- So according as the uric acid is increasing this leads to Gout and nephrolithiasis.
- 90-100% of patients get megaloblastic anemia ( because as we know purine is essential for DNA synthesis).
- and there are a lot of manifestations in the brain starting from the childhood, self mutilation behavior which is characteristic feature, dystonic movements and others.

Decrease in purine in the brain leads to decrease in the synthesis and receptors of the dopamine, but remained dopamine receptors become super sensitive.. and that explains these self mutilation behaviors.

It contains 75 mg risankizumab in 0.83 mL solution.

Risankizumab belongs to a class of drugs known as monoclonal antibodies. It works by blocking a certain natural protein in the body (interleukin-23) that may cause inflammation and swelling.

Iron overload can occur in the setting of cirrhosis due to the liver's inability to produce enough hepcidin

Hepcidin reduces serum iron levels by:-

- Reducing iron absorption in the gut.
- Reducing iron release from the liver.
- Trapping iron inside the reticuloendothelial cells (macrophages), especially those in the spleen.

Hepcidin is produced in the liver in response to many triggers like:-

- Increased iron stores in the body.
- Inflammation and chronic disease (it's a positive acute-phase protein).
- Genetic mutation (as in hereditary hemochromatosis).

It blocks, and down-regulates the ferroportin receptor (which transports iron from inside to the outside of the cells). Ferroportin is expressed in hepatocytes, macrophages, and enterocytes, among others.

يعني ببساطة
الـ hepcidin يقلل كمية الحديد بالدم ويقلل إمتصاصه من الأمعاء.

لهذا من ينفرز بشكل كبير (بحالات الـ inflammation) رح يقلل نسبة الحديد بالجسم ويتسبب بفقر الدم الناتج من نقص الحديد. هاي نشوفها بأمراض هواي، من ضمنها الفشل الكلوي (ESRD) وهالشي يفسر ليش مرضى الفشل الكلوي صعب نعالج نقص الحديد اللي عدهم باستخدام الـ oral supplements (لأن الـ hepcidin، اللي ديزيد إفرازه بسبب المرض، يمنع إمتصاص الحديد أصلًا)

بينما من ينفرز بكميات قليلة، مثلًا بحالات أمراض الكبد و hemochromatosis الوراثي، رح تزيد نسبة الحديد بالجسم ويترسب بالأعضاء مثل الكلية والقلب وغيرها.

TIBC (Transferrin) & Ferritin are both acute-phase proteins, so they must be adjusted to the CRP values.

What are acute-phase proteins?

I have a question sir

Can we give them iron infusion instead of oral supplements?

Yupp, bcuz IV will bypass the enterocytes

sister mary joseph nodule
It’s basically hemorrhagic nodule due to distal malignant metastasis via lymphatics.

I literally can't see where the problem is in occulta😂

There’s only a small gap in the spine.
It’s hidden and asymptomatic but later may appear as dimpling on the skin or could be discovered by x-ray.