Healthline

Healthline is a website that contains useful health articles for everyone. It is useful for new medical students too. Many of the topics I have taught under Lipids and related topics can be found at this website. I hope you will visit and read its articles. It is also on Facebook. I hope students will widen their reference base and see the many options available at this website.

Prof Faridah
12 October 2014

External links:
http://www.healthline.com/health/cholesterol/effects-on-body
http://www.healthline.com/understanding-cholesterol/anatomy-animations#1/bodies-in-motion-cholesterol
http://www.healthline.com/directory/topics?ref=global

Effects of high blood cholesterol on the body

I have written the following cases based on true incidences. Try and understand the underlying pathology and explain them.


Case 1

The son of a 75-year old man frantically called a close friend to seek assistance for admitting his father to the hospital for heart disease (sakit jantung). His mother already passed away many years ago. Now his lonely father is unwell and needs urgent medical attention. His son feels intimidated and uncertain about what to do for his father's condition. He has no idea what the procedure is like if he decides to bring his father to hospital. He needs help before he will take his father to hospital.

Case 2

A 39-year old man was happily married and going about his daily routine at home. His beautiful young wife had delivered their #5 child a month ago. On Thursday, when he got up to enter the toilet, he collapsed. His wife quickly took him to hospital. He was assessed for heart disease, treated, and discharged home. On the way home, again he collapsed and his wife had to rush him back to hospital. This time he was warded over the weekend and more investigations needed to be done on him the following week. He felt intimidated. He was weak and exhausted. On Sunday morning, he called his friend/boss to inform him about what had happened since he could not come to work that day. With mixed feelings, his boss went to visit him in the ward.

Case 3

A 72-year old woman was driven around in her son's car and visited all her 7 children. She was happy and felt blessed. However, her married son (the driver) did not know that his diabetic mother had heart disease. He knew she was a diabetic. One day, he drove for 4 hours and they visited a Malay bomoh far out somewhere in the jungle. After that they drove home but stopped for lunch at a nearby restaurant. Exhausted from all the travelling and not eating her meals on time, the woman passed away at lunch time. The son was shocked.

Case 4
A retired school headmaster enjoyed cow's brain. Whenever he went to kenduri, he would go into the kitchen and ask if there was a cow's brain available. The ladies would dish out the cooked cow's brain and serve it on a platter, just for him. Sitting in the corner, he ate the entire cow's brain by himself. He died the following day.

Case 5
A 56-year old man had his blood profile done at the hospital where he worked. His blood profile was fine except for his cholesterol, which was a bit high. Upon learning about his blood cholesterol from a friend/senior scientist in the clinical laboratory, he felt he needed to do something about his blood cholesterol. He contacted some doctors for dietary modification. He started taking Bragg apple cider vinegar, twice daily. He ate fresh pomegranate, dried apricots and dried dates. He started taking oat bran but had to stop since it made him urinate too frequent. He stopped eating most of the food he had once craved. His food intake seems bland and unappealing to his wife. He skips meals to avoid putting on weight. His wife feels intimidated and does not know how to help him.

Case 6
A beautiful young woman in her mid-twenties got married to a dream man of her life. Unfortunately, he died of a heart attack while on duty overseas. He died 5 years into their marriage, at age 41. She was devastated. They had no children. She went on to marry another man but her second marriage failed and she had no children. She got married for a third time and but still had no children. Now in her mid-sixties, and without any children, she still misses her first husband.

Case 7
An illiterate mother of 7 and grandmother of 52 married at age 18. A pretty young slim lady, she stayed home to cook and look after the family while her husband worked. Without proper knowledge about diabetes, she overate and suffered from chronic diabetes. She was diagnosed of diabetes at age 31, following the birth of her last child. In her 40s, 50s, and 60s, her diabetic status worsened as diabetic complications appeared one after another. She was obese beginning in her 30s. She was easily tired, her vision was poor and her body was constantly in pain. Her knees would swell which further reduced her mobility. She was constantly in and out of hospital for fatigue and loss of appetite (LOA). In her mid-60s, she was confined to a chair from morning till night, hardly ever moving about in the house. She would call on her children or grandchildren for anything she needed, including her drink and insulin injection. She had an intraocular lens (IOL) installed for her badly clouded eye lens so she could see, but that also later failed her - she was apparently 'blind'.  She consumed local herbs and preparations to help control her diabetes. She had no diabetic sores nor lesions. Her skin was clean, smooth, and well-hydrated. However, she had a big scar from a previous boil on her buttock. She died of heart attack one morning in her son's lap, aged 65. 

Case 8
A illiterate mother of 12 suffered from stroke and was looked after by one of her daughters. In her young life, she had married at age 12 and stayed at home to look after her family. She sold satay as a source of income in her middle age and late life. Before the onset of her stroke, she was visiting her youngest daughter and had consumed 1 kilo of green sour mangoes which she craved. Then she went to bed for her afternoon nap (siesta). When it was time for her to wake up for her evening prayer, she could not move - stroke had struck her. Her children panicked. Nothing her children did could make her snap out of her stroke condition. As days passed, she became overly depressed. One of her daughters and family helped to nurse her for life - feeding her soft food and whatever they knew of her favourite foods. However, she refused to eat and lost weight - still depressed. She became angry with herself and refused to eat. With a big frame and a wasted body (still heavy), she died 2 years after her stroke, apparently still depressed.


Effects of cholesterol on the body:
http://www.healthline.com/health/cholesterol/effects-on-body
http://www.healthline.com/health/high-cholesterol?ref=global

Health24

Health24 is a useful website that has many simple articles and health calculators to help readers update themselves about their own health. It also features updates on many conditions that affect most of us as we age.

http://www.health24.com/Medical/Heart

Uses of Honey

Honey has many uses and purposes - culinary, health, medical and Sunnah.

Culinary
It is used in cooking to supplement or replace sugar. Honey is used for making a basting paste to obtain a shiny chicken skin when roasting, baking and making BBQ chicken or chicken satay. Honey is also used to sweeten hot drinks such as plain tea, lemon tea, hot cocoa, and many other hot drinks.

Health
Honey is used widely in healthcare products. It is used in soaps, shampoos, lotions, and creams.

Honey is an ingredient in baby milk formula. Even if a baby milk formula does not contain honey, it can be added while re-constituting the milk powder. Honey must not be given to babies under age 1 year as they cannot defend themselves against bacterial spores and toxins in raw honey. Honey for babies must be cooked - eg honey in cereals.

Honey is an ingredient in many Malay traditional healthcare products. Honey is mixed with warm water and cinnamon powder added to make a health drink. This is taken twice a day - once in the morning on an empty stomach, and again at night before sleep. This is supposed (believed) to get rid of all kinds of ailments, including heart disease, diabetes, and cancers - including brain and breast cancers.

Cold sweet honey-lemon drink, as served by Secret Recipe, is a good stopper for tummy upset and traveller's diarrhoea. One tall glass of cold sweet honey-lemon is sufficient to abruptly stop abdominal discomfort and travellers can then travel safely to their destinations. Airport cafes and good airlines should try and consider to serve this cold sweet honey- lemon drink to their clients.

Medical
Pure honey has been applied to help heal wounds following surgery. It only works when in the pure form. It contains hydrogen peroxide which will effectively kill bacteria.

Sunnah
For Muslims, honey is a food ingredient consumed by Prophet Muhammad SAW. Please refer to texts written by Muslim nutritionists, healthcare providers, researchers, and doctors on uses of honey.

External links
http://www.webmd.com/diet/features/medicinal-uses-of-honey

Interstitial Lung Disease (ILD)

An apparently healthy looking 8-month-old baby girl has been in hospital since birth. She was in Intensive Care Unit (ICU) for six months and was moved to the open ward since then.

She has lung and breathing problems. She has shortness of breath - she breathes short rapid breaths. The lungs dip at the apex on the skin surface as she breathes.

Interstitial lung disease is suspected (ILD). However, no lung biopsy is planned.

She is dependent on external oxygen supply and cannot go off oxygen supply for long periods, or she will become cyanosed. She can be propped up, but not for long.

Doctors advised the mother to have her name changed. The baby's name was changed since 3 babies shared the same name and the other two had died while in ICU.

She is fully breastfed on expressed breast milk (EBM). At 8 months, she is old enough and should be weaned off breastmilk and semi-solid food should be introduced.

She is the youngest of 6 siblings. The eldest and youngest being girls. The sibling before her is now 3 years old. The mother is 42 years old (peri-menopausal), and is number 5 of 9 siblings.

Where do we go from here?

External links:
http://www.webmd.com/lung/interstitial-lung-disease
http://www.onhealth.com/interstitial_lung_disease/article.htm

Prof 1 Viva 17July2014

Students who scored 70% marks and above, are called for a distinction viva. The viva panel consists of 3 lecturers, one from each discipline - Anatomy, Biochemistry, and Physiology. There are usually 27-30 A-students, and they are divided into 3 groups. There are 3 groups of panel examiners.

To obtain a distinction in the viva, students had to pass all 3 components of the viva - Anatomy, Physiology and Biochemistry. The panel must come to a unanimous verbal decision whether you get/don't get a distinction.

Group A panel comprised Prof Musalmah Mazlan (Biochemistry, External Examiner, UiTM), Dr Nurul Aiman Mohd Yusof (?) and Dr Liza Nordin (?). Observer: Dr Amida Mohd Safuwan.

Group B panel comprised myself (Biochemistry), Dr Mohd Asnizam Asari (Anatomy), and Dr Ainul Bahiyah Abu Bakar (Physiology). Observer: Dr Nazlahshaniza Shafin.

Group C panel comprised Dr Asma' Hj Hassan (Anatomy), Assoc. Prof. KNS Sirajudeen (Biochemistry), and Dr Che Badariah Ab Aziz (Physiology). Observer: Dr Md Rizman Md Lazim.

My panel interviewed 8 students and we decided not to give any distinction to any of our students as none met our expectations.


Anatomy 

1. Bone specimen. The bone specimen was 2 vertebrae. The students were asked various parts of the vertebrae and what lies in the spinal canal. 
2. Spleen. The students were asked relations to the spleen.

Physiology

1. Thyroid. The students were asked about the thyroid hormones, their syntheses and iodine deficiency. 
2. Goitre. The students were asked about the etiology of goitre.

Biochemistry

1. Macromolecules. There are 4 terms - biomolecules, macromolecules, micromolecules, micronutrients. Biomolecules are all the molecules in our body, ie biological molecules. Macromolecules are large molecules in our body, ie proteins, lipids, carbohydrates, and nucleic acids (DNA and RNA). Amino acids are monomers for proteins. Amino acids are not macromolecules, but proteins are. Fatty acids are components of triglycerides, phospholipids and cholesteryl esters. Fatty acids are not macromolecules, but triglycerides, phospholpids, and cholesteryl esters are. Nucleotides are components of nucleic acids. Nucleotides are not macromolecules, but DNA and RNA are. Micromolecules are small molecules in our body, ie glucose, amino acids, glycogen, acetyl CoA, pyruvate, citrate, etc. Micronutrients are substances that are needed in small quantities by the body, ie vitamins, trace metals, and essential fatty acids (EFA).
2. Metabolism. This time I asked about lipid metabolism (the other 2 choices are protein metabolism and carbohydrate metabolism). I asked about fat metabolism during fasting. Triglycerides are lipid storage molecules in adipose tissues found under the skin and spaces in between organs. There are 2 stages of how we obtain energy during fasting - an early stage and a latter stage. In the early stage, there is glycolysis and protein breakdown. In the latter stage, there is fat mobilisation and ketolysis as energy sources. I asked the students to start with fat mobilisation; some have problems recalling the processes for energy sources during fasting. Triglycerides are complex lipids; they need to be broken down first before the body can use it as an energy source. Triglycerides are hydrolysed by hormone sensitive lipase (HSL) in a stepwise fashion, first to diglyceride (DG), then monoglyceride (MG) and finally to glycerol (G) and free fatty acids (FFA). Fat mobilisation is the breakdown and movement of simple lipids (fatty acids and glycerol) from adipose tissue to the liver, via albumin as a carrier protein. Ketolysis is the breakdown of ketone bodies from muscle and liver, and subsequent oxidation of ketone bodies in the liver. In the long term, the body utilises FFA and ketone bodies as an energy source. Some students prioritised that brain prefers glucose as an energy source, and can't utilise ketone bodies because of the blood-brain barrier (BBB).
3. Hormones. I asked how is blood glucose controlled. Most answered by 2 hormones, insulin and glucagon. I then asked what are the actions of insulin. Some accidentally said insulin raised blood glucose! Most could answer well about the mode of action of insulin. I also asked about the action of glucagon. Many could not answer about action of glucagon. I think students don't know or can't recall that glucagon is considered a counter-regulatory hormone, ie its actions are the opposite of those of insulin. I asked what are the causes of diabetes. Some answered well, but some explained the pathophysiology wrongly. 
4. Cancer. I asked about cancer - causes (DNA mutation, uncontrolled mitosis), treatment (surgery, radiotherapy, chemotherapy), and anti-cancer drugs (enzyme inhibitors). I asked about causes of cancer and some students mentioned DNA mutation. I probed about the nature of the DNA mutation, how the mutation occurs and the nature of DNA damage. I asked if the mutations can be corrected or repaired. Many students talked about presence of repair system that corrected the mutation. Some answered something about the cell cycle, disrupted apoptosis and uncontrolled mitosis, leading to cell proliferation. I asked the students whether they have studied and know about enzymes. Some could hardly recall the enzymes. A few students managed to answer well about the 2 types of enzyme inhibition - competitive inhibition and non competitive inhibition.
5. Antioxidants. I asked about antioxidants - what they are and how they function. I asked what are antioxidants. I asked how free radicals cause damage. I probed about reactive oxygen species (ROS) and body's defenses. Some mentioned the antioxidants are glutathione system. Some answered lipid peroxidation affected lipid bilayers, biomembranes. I asked the significance of lipid peroxidation and related changes to lipid bilayer. Some mentioned lipoproteins and LDL oxidation. I asked about lipoprotein composition (PL, FC, CE, and TG). I asked about function of LDL. I asked about what happened to oxidised LDL (oxLDL). Some students mentioned LDL are easily oxidised to oxLDL, which cause plaque at the arterial endothelium, and lead to atherosclerosis (some said arteriosclerosis). I then asked what happened next after atherosclerosis. Some answered heart attack and (myocardial) infarction. Nobody mentioned stroke. Prolonged hyperlipidaemia leads to oxidation of LDL. Oxidised LDL (oxLDL) are small destructive particles as they can easily penetrate the arterial intima and cause harm. The macrophages consumed the oxLDL till they become foam cells and die, leading to changes in the arterial intima and underlying area.

Prof Faridah

Heme vs Hemin

1. What is heme?
A red inorganic molecule.
Is found in rbc.
Is found in hemoglobin (Hb) and myoglobin (Mb); there are 4 hemes in Hb, and 1 heme in Mb.
Carries oxygen by binding; 1 heme binds 1 oxygen molecule.
Makes rbc red.
Makes blood appear bright red.

2. What is hemin?
A black inorganic molecule formed by heme oxidation (exposure to air).
Is found when rbcs burst open (lysed, destroyed) and exposed to oxygen in the air.
Formed from heme upon long standing outside the body.
Is formed in vitro.
Makes blood appear dark.

3. Are heme and hemin the same?
No.
Heme is functional when present inside intact rbcs.
Hemin is non functional; it is a dysfunctional molecule.

Fresh blood is bright red due to presence of heme in intact rbcs.

Stale blood is dark or black due to presence of hemin. Heme converts to hemin. The longer exposure to air, and greater conversion to hemin, the darker the blood.

External links:
http://en.wikipedia.org/wiki/Hemoglobin
http://en.wikipedia.org/wiki/Myoglobin