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.
Gaucher disease is an inherited disorder that
affects many of the body's organs and tissues. The signs and symptoms of this
condition vary widely among affected individuals. Researchers have described
several types of Gaucher disease based on their characteristic features.
Type 1 Gaucher disease is the most common
form of this condition. Type 1 is also called non-neuronopathic Gaucher disease
because the brain and spinal cord (the central nervous system) are usually not
affected. The features of this condition range from mild to severe and may
appear anytime from childhood to adulthood. Major signs and symptoms include
enlargement of the liver and spleen (hepatosplenomegaly), a low number of red
blood cells (anemia), easy bruising caused by a decrease in blood platelets
(thrombocytopenia), lung disease, and bone abnormalities such as bone pain,
fractures, and arthritis.
Types 2 and 3 Gaucher disease are known as
neuronopathic forms of the disorder because they are characterized by problems
that affect the central nervous system. In addition to the signs and symptoms
described above, these conditions can cause abnormal eye movements, seizures,
and brain damage. Type 2 Gaucher disease usually causes life-threatening
medical problems beginning in infancy. Type 3 Gaucher disease also affects the
nervous system, but tends to progress more slowly than type 2.
The most severe type of Gaucher disease is
called the perinatal lethal form. This condition causes severe or
life-threatening complications starting before birth or in infancy. Features of
the perinatal lethal form can include extensive swelling caused by fluid
accumulation before birth (hydrops fetalis); dry, scaly skin (ichthyosis) or
other skin abnormalities; hepatosplenomegaly; distinctive facial features; and
serious neurological problems. As its name indicates, most infants with the
perinatal lethal form of Gaucher disease survive for only a few days after
birth.
Another form of Gaucher disease is known as
the cardiovascular type because it primarily affects the heart, causing the
heart valves to harden (calcify). People with the cardiovascular form of
Gaucher disease may also have eye abnormalities, bone disease, and mild
enlargement of the spleen (splenomegaly).
Maple syrup urine disease is an inherited disorder in which the body is unable to process certain protein building blocks (amino acids) properly. The condition gets its name from the distinctive sweet odor of affected infants' urine.
Phenylketonuria (PKU) is an inborn error of metabolism that results in decreased metabolism of the amino acid phenylalanine. A birth defect that causes an amino acid called phenylalanine to build up in the body.
Newborns should be screened for PKU.
Untreated phenylketonuria can lead to brain damage, intellectual disabilities, behavioural symptoms or seizures.
Treatment includes a strict diet with limited protein.
Gaucher disease is an inherited disorder that
affects many of the body's organs and tissues. The signs and symptoms of this
condition vary widely among affected individuals. Researchers have described
several types of Gaucher disease based on their characteristic features.
Type 1 Gaucher disease is the most common
form of this condition. Type 1 is also called non-neuronopathic Gaucher disease
because the brain and spinal cord (the central nervous system) are usually not
affected. The features of this condition range from mild to severe and may
appear anytime from childhood to adulthood. Major signs and symptoms include
enlargement of the liver and spleen (hepatosplenomegaly), a low number of red
blood cells (anemia), easy bruising caused by a decrease in blood platelets
(thrombocytopenia), lung disease, and bone abnormalities such as bone pain,
fractures, and arthritis.
Types 2 and 3 Gaucher disease are known as
neuronopathic forms of the disorder because they are characterized by problems
that affect the central nervous system. In addition to the signs and symptoms
described above, these conditions can cause abnormal eye movements, seizures,
and brain damage. Type 2 Gaucher disease usually causes life-threatening
medical problems beginning in infancy. Type 3 Gaucher disease also affects the
nervous system, but tends to progress more slowly than type 2.
The most severe type of Gaucher disease is
called the perinatal lethal form. This condition causes severe or
life-threatening complications starting before birth or in infancy. Features of
the perinatal lethal form can include extensive swelling caused by fluid
accumulation before birth (hydrops fetalis); dry, scaly skin (ichthyosis) or
other skin abnormalities; hepatosplenomegaly; distinctive facial features; and
serious neurological problems. As its name indicates, most infants with the
perinatal lethal form of Gaucher disease survive for only a few days after
birth.
Another form of Gaucher disease is known as
the cardiovascular type because it primarily affects the heart, causing the
heart valves to harden (calcify). People with the cardiovascular form of
Gaucher disease may also have eye abnormalities, bone disease, and mild
enlargement of the spleen (splenomegaly).
Maple syrup urine disease is an inherited disorder in which the body is unable to process certain protein building blocks (amino acids) properly. The condition gets its name from the distinctive sweet odor of affected infants' urine.
Phenylketonuria (PKU) is an inborn error of metabolism that results in decreased metabolism of the amino acid phenylalanine. A birth defect that causes an amino acid called phenylalanine to build up in the body.
Newborns should be screened for PKU.
Untreated phenylketonuria can lead to brain damage, intellectual disabilities, behavioural symptoms or seizures.
Treatment includes a strict diet with limited protein.
Lactose intolerance is the inability or insufficient ability to digest lactose, a sugar found in milk and milk products. Lactose intolerance is caused by a deficiency of the enzyme lactase, which is produced by the cells lining the small intestine. Lactase breaks down lactose into two simpler forms of sugar called glucose and galactose, which are then absorbed into the bloodstream.
Not all people with lactase deficiency have digestive symptoms, but those who do may have lactose intolerance. Most people with lactose intolerance can tolerate some amount of lactose in their diet.
People sometimes confuse lactose intolerance with cow milk allergy. Milk allergy is a reaction by the body's immune system to one or more milk proteins and can be life threatening when just a small amount of milk or milk product is consumed. Milk allergy most commonly appears in the first year of life, while lactose intolerance occurs more often in adulthood.
National Institute of Diabetes and Digestive and Kidney Diseases:
-water balance --> body composed of about 60-70% water
-total body water-->42L, ICF --> 28L, ECF --> 14L
- water output by urine,skin,lungs,feces.
-electrolyte bALANCE , expressed as mEq/L.
Definition:
Many childhood conditions are caused by gene mutations that encode specific proteins. These mutations can result in the alteration of primary protein structure or the amount of protein synthesized.
The functional ability of protein, whether it is an enzyme, receptors, transport vehicle, membrane, or structural element, may be relatively or seriously compromised.
These hereditary biochemical disorders are collectively termed as ‘’Inborn errors of metabolism’’
Lactose intolerance is the inability or insufficient ability to digest lactose, a sugar found in milk and milk products. Lactose intolerance is caused by a deficiency of the enzyme lactase, which is produced by the cells lining the small intestine. Lactase breaks down lactose into two simpler forms of sugar called glucose and galactose, which are then absorbed into the bloodstream.
Not all people with lactase deficiency have digestive symptoms, but those who do may have lactose intolerance. Most people with lactose intolerance can tolerate some amount of lactose in their diet.
People sometimes confuse lactose intolerance with cow milk allergy. Milk allergy is a reaction by the body's immune system to one or more milk proteins and can be life threatening when just a small amount of milk or milk product is consumed. Milk allergy most commonly appears in the first year of life, while lactose intolerance occurs more often in adulthood.
National Institute of Diabetes and Digestive and Kidney Diseases:
-water balance --> body composed of about 60-70% water
-total body water-->42L, ICF --> 28L, ECF --> 14L
- water output by urine,skin,lungs,feces.
-electrolyte bALANCE , expressed as mEq/L.
Definition:
Many childhood conditions are caused by gene mutations that encode specific proteins. These mutations can result in the alteration of primary protein structure or the amount of protein synthesized.
The functional ability of protein, whether it is an enzyme, receptors, transport vehicle, membrane, or structural element, may be relatively or seriously compromised.
These hereditary biochemical disorders are collectively termed as ‘’Inborn errors of metabolism’’
Management of Severe Acute Malnutrition.pptxEfosa Aimien
Severe acute malnutrition is a standard term referred to a condition where a child has severe wasting and/or bilateral pedal edema.
The health, social and economic burden of this condition cannot be overemphasised. It is needful and timely yet again to reiterate and summarily but comprehensively outline the management of this condition. Thus, this presentation is a comprehensive summary of the management of severe acute malnutrition as outlined in standard paediatric textbooks.
A detailed explanation should however be sourced from standard texts and updated journals.
This presentation is cannot be cited or referenced in publications, presentations nor public fora.
The presenters:
Dr Efosa Emmanuel Aimien is a Paediatric Resident on outside posting at the National Hospital Abuja. He had his medical training at the prestigious College of Health Sciences, Ahmadu Bello Univeristy, Zaria. Nigeria.
Dr Zarah Fatima Abdu is a Paediatric Senior Resident at the Department of Paediatrics, National Hospital Abuja. Her vastness and clinical acumen in child health especially malnutrition is without question.
We hope this presentation contributes to the ease of gaining medical knowledge especially in Paediatrics.
Thank you.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
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Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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3. Inborn errors of metabolism
A group of diseases caused by
a defect in the activity of an enzyme
that affect a wide variety of
metabolic processes;
defective processing or transport of
amino acids, fatty acids, sugars or metals
4. 15 August 2019 Total slide. 132 4
Inborn Errors of Metabolism
• An inherited enzyme deficiency leading to
the disruption of normal bodily
metabolism
• Impaired formation of a product normally
produced by the deficient enzyme
• Accumulation of a toxic substrate
(compound acted upon by an enzyme in a
chemical reaction)
5. 15 August 2019 Total slide. 132 5
What is a metabolic disease?
• Garrod’s hypothesis
product deficiency
substrate excess
toxic metabolite
A
D
B C
7. 15 August 2019 Total slide. 132 7
Genetic Basis
of
Inherited Disorders
Point mutations,
Insertions, Deletions,
Missense Mutations
and Rearrangements
8. 15 August 2019 Total slide. 132 8
Epidemiology and Inheritance
• Although each
individual IEM is rare,
cumulatively they occur
~ 1:5000 live births
• Majority of IEM follow
an autosomal recessive
mode of inheritance
9. 15 August 2019 Total slide. 132 9
Classification of Metabolic Diseases
Small molecule disease
– Carbohydrate
– Protein
– Lipid
– Nucleic Acids
– Minerals
– Vitamins
Organelle disease
– Lysosomes
– Mitochondria
– Peroxisomes
– Cytoplasm
10. Metobolic Disorders
• Aminoacid Metabolim
• Lipid Metabolism
• Carbohydrate Metabolism
• Mitochondrial Energy Metabolism
• Vitamin Metabolism
• Metal Transport
• Nucleic acid and Heme Metabolism
• Organelles – lysosomes , peroxisomes
11. Defects in Amino and Organic Acid Metabolism
Defects in Carbohydrate Metabolism
Errors in Fatty Acid Metabolism
Defects in Cholesterol and Lipoprotein Metabolism
Mucopolysaccharide and Glycolipid Disorders
Defects in Nucleotide Metabolism
Disorders in Metal Metabolism and Transport
Porphyrias and Bilirubinemias
Diseases Associated with Defective DNA Repair
Metobolic Disorders
12. Categories of IEMs
Disorders of protein metabolism
(amino acidopathies, organic acidopathies,
and urea cycle defects)
Disorders of carbohydrate metabolism (eg,
carbohydrate intolerance disorders, glycogen
storage disorders, disorders of gluconeogenesis
and glycogenolysis)
Fatty acid oxidation defects
Lysosomal storage disorders
Mitochondrial disorders
Peroxisomal disorders
25. 25
AMINO ACID DISORDERS
Phenyl Ketonuria (PKU)
Phenylalanine Tyrosine
Hydroxylase
Phenylalanine
Phenyl ethylamine Phenyl pyruvic acid
Phenyl pyruvic acid is what gives the urine its smell because its ketonic and acidic.
27. Child with PKU –
born before NBS
Full expression of
this genetic
disease
+ gene mutation
+ environmental
exposure
28. Clinical Biochemistry Metabolic Disorders of Proteins
15 August 2019 Total slide. 132 28
Defect here causes
Type I Tyrosinemia
Defect here causes
alkaptonuria
Catabolic pathway for phenylalanine and
tyrosine
Homogentisate
dioxygenase
Fumarylacetoacetate
hydrolase
30. Clinical Biochemistry Metabolic Disorders of Proteins
15 August 2019 Total slide. 132 30
abnormalities appear in the
first month of life
poor weight gain
enlarged liver and spleen
distended abdomen
swelling of the legs
increased tendency to
bleeding, particularly nose bleeds
Jaundice
death from hepatic failure
frequently occurs between three
and nine months of age unless a
liver transplantation is
performed.
Acute tyrosinemia
31. Clinical Biochemistry Metabolic Disorders of Proteins
15 August 2019 Total slide. 132 31
Normal urine
Urine from patients
with alkaptonuria
Symptoms of alkaptonuria
32. Clinical Biochemistry Metabolic Disorders of Proteins
15 August 2019 Total slide. 132 32
Patients may display painless bluish darkening of the outer ears,
nose and whites of the eyes. Longer term arthritis often occurs.
33. 15 August 2019 Total slide. 132 33
MSUD Clinical Manifestations
Time Symptom/Sign
12-24 hours Maple syrup odor to cerumen
Elevated BCAA
2-3 days Irritability, poor feeding
Ketonuria
4-5 days Encephalopathy (lethargy,
apnea, atypical movements
7-10 days Coma and respiratory failure
35. Clinical Biochemistry Metabolic Disorders of Proteins
15 August 2019 Total slide. 132 35
Homocystinuria
Defective activity of cystathionine synthase
36. Clinical Biochemistry Metabolic Disorders of Proteins
15 August 2019 Total slide. 132 36
Major phenotypic expression
Ectopia lentis
Vascular occlusive disease
Malar flash
Osteoporosis
Accumulation of homocysteine and methionine
41. Clinical Biochemistry Metabolic Disorders of Proteins
15 August 2019 Total slide. 132 41
Characteristics of albinism:
Low Vision (20/50 to
20/800)
Sensitivity to bright light
and glare
Rhythmic, involuntary
eye movements
Absent or decreased
pigment in the skin and
eye and sensitivity to
sunburn that could lead to
skin cancers or cataracts
in later life
"Slowness to see" in
infancy
42. Clinical Biochemistry Metabolic Disorders of Proteins
15 August 2019 Total slide. 132 42
Characteristics of albinism:
Farsighted, nearsighted,
often with astigmatism
Underdevelopment of the
central retina
Decreased pigment in the
retina
Inability of the eyes to
work together
Light colored eyes ranging
from lavender to hazel,
with the majority being
blue
47. Disorders of Fat Metabolism
Defect in enzymes which allows transport of
fatty acids into the mitochondria; specific
to short-, medium- or long-chain fatty acids
Fatty acids not utilized resulting in
hypoglycemia, hyperammonemia, death
MCADD most common
Deficiencies of carnitine metabolism
61. Peroxisomal disorders
Zellweger syndrome
Adrenoleukodystrophy
Hyperoxaluria type I (alanine glyoxylate
aminotransferase deficiency)
Refsum disease (phytanyoyl CoA
hydroxylase deficiency)
62. 62
Hypotonia.
Dysmorphia.
Psychomotor delay and seizures.
Hepatomegaly.
Abnormal eye findings such as retinitis
pigmentosa or cataract.
Hearing impairment.
PEROXISOMAL DISORDERS
Clinical Manifestations:
63. Peroxisomal Disorders
• Zellweger Syndrome
(Cerebro-hepato-renal
syndrome)
• Dysmorphic facies.
• Progressive
degeneration of
Brain/Liver/Kidney,
• Death ~6 mo after onset.
• When screening for PDs. obtain
serum Very Long Chain Fatty Acids-
VLCFAs
67. Mucopolysaccharidoses (MPS)
MPS I (Hurler, Hurler-Scheie, Scheie)
MPS II (Hunter)
MPS III (Sanfillippo)
MPS IV (Morquio)
MPS VII (Sly)
MPS IX (Natowicz)
68. 68
Hurler’s
In hurler :
Nasal bridge is depressed , increase distance of philthrum , epicanthal
folds, bossing of the head , thick eyebrows , upturn nostrils
70. Mucolipidosis
Mucolipidoses type I (Sialidosis)
Mucolipidoses type II (I-cell)
Mucolipidoses type III (pseudo-Hurler)
Mucolipidoses type V (Sialolipidosis)