1. 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

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

4. 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?

6. Table and images, p. 411

7. p413

10. Common OTC agents Acetaminophen Acetaminophen Aspirin Aspirin

11. Pollution Outdoor Outdoor Indoor Indoor

12. 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

13. Effects of lead Clinical manifestations? Clinical manifestations?

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

15. 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

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

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

18. Protein Energy Malnutrition

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

20. Vit. A vs. Vit. C vs Vit. D A: Fig. 10-23, pg. 442 A: Fig. 10-23, pg. 442 –Eye; xerophthalmia, etc. D: Fig. 10-24, pg. 443 D: Fig. 10-24, pg. 443 –rickets, osteomalacia C: Fig. 10-30, pg. 451 C: Fig. 10-30, pg. 451 –scurvy Others: beriberi, chelitis, pellagra, macrocytic anemia,acroderma titis enteropathica,

22. 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

23. Chemoprevention of cancer ?????? ??????

24. 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