut
This document summarizes the history and treatment of phenylketonuria (PKU). It describes the discovery of PKU in the 1930s and milestones that led to newborn screening starting in the 1960s. Untreated PKU causes intellectual disability, but treatment involving a phenylalanine-restricted diet or medications can prevent disability. Current treatments include dietary therapy, cofactor therapy with sapropterin, and enzyme therapy with phenylalanine ammonia lyase. Gene therapy is also being explored. Newborn screening programs have helped identify thousands of cases annually to facilitate early treatment and prevention of intellectual disability.
Homocystinuria is a disorder of methionine metabolism, leading to an abnormal accumulation of homocysteine and its metabolites (homocystine, homocysteine-cysteine complex, and others) in blood and urine. Normally, these metabolites are not found in appreciable quantities in blood or urine.
Electrophoresis of LDH Isoenzymes and Activity StainingASHIKH SEETHY
The slides prepared for MD(Biochemistry) and MSc (Biochemistry) teaching comprehensively covers isoenzymes, isoforms, clinical utility of Lactate Dehydrogenase (LDH), LDH isoenzymes and basics of zymography.
Download and view in presenter mode for better visual experience.
Mitochondrial diseases are caused by defects in mitochondrial structure or enzymes that result in deficient energy production. They can affect multiple organ systems and occur across all age groups. Mitochondrial DNA mutations can be inherited from the mother and nuclear DNA mutations can affect mitochondrial proteins or DNA maintenance. Common mitochondrial diseases include MELAS, MERRF, and Leigh syndrome. Mitochondrial dysfunction has also been implicated in aging and common diseases like heart disease and Parkinson's.
The document provides information on various mitochondrial disorders including Kearns-Sayre syndrome, MELAS syndrome, and Mitochondrial Neurogastrointestinal Encephalopathy Syndrome (MNGIE). It describes the symptoms, causes, and diagnosis of each disorder. Kearns-Sayre syndrome is characterized by progressive paralysis of the eye muscles and can affect multiple systems. MELAS syndrome causes seizures, headaches, and muscle weakness and is caused by mitochondrial DNA mutations. MNGIE is a rare multisystem disorder causing gastrointestinal problems and is caused by mutations in the TYMP gene encoding thymidine phosphorylase.
Comprehensive description of various primary dyslipidemias, cholesterol transport and molecular mechanisms involved.
View in slideshow after downloading for better experience.
Prepared in Dec 2013.
This document summarizes various inborn errors of metabolism, including:
- Disorders of amino acid metabolism such as phenylketonuria (PKU), tyrosinemia, maple syrup urine disease (MSUD), homocystinuria, and nonketotic hyperglycinemia.
- Urea cycle defects which result in abnormal nitrogen metabolism and elevated ammonia levels.
- Disorders of organic acid metabolism including propionic acidemia, methylmalonic acidemia, isovaleric acidemia, and glutaric aciduria type 1.
- A disorder of fatty acid metabolism, medium-chain acyl-CoA dehydrogenase deficiency (MCAD), is also mentioned.
The document summarizes pyrimidine nucleotide degradation and the salvage pathway. It also describes orotic aciduria, a rare metabolic disorder characterized by orotic acid in urine, anemia, and stunted growth. Orotic aciduria can be caused by deficiencies in enzymes involved in pyrimidine synthesis or a defect in the urea cycle enzyme ornithine transcarbamoylase, which diverts carbamoyl phosphate to increased orotic acid synthesis. The condition can be treated by supplementing with cytidine or uridine.
Phenylketonuria (PKU) is a genetic disorder caused by a deficiency of the enzyme phenylalanine hydroxylase. This enzyme is needed to break down the amino acid phenylalanine. Without treatment, high phenylalanine levels can cause intellectual disabilities and other neurological problems. Treatment involves a lifelong low-phenylalanine diet using phenylalanine-free medical foods and supplements. Tyrosinemia and Wilson's disease are also inherited disorders of amino acid or copper metabolism that can cause liver, neurological and other health issues if left untreated. Medical nutrition therapy and medication are used to manage symptoms and prevent complications.
Homocystinuria is a disorder of methionine metabolism caused by an inability to metabolize homocysteine. There are three main types: classic homocystinuria caused by cystathionine β-synthase deficiency; defects in methylcobalamin formation; and methylenetetrahydrofolate reductase deficiency. Symptoms vary but can include developmental delay, dislocated lenses, skeletal abnormalities, thromboembolism, and intellectual disability. Treatment depends on the type but may include vitamin B6, betaine, folic acid, vitamin B12, methionine supplementation, and dietary restrictions.
This document discusses the molecular basis of three genetic diseases: phenylketonuria (PKU), alkaptonuria, and albinism. PKU is caused by a defect in the enzyme phenylalanine hydroxylase, leading to increased phenylalanine levels and potential mental retardation if left untreated. Alkaptonuria is caused by a defect in homogentisate 1,2-dioxygenase, causing a buildup of homogentisic acid and darkening of connective tissues over time. Albinism is caused by defects in enzymes involved in melanin production, resulting in little to no pigmentation in hair, skin, and eyes.
MELAS is a mitochondrial disorder caused by mutations in mitochondrial DNA. It is characterized by:
- Stroke-like episodes affecting brain function that predominantly involve the temporal, parietal and occipital lobes.
- Additional neurological manifestations including seizures, headaches, hearing loss and dementia.
- Diagnosis requires evidence of elevated lactate levels as well as mitochondrial abnormalities on muscle biopsy and identification of a pathogenic gene mutation.
- Neuroimaging during episodes shows lesions in areas not corresponding to vascular territories.
Maple syrup urine disease (MSUD) is a rare genetic metabolic disorder caused by a deficiency of the enzyme branched chain alpha ketoacid dehydrogenase, which prevents the body from properly breaking down three amino acids found in protein. This causes a buildup of these amino acids and their byproducts in the body. Symptoms can range from a characteristic maple syrup smell in urine to poor feeding, vomiting, and weight loss. Treatment involves a restricted diet low in these amino acids and use of a special metabolic formula. Management aims to keep amino acid levels from becoming too high or too low to prevent health complications.
Mitochondrial disease includes a group of neuromuscular diseases caused by damage to intracellular structures that produce energy, the mitochondria; disease symptoms usually involve muscle contractions that are weak or spontaneous.
Leber's hereditary optic neuropathy (LHON)
Leigh syndrome,
Myoneurogenic gastrointestinal encephalopathy (MNGIE)
KSS – (Kearns-Sayre Syndrome)
This document discusses several inherited metabolic disorders involving amino acid metabolism. Phenylketonuria is described as the most common disorder, caused by a deficiency of the enzyme phenylalanine hydroxylase, leading to toxic accumulation of phenylalanine. Maple syrup urine disease results from a defect in the enzyme branched-chain keto acid dehydrogenase, causing a buildup of leucine, isoleucine, and valine breakdown products. Homocystinuria is caused by a cystathionine beta-synthase deficiency, preventing the breakdown of homocysteine. These disorders are typically detected via newborn screening and require dietary modifications and supplements to prevent associated complications.
Metabolic disorders are caused by defects in enzymes involved in metabolic processes. There are several categories of inborn errors of metabolism including disorders of amino acid, carbohydrate, lipid, protein, and organic acid metabolism. Symptoms vary depending on the specific enzyme deficiency but can include developmental delay, organomegaly, neurological symptoms, and in some cases death in infancy if left untreated. Many metabolic disorders are inherited in an autosomal recessive pattern and while individually rare, as a group they have a prevalence of around 1 in 5,000 live births.
The document summarizes urea cycle defects and hyperammonemia. It discusses that defects in any of the six urea cycle enzymes or two transporters can cause toxic buildup of ammonia in the blood. Specific urea cycle disorders are described including ornithine transcarbamylase deficiency and N-acetylglutamate synthase deficiency. Treatment focuses on removing ammonia through hemodialysis or drug therapy, and maintaining a protein-restricted diet to prevent further ammonia production. Long-term management requires monitoring amino acid intake and considering liver transplantation.
Glycine is a simple amino acid that plays many important roles in the body. It is involved in the synthesis of collagen, creatine, glutathione, heme, purines, and other specialized products. Glycine can be synthesized from carbon dioxide and ammonia in the liver, from glyoxylate, serine, and threonine. It can be broken down through the glycine cleavage complex to produce carbon dioxide and ammonia, or through oxidation to glyoxylate. Glycine participates in many transamination, decarboxylation, and conjugation reactions throughout the body. Excessive consumption of glycine can lead to kidney stones due to oxalate accumulation.
Lesch-Nyhan syndrome is a rare, inherited disorder caused by a deficiency of the HPRT enzyme. It is characterized by overproduction of uric acid leading to physical issues like kidney stones and neurological effects such as cognitive impairment and self-mutilation. There is no cure, and treatment focuses on managing symptoms. Prognosis is generally poor due to the neurological disabilities associated with the condition.
Glucosuria, or glucose in the urine, can occur due to diabetes mellitus resulting in hyperglycemia that exceeds the renal threshold, or due to renal tubular disorders resulting in glycosuria without hyperglycemia. Renal glycosuria is caused by defects in glucose transporters like SGLT2 that normally reabsorb glucose from the glomerular filtrate in the proximal tubule. This leads to glucose appearing in the urine despite normal blood glucose levels. Renal glycosuria is usually benign and inherited in an autosomal recessive pattern, though it can also be caused by advanced chronic kidney disease.
The document discusses the biochemical basis of nephrotic syndrome. It introduces nephrotic syndrome as a kidney disorder characterized by large proteinuria, hypoalbuminemia, hyperlipidemia, and edema. It then examines the causes of proteinuria in more detail, describing the pathological features and clinical presentations of minimal change glomerulonephritis, membranous glomerulonephritis, proliferative glomerulonephritis, and focal segmental glomerulonephritis. Finally, it discusses two hypotheses for the cause of edema in nephrotic syndrome: the underfill hypothesis involving activation of the renin-angiotensin system, and the overfill hypothesis involving increased sodium re
This document discusses glycogen storage disorders (GSD), specifically GSD type 1a (von Gierke's disease). It begins with an overview and lists the different types of GSD. It then provides more details on the background, causes, signs and symptoms, diagnosis, and treatment of GSD type 1a. GSD type 1a is caused by a deficiency of the glucose-6-phosphatase enzyme and results in glycogen accumulation in the liver and kidneys. Patients experience hypoglycemia, lactic acidosis, ketosis, and hyperlipidemia. Diagnosis involves blood and urine tests and liver biopsy to check enzyme levels. Treatment focuses on dietary management to avoid low blood glucose.
Lysosomal storage diseases (LSDs) are a group of over 50 inherited metabolic disorders caused by defects in lysosomal function. The main types are sphingolipidoses, mucopolysaccharidoses, and glycoproteinoses. Symptoms often involve the brain and nervous system. On MRI, the corpus callosum may be not visualized or partially visualized in some LSDs. Histopathology reveals neuronal storage material, spheroids in white matter, and membranous cytoplasmic bodies in neurons. LSDs can also affect dogs and cats, with clinical signs appearing in early life and pathology showing tissue storage.
Inborn errors of purine and pyrimidine metabolismRamesh Gupta
This document discusses inborn errors of purine and pyrimidine metabolism. It notes that errors can occur in the enzymes involved in these pathways, affecting processes like de novo synthesis, salvage, and catabolism of purines and pyrimidines. Important disorders discussed include primary gout, Lesch-Nyhan syndrome, adenosine deaminase deficiency, and purine nucleoside phosphorylase deficiency. Treatment options aim to lower uric acid levels through drugs like allopurinol or increase urinary excretion of uric acid. Disorders of pyrimidine metabolism are also discussed, including different types of orotic aciduria.
Leigh's Disease is a rare, inherited neurometabolic disease that typically affects infants between 3 months and 2 years old. It is caused by mutations in mitochondrial DNA or deficiencies in an enzyme called pyruvate dehydrogenase. Symptoms include loss of motor skills, weakness, and lactic acidosis. The prognosis is very poor, with most children dying within the first few years, though some have lived until 6-7 years old. Current treatments focus on managing symptoms like lactic acidosis, while researchers work to find cures and better treatments.
Kira Pauline Bekker was born on June 6, 2003 and showed signs of poor muscle strength and irritability from a young age. After several tests, she was diagnosed with Leigh's disease, a rare neurological disorder caused by defects in mitochondria. Her condition deteriorated over time as she had seizures, difficulty breathing, and her brain stem was damaged. She passed away on January 4, 2005 at the age of 1 year and 7 months, surrounded by her parents, after battling numerous infections from her weakened immune system due to the disease.
Comprehensive description of various primary dyslipidemias, cholesterol transport and molecular mechanisms involved.
View in slideshow after downloading for better experience.
Prepared in Dec 2013.
This document summarizes various inborn errors of metabolism, including:
- Disorders of amino acid metabolism such as phenylketonuria (PKU), tyrosinemia, maple syrup urine disease (MSUD), homocystinuria, and nonketotic hyperglycinemia.
- Urea cycle defects which result in abnormal nitrogen metabolism and elevated ammonia levels.
- Disorders of organic acid metabolism including propionic acidemia, methylmalonic acidemia, isovaleric acidemia, and glutaric aciduria type 1.
- A disorder of fatty acid metabolism, medium-chain acyl-CoA dehydrogenase deficiency (MCAD), is also mentioned.
The document summarizes pyrimidine nucleotide degradation and the salvage pathway. It also describes orotic aciduria, a rare metabolic disorder characterized by orotic acid in urine, anemia, and stunted growth. Orotic aciduria can be caused by deficiencies in enzymes involved in pyrimidine synthesis or a defect in the urea cycle enzyme ornithine transcarbamoylase, which diverts carbamoyl phosphate to increased orotic acid synthesis. The condition can be treated by supplementing with cytidine or uridine.
Phenylketonuria (PKU) is a genetic disorder caused by a deficiency of the enzyme phenylalanine hydroxylase. This enzyme is needed to break down the amino acid phenylalanine. Without treatment, high phenylalanine levels can cause intellectual disabilities and other neurological problems. Treatment involves a lifelong low-phenylalanine diet using phenylalanine-free medical foods and supplements. Tyrosinemia and Wilson's disease are also inherited disorders of amino acid or copper metabolism that can cause liver, neurological and other health issues if left untreated. Medical nutrition therapy and medication are used to manage symptoms and prevent complications.
Homocystinuria is a disorder of methionine metabolism caused by an inability to metabolize homocysteine. There are three main types: classic homocystinuria caused by cystathionine β-synthase deficiency; defects in methylcobalamin formation; and methylenetetrahydrofolate reductase deficiency. Symptoms vary but can include developmental delay, dislocated lenses, skeletal abnormalities, thromboembolism, and intellectual disability. Treatment depends on the type but may include vitamin B6, betaine, folic acid, vitamin B12, methionine supplementation, and dietary restrictions.
This document discusses the molecular basis of three genetic diseases: phenylketonuria (PKU), alkaptonuria, and albinism. PKU is caused by a defect in the enzyme phenylalanine hydroxylase, leading to increased phenylalanine levels and potential mental retardation if left untreated. Alkaptonuria is caused by a defect in homogentisate 1,2-dioxygenase, causing a buildup of homogentisic acid and darkening of connective tissues over time. Albinism is caused by defects in enzymes involved in melanin production, resulting in little to no pigmentation in hair, skin, and eyes.
MELAS is a mitochondrial disorder caused by mutations in mitochondrial DNA. It is characterized by:
- Stroke-like episodes affecting brain function that predominantly involve the temporal, parietal and occipital lobes.
- Additional neurological manifestations including seizures, headaches, hearing loss and dementia.
- Diagnosis requires evidence of elevated lactate levels as well as mitochondrial abnormalities on muscle biopsy and identification of a pathogenic gene mutation.
- Neuroimaging during episodes shows lesions in areas not corresponding to vascular territories.
Maple syrup urine disease (MSUD) is a rare genetic metabolic disorder caused by a deficiency of the enzyme branched chain alpha ketoacid dehydrogenase, which prevents the body from properly breaking down three amino acids found in protein. This causes a buildup of these amino acids and their byproducts in the body. Symptoms can range from a characteristic maple syrup smell in urine to poor feeding, vomiting, and weight loss. Treatment involves a restricted diet low in these amino acids and use of a special metabolic formula. Management aims to keep amino acid levels from becoming too high or too low to prevent health complications.
Mitochondrial disease includes a group of neuromuscular diseases caused by damage to intracellular structures that produce energy, the mitochondria; disease symptoms usually involve muscle contractions that are weak or spontaneous.
Leber's hereditary optic neuropathy (LHON)
Leigh syndrome,
Myoneurogenic gastrointestinal encephalopathy (MNGIE)
KSS – (Kearns-Sayre Syndrome)
This document discusses several inherited metabolic disorders involving amino acid metabolism. Phenylketonuria is described as the most common disorder, caused by a deficiency of the enzyme phenylalanine hydroxylase, leading to toxic accumulation of phenylalanine. Maple syrup urine disease results from a defect in the enzyme branched-chain keto acid dehydrogenase, causing a buildup of leucine, isoleucine, and valine breakdown products. Homocystinuria is caused by a cystathionine beta-synthase deficiency, preventing the breakdown of homocysteine. These disorders are typically detected via newborn screening and require dietary modifications and supplements to prevent associated complications.
Metabolic disorders are caused by defects in enzymes involved in metabolic processes. There are several categories of inborn errors of metabolism including disorders of amino acid, carbohydrate, lipid, protein, and organic acid metabolism. Symptoms vary depending on the specific enzyme deficiency but can include developmental delay, organomegaly, neurological symptoms, and in some cases death in infancy if left untreated. Many metabolic disorders are inherited in an autosomal recessive pattern and while individually rare, as a group they have a prevalence of around 1 in 5,000 live births.
The document summarizes urea cycle defects and hyperammonemia. It discusses that defects in any of the six urea cycle enzymes or two transporters can cause toxic buildup of ammonia in the blood. Specific urea cycle disorders are described including ornithine transcarbamylase deficiency and N-acetylglutamate synthase deficiency. Treatment focuses on removing ammonia through hemodialysis or drug therapy, and maintaining a protein-restricted diet to prevent further ammonia production. Long-term management requires monitoring amino acid intake and considering liver transplantation.
Glycine is a simple amino acid that plays many important roles in the body. It is involved in the synthesis of collagen, creatine, glutathione, heme, purines, and other specialized products. Glycine can be synthesized from carbon dioxide and ammonia in the liver, from glyoxylate, serine, and threonine. It can be broken down through the glycine cleavage complex to produce carbon dioxide and ammonia, or through oxidation to glyoxylate. Glycine participates in many transamination, decarboxylation, and conjugation reactions throughout the body. Excessive consumption of glycine can lead to kidney stones due to oxalate accumulation.
Lesch-Nyhan syndrome is a rare, inherited disorder caused by a deficiency of the HPRT enzyme. It is characterized by overproduction of uric acid leading to physical issues like kidney stones and neurological effects such as cognitive impairment and self-mutilation. There is no cure, and treatment focuses on managing symptoms. Prognosis is generally poor due to the neurological disabilities associated with the condition.
Glucosuria, or glucose in the urine, can occur due to diabetes mellitus resulting in hyperglycemia that exceeds the renal threshold, or due to renal tubular disorders resulting in glycosuria without hyperglycemia. Renal glycosuria is caused by defects in glucose transporters like SGLT2 that normally reabsorb glucose from the glomerular filtrate in the proximal tubule. This leads to glucose appearing in the urine despite normal blood glucose levels. Renal glycosuria is usually benign and inherited in an autosomal recessive pattern, though it can also be caused by advanced chronic kidney disease.
The document discusses the biochemical basis of nephrotic syndrome. It introduces nephrotic syndrome as a kidney disorder characterized by large proteinuria, hypoalbuminemia, hyperlipidemia, and edema. It then examines the causes of proteinuria in more detail, describing the pathological features and clinical presentations of minimal change glomerulonephritis, membranous glomerulonephritis, proliferative glomerulonephritis, and focal segmental glomerulonephritis. Finally, it discusses two hypotheses for the cause of edema in nephrotic syndrome: the underfill hypothesis involving activation of the renin-angiotensin system, and the overfill hypothesis involving increased sodium re
This document discusses glycogen storage disorders (GSD), specifically GSD type 1a (von Gierke's disease). It begins with an overview and lists the different types of GSD. It then provides more details on the background, causes, signs and symptoms, diagnosis, and treatment of GSD type 1a. GSD type 1a is caused by a deficiency of the glucose-6-phosphatase enzyme and results in glycogen accumulation in the liver and kidneys. Patients experience hypoglycemia, lactic acidosis, ketosis, and hyperlipidemia. Diagnosis involves blood and urine tests and liver biopsy to check enzyme levels. Treatment focuses on dietary management to avoid low blood glucose.
Lysosomal storage diseases (LSDs) are a group of over 50 inherited metabolic disorders caused by defects in lysosomal function. The main types are sphingolipidoses, mucopolysaccharidoses, and glycoproteinoses. Symptoms often involve the brain and nervous system. On MRI, the corpus callosum may be not visualized or partially visualized in some LSDs. Histopathology reveals neuronal storage material, spheroids in white matter, and membranous cytoplasmic bodies in neurons. LSDs can also affect dogs and cats, with clinical signs appearing in early life and pathology showing tissue storage.
Inborn errors of purine and pyrimidine metabolismRamesh Gupta
This document discusses inborn errors of purine and pyrimidine metabolism. It notes that errors can occur in the enzymes involved in these pathways, affecting processes like de novo synthesis, salvage, and catabolism of purines and pyrimidines. Important disorders discussed include primary gout, Lesch-Nyhan syndrome, adenosine deaminase deficiency, and purine nucleoside phosphorylase deficiency. Treatment options aim to lower uric acid levels through drugs like allopurinol or increase urinary excretion of uric acid. Disorders of pyrimidine metabolism are also discussed, including different types of orotic aciduria.
Leigh's Disease is a rare, inherited neurometabolic disease that typically affects infants between 3 months and 2 years old. It is caused by mutations in mitochondrial DNA or deficiencies in an enzyme called pyruvate dehydrogenase. Symptoms include loss of motor skills, weakness, and lactic acidosis. The prognosis is very poor, with most children dying within the first few years, though some have lived until 6-7 years old. Current treatments focus on managing symptoms like lactic acidosis, while researchers work to find cures and better treatments.
Kira Pauline Bekker was born on June 6, 2003 and showed signs of poor muscle strength and irritability from a young age. After several tests, she was diagnosed with Leigh's disease, a rare neurological disorder caused by defects in mitochondria. Her condition deteriorated over time as she had seizures, difficulty breathing, and her brain stem was damaged. She passed away on January 4, 2005 at the age of 1 year and 7 months, surrounded by her parents, after battling numerous infections from her weakened immune system due to the disease.
Pearson syndrome is a rare mitochondrial disorder caused by a large-scale rearrangement of mitochondrial DNA. It is characterized by sideroblastic anemia, neutropenia, exocrine pancreatic dysfunction, and abnormal liver function. Affected individuals may present in infancy with anemia, cytopenias, organ involvement of the GI tract, muscles and liver. Complications include metabolic crises, infections, hepatic failure and neurological deterioration over time. The disorder is diagnosed through DNA testing and has no cure, with most patients dying in early childhood, though some survive into adulthood with progressive neurological symptoms.
Malnutrition is defined as a cellular imbalance between nutrient supply and demand for growth, maintenance, and functions. Undernutrition classifications include wasting (low weight-for-height) and stunting (low height-for-age). Identifying malnutrition involves weighing, measuring height/length, and calculating standard deviation scores. Mid-upper arm circumference less than 11.5cm indicates severe acute malnutrition. Treatment of severe malnutrition requires special care due to the body's reductive adaptation system slowing functions to survive on limited calories. Essential treatment steps include treating hypoglycemia, infections, and micronutrient deficiencies; providing cautious feeding with formulas F75 and F100; and monitoring progress until weight-for-height reaches -1 SD
- NRCs (Nutrition Rehabilitation Centers) in Heevi Hospital treat children under 5 with SAM (Severe Acute Malnutrition), admitting up to 4680 cases annually in Duhok province.
- The NRCs became inactive due to discontinued support from UNICEF and interrupted supplies of therapeutic milk.
- To reactivate the NRCs, a training course was conducted in April 2014 but therapeutic milk supplies remained inconsistent, limiting treatment.
- From October 2014 until present, 49 children were treated but only 20 recovered fully, while 6 died, demonstrating the need for improved support and sustainability of services.
This document outlines immunology and immunity to infection. It discusses the immune system's role in fighting infection, including humoral immunity from B cells and cellular immunity from T cells. It also addresses intracellular and extracellular pathogens. The document then focuses on primary and secondary immunodeficiency, describing the types of primary immunodeficiencies including B cell, T cell, phagocytic, and complement defects. It provides guidance on diagnosing immunodeficiency through history, examination, investigations, and considering features like recurrent infections.
Fast and safe technique for collection of urine in newbornsAzad Haleem
This study aimed to evaluate a new noninvasive technique for obtaining clean catch urine samples from newborns. The technique involves breastfeeding or formula feeding followed by gentle tapping and massaging of the bladder and lower back areas. It was tested on 75 newborns and achieved an 82.7% success rate in obtaining urine samples within 5 minutes with no reported complications. The results suggest this technique is effective, safe, and faster than traditional bag collection methods for getting urine samples from newborns when evaluating for potential urinary tract infections.
Congenital heart disease for undergraduates student uod 2015Azad Haleem
The document provides an overview of pediatric cardiology including:
1. The anatomy and physiology of the heart is described along with embryological development and how circulation changes with age.
2. Congenital heart diseases are discussed including prevalence, etiology, evaluation, diagnosis, and classifications.
3. Key aspects of history taking and physical examination for congenital heart disease are outlined along with important investigations like ECG, chest x-ray, and echocardiography.
Pediatric pharmacology by dr.azad al.kurdiAzad Haleem
This document discusses several key topics in pediatric pharmacology:
1) Dosing methods for children include weight-based and surface area-based calculations since clinical drug data for children is often limited. Surface area dosing is generally more accurate.
2) Drug monitoring is important for medications with narrow therapeutic windows to ensure safe and effective levels. Common drugs monitored include antiepileptics and antibiotics.
3) Drug interactions can impact medication levels and effects through induction or inhibition of liver enzymes. Incompatibilities between injectable drugs must also be considered.
4) Most drugs are considered safe during breastfeeding as exposure risk to infants is low, but some medications like cancer drugs are contraindicated. The benefits of breast
This document discusses antibiotics and their mechanisms of action, including inhibition of cell wall synthesis, DNA gyrase, RNA polymerase, and protein synthesis. It describes antibiotics as being either bacteriostatic, arresting bacterial growth, or bactericidal, killing bacteria. It also covers antimicrobial activity, minimum inhibitory concentrations, classification as narrow or broad spectrum, drug resistance developing, and thanks the reader.
1. Short stature can be defined as a height more than 2 standard deviations below the mean height for age and gender.
2. Evaluation of a child with short stature includes assessing height, mid-parental height, bone age, basic lab tests, growth hormone stimulation tests, and IGF-1 and IGFBP-3 levels.
3. Causes of short stature include growth hormone deficiency, Turner syndrome, chronic renal insufficiency, and being small for gestational age. Growth hormone treatment dosages vary depending on the underlying cause.
This document discusses pediatric pharmacology, including:
- Age groups from neonate to adolescent
- Differences in absorption, distribution, metabolism and excretion of drugs in children compared to adults
- Slower gastric emptying and hepatic function in neonates affects drug absorption and clearance
- The blood-brain barrier is more permeable in neonates, increasing drug penetration to the brain
- Renal function is immature at birth but matures rapidly in the first year of life
- Understanding developmental changes is crucial for safe and effective pediatric prescribing
This case report describes a 13-year-old boy who presented with headache, vomiting, and fever and was diagnosed with meningitis. After two days, he developed seizures and impaired consciousness. MRI showed lesions in multiple areas of the brain. A follow up MRI months later showed the lesions had completely resolved. He was diagnosed with reversible posterior leukoencephalopathy syndrome (RPLS), likely caused by severe hypertension. RPLS is characterized by reversible brain lesions and is associated with conditions that cause abrupt changes in blood pressure. The patient's symptoms improved with blood pressure control and he made a full recovery.
Fever is a common reason children see doctors and causes concern for parents. A fever is defined as a temperature over 37.2°C before noon or 37.7°C after noon. Fever occurs due to infection, inflammation or injury and raises the hypothalamic temperature set point. While sometimes indicating a minor self-limiting infection, fever can also signal a serious disorder. The document discusses evaluating fever, defining related terms like bacteremia and sepsis, the pathophysiology of fever production, and methods for safely measuring a child's temperature.
Asthma is a chronic inflammatory disease of the airways characterized by episodic obstruction, bronchial hyperresponsiveness, and reversibility of airflow obstruction. It has both genetic and environmental causes. Childhood asthma affects 13.1% of children in the US, with boys and children in poor families at higher risk. There are two main types - recurrent wheezing in early childhood triggered by viruses, and chronic asthma associated with allergy. Treatment involves assessment, education, trigger management, and medications to reduce bronchoconstriction and inflammation.
The TCA cycle, also known as the Krebs cycle or citric acid cycle, is the central metabolic pathway that catalyzes the oxidation of acetyl-CoA derived from carbohydrates, fats, and proteins to produce carbon dioxide, water, and energy in the form of ATP, NADH, and FADH2. The TCA cycle occurs in the mitochondrial matrix and is the final common pathway for the oxidation of these three macronutrient types. Through a series of chemical reactions, acetyl-CoA is oxidized, producing carbon dioxide and hydrogen ions that will be used in the electron transport chain to generate ATP through oxidative phosphorylation.
Cow’s milk protein allergy in infants and childrenAzad Haleem
Cow's milk protein allergy (CMPA) is the leading cause of food allergy in infants under 3 years old. It can cause both immediate and delayed reactions involving the skin, gastrointestinal, and respiratory systems. Diagnosis involves a clinical history, elimination diet, and oral food challenge. Treatment is strict avoidance of cow's milk protein and use of extensively hydrolyzed or amino acid-based formula. CMPA usually resolves by age 1-3 years.
This document discusses prebiotics and probiotics. It begins by providing background on the physiology of the human gastrointestinal tract (GIT) and development of GIT immunity. It defines probiotics as live microorganisms that provide health benefits when consumed, and lists common probiotic bacteria genres and species. Potential health benefits of probiotics are outlined. Prebiotics are defined as non-digestible food ingredients that promote the growth of beneficial bacteria. Established prebiotic foods are listed along with their effects. Potential health benefits of prebiotic supplementation in infant formulas are reviewed based on literature.
The document summarizes cardiac physiology, including:
1) The circulatory system consists of the heart, blood vessels, and blood, with the heart serving as a pump that establishes blood pressure.
2) The heart has two main functions - generating blood pressure and routing blood flow between the pulmonary and systemic circulations to ensure one-way flow.
3) An electrocardiogram (ECG) provides a non-invasive record of the heart's electrical activity and can help identify conditions like arrhythmias.
The document summarizes the key processes of digestion and absorption in the gastrointestinal tract. It discusses:
1) The three main stages of digestion - mechanical and chemical breakdown of food, secretion of enzymes and electrolytes to provide optimal conditions for digestion, and transport of nutrients into the bloodstream.
2) The major secretions at each stage - saliva, gastric juices, pancreatic and bile secretions, and secretions from the small intestine.
3) The enzymes and constituents involved in digesting carbohydrates, proteins, lipids, and their absorption mechanisms.
4) Some common digestive disorders that can result from enzyme deficiencies or malabsorption.
This document discusses the evaluation and management of metabolic emergencies. It notes that congenital metabolic disorders result from enzyme or cofactor abnormalities, leading to metabolite accumulation or deficiencies. Metabolic crises occur when toxic metabolites build up. The initial evaluation of a patient with a suspected metabolic disorder includes blood tests like a CBC, blood gases, glucose, electrolytes, ammonia, and urine tests. Specific critical presentations like hypoglycemia are further evaluated. Hypoglycemia is treated with intravenous glucose boluses and infusions. Hyperammonemia treatment focuses on rehydration, removing nitrogen from the body, stopping protein intake, and using medications like sodium phenylacetate and sodium benzoate.
Carbohydrate metabolism involves the breakdown and use of carbohydrates like glucose and glycogen. Glucose is broken down through glycolysis which occurs in the cytoplasm and produces energy. Glycolysis is the first step in both aerobic and anaerobic respiration. Glycogen is stored in the liver and muscles as a source of glucose. Fructose and galactose are other carbohydrates that are metabolized and converted to glucose. Hormones like insulin and glucagon tightly regulate blood glucose levels. Diabetes occurs when blood glucose levels are too high due to issues with insulin production or sensitivity.
This document provides an overview of carbohydrate metabolism. It discusses the major pathways including glycolysis, the citric acid cycle, gluconeogenesis, glycogen metabolism, the hexose monophosphate shunt, and the roles of hormones. Glycolysis converts glucose to pyruvate with ATP production. The citric acid cycle further oxidizes carbohydrates, lipids, and proteins to generate more ATP. Gluconeogenesis produces glucose from non-carbohydrates. Glycogen is stored glucose that is synthesized and broken down as needed. The hexose monophosphate shunt produces NADPH and pentoses using glucose. Hormones like glucagon and insulin regulate carbohydrate metabolism.
Clinical chemistry review sheet for mlt certification and ascpDonna Kim
This is a fairly thorough without being bogged down with unnecessary detail study guide for Medical Laboratory Technician studying for the review and state exams
Acid Base
Carbohydrates
Lipids
Proteins
Amino Acids
Glycolysis is the breakdown of glucose to pyruvate with production of energy. It occurs in the cytoplasm and can proceed with or without oxygen. Glycolysis is regulated by energy requirements of the cell and key enzymes. The citric acid cycle is the final common pathway for oxidation of acetyl CoA derived from carbohydrates, lipids, and proteins. It occurs in mitochondria and produces carbon dioxide, water, and energy in the form of ATP and NADH. Glycogen is the storage form of glucose and its synthesis and breakdown are regulated by hormones to maintain blood glucose levels. Gluconeogenesis produces new glucose from non-carbohydrate sources in the liver. Hormones like insulin and glucagon
This document provides an overview of carbohydrate metabolism, specifically the digestion and absorption of carbohydrates. It describes the processes of carbohydrate digestion in the mouth, stomach, and small intestine by salivary amylase, gastric acid, pancreatic amylase, and intestinal disaccharidases. Absorption occurs primarily as monosaccharides via passive diffusion, facilitated diffusion using glucose transporters, and active transport against gradients using sodium-glucose cotransporters. Lactose intolerance results from lactase deficiency in adulthood.
Digestion and absorption of Lipids.pptxjaswant kaur
Lipids are digested and absorbed in the stomach and small intestine. Lingual and gastric lipases begin digestion in the stomach. Co-lipase and pancreatic lipase work together to further digest triglycerides in the small intestine. Absorbed fatty acids are packaged into chylomicrons for transport. The liver regulates lipid metabolism through synthesis and breakdown of triglycerides and cholesterol. Excess lipids are stored as triglycerides or converted to ketone bodies.
The document provides information on liver anatomy, physiology, and functions. It also discusses causes of liver disease including dietary deficiencies, infectious agents like hepatitis viruses, toxic agents like alcohol and drugs, and inborn errors of metabolism. Specific conditions discussed include fatty liver disease (NAFLD), hepatitis, gallbladder conditions like cholecystitis, and bile duct inflammation (cholangitis). Diet and lifestyle factors are presented for managing conditions like NAFLD and viral hepatitis.
Carbohydrate metabolism and glycolysis.pptxDRx Chaudhary
This document provides an overview of carbohydrate metabolism. It discusses the major pathways involved including glycolysis, gluconeogenesis, and the citric acid cycle. Glycolysis involves the breakdown of glucose to pyruvate, occurring in the cytosol of cells. Gluconeogenesis is the synthesis of glucose from non-carbohydrate precursors, primarily occurring in the liver and kidneys. Glucose transport into cells is regulated by insulin-dependent and independent mechanisms. The citric acid cycle is the final common pathway for carbohydrates, fats, and proteins, where acetyl CoA is oxidized to carbon dioxide. Carbohydrates provide a major source of energy for cells through these metabolic pathways.
The document discusses the importance of the gastrointestinal tract and its functions of digestion and absorption. It provides details on the digestion of carbohydrates, proteins, lipids, and vitamins/minerals in the GI tract. Key enzymes and their sites of action are identified. Malabsorption syndromes are then examined, including causes, classification, epidemiology, clinical presentation, and relevant laboratory studies. Overall, the document emphasizes the critical role of proper GI function for overall health and nutrition.
Ketoacidosis is a pathological metabolic state characterized by high levels of ketone bodies in the blood and urine due to the body breaking down fat for energy instead of carbohydrates. This occurs during periods of low food intake like starvation, prolonged exercise, or in type 1 diabetes when insulin levels are too low. The liver produces three ketone bodies which can be used as fuel by tissues except the liver. Diabetic ketoacidosis is the most common type and occurs when untreated diabetes causes a lack of insulin and increased fat breakdown. Symptoms include frequent urination, thirst, high blood sugar, and ketones in urine. Treatment involves insulin, fluids, and correcting electrolyte and pH imbalances.
Lipids and lipoproteins metabolism involves the digestion, absorption, transport, and utilization of dietary fats and cholesterol. Key points include:
1) Dietary fats are digested in the GI tract by lingual, gastric, and pancreatic lipases into fatty acids and monoglycerides which are absorbed by enterocytes.
2) Enterocytes package the absorbed lipids into chylomicrons which transport them via the lymphatic system and bloodstream to tissues.
3) Tissues utilize fatty acids for energy production or storage. Chylomicrons are broken down by lipoprotein lipase releasing fatty acids for tissue uptake.
4) The liver synthesizes lipoproteins like
This document discusses the anatomy, functions, and disorders of the liver and biliary system. It provides details on:
- The liver's role in producing bile to aid digestion, regulating blood clotting factors, filtering toxins, and storing vitamins and minerals.
- The structure of the liver including lobules, hepatocytes, blood supply from the hepatic artery and portal vein, and bile duct network.
- Common liver disorders like hepatitis, cirrhosis, cancer, and how they impact liver function and cause symptoms like jaundice, abdominal pain, and fatigue.
- Tests used to evaluate liver function such as albumin, prothrombin time, and transaminase levels.
The liver plays a critical role in metabolizing lipids, carbohydrates, and proteins. It regulates glucose levels in the blood by storing excess glucose as glycogen and releasing it later. When glycogen reserves are depleted, the liver synthesizes new glucose from other substrates. The liver also metabolizes fatty acids, producing energy and lipoproteins, and converts excess carbohydrates and proteins into fatty acids and triglycerides. Additionally, the liver removes toxic ammonia by synthesizing urea, and produces non-essential amino acids, plasma proteins, and clotting factors.
This document provides information on the digestion and absorption of carbohydrates with clinical significance. It discusses the digestion of carbohydrates starting in the mouth by salivary amylase and continuing in the stomach and small intestine by pancreatic amylase. Disaccharides in the small intestine are broken down by disaccharidases into absorbable monosaccharides. Clinical points discussed include lactose intolerance caused by lactase deficiency and its diagnosis and management. Absorption of monosaccharides occurs primarily by sodium-dependent and sodium-independent glucose transporters in the intestine and peripheral tissues.
1. The pancreas contains clusters of cells called islets of Langerhans that secrete hormones like insulin and glucagon to regulate blood glucose levels. Insulin allows cells to take in glucose from the bloodstream and lowers blood glucose levels, while glucagon has the opposite effect.
2. In diabetes, the pancreas either produces little or no insulin (type 1 diabetes) or the body develops a resistance to insulin's effects (type 2 diabetes), disrupting the body's ability to regulate blood glucose levels and maintain homeostasis. This leads to high blood glucose levels (hyperglycemia).
3. Without enough insulin to allow cells to take in glucose, the body begins to breakdown proteins and fats
Pediatric Pharmacology:Pharmacokinetics and pharmacodynamics .pptxAzad Haleem
This document discusses several key topics related to pediatric pharmacology:
- It outlines age classifications in childhood and describes differences in absorption, distribution, metabolism and excretion of drugs between neonates, infants, children and adolescents compared to adults.
- Specific examples are provided of how drug properties like protein binding and hepatic/renal function impact drug levels at different ages.
- Indications for drug monitoring are outlined for medications with a narrow therapeutic window.
- The importance of considering drug interactions is emphasized, especially for drugs metabolized by the liver.
- Factors determining excretion of drugs into breast milk and safety for breastfeeding are summarized.
- A short list of drugs contraindicated in breastfeeding
Neonatal Hypoglycemia approach and Management .pptxAzad Haleem
Dr. Azad Haleem provides an overview of neonatal hypoglycemia. Key points include:
1) Neonates are susceptible to hypoglycemia due to their high brain glucose needs and immature defenses against low blood sugar. Transitional hypoglycemia is common in the first 48 hours while persistent low blood sugar beyond 48 hours requires investigation.
2) Causes of persistent hypoglycemia include hyperinsulinism, hypopituitarism, inborn errors of metabolism, and rarely other conditions. Diagnostic testing aims to identify the underlying etiology.
3) Management involves glucose supplementation, identifying and treating the cause, and careful feeding advancement. Specific treatments depend on the condition, such as diet modifications for
This document provides guidance on nutritional assessment and management for preterm infants. It outlines the ABCDE approach:
A) Anthropometry - Regularly monitor weight, head circumference, and length and plot on a growth chart. Look for weight maintenance or gain.
B) Biochemistry and bloods - Monitor glucose, electrolytes, and minerals. Serum ferritin indicates iron status.
C) Clinical examination and status - Consider individual needs based on conditions. Check for edema.
D) Dietary intake - Calculate protein and energy intake and compare to targets of 3-4.5 g/kg/day protein and 110-135 kcal/kg/day energy.
E) Environment
Preterm : ABCDE; approach to nutritional assessment in preterm infants.pptxAzad Haleem
- The ABCDE approach provides a concise and systematic way for healthcare professionals to assess the nutrition of preterm infants.
- It involves evaluating: A) Anthropometry by regularly monitoring weight, head circumference, and length; B) Biochemistry and blood tests; C) Clinical examination and status; D) Dietary intake by calculating protein and energy intake; and E) The wider environment and evaluating the infant's progress.
- This approach can be completed at the bedside for every infant and helps ensure their nutritional needs are met, which is essential for survival, growth, and neurodevelopmental outcomes. While technology may advance monitoring in the future, currently the key tools needed are pen, paper and a calculator.
This document discusses breastfeeding versus formula feeding. It begins by outlining the benefits of breastfeeding according to WHO and AAP. It then describes the production of breastmilk, including the prolactin and oxytocin reflexes involved. The document details the composition of colostrum, transitional milk, and mature milk. It compares the nutrients in human milk versus cow's milk and other animal milks. The document outlines numerous health benefits of breastfeeding for both infants and mothers. It provides rules and recommendations for successful breastfeeding. In the end, it notes that mother's milk is uniquely adapted to the infant's needs each day unlike formula milk.
Role of Supplements in Growth Failure in Children .pptxAzad Haleem
1. Growth failure refers to a lack of increase in physical size and can be caused by endocrine disorders like growth hormone deficiency or hypothyroidism.
2. Evaluating a child with growth failure involves accurately measuring height and growth velocity over time, performing screening tests, and growth hormone stimulation tests if endocrine disorders are suspected.
3. Treatment depends on the underlying cause but may involve supplements, hormone therapy like growth hormone, addressing nutritional deficiencies, or treating specific conditions.
Here are the steps I would take to switch Alin from glargine U100 to degludec:
1. Calculate Alin's total daily insulin dose (TDD) as glargine 8 units + aspart 12 units = 20 units or 0.88 units/kg
2. Start degludec at 30-50% of the TDD, which is 0.26-0.44 units/kg. For Alin, this would be 6-10 units.
3. Start degludec at 6 units once daily, any time of the day.
4. Continue aspart doses with meals.
5. Adjust doses based on BG levels over next 1
1. Viral hemorrhagic fevers (VHFs) are a group of diseases caused by RNA viruses from several virus families that can cause bleeding and damage the cardiovascular system.
2. Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne VHF caused by a Nairovirus that is found across parts of Africa, Asia, and Europe.
3. CCHF is transmitted through tick bites or contact with infected animal blood/body fluids and can spread between humans through contact with infected blood or body fluids. Treatment is supportive and may include ribavirin.
Micronutrient deficiencies in children .pptxAzad Haleem
- Micronutrient deficiencies are a major global health issue affecting children's growth and development. The most common deficiencies are iron, iodine, folate, vitamin A, and zinc.
- Children under 5 and pregnant/breastfeeding women are most vulnerable to micronutrient deficiencies due to higher requirements. Global prevalence is estimated to be over 50% of children aged 6 months to 5 years suffering from one or more micronutrient deficiency.
- Key strategies to address deficiencies include supplementation programs, food fortification, and biofortification of staple crops. Universal salt iodization programs have helped increase iodized salt access to 71% of households globally.
This document discusses insulin therapy in children with type 1 diabetes mellitus. It begins with definitions, epidemiology, management, and types of insulin. It then discusses in detail the various types of insulin including regular, rapid-acting analogues, intermediate-acting, long-acting, and newer ultra-long acting insulins. It covers administration, storage, injection techniques, insulin requirements, regimens including basal-bolus, and monitoring therapy including dose adjustment and targets for glycemic control.
Diagnostic test for testicular and ovarian disorders in children 2.pptxAzad Haleem
This document provides reference ranges and clinical utility for various diagnostic tests related to disorders of the testes and ovaries in children, including hormones like LH, FSH, estradiol, and testosterone. It describes tests such as the GnRH agonist test to assess pituitary function, the HCG test to evaluate testicular function, and Anti-Mullerian Hormone (AMH) as a marker of ovarian or testicular function. Reference ranges for each hormone are provided for males and females of different pubertal stages.
Diagnostic test for Adrenal disorders in children 2.pptxAzad Haleem
The document provides information on various diagnostic tests for adrenal disorders in children, including the ACTH test, serum cortisol test, urinary free cortisol test, salivary cortisol test, and different dexamethasone suppression tests. The ACTH test can help differentiate primary and secondary adrenal insufficiency and ACTH-dependent and independent causes. The cortisol tests evaluate cortisol levels at different times to screen for adrenal insufficiency or excess. The dexamethasone suppression tests use dexamethasone to inhibit ACTH and cortisol production, with inability to suppress indicating hypercortisolism.
Diagnostic test for Thyriod disorders in children.pptxAzad Haleem
1. The document discusses diagnostic tests for thyroid disorders in children, including TSH, total T3, free T3, total T4, free T4, and thyroid peroxidase antibody (TPO) tests.
2. It provides details on the role, sample collection and handling, reference ranges, and interpretation of results for each of these common thyroid function tests.
3. Thyroid disorders that can affect children include goiter, hyperthyroidism, hypothyroidism, thyroid cancer, thyroid nodules, and thyroiditis. Abnormal thyroid function test results can help diagnose and monitor these conditions.
This document discusses achondroplasia and the new treatment vosoritide. Achondroplasia is caused by a change in the FGFR3 gene and is characterized by disproportionate short stature and other skeletal abnormalities. Vosoritide works by binding to the NPR-B receptor to inhibit FGFR3 and promote bone growth. Phase 2 and 3 clinical trials found that vosoritide significantly increased annual growth velocity and height in children with achondroplasia compared to placebo. Vosoritide has been approved in Europe and the US for treatment of achondroplasia in children aged 2 to adulthood.
Respiratory Syncytial Virus in childrenAzad Haleem
This document discusses respiratory syncytial virus (RSV) in children. It covers the epidemiology, transmission, risk factors, signs and symptoms, diagnosis, management, and prophylaxis of RSV. RSV is a common cause of childhood illness and lower respiratory tract infections. It most often affects children under 2 years old during winter outbreaks. Hospitalization may be required for severe cases, especially in high-risk groups like premature infants. While supportive care is usually sufficient, prophylaxis with palivizumab can help prevent severe RSV disease in high-risk infants.
- Growth refers to an increase in physical size while development is a progressive increase in skills and functional capacity.
- Growth failure is a common presentation to pediatricians and most cases have physiological causes rather than pathological ones.
- Growth is regulated by nutrition, hormones like growth hormone and IGF-1, and sex steroids. Final height is determined 60-80% by genetics.
- Physiological causes of short stature include familial short stature and constitutional delay of growth and puberty while pathological causes can be endocrine disorders, malnutrition, or genetic conditions.
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Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
2. Metabolic pathways
• The term metabolism refers to all biochemical
processes and pathways in the body.
• Enzymes play a key role in many of these
processes and changes in their function, as a
result, of genetic mutation can lead to
problems in these pathways.
3. • The major metabolic pathways for proteins,
carbohydrates and lipids are closely integrated
with key molecules, such as acetyl co-enzyme
A via complex mechanisms.
• A genetic defect in any part of the major
metabolic pathways is known as an inborn or
congenital (if present from birth) error of
metabolism.
4. • Inborn errors of metabolism can be divided into
three pathophysiological diagnostic groups:
• Disorders that disrupt the synthesis or
catabolism of complex molecules with
symptoms that are permanent, progressive,
independent of intercurrent events and not
related to food intake.
• These include lysosomal disorders, peroxisomal
disorders and disorders of intracellular transport
and processing.
5. • Disorders that lead to an acute or progressive
accumulation of toxic compounds as a result
of metabolic block.
• These include disorders of amino acid
metabolism , organic acidurias, congenital
urea cycle defects and sugar intolerances
(galactosaemia).
6. • Disorders with symptoms due to a deficiency
of energy production or utilisation within the
liver, myocardium, muscle or brain.
• These include congenital lactic acidemias,
fatty acid oxidation defects, gluconeogenesis
defects and mitochondrial respiratory chain
disorders.
7. BASIC METABOLISM
• Carbohydrate metabolism
• Glucose has three metabolic pathway in the
body:
• oxidation for energy,
• storage as glycogen,
• and conversion to amino acids and
triglycerides.
8. Glycolysis
• Glycolysis takes place in the cytoplasm of all
cells and describ'es the break down of one
molecule of glucose to produce two molecules
of pyruvate·
• It can occur under aerobic via the
tricarboxylic acid (TCA) cycle and oxidative
phosphorylation)
• or under anaerobic conditions via lactate.
9. • Glycolysis provides an emergency mechanism
for energy production when oxygen is limited,
i.e. in red cells (which have no mitochondria,
thus glycolysis is their only means of energy
production) or in skeletal muscle during
exercise.
• Glycolysis also provides intermediates for
other metabolic pathways, e.g. pentoses for
DNA synthesis.
10. • Pyruvate metabolism:
• Pyruvate, produced by glycolysis and other
metabolic pathways, can be converted to
• oxaloacetate (by pyruvate carboxylase) for
entry into the TCA cycle,
• or acetyi-CoA (by pyruvate dehydrogenase)
11. • Tricarboxylic acid (TCA) cycle
• This cycle is present in all cells with
mitochondria (not red cells) and provides the
final common pathway for glucose, fatty acids
and amino acid oxidation via acetyi-CoA or
other TCA cycle intermediates.
• The cycle's main function is ATP production .
• The cycle also provides metabolic
intermediates for other synthetic pathways,
e.g. amino acid synthesis.
12. • Glycogen metabolism
• Glycogen is a branched glucose polymer
stored in liver, kidney and muscle for the rapid
release of glucose when needed.
• Liver glycogen is a store to release glucose to
the rest of the body,
• whereas muscle glycogen supports muscle
glycolysis only.
13. • Glycogen synthesis is promoted by insulin.
• Glycogenolysis is promoted by adrenaline
and glucagon .
14. Protein metabolism
• Proteins are assembled from amino acids which
are composed of amino group
• Proteins metabolized to urea via ammonia.
• Proteins also metabolized a carbon skeleton
which has a number of potential metabolic fates:
• acetyi-CoA,
• pyruvate and
• ketone bodies.
15. • Amino acids may be used for protein
synthesis,
• or may be converted to other non-essential
amino" acids (transamination) or
• oxidized via the TCA cycle.
• Essential amino acids cannot be synthesized
in the body.
16. • Protein cannot be stored and therefore any
amino acids not used are catabolized,
• and hence to remain in neutral nitrogen
balance, protein is an essential constituent of
a healthy diet.
17. • Gluconeogenesis is the de novo synthesis of
glucose from non-carbohydrate sources such
as amino acids, lactate and glycerol.
• This usually occurs in the liver but also occurs
in the kidney in prolonged starvation.
• Gluconeogenesis is promoted by glucagon,
cortisol and adrenocorticotrophic hormone
(ACTH).
18. Fat metabolism
• Fat has the highest caloric value and therefore
is an essential energy source.
• Triglycerides comprise three fatty acid
molecules and one glycerol molecule which
are broken down by lipase (lipolysis).
• The released glycerol is converted to
glyceraldehyde-3-phosphate in the liver, a key
intermediate of both glycolysis and
gluconeogenesis.
19. • The fatty acids undergo ~oxidation within
mitochondria which shortens the fatty acid by
two carbons per cycle releasing acetyi-CoA for
entry to
• the TCA cycle or
• for the production of ketone bodies.
20. • Fatty acids can be synthesized from acetyi-CoA
(lipogenesis).
• Essential fatty acids cannot be synthesized by
the body
• The principal essential fatty acids are linoleic
and a-linolenic acids.
21. APPROACH TO THE METABOLIC CASE
• Inheritance
• Inborn errors of metabolism are individually rare but
collectively they have an incidence of about 1 per
3,000 to 4,000 births.
• Autosomal recessive inheritance is commonest.
• Exceptions include:
• • X-linked recessive- Lesch-Nyhan syndrome; Hunter
syndrome; ornithine transcarbamylase (OTC)
deficiency; Fabry disease; adrenoleukodystrophy
• • Autosomal dominant - Porphyrias (some recessive)
• • Matrilineal - Mitochondrial DNA mutations
22. • Presentation
• Presentation is non-specific, therefore clues
should be sought in the history.
• The commonest misdiagnosis is sepsis.
23. Clues from history
• Consanguineous parents
• Previous sudden infant death (especially late, i.e. > 6
months)
• Ethnicity (for certain conditions only)
• Previous multiple miscarriages (indicating non-viable
fetuses)
• Maternal illness during pregnancy, e.g.:
- Acute Fatty Liver of Pregnancy (AFLP) and Haemolysis,
Elevated Liver enzymes, Low Platelets (HELLP)
syndrome association with carrying fetus with long-
chain fat oxidation defect
- Increased fetal movements (in utero fits)
24. • Faddy eating (avoidance of foods that provoke
feeling unwell)
• Previous encephalopathic or tachypnoeic
episodes (latter implies acidosis)
History
25. • Inborn errors of metabolism present at times of
metabolic stress, e.g.:
• Neonatal period
• Weaning (increased oral intake, new challenges,
e.g. fructose)
• End of first year (slowing in growth rate,
therefore more protein catabolized as less used
for growth. May exceed metabolic capacity of
defective pathway)
• Intercurrent infections
• Puberty
History
26. Examination
• Clinical examination may reveal few clues in
many disorders of intermediary metabolism.
• Dysmorphic features may suggest certain
diagnoses.
27. • Peroxisomal disorders and Zellweger’s
syndrome:
• Large fontanelle, high prominent forehead,
hypoplastic supra-orbital ridges, epicanthic
folds, flat nasal bridge
28. • Pyruvate dehydrogenase deficiency:
• Epicanthic folds, flat nasal bridge, small nose
with anteverted flared alae nasi, long philtrum
Examination
30. • Lysosomal storage diseases (I cell disease):
• Hurler-like phenotype (coarse facial features,
large tongue)
Examination
31. • Odours are usually unhelpful and rarely
significant exceptions include:
Urine OdorInborn Error of Metabolism
Sweaty feetGultaric Academia
Maple syrupMaple Syrup urine disease
Boiled cabbageHypermethioninemia
Mousy or mustyPhenylketonuria
Rotten fishTrimethylaminuria
Cat urineMultiple crboxylase deficiency
Examination
32. • Eyes should be carefully examined for
• corneal clouding (mucopolysaccharidoses,
cystinosis),
• cataracts (galactosaemia, peroxisomal,
mitochondrial),
• pigmentary retinopathy (fat oxidation,
mitochondrial) and
• cherry-red spot (lay-Sachs, Niemann-Pick,
Sandhoff, GM1 ).
Examination
33. • Organomegaly is a key revealing sign.
• Hepatosplenomegaly is a feature of storage
disorders.
• Massive hepatomegaly in the absence of
splenomegaly suggests glycogen storage
disease because glycogen is not stored in the
spleen.
• More prominent splenomegaly is suggestive
of Gaucher disease.
Examination
34. Investigation
• Perform investigations at the time of
decompensation when diagnostic metabolites
are most likely to be present and avoid the
need for stress tests at a later date.
36. Acid-base status
• Anion gap = Na + K - (CI + HC03 -)
• A normal anion gap in the presence of metabolic
acidosis signifies bicarbonate loss rather than an
excess of acid, e.g. renal or gut.
• Marked ketosis is unusual in the neonate and is
therefore highly suggestive of an underlying
metabolic disorder.
• Urea cycle defects may initially present with a
mild respiratory alkalosis because ammonia acts
directly on the brainstem as a respiratory
stimulant.
Investigation
37. Hypoglycaemia
• Hypoglycaemia is defined as a blood glucose
concentration of ~ 2.6 mmol/1, and should always be
confirmed in the laboratory.
• The key additional investigation is the presence or
absence of ketosis.
• Hypoketotic hypoglycaemia has a limited differential
diagnosis that can usually be resolved on history and
examination:
• Hyperinsulinism (endogenous or exogenous)
• Fat oxidation defects (e.g. MCAD)
• Liver failure
Investigation
38. Lactate
• Lactate is a weak acid which can be used directly
as a fuel for the brain and is readily produced
during anaerobic respiration.
• Secondary causes of lactate level anomalies (e.g.
hypoxia, sepsis, shock, liver failure, poor
sampling, etc.) are much more common than
primary metabolic causes.
• Cerebrospinal fluid (CSF) lactate is raised in
mitochondrial disorders, central nervous system
(CNS) sepsis and seizures.
Investigation
39. Ammonia
• Hyperammonaemia may result from poor
sampling (squeezed sample) and/or delays in
processing.
• The level of ammonia may give a clue to the
cause.
Differential diagnosisAmmonia concentration
(mic mol/1)
Normal< 40
Sick patient, fat oxidation defect, OA, liver failure, UCD40 to< 150
Fat oxidation defect, OA, liver failure, UCD150 to< 250
OA, liver failure, UCD250 to< 450
Liver failure, UCD450 to> 2000
OA, organic acidaemia; UCD, urea cycle defect.
40. • Transient hyperammonaemia of the newborn
(THAN) is characterized by very early onset,
• usually in the first 36 hours before feeding is
truly established.
• It is associated with low glutamine.
• THAN is managed as other urea cycle defects
but has an excellent prognosis if treated early
as the hyperammonaemia is secondary to
blood bypassing the liver (e.g. patent ductus
venosus), rather than a block in the urea cycle.
Investigation
41. • Amino acids
• Amino acids are measured in both blood and
urine. The latter reflects renal threshold, e.g.
• generalized aminoaciduria of a proximal renal
tubulopathy or the specific transporter defect
of cystinuria (Cystine, Ornithine, Arginine,
Lysine).
Investigation
42. • An increase in the serum levels of a specific
amino acid may be missed if only a urine
sample is analysed and the renal threshold
has yet to be breached.
• Plasma amino acids are useful in the work up
of a number of metabolic disorders, and are
essential in monitoring some metabolic
disorders.
44. Organic acids
• These are measured in urine only and are
diagnostic in many organic acidaemias, e.g.
• increased propionate in propionic acidaemia,
increased isovalerate in isovaleric acidaemia,
etc.
45. Organic acids
• Organic acids are also essential in the
diagnosis of other disorders.
• ↑ Orotic acid - UCDs, mitochondrial.
• ↑ Succinylacetone- tyrosinaemia type I
• ↑ Dicarboxylic acids- fat oxidation defects,
medium-chain triglyceride feeds,
mitochondrial.
Investigation
46. Acylcarnitines
• Carnitine conjugates with acyl-CoA intermediates
proximal to the block in fat oxidation defects.
• The chain length of the acylcarnitines formed is
diagnostic of where the block lies, e.g. medium-
chain (MCAD), very long-chain (VLCAD), etc.
• Likewise, conjugation with organic acids allows
diagnosis of organic acidaemias, e.g.
propionylcarnitine.
Investigation
47. Urate
• Urate is the end product of the breakdown of purines.
• Raised levels in plasma may indicate:
• Increased production (eg Lesch-Nyhan syndrome, GSD
type I, rhabdomyolysis) or
• Decreased excretion (familial juvenile hyperuricaemic
nephropathy, FJHN).
• It is essential to measure a concurrent urinary urate
because urate clearance in children is so efficient that
plasma levels may be in the upper normal range in
Lesch-Nyhan syndrome, whereas urinary levels are
grossly elevated.
• In FJHN the reverse is true with high plasma urate, but
low urinary urate.
Investigation
48. Acute patient screening
• Specific metabolites are used to screen acute
patients for specific disorders or groups of
disorders.
DisorderMetabolite
Peroxisomal disorders, e.g. Zellweger
syndrome, adrenoleukodystrophy
Very-long-chain fatty acids
Congenital disorders of glycosylationTransferrin isoelectric focusing
Purine disordersUrate
Smith-Lemli-Opitz syndrome7 -Dehydrocholesterol
Mucopolysaccharidoses and
mucolipidoses
Urinary glycosaminoglycans
and oligosaccharides
GalactosaemiaUrinary reducing substances
Purine and pyrimidine disordersUrinary purine and pyrimidine
metabolites
49. Secondary investigations include:
• Neuroimaging- basal ganglia signal change in
mitochondrial disorders
• Neurophysiology - mitochondrial, peroxisomal
• Echocardiogaraphy - especially hypertrophic
cardiomyopathy, mitochondrial, fat oxidation,
Pompe (GSD type II), storage disorders
• ECG - fat oxidation, mitochondrial
• EEG- metabolic encephalopathy, e.g. MSUD,
hyperammonaemia
Investigation
50. Enzymology
• Definitive diagnosis is confirmed on
enzymology.
• The sample requirement depends on which
tissues express the enzyme, e.g.
galactosaemia (blood), OTC deficiency (liver),
mitochondrial (muscle).
Investigation
51. • White cell enzymes are often requested in
patients with potential neurodegenerative or
storage disorders.
• The neurodegeneration panel includes GM1
gangliosidosis, arylsulphatase A deficiency,
Krabbe and fucosidosis in white cells.
• Where us Tay-Sachs, Sandhoff, Sly
mucopolysaccharidosis (MPS VII) and
mannosidosis in plasma;
Investigation
52. • The organomegaly panel includes GM1
gangliosidosis, Gaucher, Niemann-Pick A and
B, mannosidosis, fucosidosis and Wolman
disease in white cells.
• while Sly (MPS VII), and mannosidosis in
plasma.
Investigation
53. Acute management
• Stop feeds
• Promote anabolism- give 10% dextrose with
appropriate electrolyte additives (add insulin
rather than reduce% dextrose if
hyperglycaemiq.
• Correct biochemical disturbance along
standard guidelines, e.g. hypernatraemia, low
phosphate, etc.
55. Specific treatment
• Dietary restriction
• Drugs, e.g. nitisinone in tyrosinaemia
• Enzyme replacement therapy in Gaucher, Fabry,
Pompe, Hurler, and Hunter syndromes
• Substrate deprivation therapy in Niemann Pick C and
Gaucher
• Transplantation (liver, bone marrow)
• Hepatocyte transfer (future)
• Gene therapy (future)
• Genetic counselling(future prenatal counselling)
• Screen siblings if indicated
56. SCREENING
• Principles of screening
• Screening for defined disorders aims to
prevent avoidable morbidity and mortality.
• The sensitivity of a screening test is the rate
of true-positives, and its specificity is the rate
of true-negatives.
• The aim is not to miss any cases with the
minimum of false-positives.
57. • The necessary requirements for including a
condition in a screening program are:
• Important health problem
• Accepted treatment
• Facilities available for diagnosis and treatment
• Latent or asymptomatic disease
• Suitable test
• Natural history understood
• Agreed case definition
• Early treatment improves prognosis
• Economic
• Case-finding may need to be continuous
58. • Neonatal blood spots are collected on day 5-8 .
• Laboratories still using the Guthrie test for PKU,
• which relies on phenylalanine-dependent
bacterial growth,
• may give false-negatives if the baby is receiving
antibiotics.
• The feeding status is also requested to ensure
adequate protein intake, but newer techniques
are able to detect PKU reliably on day 1 (routine
screening day in the USA).
59. Current UK program
• Universal
• Congenital hypothyroidism (thyroid-stimulating
hormone)
• Phenylketonuria (phenylalanine)
• Haemoglobinopathies (sickle-cell disease and
thalassaemia)
• Some regions
• MCAD
• Cystic fibrosis (to become universal)
• Galactosaemia
• Homocystinuria
• Duchenne muscular dystrophy