Fila table (PBL 2) (Qila)

PBL 2 (BIOCHEMISTRY)
DATE: 16/12/2019 TIME: 8:00 - 11:00AM
GROUP PBL: GROUP 5

NO	NO MATRIC	NAME
1	72590	NURIN NAJIHAH BINTI NOR AZAMIR
2	72020	YVONNE CHEW YIN SHI
3	70565	MUHAMMAD AMERULL SYAFIQ BIN MOHD ZAINAL
4	72472	NOOR AISHAH NABILAH BT SHAHRANI
5	69456	DAYANG HASMIERRA BINTI MOHD HASSAN
6	70878	NUR AQILAH SYAFIQAH BINTI SUHEIMY
7	72621	NURUL NABILAH BINTI KHAIRUDIN
8	71921	WAI CHEE SIONG
9	69946	JASMINE TANG YING YING

FILA Table

Facts	Ideas	Learning Outcome	Action
1. A 23-year old man developed an irregular heart rhythm, complained lethargy, tremor of hands and arms.	1. How to detect irregular heart rhythm?	Able to feel – heart skipped a beat or added a beat. Beating too fast – tachycardia, beating too slow – bradycardia. Tests – Electrocardiogram, Holter monitor, event monitor, stress test, echocardiogram, cardiac catheterization, electrophysiology study (EPS), head-up tilt table test.	Did researches online. Held discussion meetings atAllamanda’sstudy room. Share our findings among team members.
	2. Whatcausesirregular heart rhythm?	• Coronary artery diseases Artery is the main pathway to transport oxygen and nutrients. But fat, cholesterol and calcium can build up a layer of plaque in artery to block the pathways. The pressure in the artery will increase because the diameter of lumen decreases. It can lead to arrythmias. • Heart surgery Although heart surgery can remove the plaque inside the heart, but it will change the way of the way of the heart to work. The heartbeat will be different and not regular. • Changes in heart muscle When heart attack happens before that mean we got scar tissue in the heart muscles. This scar will change the beat of the heart by restricting or changing the heart. It will also lead to abnormality of the heart because the heart will swell and hard to pump the blood. • Electrolyte imbalances Electrolyte is in small trace of metal, but it will provide electricity for the heart to beat. If too much or too few of the electrolyte will give the effect to the heartbeat.

1. A 23-year old man developed an irregular heart rhythm, complained lethargy, tremor of hands and arms.

3. How to treat irregular heart rhythm?

Arrhythmia, irregular heart rhythm, which means heart beating too fast, too slow or at abnormal pattern (Mayo Clinic, 2019). Treat slow heartbeat (bradycardias) – using the pacemaker. Pacemaker is a tiny device that will be implanted at the collarbone. The function of the pacemaker is it will send out electrical impulses to give the heart it is normal beating again (Mayo Clinic, 2019). To treat fast heartbeat (tachycardias) – with vagal maneuvers such as dunking your face in ice water or coughing (Mayo clinic, 2019). Medications which is anti-arrhythmic medication. Cardioversion (Mayo clinic, 2019). Catheter ablation (Mayo clinic, 2019). Doctor will thread one or more catheters through blood vessel to heart. Irregular heartbeats can be treated by using implantable cardioverter-defibrillator (ICD) (Mayo clinic, 2019). It will detect the abnormal heart rhythm and send two kinds of energy shock which is low or high energy shock so it will make the heart back to normal rhythm. Maze procedure (Mayo clinic, 2019). The surgeon will make a surgical incision in heart tissue to make a maze of scar tissue. This is because scar tissue cannot conduct electricity, it will interfere the electric flow throughout the heart. Coronary bypass surgery (Mayo clinic, 2019). This surgery will improve the blood flow to heart.

Did researches online. Held discussion meetings atAllamanda’sstudy room. Share our findings among team members.

1. A 23-year old man developed an irregular heart rhythm, complained lethargy, tremor of hands and arms.	4. Whatcauseslethargy?	Many kinds of acute illnesses can make you feel lethargic. This includes the flu or a stomach virus. Other physical or medical conditions can also cause lethargy, such as: carbon monoxide poisoning, dehydration, fever hyperthyroidism, hypothyroidism hydrocephalus or brain swelling kidney failure, Lyme disease, meningitis pituitary diseases, such as pituitary cancer nutrition deficiencies sleep apnea stroke traumatic brain injury Lethargy can also be the result of mental health conditions. These include: major depressive disorder postpartum depression premenstrual syndrome (PMS) Lethargy can also be a side effect of taking certain medications, such as narcotics.	Did researches online. Held discussion meetings atAllamanda’sstudy room. Share our findings among team members.
	5. How to treat lethargy?	Treatment for lethargy depends upon its underlying cause. For example, they may prescribe antidepressants if your lethargy is caused by depression or another mental health disorder. You can practice healthy habits at home to reduce the fatigue related to lethargy. Examples include: drinking plenty of fluids eating a healthy diet getting plenty of sleep reducing stress levels Make an appointment with your healthcare provider if these healthy habits do not help your symptoms.

1. A 23-year old man developed an irregular heart rhythm, complained lethargy, tremor of hands and arms.	6. Whatcausestremorof hands and arms?	Caused by metabolism problems and toxins (alcohol) that affect brain and nervous system. Psychiatric conditions, such as depression or post-traumatic stress disorder. Inherited degenerative disorders, such as hereditary ataxia or fragile X syndrome Caffeine, mercury poisoning hyperthyroidism, or an overactive thyroid liver or kidney failure anxiety or panic	Did researches online. Held discussion meetings atAllamanda’sstudy room. Share our findings among team members.
	7. How to treat tremor of hands and arms?	Lifestyle changes• Limiting or avoiding substances that can cause tremors, such as caffeine and amphetamines Physical therapy Improve muscle control, functioning, and strength while enhancing coordination and balance. Help people continue to engage in daily activities. Psychological techniques • Anxiety or panic - practice relaxation techniques, such as breathing exercises. Essential tremor treatments For essential tremor, a doctor may prescribe beta-blockers, such as propranolol, metoprolol, or nadolol. A doctor may also recommend anti-seizure medication, such as primidone.

1. A 23-year old man developed an irregular heart rhythm, complained lethargy, tremor of hands and arms.	7. How to treat tremor of hands and arms?	Parkinson's disease treatments• Doctors often prescribe disease-specific drugs, such as levodopa and carbidopa, to manage advanced cases. MS treatments• Beta-blockers, anti-anxiety drugs, and anticonvulsive medications are among the treatment options for people with MS-related tremors. Tremors with no obvious cause• If doctors cannot determine the cause of tremors, they may prescribe tranquilizers. Some may prescribe injections of botulinum toxin, or Botox, though these can lead to weakness in the fingers.	Did researches online. Held discussion meetings atAllamanda’sstudy room. Share our findings among team members.
	8. Is it normal if a young person shows such symptoms?	Uncommon in young adults who are not being treated for diabetes. May be due to varied or multiple etiologies – food restriction. Develop symptoms associated with hypoglycemia, if fail to get a regular intake of energy throughout the day. Prolonged time between meals can make them shaky, irritated, unable to concentrate and sweaty. General reason for these experiences is stress.

2. He complained about anxiety, sweating and hunger.

1. Why is he experiencing anxiety, sweating and hunger?

• Anxiety, sweating, and hunger is a few of signs and symptoms that happen when blood sugar levels become too low. Anxiety • • • An abnormally high activity of noradrenergic and/or serotoninergic neuronal pathways, all originating in the lower brainstem has been proposed by various authors to be critical for the activation of neuronal networks generating anxiety. An abnormal neuronal activity of the nonconvulsive type in the limbic system generates the emotion of anxiety and the accompanying behavioral, autonomic, and motor symptoms. A central role is suggested for gamma-aminobutyric acid (GABA), which normally prevents those types of neurons possessing the inherent properties for paroxysmal activity to respond with epileptiform activity to normal or excessive stimuli. The GABA receptor/chloride channel complex with its regulatory sites may be the site of a primary biochemical functional lesion. Sweating• A heat loss thermoeffector is indispensable for proper thermoregulation. • Efferent signals from the pre-optic hypothalamus travel via the tegmentum of the pons and the medullary raphe regions to the intermediolateral cell column of the spinal cord. In the spinal cord, neurons emerge from the ventral horn, pass through the white ramus communicans and then synapse in the sympathetic ganglia. Postganglionic non-myelinated C-fibers pass through the gray ramus communicans, combine with peripheral nerves and travel to sweat glands, with these nerve fibers “entwined around” the periglandular tissue of the eccrine sweat gland.

Did researches online. Held discussion meetings atAllamanda’sstudy room. Share our findings among team members.

2. He complained about anxiety, sweating and hunger.	1. Why is he experiencing anxiety, sweating and hunger?	Hunger. • When our bodies have burned up the food in our stomachs and our blood sugar and insulin levels begin to drop, ghrelin communicates with the hypothalamus in the brain. The hypothalamus, housed in the deep center portion of our brain cavity, regulates our basic body functions such as thirst and sleep. Once it receives the message, delivered by ghrelin, that we need to eat something to keep our bodies running, the hypothalamus triggers the release of neuropeptide Y, which stimulates our appetites .	Did researches online. Held discussion meetings atAllamanda’sstudy room. Share our findings among team members.
3. Biochemical investigation on blood revealed blood sugar levels is 2.7 mmol/L.	1. What is the normal level of blood sugar?	Less than 100 mg/dL after not eating (fasting). Less than 140 mg/dL two hours after eating. Levels tend to be at their lowest just before meals. Before meals hover around 70 to 80 mg/dL, normally. For some people, 60 is normal; for others, 90 is the normal.
	2. Why are his blood sugar level drops?	A. Possible causes, with diabetes May not make enough insulin (type 1 diabetes). May be less responsive to it (type 2 diabetes). Glucose tends to build up in the bloodstream. May reach dangerously high levels. Solution: take insulin or other drugs to lower blood sugar levels. Too much insulin or other diabetes medications may cause your blood sugar level to drop too low, causing hypoglycemia. Did not eat as much food as usual after taking diabetes medication. Exercise more than you normally would.

3. Biochemical investigation on blood revealed blood sugar levels is 2.7 mmol/L.

2. Why are his blood sugar level drops?

B. Possible causes, without diabetes Medications - taking oral diabetes medication accidentally. Especially in children or in people with kidney failure. Example: quinine (Qualaquin), which is used to treat malaria. Excessive alcohol consumption without eating. Can block your liver from releasing stored glucose into your bloodstream, causing hypoglycemia. Severe illnesses of the liver, such as severe hepatitis. Cannot keep body from properly excreting medications. Long-term starvation, eating disorder anorexia nervosa, can result in the depletion of substances your body needs to generate glucose (gluconeogenesis). Insulin overproduction, can be caused by rare tumor of the pancreas (insulinoma) may cause overproduction of insulin, resulting in hypoglycemia. Other tumors may result in excessive production of insulin-like substances. Enlargement of beta cells of the pancreas that produce insulin (nesidioblastosis) may result in excessive insulin release, causing hypoglycemia. Hormone deficiencies. Certain disorders of the adrenal glands and the pituitary gland can result in a deficiency of key hormones that regulate glucose production. Children may experience hypoglycemia if they have a deficiency of growth hormone.

Did researches online. Held discussion meetings atAllamanda’sstudy room. Share our findings among team members.

3. Biochemical investigation on blood revealed blood sugar levels is 2.7 mmol/L.

3. Cause and treatment for hypoglycemia?

Hypoglycemia is caused by low level of blood sugar (glucose). This occurs when blood sugar is less than 70mg/dL. It is also a side effect of insulin or other types of diabetes medication that produces insulin for the body. The two types of medication that causes hypoglycemia are sulfonylureas and meglitinides. Sulfonylureas and meglitinides inhibits ATP-sensitive potassium channels in pancreatic beta cells membranes. These potassium channels allow potassium efflux from the cells. Overdose of these medications will lead to high intracellular potassium levels, which causes depolarization. This leads to calcium influx, which activates the secretory system that releases insulin. Treatments: According to the 15-15 rule: have 15 grams of carbohydrates to raise blood sugar and check blood sugar levels after 15 minutes. Repeat these steps until blood sugar is at least 70mg/dL. Once blood sugar is back to normal eat a meal to ensure it doesn’t lower again. Glucose tablet Gel tube 1⁄2 cup of juice or regular soda (not diet) 1 tablespoon of sugar, honey, or corn syrup

Did researches online. Held discussion meetings atAllamanda’sstudy room. Share our findings among team members.

Reference
Barrell, A. (2018). What does it mean if you have shaky hands? Retrieved from
https://www.medicalnewstoday.com/articles/322195.php#what-is-a-tremor

Burgess, L. (2018). Can you have hypoglycemia without diabetes? Retrieved from
https://www.medicalnewstoday.com/articles/322744.php

Conger, C. (n.d.). How food cravings work. Retrieved from https://science.howstuffworks.com/innovation/edible-innovations/food- craving5.htm

Haefely, W. (1985). Biochemistry of anxiety. Ann Acad Med Singapore, 14(1), 81-83. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/2988406

Health and wellness articles. 4 reasons behind irregular heartbeat. Retrieved from https://www.geisinger.org

Low, P. A. (2012). Sweating. Primer on the Autonomic Nervous System, 3. Retrieved from
https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/sweating

Mayo Clinic, Mayo Foundation for Medical Education and Research. (2019). Heart arrhythmia. Retrieved from
http://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/diagnosis-treatment/drc-20350674

Mayo Clinic, Mayo Foundation for Medical Education and Research. (2018). Hypoglycemia. Retrieved from
https://www.mayoclinic.org/diseases-conditions/hypoglycemia/symptoms-causes/syc-20373685

Shibasaki, M., & Crandall, C. G. (2010). Mechanisms and controllers of eccrine sweating in humans. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866164/