Environmental and Nutritional Diseases PDF

Assist. Prof. Dr. Ziad Amran Department of Pathology Faculty of Medical Sciences Thamar University Dhamar, Yemen  OBJECTIVES Environmental pathology- Disease Health effects of climate change Physical and Chemical Injury Air pollution Poor cultural factors N...

Assist. Prof. Dr. Ziad Amran Department of Pathology Faculty of Medical Sciences Thamar University Dhamar, Yemen  OBJECTIVES Environmental pathology- Disease Health effects of climate change Physical and Chemical Injury Air pollution Poor cultural factors Nutritional disorders  Obesity  Undernutrition  Protein deficiency  Vitamin deficiency Vitamin D deficiency Rickets  Osteomalacia Many diseases are caused or influenced by environmental factors. The term environmental disease refers to disorders caused by exposure to chemical or physical agents in the ambient, workplace, and personal environments, including diseases of nutritional origin. Age Genetics Allergy Health effects of climate change Such as the methyl mercury contamination of Minamata Bay in Japan in the 1960s. leakage of methyl isocyanate gas in Bhopal, India, in 1984, Chernobyl nuclear accident in 1986, city of Pripyat in northern Ukraine, near the Belarus border in the Soviet Union. Fukushima nuclear meltdown following the tsunami in 2011(20,000) in northern Japan. lead poisoning resulting from contaminated drinking water in the city of Flint in the United States in 2016.  I-Radiation injury: 2-Temperature injury: a) Heat (sun) stroke: Exposure to high climate temperature → over-sweating & vasodilatation → loss of sodium & water , hyperkalemia, hypotension, dehydration & hypoxia. b) Frostbite: Exposure to severe cold → vasoconstriction & capillary thrombi →gangrene of fingers, toes, nose & ears. 3-Electric Injury: Including skin burns, bone fractures, rupture of organs & vessels, cardiac or respiratory derangements, sudden death due to nervous. 4-Physical carcinogens (mainly causing skin cancer).  100000 I-Carbon monoxide: CNS depression. 2-lnsecticides: →CNS disturbances, arrhythmias, impotence & infertility. 3-Lead poisoning (plumbism): neurological symptoms & anemia. 4-MethyI alcohol: toxic to retina and brain. 5-Chemical carcinogens: Drink methyl alcohol instead of ethyl alcohol News papers Inks Lead poisoning Sources of air pollution are numerous such as gases, fumes, fibers, dust, bacteria... etc. Air pollution effects such as: I-Inflammations as conjunctivitis, bronchitis, dermatitis. 2-lmmunological disorders and allergy such as bronchial asthma, allergic rhinitis and hay fever. 3- Pneumocniosis (chronic granulomatous lung disease due to inhalation of particles e.g. silicosis) 4-Carcinogens →malignancy. Fumes-London city Fumes-London city 1 -Smoking: Tobacco smoking is a toxic and carcinogenic mixture of more than 5,000 chemicals According to WHO estimates. More than 7 million of those deaths (10 million-2025) a) Atherosclerosis →coronary heart disease & ischemic lesions in different organs. b) Buerger's disease (thromboangiitis obliterans) c) Chronic obstructive lung disease: chronic bronchitis & emphysema d) Cancer e.g. bronchogenic carcinoma, laryngeal cancer, oral cancer and others. e) Maternal smoking → fetal hypoxia. f) Decreased fertility in males and females. The most common o cardiovascular disease, Hypertension o chronic obstructive pulmonary disease, o various types of cancer, particularly lung cancer.  Responsible for 90% of lung cancers. Buerger's disease (thromboangiitis obliterans) 2-Alcohol abuse: It is pre/disposes to many conditions as a) Steatosis (fatty liver) → alcoholic steatohepatitis (ASH) → cirrhosis. b) Gastritis & pancreatitis. c) Peripheral neuritis. d) Testicular atrophy. e) Cardiomyopathy. f) Cancer (oropharyngeal & hepatic). euphoria 3 million deaths every year 3-Addictive drugs (street drugs, dope) e.g.: a) Bango→ disturbed psychology & adverse behavior, disturbed pulmonary & immunological symptoms. b) Cocaine: It increases dopamine & norepinephrine leading to euphoria, arrhythmias & mental changes. c) Heroin: It leads to behavioral changes, organ damage (respiratory, cardiovascular.. etc), angitis, peripheral neuritis & transmitted infections (through contaminated syringes) as AIDS, infective endocarditis, hepatitis, meningitis & encephalitis. 750,000 deaths per year. Responsible for 585,000 premature deaths by increasing the risk of particular disease and injury. 166,000 die from drug overdoses each year.  Bango Heroin Malnutrition is suboptimal nutrition; either in excess or deficiencies. Thus it includes 1- Obesity 2- Undernutrition  2.8 million people dying each year Etiological factors: Obesity is overweight related to dietary over-intake. Genetic predisposition. Defective physical exercise. Some endocrine disorders Drug medication What are Diseases caused by obesity? Cushing's syndrome Definition of Obesity? Diseases caused by obesity: Definition Malnutrition? 1 -Diabetes mellitus 2-Hypertension 3-Atherosclerosis 4-Higher incidence of thrombosis (due to hyperlipidemia & other factors) 5-Heart disease 6-lncreased risk of developing cancer (particularly of GIT) 7- Breast cancer Cushing's syndrome is a disorder that occurs when your body makes too much of the hormone cortisol over a long period of time. Cortisol is sometimes called the “stress hormone” because it helps your body respond to stress. Cortisol also helps. maintain blood pressure.  Poor nutrition and hunger is responsible for the death of 3.1 million children a year. That's nearly half of all deaths in children under the age of 5. Types of undernutrition: 1 -Total (starvation) 2-Selective as: o Protein deficiency (protein calorie undernutrition) o Vitamin deficiency The causes of undernutrition: o Decreased diet intake as in cases of Dysphagia and anorexia nervosa. o Digestive, Malabsorption states, liver disease. o Increased requirements as in infants & children due to their rapid rate of growth, pregnancy. o Malignant cachexia. o Other factors including genetic disorders. It is also called protein energy malnutrition (PEM). (affect on growing infants). 1) Kwashiorkor: (apathetic) o Generalized edema o Increase of subcutaneous fat o Moon face o Fatty liver (hepatomegaly) o low serum albumin 2) Marasmus (non-apathetic) o Severe wasting including subcutaneous fat o Stunted growth o Premature aging o No edema or hepatic enlargement  Table 8.10 Selected Trace Elements and Deficiency Syndromes Element Function Basis of Deficiency Clinical Features Zinc Component of enzymes, Inadequate supplementation in Rash around eyes, mouth, nose, and anus principally called oxidases artificial diets acrodermatitis enteropathica Interference with absorption by Anorexia and diarrhea other dietary constituents Growth retardation in children Inborn error of metabolism Depressed mental function Depressed wound healing and immune response Impaired night vision Infertility Iron Essential component of Inadequate diet Hypochromic, microcytic hemoglobin as well as several Chronic blood loss iron-containing anemia metalloenzymes Iodine Component of thyroid hormone Inadequate supply in food Goiter and hypothyroidism and water Copper Component of cytochrome c Inadequate supplementation in Muscle weakness oxidase, dopamine β-hydroxylase, artificial diet tyrosinase, and lysyl oxidase Interference with absorption Neurologic defects (involved in crosslinking collagen) Abnormal collagen crosslinking Fluoride Replaces calcium during Inadequate supply in soil and Dental caries water remineralization of teeth, Inadequate supplementation producing fluorapatite, which is more resistant to acids Selenium Component of GSH Inadequate amounts in soil Myopathy Cardiomyopathy (Keshan disease) peroxidase Anti-oxidant with and water vitamin E Fluoride  In children called Rickets In adult called Osteomalacia Rickets is a disease of infants (calcium & phosphate), bone softening and abnormalities of bone growth.  Affects infants during the first two years of age (inadequate calcium).  The resulting deformities remain for life. Aetiology: 1 -Vitamin D deficiency ;commonly due to lack of exposure to sun. 2-Chronic renal disease (renal rickets). 3-Deficiency of calcium & phosphorus Boys more than girl 4-Hereditary (X-linked dominant) vitamin D resistant rickets. Pathogenesis: a) Cartilage hypertrophy leading to various effects as rachitic metaphysis (thick epiphyseal cartilage plate) and hypertrophy of costochondral cartilage. b) Osteoid will form but without changing into osseous tissue. 1 -Skeletal Lesions: Skull a)Delayed closure of fontanelles. b) Delayed eruption of teeth. c) Craniotabes (flattening of occipital bones, due to their softening).. d)Bossing of frontal and parietal bones. Vertebrae: a)Dorsal kyphosis: Backward bending. b)Lumbar lordosis: Forward bending. c)Scoliosis: Lateral bending. Chest: a)Rosary Chest: Beaded costochondral junctions due to masses of osteoid that develop at the costochondral junctions b)Harrison's sulcus: A groove opposite insertion of diaphragm (transverse line across the lower rib c) Pigeon Chest: Flatting of chest sides and forward protrusion of the sternum. Long bones: a) Bowing of weight-bearing bones and pathological fractures. b)Rachitic metaphysis: Thick epiphyseal cartilage plate due to growth of cartilage without significant cartilage degeneration caused by defective calcification- Pelvis: Narrow contracted trefoil pelvis  d)Bossing of frontal and parietal bones. Skull a) Delayed closure of fontanelles. b) Delayed eruption of teeth. c) Craniotabes (flattening of occipital bones, due to their softening).. d)Bossing of frontal and parietal bones. Vertebrae: a) Dorsal kyphosis: Backward bending. b) Lumbar lordosis: Forward bending. c) Scoliosis: Lateral bending. Chest: a) Rosary Chest: Beaded costochondral junctions due to masses of osteoid that develop at the costochondral junctions. b) Harrison's sulcus: A groove opposite insertion of diaphragm (transverse line across the lower rib. c) Pigeon Chest: Flatting of chest sides and forward protrusion of the sternum. Long bones: a) Bowing of weight-bearing bones and pathological fractures. b) Rachitic metaphysis: Thick epiphyseal cartilage plate due to growth of cartilage without significant cartilage degeneration caused by defective calcification- Pelvis: Narrow contracted trefoil pelvis 2-Somatic Lesions: Lymphoid hyperplasia of lymph nodes and spleen. Weak muscles & weak joint ligaments 3-General Effects : Muscle weakness leads to protrusion of abdomen ( pot belly ). Limited movement may lead to overweight Delayed sitting, standing and walking. 1 - Bone deformities 2- Pathological fracture 3- Infections due to low immunity. 4- Future labour problems in female patients (narrow pelvis). It mainly affects adult females due to deficiency of calcium & vitamin D. as a result of repeated pregnancies and lactations. Bone turnover is disturbed, where the normal bone resorption is replaced by osteoid tissue (poorly calcified bone). Bone becomes porous & soft resulting in: 1) Bowing of legs & pathological fracture 2) Trefoil pelvis 3) Lumbar lordosis. Assist. Prof. Dr. Ziad Amran Department of Pathology Faculty of Medical Sciences Thamar University Dhamar, Yemen  Definition of Infectious diseases and cycle of infection.  Spectrum of infectious micro-orgasnisms. Prions Viruses Bacteria Fungi Parasites Microbiome  Kuru  Little  Superfici info How do they al  BS infections damage our  Protozoa E  Helminth  Viral Inclusionscells  How do viruses damage our s cells  Insects  Viral tropism  Transmission, entry and dissemination of infections  How can immune system increase the damage  How can microbes escape from immunity  Techniques for Identifying Infectious Agents  Agents of bioterrorism Infectious diseases are an important health problem in the worldwide despite the availability of effective vaccines and antibiotics for many types of infections. Infectious diseases are disorders caused by organisms — such as bacteria, viruses, fungi or parasites. Many organisms live in and on our bodies. They're normally harmless or even helpful, but under certain conditions, some organisms may cause disease.  Infection: invasion and multiplication of microorganisms in the living tissues causing diseases, infectious agent could be : Abnormal forms Prions: (structures made of proteins called prion proteinsPrP) Prions cause manydiseases such as : 1)- (cannibalism) 2)- (madcow) Grossly : Brainatrophy Microscopic : Spongiform transformation of brain tissue  Viruses :( ) Viral Inclusions How do viruses damage our cells ? Cytomegalic virus : eosinophilic nuclear, basophilic cytoplasmic Induce apoptosis Produce toxins and degradative Herpes 2 virus : nuclear enzymes Inclusion surrounded By clear halo Prevention of macro-molecules production Small pox and rabies: Cytoplasmic inclusion Cytotoxic T lymphocyte attack viral infected cell Polio virus: No inclusions What is Viral Tropism Host Cell Receptors for Viruses Specificity of transcription factors Tissue  Human papillomavirus (benign warts and cervical carcinoma) Chronic - Years- [HBV] Latent-herpes zoster virus, the cause of chickenpox Clinical picture Latent-herpes zoster virus, the cause of chickenpox John Cunningham virus  Bacteria : Prokaryotic, mostly extracellular microorganisms, exceptions Damage blood vessles : Blindness causing hemorhhagic vasculitis : infertility Epidemic typhus Rocky mountain spotted How does bacteria fever damage our cells? By By directly By their using adhering to toxins virulenc our ( e cells/tissues ) factors ) ( and ) ( damaging  Epidemic typhus bacteria called Rickettsia prowazekii Fungi : Eukaryoticmicroorganisms , may cause Fungal cell wall is made of complex Carbohydrate (Chitin) Fungi grow best in warm, dark, moist Maycause areas.  Organisms such as yeasts, molds, and mushrooms are known as fungi (FUN jy). Fungi grow best in warm, dark, moist areas.  Protozoa : Single cell Eukaryotic, examples : (Leishmania,Trichomonas vaginalis)  Helminth (Multi-Systemic)  Insects and Arachnids , called : (Ectoparasites)  Microbiome : (normal flora in our body) Helminth (Multi-Systemic)   skin contacts  insect bite or Animal bites  inhalation  I.V in by drug abusers  fecal-oral route  Vertical  sexual  Zoonotic (spreading to different parts of the body ) : 1. Lymphatic spread 2. Direct invasion and lysis of tissue 3. 4. Blood spread Neural spread Toxemia Pyemia 5. Natural passage Septicemia Portal Systemic 6. Cell to cell Bacteremia Pyemia Pyemia Bacteria: PLAGUE caused by pasturella pestis or yersinia pestis.  Vertical  Endemic: ”Constant presence of a disease or infectious agent within a given geographic area. The usually prevalence of a given disease within such an area.”  Epidemic: “Occurrence in a community or region of cases of an illness or outbreak clearly in excess of expectancy.”  Pandemic: ”Occurring over a wide geographic area and affecting an exceptionally high proportion of the population, i.e. malaria.”82  Post streptococci golemru nephritis 1)- Constant change of Antigens (surface proteins) 2)- Resist binding to Antimicrobial peptides 3)- Inactivating antibodies 4)- Escaping phagocytosis or Complement mediated lysis 5)- Inhibition cytokines) 6)- Interfere with normal function of T lymphocytes  (S. pneumoniae, Neisseria meningitidis, H. influenzae) M. tuberculosis Legionella Agents of bioterrorism   Top 10 Diseases 1. HIV/AIDS 2. Ebola 3. SARs-Severe Acute Respiratory Syndrome 4. Malaria 5. Anthrax 6. Cholera 7. Bubonic Plague 8. Influenza 9. Typhoid fever 10. Smallpox 89  Newly emerging and reemerging infectious diseases New infectious agents continue to be discovered due to improved methods of detection. Factors contributing to the emergence of infectious diseases: Human demographics and behaviour Technology and industry Economic development and land use International travel and commerce Microbial adaptation and change Breakdown of public health measures Human susceptibility to infection Climate and weather Changing ecosystems Poverty and social inequality War and starvation Lack of political will Intent to harm  Factors contributing to the emergence of infectious diseases Changing ecosystems Poverty and social inequality War and starvation Lack of political will Intent to harm Methicillin-resistant Staphylococcus aureus (MRSA)  Best wishes Enjoy your life and good luck with your future, happy and healthy life. And pass of final pathology exam.