Sickle diabetes

In nephrogenic diabetes insipidus the kidney s ability to respond to AVP is impaired by different causes, such as drugs (e.g. lithium), chronic disorders (e.g. sickle cell disease, kidney failure) or inherited genetic disorders (X-linked or autosomal NDI). This type of diabetes insipidus can not be treated by exogenous administration of AVP or AVP analogues. Instead, diuretics (hydrochlorothiazide combined or not with amiloride) and NSAI (indomethacin) are administrated to ameliorate polyuria. 

Influenza vaccine. Influenza vaccine is recommended annually for children age > 6 months with certain risk factors (including but not limited to asthma, cardiac disease, sickle cell disease, HIV, diabetes see MMWR. 2001 50(RR-4) 1-44), and can be administered to all others wishing to obtain immunity. Children aged <12 years should receive vaccine in a dosage appropriate for their age (0.25 mL if age 6-35 months or 0.5 mL if age >3 years). Children aged <8 years who are receiving influenza vaccine for the first time should receive two doses separated by at least 4 weeks. 

Figure 1-1. Examples ofthe two-way street connecting biochemistry and medicine. Knowledge ofthe biochemical molecules shown in the top part of the diagram has clarified our understanding ofthe diseases shown in the bottom half—and conversely, analyses ofthe diseases shown below have cast light on many areas of biochemistry. Note that sickle cell anemia is a genetic disease and that both atherosclerosis and diabetes mellitus have genetic components.

The trivalent inactivated influenza vaccine can be administered to all age groups and risk populations. It is recommended that the vaccine be administered yearly to children older than 6 months of age at risk for complications from influenza, such as those with asthma, cardiac disease, sickle cell disease, human immunodeficiency virus (HIV) infection, diabetes, and other conditions that compromise respiratory function. Healthy children 6 to 23 months of age should be vaccinated because of the increased risk for influenza-related... 

The 23-valent pneumococcal polysaccharide vaccine is recommended for use in all adults 65 years of age or older and adults less than 65 years who have medical comorbidities that increase the risk for serious complications from S. pneumoniae infection, such as chronic pulmonary disorders, cardiovascular disease, diabetes mellitus, chronic liver disease, chronic renal failure, functional or anatomic asplenia, and immunosuppressive disorders. Alaskan natives and certain Native American populations are also at increased risk. Children over the age of 2 years may be vaccinated with the 23-valent pneumococcal polysaccharide vaccine if they are at increased risk for invasive S. pneumoniae infections, such as children with sickle cell anemia or those receiving cochlear implants. 

Medical indications Chronic pulmonary disease (excluding asthma) chronic cardiovascular diseases, diabetes mellitus chronic liver diseases, including liver disease as a result of alcohol abuse (e.g., cirrhosis) chronic alcoholism, chronic renal failure or nephrotic syndrome functional or anatomic asplenia (e.g, sickle cell disease or splenectomy [if elective splenectomy is planned, vaccinate at least 2 weeks before surgery]) immunosuppressive conditions and cochlear implants and cerebrospinal fluid leaks. Vaccinate as close to HIV diagnosis as possible. 

It is also important to understand the source and significance of genetic variations. The Pima Indians have the highest rates of diabetes in the world Tay-Sachs disease is primarily found in Ashkenazi Jews. Contemporary literature indicates that these differences stem from reproductive isolation, not race. Genetic traits common to persons with sickle-cell disease are related to malaria frequency and not our social view of race. This is why the disease can be found in high frequency in Yemen, West Africa, Greece, and Saudi Arabia. 

A family medical history can identify people with a higher-than-usual chance of having common disorders, such as heart disease, high blood pressure, stroke, certain cancers, and diabetes. These complex disorders are influenced by a combination of genetic factors, environmental conditions, and lifestyle choices. A family history also can provide information about the risk of rarer conditions caused by mutations in a single gene, such as cystic fibrosis and sickle cell anemia. 

The risk factors for vascular dementia are essentially the same as those for stroke and heart attack. They include high blood pressure, heart disease, diabetes mellitus, sickle cell disease, obesity, smoking, alcohol use, depression, and high cholesterol levels. 

Breaches in the integrity of the skin (eczema, trauma or burns) are predisposing factors for infection. Lymphoedema represents a risk for erysipelas. Open complicated fractures are often complicated by chronic osteomyelitis. Patients with diabetes mel-lims have more frequent as well as more severe infections of the skin, soft tissue and of bone. Sickle cell disease predisposes to osteomyelitis. 

Unlabeled Uses Prevention of postoperative deep vein thrombosis (DVT), protection of aortocoronary bypass grafts, reduction of graft loss after renal transplant, treatment of intermittent claudication, sickle cell disease, subarachnoid hemorrhage, diabetic microangiopathy, ischemic heart disease... 

Water Deficiency. This condition occurs when water output exceeds intake. Water is continually losl by way of the lungs, skin, and kidneys and dius a deficiency of body water will occur if a critical minimal supply is not maintained. Decreased intake when water is available is uncommon. Very rarely, a brain malfunction may interfere with one s sense of diirst. Increased output of water can result from many causes. For example, a person with diabetes insipidus who lacks ADH (antidiuretic hormone) or a person whose kidneys do not respond normally to ADH, as in instances of nephrogenic diabetes insipidus, will increase water output Other diseases which may cause excess excretion of water include osmotic diuresis, hypercalcemia, hypokalemia, chronic pyelonephritis, and sickle cell anemia, among others. Excessive water losses are also experienced in some cases with advanced age and in some burn cases. Two clinical features are good measures of dehydration—weight loss of the patient and an elevation of the serum sodium concentration. In situations of dehydration, the body initiates mechanisms which manipulate the transfer of water from one compartment to the next, retaining water in those cells and organs where it is most needed. 

Despite its considerable involvement in metabolic processes, no specific deficiency syndrome in humans has been attributed to vitamin B6 (19,103). A considerable number of nonvitamin functions have been suggested, but they remain controversial (102,103,108-111). These include roles in coronary heart disease, immune response, premenstrual syndrome, sickle-cell anaemia, asthma, autism, gestational diabetes, carpal tunnel syndrome, and cancer. 

Common risk factors for developing branch retinal vein thrombosis (BRVT) and central retinal vein thrombosis (CRVT) include increased plasma fibrinogen, diabetes, decreased exercise, hypertension, and hyperviscosity (205). Sickle cell anemia, polycythemia vera, and other proliferative disorders may also lead to this syndrome. 

Many people, unfortunately, are all too aware of the pickiness of biochemistry. People who suffer with sickle cell anemia, enduring much pain in their shortened lives, know the importance of the little detail that changed one out of 146 amino acid residues in one out of the tens of thousands of proteins in their body. The parents of children who die of Tay-Sachs or cystic fibrosis, or who suffer from diabetes or hemophilia, know more than they want to about the importance of biochemical details. 

Only Wilson s disease is associated with copper metabolism. Sickle cell anemia and acrodermatitis enteropathica are associated with Zn metabolism, and geriatric diabetes, with Cr deficiency. 

Proliferative retinopathy (e.g., proliferative stage of sickle cell, diabetes, retinal vein occlusion)... 

Acute intermittent porphyria Amyloidosis Diabetes mellitus Eclampsia Glycogenosis I Haemochromatosis Reye s syndrome Sickle-cell anaemia Tyrosinaemia, oxalosis Wilson s disease... 

A 56-year-old Nigerian woman, with a previous history of sickle cell trait, osteoarthritis, and non-insulin-dependent diabetes mellitus, took amlodipine 5 mg/day for hypertension for 2 weeks and developed a lichenoid eruption (15). Histological examination confirmed the diagnosis of lichen planus. Amlodipine was withdrawn and there was rapid symptomatic and clinical improvement after treatment with glucocorticoids and antihistamines. 

The immunogenicity and safety of pneumococcal polysaccharide vaccine have been studied in renal allograft recipients, dialysis patients (19), children and adolescents with sickle-cell anemia (SED-11, 682) (SEDA-12, 277), people with diabetes mellitus (SED-11, 682), and children with nephrotic syndrome (20). When comparing the results with healthy persons there were no significant differences. 

Other athrombogenic factors (e.g., anticardiolipin antibodies, thrombocytosis, sickle cell disease, polycythemia, diabetes mellitus, hypercholesterolemia, hyperhomocysteinemia)... 

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