June Gems
One of the delights for a University teacher in June, when the examination
papers have to be marked (and medical clases are in excess of 340, so there
are a lot of scripts to mark) is seeing how students remember what they thought
we said in lectures, and how they express themselves under the stressful conditions
of the exam room.
Just occasionally we get a chance to see what students make of our lectures
before the exams - some years ago a student came up to me at the end of a lecture
on collagen synthesis and gave me these two copies of the handout
for the lecture, saying shyly "me and Mady done this".
My late father started me collecting these "June gems", and indeed
some of what follows comes from his collection. From time to time we would phone
each other, read out a choice morsel from an exam script, and ask the other
one what the question might have been.
Some novel diseases I have learnt about include: divetoseclerosis; photophobia
(fear of life); metalablastic anaemia; obesiety
I am grateful to the many students whose work I have marked over the years,
and those I have seen in oral examinations, for the enjoyment the following
(sometimes mysterious) quotations have given me:
- Man is curious in many ways, like earth, moon, himself.
- One can only has at a guess
- Optical activity is the activity that can be recognised optically with
the eye or the microscope.
- These people eat only what they can get.
- Thermogenesis law – 1st saying is no-one can get anything from something.
- Heisenberg’s law of uncertainty which says you can’t measure
anything without loss.
- Diseases: divetoseclerosis; photophobia – fear of life; metalablastic
anaemia; obesiety
- Its usefulness is of more value than its harmfulness.
- Because they had no income they were poor.
Some definitions of medical terms
- Diuretic: a blood thinner.
- Entero-hepatic circulation: This is when a drug which has already entered
the liver re-enters again via the circulation. Therefore taken via circulation
to the liver twice.
- Entero-hepatic circulation: Despite entering the liver the drug is recirculated
around the body without being metabolised.
- Entero-hepatic circulation: … is not metabolised by the liver and
is passed into the bile. Circulates within the bile between the liver and
gall bladder.
- Entero-hepatic circulation: The drug is not affected / metabolised in the
hepatic system and is therefore allowed to recirculate in the blood.
- Gynaecomastia: Enzymes in the faeces.
- Nocturia: does not sleep at night.
- Nocturia: cannot sleep at night due to breathing problems.
- Nocturia: darkened urine.
- Nocturia: the retention of uria in the bloodstream.
- Nystagmus: movement of hte eyes in rsponse to cold and warm water poured
into the ear.
- Nystagmus: loss of balance.
- Nystagmus: the eye moves away from the ear when touched with warm water.
Pregnancy, mother and infant nutrition
- The placenta is an organ of display. [When asked about this in a viva the
student turned to the lecturer and said “you said it in your lecture”.
The student was Iranian, and we subsequently learnt that she meant “transport”
– in Pharsee transport and displacement are the same word.]
- In the final trimester, which is the third trimester of pregnancy, the
growth of the foetus will by then be in the process of completion towards
the end. Voluntary food intake by the mother-to-be declines at this time because
she has stored all the higher amounts of nutrients that she has consumed in
the foetus that is being used up for its growth.
- If a child could be made to utilise a higher concentration of milk it is
calculated it could reproduce in two years.
- The patient is not the child of one of the parents
- A rat who had just given birth was used to feed 3 babies and 18 babies
at different times. She had sufficient milk for 12 babies. This gives an idea
of the required intake.
- A school feeding programme may precipitate early weaning of children. This
results in infection of feeding bottles and a higher incidence of pregnancy.
- Calcium is very essential during pregnancy. The mother finds the expectant
baby in the womb.
- For all the food we eat since we were born and if they were all converted
to fat we would be obese.
- Extracellular cells (4th trimester of pregnancy?).
Genetics
- It was found that DNA had a base sequence by the human genome project.
- . ..denamination of cytosine.
- The sickling effect is due to abnormal chromosome coding for the red blood
cells.
- Electrophoresis: a process of passing an electric current through a solution
of genetic information
Obesity
- The body weight can be assessed by weighing the patient and finding the
weight.
- If a subject is overweight then (s)he has a greater chance of contracting
a disease of the affluence.
- The current extent of obesity on the UK in comparison with the past has
increased in terms of rate per year.
- Obese people will eat what is given, but will also devour anything else
they can see.
- One method of preventing obesity is to prevent food intake.
- A group of normal and obese subjects were asked to remain alive in a room
for a few days.
- Many people assume that obesity is merely due to greed or bad moral training
in upbringing.
- The health consequences of obesity are huge.
- Obesity in unaesthetically appealing.
- ...the rationale is that the person becomes bored with eating and does
something else instead. This is not very successful.
- A group of women were given 5000 calories / day of energy and they consequently
gained weight until they stopped and then did not gain any more.
- Weight is determined by age expectancy.
- Obesity: a high percentage of fat in the body and a high consumption of
CO2 which leads to cough.
- As a nation we are no longer content to eat enough, preferring in almost
all cases to have an extra helping.
- Diseases of overnutrition such as dental decay.
- Fibre acts as bulk and therefore results in obesity.
- The doctor should treat obesity as an uncurable disease.
- Allow the obese person to eat as much fat and protein as he desires providing
this is not excessive.
- Since the man is clinically obese this would prove that (because of his
obesity) he may be suffering from further complications that are related to
obesity.
- In some individuals the appetite centre is at fault and they cannot control
themselves when they see food.
General physiology, cell biology and metabolism
- Less is known about peroxisomes, but they are fewer in number than lysosomes.
- Lysosomes … may also be used in programmed cell death by exploding
and destroying the cell.
- As the food moves further down the osephagus (sic) it is acted on by pancreatic
juice and bile.
- Simple constipation is due to low bulk of the food in the colon, which
causes high transit time and it produces dry stool (due to lack of water)
known as diarrhoea or fatty stool known as steatorrhoea.
- Once a patient has entered chronic renal failure the blood creatinine levels
slowly rise until a certain level when they require a transplant, haemodialysis
or peritoneal dialysis.
- Usually, when protein is ingested it can either be used as energy and for
extra protein, it will undergo deamination. The products may be used to synthesis
(sic) non-essential amino acid or stored as fat or excreted as urea.
- The less harmful fat is double stranded and known as polyunsaturated fat
i.e. the carbon is not very saturated with nitrogen.
- Urine contains all the insoluble metabolites of the body dissolved in water.
- It is not known what factors regulate hunger, but if two monkeys are taken
and one is fed while the other is not then the fed animal will no longer take
any more food while the unfed one will desire food.
- Non-steroidal anti-inflammatory drugs precipitate gastric ulceration because
they reduce the inflammation caused by the acid released from the ulcer.
- Carbohydrates are not normally excreted in the breath but are stored in
the adipose tissue.
- If inadequate carbohydrate is present in dietary form, the body will use
extra kilocalories from other sources such as fat, causing obesity.
- Carbohydrate is present as excess fat.
- Carbohydrate is present in the body as spare protein.
- Fat has a low respiratory quotient and is oxidised frequently.
- Protein in the diet comes from food products.
- Ammonia is highly toxic to the central nervous system by its action of
depleting the alcohol levels and thus must be removed.
- Copper forms the blue pigment with protein and is responsible for the colour
of the red cell.
- They inhabit the reaction of choline in betel (no, we don’t know
what this is supposed to mean)
- If all the protein required by the body has been used up and more is needed,
carbohydrates are used as a spare.
- The expected weight of a patient with one leg is half normal.
Diet and health
- Concerning diet and the diseases of affluence: Performing post mortems
can indicate what a deceased person ate.
- Moderate alcoholism is beneficial for health.
- One of the most famous diseases associated with alcohol is the disease
of the liver.
- Alcohol contains ethanol which is converted into acetaldehyde which enters
the lipid oxidation in the cells causing accumulation of blood lipids. This
in turn will lead to hyperlipidaemia.
- A new source of reactive oxygen species – univalent reduction of
water to oxygen.
- High blood pressure causes hypertension.
- Symptoms of stroke are headaches, cardiac arrythmias, nausea and arthritis
of the limbs.
- LDL: bad lipoprotein – it is internalised
- Decease has been rife in our environment
- Atherosclerosis: a plage of lipid and scare tissue
- Experimental methods, statistics and epidemiology
- .. and death varying on a scale of seven depending on its severity.
- People have a nasty habit of not sitting on a normal distribution curve.
- The RDA of nutrients are determined by statistics because human experiments
are unethical and animal experiments are not applicable.
- The determining of dietary intake is essential for acquiring some knowledge
of what people are eating.
- Patients should be studied in the natural state, uncontaminated by drugs.
- One can measure the diameter of the head of the subject and compare it
with tables to check normal mental development
- In [the glucose tolerance test] the patient is given a large dose of glucose,
the amount being known, and blood measurements are made at frequent intervals
to determine the amount of blood in the urine.
- After 45 days the animals are killed and examined thoroughly to see what
they died of.
- The method has its disadvantages – animals are killed at the end,
meaning that the experiment would have to be repeated.
- It is no use putting a fat-soluble vitamin into a watery product because
it is impossible. The vitamin would not dissolve and would just pass through
unnoticed.
- … a survey carried out by one Mr Lancet.
- A group of mice fed on saccharine developed tumours of the uterus. Male
rats were observed to be significant in the results.
- The requirements for protein can be assessed by following the recommended
intakes made by FAO.
Nutrition through the life cycle
- Everyone in Ireland is well nourished – except for pregnant women,
babies, lactating women, growing children, adolescents, the elderly, poor
people, alcoholics and tinkers.
- Diet can influence the elderly person’s health more than food intake.
- Physiological factors that occur in an elderly person are … dystrophy
of the gastro-intestinal parts and loss of sensory organs.
- Apoptosis of cells occurs in elderly people to cause organ malfunction.
- As people get older, by the time they reach the elderly age, they will
tend to change their ideas on food and stick by these ideas.
- Many elderly undergoes diuretic process and thus higher fluid consumption
is needed. However, elderly who intends to avoid waking up during bed time
may restrain themselves from drinking water. This may lead to dehydration
and even unconsciousness.
- Infection always happens in the elderly. First it may be due to their poor
vision as they may not be able to spot any food contamination eg mould on
food and may have food poisoning.
- Adolescents if male, have an increase chance of morbidity as an adult and
an increased chance of morbidity as a female.
- The most important sites of fracture in diagnosing osteoporosis is the
femoral area of the neck and hip areas.
- An important factor in osteoporosis: … weight, especially in later
life about over the age of 65 years and premenopause. It is better for the
individual to have a higher BMI still within reason limits because of the
bounce factor, where the heavier the individual the less risk of developing
osteoporosis. This tends to be a problem in older vegetarians.
Deficiency diseases
- Malnutrition may be treated by a change of diet.
- Clearly, nutritional deficiency will occur if failure to eat goes on for
a long time.
- Lack of a particular deficiency can cause serious health problems.
- In famine all except the mind is emaciated.
- Other causes of protein deficiency could include a general lack of diet
due to anorexia nervosa.
- ...night blindness and reduced dark adaptation are symptoms of vitamin A
deficiency that may only be obvious when the subject experiences the dark.
- The patient walks with an ataxic gait in an attempt to keep his feet from
hitting the ground and tripping him up.
- Undernourished people suffer from severe emancipation.
- Signs of kwashiorkor are hepatomegaly and a swelled head, seen in chronic
alcoholics.
- Vitamin K is required to prevent hypokalaemia, a condition due to lack
of this vitamin.
- In iodine deficiency there is a deficiency of the thyroid hormone; this
occurs in the disease coitus.
- ... a bowl of rice will not contain enough energy to prevent protein deficiency,
and its effect is compounded by being tasteless and milky.
- Kwashiorkor may also be seen after a child has measles because it is believed
that they should not eat for 6 months afterwards. It is due to ignorance as
well as poverty.
- cows which eat clover have improper prothrombin
- In severe scurvy the teeth are resorbed.
- Rickets: when people are so poor they cannot afford to live in the country
- Bread is enriched because after the war there was widespread anaemia among
the people.
- An individual under stress requires more vitamin C; this was one reason
for the high incidence of scurvy on sea voyages.
- Vitamin A was discovered by night fighter pilots who ate carrots before
they took off and found they could see in the dark.
- Vitamin B1 was found to cause beriberi a disease which is fatal to Philipeans.
- Retinol itself is invaluable in the prevention of vitamin A deficiency.
- Vitamin A deficiency: brown spots on the cornea known as biotic spores.
- Vitamin C helps to keep the body generally healthy if the person is in
normal health.
- Rickets: a baby developing this disease will cry when approached, its head
will wobble and perspire considerably.
- The deficiency of vitamin B12 will lead to megaloblastic anaemia of the
consumer.
Dietary treatment of disease
- Type II diabetes is also clinically diagnosed as diabetes insipidus, which
is characterised by destruction of the beta cells of the liver.
- Maple syrup urine disease: this is when maple syrup is formed in the urine.
It is sticky and blocks the metabolic pathway
- We don’t supply food to diabetics or other sick but we supply medicine
Public health nutrition, policy and planning
…because farmers leave their farms and go to the city to enter parliament
and they stop producing food.
- The potato forms the stable (sic) diet in Ireland, providing all the nutrients
required.
- … a store for 2000 people should contain 2000 x 1500 calories.
- The food store should be at the top of a mountain
- One answer to the problem of plenty of food but no-one eating it is to
educate the people to eat it or to provide it free by the Government.
- Suppose a million starving people suddenly turned up on the doorstep -
probably a sensible first approach would be orange juice.
- The public health inspector: looks for rats and mice eggs in all sorts
of places.
- The public health inspector: makes sure they have clean clothes and overalls
and clean boots with clean hands when touching food.
- Plenty of light is essential in the kitchen. In dim light insects, rats
and mice cannot be seen.
- The Food Standards Committee sets new laws for the prevention of the consumer.
Food science and technology
- Dry freezing. Foods are dried before being frozen
- Man used to make wineberry beer in a bowel which was glazed with lead.
- The traditional method of freezing was to put food in the Arctic.
- Much more can be made of protein-rich foods such as castor oil, cotton
seed oil and cocoa butter and forms of bacteria rich foods.
- Dehydrated potatoes will also provide carbohydrate and water.