Mechanisms of Disease Environmental/Nutritional / Diseases of Infancy and Childhood June 17, 2003 Stephen L. Putthoff, D.O., FCAP Chairman, Department of Pathology and Anatomy

Table 10-3, pg. 409 Table 10-4, pg. 409

How much do you drink? Do you have an alcohol problem? It might be useful if you reflected upon it Do you have an alcohol problem? It might be useful if you reflected upon it Do you have any friends who you think have, or may have a predilection for alcohol abuse – but they seem oblivious? Do you have any friends who you think have, or may have a predilection for alcohol abuse – but they seem oblivious?

Table and images, p. 411

p413

Common OTC agents Acetaminophen Acetaminophen Aspirin Aspirin

Pollution Outdoor Outdoor Indoor Indoor

Industrial exposures Volatile organics Volatile organics Halogenated hydrocarbons Halogenated hydrocarbons Plastics, rubber and polymers Plastics, rubber and polymers Metals Metals –Table 20-12, pg. 421 Table 10-11, p 419

Effects of lead Clinical manifestations? Clinical manifestations?

Pesticides DDT DDT Diazanon Diazanon Malathion Malathion Nicotine Nicotine Arsenic Arsenic Paraquat Paraquat Warfarin Warfarin Strychnine Strychnine

Natural Toxins Radiation Injury UV irradiation Physical Environment Wounding = E x 1/T x 1/A x k abrasion laceration contusion gunshot wounds characteristics, range, etc. entries exits

Physical Injury [cont’d] Thermal injuries burns hyperthermia hypothermia Electrical injuries Atmospheric pressure injury

Food and Nutrition Nutritional deficiencies Nutritional deficiencies Protein-energy malnutrition Protein-energy malnutrition KwashiorkorMarasmus Table 10-20, pg. 438

Protein Energy Malnutrition

Vitamin deficiencies Fat soluble Fat soluble Water soluble Water soluble Table 10-21, pg. 440 Deficiency states vs. toxicity

Vit. A vs. Vit. C vs Vit. D A: Fig , pg. 442 A: Fig , pg. 442 –Eye; xerophthalmia, etc. D: Fig , pg. 443 D: Fig , pg. 443 –rickets, osteomalacia C: Fig , pg. 451 C: Fig , pg. 451 –scurvy Others: beriberi, chelitis, pellagra, macrocytic anemia,acroderma titis enteropathica,

Diet High protein/low carbohydrate High protein/low carbohydrate Low protein Low protein High carbohydrate High carbohydrate Basic principle: eat less, exercise more Basic principle: eat less, exercise more

Chemoprevention of cancer ?????? ??????

Diseases of Infancy and Childhood Congenital malformations Congenital malformations Perinatal infections Perinatal infections RDS-newborn RDS-newborn Erythroblastosis Erythroblastosisfetalis PKU PKU Galactosemia Galactosemia Cystic fibrosis Cystic fibrosis SIDS SIDS Neuroblastoma Neuroblastoma Wilms tumor Wilms tumor