Environment and Nutrition Flashcards
Diseases predicted to increase due to Climate Change
- Cardiovascular disease.
- Cerebrovascular disease.
- Respiratory disease.
- Gastroenteritis.
- Vector-borne infectious diseases.
- Malnutrition.
How is climate change predicted to increase the incidence of cardiovascular, cerebrovascular and respiratory disease
Increased heat waves and air pollution –> increased exacerbations.
How is climate change predicted to increase the incidence of gastroenteritis / cholera / other foodborne and waterborne infections
Increase of flooding, heavy rain and other environmental disasters –> increased contamination of food / water and disruption of clean water supplies / sewage treatments.
How is climate change predicted to increase the incidence of Vector-borne infections
Increased temperatures, crop failures and extreme weather variation –> changes to vector numbers and geographic distributions.
How is climate change predicted to increase the incidence of malnutrition
Changes in local climate –> disruption of crop production.^
^Likely to be most severe in tropical climates.
Toxicity
Poison
Any substance given at a dosage which causes harmful effects.
Xenobiotics
Exogenous chemical in the environment that are absorbed into the body and stored in various organs or metabolised.
Metabolised either to:
- Inactive water soluble compounds (which are excreted).^
OR
- Toxic metabolites.
^Detoxification.
Xenobiotic Metabolism
- Phase 1 reaction = Hydrolysis, reduction or oxidation of Xenobiotic with help of Cytochrome P-450 enzyme catalyst.
- Primary metabolite.
- Phase 2 reaction = Glucuronidation, sulfation, mehtylation or conjugation with glutathione (GSH).
- Water soluble compounds OR toxic metabolites.
- Excretion OR cell damage.
Cytochrome P450 enzymes (CYPs)
- Heme-containing enzymes.
- Each has its own preferred substrate.
- Primarily in endoplasmic reticulum of hepatocytes.
- Catalyses xenobiotic reactions to either inactive water-soluble OR active toxic metabolites.
- By-product of either reaction = ROS (reactive oxygen species).
Cytochrome P-450 enzyme (CYP) inducers
- Environmental chemicals.
- Drugs.
- Smoking.
- EtOH.
- Hormones.
NB. Fasting or starvation decrease CYP activity
Effects of cytochrome P-450 enzyme (CYP) inducers
- Inducer binds specific nuclear receptors.
- Combine with retinoic X receptor (RXR).
- Complex formed binds 5’-flanking region promotor elements of CYP gene.
- Activates transcription of CYP.
- Increased CYP activity.
Receptors which bind inducers to activate cytochrome P-450 (CYP)
- Aryl hydrocarbon receptor.
- Peroxisome proliferator-activated receptors (PPARs).
- Constitute androstane receptor (CAR).
- Pregnane X receptor (PXR).
Most common Outdoor Air Pollutants
- Ground-level ozone (gas formed by nitrogen oxide and volatile organic compound reactions in presence of sunlight)
- Sulfur dioxide.
- Acid aerosols.
- Particles < 10 microm diameter (“soot”).
Health effects of Outdoor Air Pollutants:
-Ground-level Ozone
Healthy adults and children:
- Decreased lung function.
- Increased airway reactivity.
- Lung inflammation.
Athletes / outdoor workers / asthmatics:
- Decreased exercise capacity.
- Increased hospitalisatons.
Health effects of Outdoor Air Pollutants:
-Nitrogen dioxide
Healthy adults:
- Increased airway reactivity.
Asthmatics:
- Decreased lung function.
Children:
- Increased respiratory infections.
Health effects of Outdoor Air Pollutants:
-Sulfur dioxide
Healthy adults:
- Increased respiratory symptoms.
Chronic lung disease patients:
- Increased mortality.
Asthmatics:
- Increased hospitalisation.
- Decreased lung function.
Health effects of Outdoor Air Pollutants:
-Acid aerosols
Healthy adults:
- Altered mucociliary clearance.
Children:
- Increased respiratory infections.
Asthmatics:
- Decreased lung function.
- Increased hospitalisations.
Health effects of Outdoor Air Pollutants:
-Particulate matter (“soot”)
Children:
- Increased respiratory infections.
Chronic lung or heart disease patients:
- Decreased lung function.
Asthmatics:
- Excess mortality.
- Increased attacks.
Carbon monoxide
- Non-irritating.
- Colourless.
- Odourless.
- Tasteless.
- Produced during incomplete oxidation of hydrocarbons (e.g. car engines, furnaces, cigarettes).
- Bind Hb with high affinity (carboxyHb) –> CNS depression and systemic asphyxiation..
Chronic CO poisoning
- Occurs when exposed to low-level persistent CO.
- CarboxyHb is very stable once formed.
- Persistnet carboxyHb –> slowly developing hypoxia –> widespread iscaemic changes in CNS.^
- May have permanent memory / vision / hearing / speech loss despite cessation of CO exposure.
- Dx by blood carboxyHb levels.
^Most commonly basal ganglia and lenticular nuclei.
Acute CO poisoning
- Usually accidental or suicide attempt.
- Chrctrsd by generalized cherry-red coloured skin and mucous membranes (in light-skinned people).
- Rapid death = no morphologic changes.
- Slower death = edematous brain, punctate haemorrhages, hypoxia-induced neuronal changes.
Common Indoor Air Pollutants
- Smoke.
- Bioaerosols.
- Radon.
- Formaldehyde.
- CO.
- NO2.
- Asbestos.
Health effects of Indoor Air Pollutants:
-Smoke
From burning of organic materials (wood, dung, charcoal).
- Lung infections.
- Cancer.^
^May contain carcinogenic polycyclic hydrocarbons.
Indoor Air Pollutants:
Bioaerosols:
-Examples
- Microbes (e.g. Legionnaires, viruses).
- Allergens (e.g. pet dander, dust mites, fungi, moulds).
Indoor Air Pollutants:
-Radon
- Radioactive gas.
- Derived from uranium.
- Present in soil and homes.
Health effects of Indoor Air Pollutants:
-Radon
- Lung cancer.
Health effects of Indoor Air Pollutants:
-Formaldehyde
Carcinogen
- Breathing difficulties.
- Burning sensation in eyes and throat.
- Trigger asthma attacks.
NB. In concentrations of >=0.1 ppm.
Sources of Lead:
-Occupational
- Spray painting.
- Foundry work.
- Mining and extracting lead.
- Battery manufacturing.
Sources of Lead:
-Non-occupational
- Water supply.^
- Paint dust and flakes^ in older housing.
- Automotive exhaust.
- Urban soil.
^Most common sources.
Lead Absorption in Children
from food
50% or greater.
Lead absorption in Adults
from food
15%.
Effects of 10 microg / mL lead in children
Measured blood levels
Developmental toxicity:
- Decreased IQ.
- Decreased hearing.
- Decreased growth.
- Impaired peripheral nerve function.
- Foetal effects (through tranplacental transfer)
Effects of 10 - 20 microg / mL lead in children
Measured blood levels
- Altered calcium homeostasis.
- Altered vitamin D metabolism.
- Increased level of erythrocyte protoporphyrin.
- Decreased nerve conduction velocity.
Effects of 40 microg / mL lead in children
Measured blood levels
Decreased Hb synthesis.
Effects of 70 - 100 microg / mL lead in children
Measured blood levels
- Colic.
- Frank anaemia.
- Nephropathy.
- Encephalopathy.
Effects of 150 microg / mL lead in children
Measured blood levels
Death.
Organ where majority of lead is absorbed
80 - 85%
Developing teeth and bone.
Effects of lead in developing teeth and bone
- Competes with calcium.
- Binds phosphate.
Lead Half Life in teeth and bone
20 - 30 years.
Morphology Features of Lead:
-Bone changes in children
i.e. developing bone.
Chrctrstc feature
Radiodense lead line deposits in epiphyses due to impaired remodelling of calcified cartilage.
Morphology Features of Lead Poisoning:
-Bone marrow changes
NB. Changes occur rapidly and are most chrctrstc features.
Ring sideroblasts.
Ring sideroblasts = precursor red cells with** iron-laden** mitochondria. Detected with Prussian blue stain.
Morphology Features of Lead:
-How ring sideroblasts formed
- Lead binds ferrochelatase^ –> impaired heme synthesis –> cannot incorporate iron into heme –> excess iron in precursor cells.
^Ferrochelatase = enzyme involved in heme synthesis which has a sulfhydryl group. Lead has high affinity for sulfhydryl groups.
Morphology Features of Lead:
-Peripheral blood changes
NB. Changes occur rapidly and are most chrctrstc features.
- Microcytic, hypochromic anaemia.
- Mild haemolysis.
- Basophilic stippling of RBCs.
Morphology Features of Lead:
-How peripheral blood changes occur
- Lead binds delta-aminolevulinic acid dehydratase and ferrochelatase –> impaired haemoglobin synthesis (no iron in heme) –> microcytosis, hypochromic anaemia.
- Lead inhibits Na+ and K+ dependent ATPases in cell membranes –> increased RBC fragility –> haemolysis.
Pathological Features of Lead:
-Brain changes in child
- Encephalopathy.
- Mental deterioration.
- Impaired brain development of fetus (pregnant women with lead toxicity).
Morphology Features of Lead:
-Brain changes in child
- Brain oedema.
- Demyelination of cerebral and cerebellar white matter.
- Necrosis of cortical neurons.
- Diffuse astrocytic proliferation.
NB. seen with severe lead poisoning.
Are peripheral and central nervous system lead abnormalties in children reversible or irreversible?
Irreversible.
Pathological Features of Lead:
-Brain changes in adults
- Headaches.
- Memory loss.
Morphology Features of Lead:
-Peripheral nervous system changes in adults
- Demyelinating neuropathy.
NB. Typically motor nerves of commonly used muscles (e.g. extensor muscles of wrist and fingers –> wristdrop followed by peroneal muscles –> footdrop).
Pathological Features of Lead:
-GI changes
- Severe, poorly localised abdominal pain (lead colic).
Pathological Features of Lead:
-Kidney changes
- Chronic tubulointerstitial disease.
- Renal failure.
Morphology Features of Lead:
-Kidney changes
- Proximal tubular damage with intranuclear inclusions of protein aggregates.
- Chronic: Interstitial fibrosis.
Pathological Features of Lead:
-Gum (gingiva) changes
- Lead line.
Hyperpigmentation from excess lead.
Pathological Features of Lead:
-Other
Gout^ from decreased uric acid excretion (due to renal failure)
^Saturnine gout.
Mercury:
-Forms
- Metallic mercury (elemental mercury).
- Inorganic mercury compounds (mostly mercuric chloride).
- Organic mercury (mostly methyl mercury).
Mercury:
-Sources
- Contaminated fish^ (methyl mercury).
- Mercury vapors (metallic mercury in dental amalgams).
^Most common source.
Mercury:
-Most common organs affected
- Central nervous system.^
- Kidney.
^Associated with accumulation of methyl mercury.
Mercury:
-Minamata disease
In utero fetal mercury poisoning.
Manifestations:
- Cerebral palsy.
- Deafness.
- Blindness.
- Intellectual disability.
Mercury:
-Mad Hatter disease
Inhaled mercury poisoning.
Symptoms:
- Tremor.
- Gingivitis.
- Bizarre behaviours.
Mercury:
-Bodies protective mechanism
Intracellular glutathione (GSH).
GSH has sulfhydryl group –> acts as sulfhydryl donor for mercury (i.e. binds mercury preventing mercury damage to CNS and kidneys).
NB. Mercury (like lead) has high affinity for sulfhydryl groups.
Mercury:
-Kidney damage
- Acute tubular necrosis.
- Renal failure.
- Nephrotic syndrome (chronic exposure).
Mercury:
-GI manifestations
- Ulcerations.
- Bloody diarrhoea.
Arsenic:
-Sources
- Soil.
- Water.
- Wood preservatives.
- Herbicides.
Arsenic poisoning:
-Mechanism of action
Interferes with mitochondrial oxidative phosphorylation and function of variety of proteins.
Arsenic poisoning:
-Main organs affected
- GI tract.
- CNS.
- Cardiovascular system.
- Skin.
NB. Large quantities are often fatal.
Arsenic poisoning:
-CNS effects
Sensorimotor neuropathy.
NB. Occurs 2 - 8 weeks post exposure.
Arsenic poisoning:
-Cardiovascular effects
- Hypertension.
- Prolonged QTc.
- Ventricular arrhythmia.
Arsenic poisoning:
-Skin effects
- Hyperpigmentation.
- Hyperkeratosis.
NB. Occurs with chronic exposure.
Arsenic poisoning:
-Other effects of chronic exposure
Increased risk for development of lung, bladder and skin^ cancer.
^Usually on palms and soles and often in multiple numbers.
Cadmium:
-Sources
- Nickel-cadmium batteries.
- Mining pollutant.
- Electroplating pollutant.
- Chemical fertilisers –> contamination of plants / food^ and soil.
^Most important source of exposure.
Cadmium:
-Main organs affected
- Kidneys.
- Lungs.
Effects of tobacco on human health
Which respiratory infection are Vitamin D deficiency patients susceptible to due to decreased cathelicidin?
TB
What are the fat soluble vitamins?
- A.
- D.
- E.
- K.
What vitamin deficiency is common in cystic fibrosis and why?
Vitamin D deficiency.
Why:
Impairment of fat soluble vitamins (ADEK)
Niacin:
-Which vitamin is it and what can deficiency in this vitamin cause
Vitamin:
- Vitamin B3.
Deficiency causes:
The 3 D’s:
- Dementia.
- Dermatitis.
- Diarrhoea.
What are the histology features of a duodenal biopsy in coealic disease
- Villous atrophy (gives duodenal surface flat appearance as opposed to normal long finger-like projections of villi).
- Crypt hyperplasia (crypts elongated in the lamina propria).
- Intraepithelial lymphocytes.
What are the symptoms of coeliac disease and what are some general lab findings
Symptoms:
- Lethargy.
- Fatigue.
- Abdominal pain.
- Diarrhoea.
General lab findings:
- Anaemia.
- Low iron.
- Low Vitamin B.