Metabolic diseases

This study was performed with the aim of determining the diagnostic profile of newborns with hypotonia and of analyzing the usefulness of different procedures in the diagnostic process. One hundred thirty-eight hypotonic newborns were identified through the search of hospital records in a 10-year period: 121 (88%) had central hypotonia and 13 (9%) had peripheral hypotonia, whereas 4 (3%) remained unclassified. Analysis of the contribution of clinical data and results of investigations led to the construction of an algorithm, by which all cases in the group were diagnosed. Step 1, which included clinical data and results of examinations, solved 50% of all diagnosed cases. Neuroimaging techniques made up step 2 and contributed to the diagnosis in 13%. Step 3 was accomplished by a search through Oxford Medical Databases, which yielded the final diagnosis in 9%, whereas karyotyping and fluorescent in situ hybridization for Prader-Willi syndrome comprised step 4 and contributed to the di...

Cardiovascular risk is poorly managed in women, especially during the menopausal transition when susceptibility to cardiovascular events increases. Clear gender differences exist in the epidemiology, symptoms, diagnosis, progression, prognosis, and management of cardiovascular risk. Key risk factors that need to be controlled in the peri-menopausal woman are hypertension, dyslipidaemia, obesity, and other components of the metabolic syndrome, with the avoidance and careful control of diabetes. Hypertension is a particularly powerful risk factor and lowering of blood pressure is pivotal. Hormone replacement therapy is acknowledged as the gold standard for the alleviation of the distressing vasomotor symptoms of the menopause, but the findings of the Women's Health Initiative (WHI) study generated concern for the detrimental effect on cardiovascular events. Thus, hormone replacement therapy cannot be recommended for the prevention of cardiovascular disease. Whether the findings of WHI in older post-menopausal women can be applied to younger peri-menopausal women is unknown. It is increasingly recognized that hormone therapy is inappropriate for older post-menopausal women no longer displaying menopausal symptoms. Both gynaecologists and cardiovascular physicians have an important role to play in identifying peri-menopausal women at risk of cardiovascular morbidity and mortality and should work as a team to identify and manage risk factors such as hypertension.

Endocrine dysfunction and parameters of metabolic syndrome were assessed in 91 patients aged 4.3-32.5 years who underwent allogeneic or autologous BMT in childhood. Final short stature, found in five of the 35 patients who attained final height, was associated with the underlying disease (specifically, Fanconi anemia) (P ¼ 0.0013), previous cranial irradiation (P ¼ 0.0007), type of conditioning irradiation (Po0.05) and allogeneic BMT (P ¼ 0.05). Growth hormone deficiency (n ¼ 10) was associated with previous cranial irradiation (Po0.005) and conditioning total body irradiation (Po0.001). Twelve patients had primary hypothyroidism, one had hyperthyroidism and one papillary thyroid carcinoma. Hypothyroidism was associated with neck/mediastinal (Po0.005) and conditioning irradiation (Po0.05). Primary gonadal failure was found in 24 of the mature patients (62.5% females). Hypogonadism was associated with the underlying disease (especially hematological malignancies) (Po0.05), pretransplant treatment (Po0.05), irradiation conditioning (Po0.001), older age (Po0.005) and advanced pubertal stage at BMT (Po0.05). Obesity (body mass index 42 s.d.) was found in 4.4% and type II diabetes and impaired glucose tolerance in 3.3% each. Dyslipidemia was found in 27.9% of the 43 patients tested. These findings emphasize the need for long-term follow-up of endocrine and metabolic parameters in young patients after BMT in order to offer proper treatment and improve quality of life.

One of the aims of this research work is the isolation and identification of various constituents of two medicinally important plants (Iris loczyi and Iris unguicularis). Secondly, the prime aim is the biological evaluation of these natural products to discover new potential inhibitors of α-glucosidase enzyme and protein glycation. Main methods: Plants of the genus Iris contain a variety of secondary metabolites. Chromatographic techniques were applied for the isolation of different compounds from Iris loczyi and Iris unguicularis. All the isolated compounds were screened for their α-glucosidase enzyme inhibition and antiglycation potential. Key findings: It is shown in the results that two compounds (Kaempferol and 8-Methoxyeriodictyol) isolated from plant Iris unguicularis and compounds (Arborinone and 5,7-dihydroxy-2′,6-dimethoxyisoflavone) isolated from plant Iris loczyi possess promising activity against α-glucosidase enzyme as compare to acarbose which is used as a standard α-glucosidase inhibitor in this study. A flavanone (2′,5-dihydroxy-6,7-methylenedioxy) isolated from Iris loczyi was explored as most active anti-glycating agent. Significance: α-Glucosidase enzyme is a therapeutic target to treat carbohydrate mediated diseases. In this study various inhibitors of α-glucosidase are identified which might be important for the management of diabetes. Similarly, antiglycation agents may have application for the management of late diabetic complications.

Purpose: This communication reports skeletal pathology in a Pleistocene endemic deer from the Mavromouri caves of Crete. Materials: 287 bones and bone fragments from Mavromouri caves are compared to 2986 bones from Liko Cave. Methods: Bones were evaluated macroscopically, and measurements were made of morphometric characteristics of limb long bones. Representative bone specimens were examined radiographically and histologically. Results: Macroscopic hallmarks were loss of bone mass and increased porosity. The long bones were brittle, some of them having thin cortices, and others reduction of medullary cavities that contain dense Haversian tissue. The flat bones were spongy and fragile. Erosions of the metaphyses and articular surfaces were noted. Histological findings included: sub-periosteal resorption; loss of lamellar bone; enlargement of vascular canals; and re-modeling of cortical bone. Two types of fibrous osteodystrophy were recognized in skeletal remains, subostotic and hyperostotic. Conclusions: The deer of Mavromouri caves were affected by severe metabolic bone disease, likely nutritional secondary hyperparathyroidism. We hypothesize a multifactorial cause, including overgrazing, flora senescence, soil mineral deficiencies, and a prolonged period of climate extremes, degrading the Cretan deer habitat. Value: This is the first evidence of a metabolic bone disease causing this level of destructive pathology in an insular fossil deer. Limitations: The lack of absolute chronometric dates for the site limits potential linking with the prevailing environmental conditions. Suggestions for further research: Investigation of similar skeletal pathologies at other islands or isolated habitats is advised.

The need for performing clinical trials to develop well-studied and appropriate medicines for inherited neurometabolic disease patients faces ethical concerns mainly raising from four aspects: the diseases are rare; include young and very young patients; the neurological impairment may compromise the capability to provide 'consent'; and the genetic nature of the disease leads to further ethical implications. This work is intended to identify the ethical provisions applicable to clinical research involving these patients and to evaluate if these cover the ethical issues. Three searches have been Communicated by Peter de Winter

In recent years, advances in epidemiological approaches and laboratory technology, along with the availability of sophisticated imaging methods to evaluate body fat distribution, made it possible to define the close correlation between visceral fat accumulation and the occurrence of metabolic abnormalities, cardiovascular diseases and respiratory disturbances in obese patients. Some 250 y ago, JB Morgagni with the help of only a knife for anatomical dissection, an acute mind, and an observational skillfulness was able to identify the intra-abdominal and mediastinal fat accumulation in android obesity. He clearly described the association between visceral obesity, hypertension, hyperuricemia, atherosclerosis and obstructive sleep apnea syndrome, long before the modern recognition of this syndrome.

In the last year, different diseases possibly linked to Helicobacter pylori infection but localized outside of the stomach have been investigated. There are, in fact, several studies concerning cardiovascular diseases, hematologic disorders, neurologic diseases, metabolic, hepatobiliary diseases, and other conditions. Some of those studies, such as those on sideropenic anemia and idiopathic thrombocytopenic purpura, are quite large and well conducted, while in other cases there are just small or isolated studies or even case reports. Nonetheless, there is much interest among researchers all over the world for such a topic as demonstrated by the large number of studies published in the last year.

“You Are What You Eat; how to win and keep health with diet”, was the title of a book, that nutritionist Victor Lindlahr wrote in
1920s. Since then, several nutritionists have written extensively on this topic. Over the years, scientists, clinicians, policy makers,
and professional societies, have offered contradictory advice of what to eat or what not to eat, and when to eat. In view of the fact,
that my interests are focused on metabolic diseases, I will start this essay with some introduction to metabolism, as it modulates the
activities at molecular, cellular, organ, and total body level. In brief, metabolism is the chemical process your body uses, to transform
the food you eat into the fuel, that keeps you alive and well. Diet and nutrition by and large, consists of proteins, carbohydrates, fats
and a variety of micronutrients. These substance’s when ingested are broken down by enzymes in our digestive system, and then
carried to the cells, where they can be used as fuel. The body either uses these metabolites immediately, or stores them in the liver,
body fat, and muscles for later use. A metabolic disorder occurs, when the metabolic process fails and causes body to have either
too much or too little of the essential metabolites needed to stay healthy. In the ancient science of Ayurveda, the Indian Traditional
Medicine, alterations in metabolism are called “doshas”, meaning metabolic defects. In the holistic approach, attempts are made to
keep these dos has in a perfect balance, so that the risks for various diseases are not developed. All the known metabolic diseases,
such as hypertension, excess weight, endothelial dysfunction, subclinical atherosclerosis, obesity, metabolic syndrome, and type-2
diabetes, have reached epidemic proportions worldwide. In this overview, we will discuss some of the known metabolic alterations
that promote the risks for developing metabolic diseases and present our views on the subject. .

Systemic diseases can present with ocular manifestations to the emergency physician. Although most ocular findings serve to alert the physician to a possible ocular complication, many are different enough to aid the physician in making an obscure diagnosis. Knowledge of the characteristic ophthalmologic manifestations of systemic disease can aid the physician in diagnosing a particular disorder, limit the progression of more common diseases, and prevent further visual loss or blindness in patients with serious ophthalmologic complications.

HIV-infected patients on highly active antiretroviral therapy (HAART) have increased prevalence of a number of chronic metabolic disorders of multifactorial but unclear etiology. These include disorders of lipid metabolism with or without lipodystrophy, insulin resistance, and an increased prevalence of impaired glucose tolerance, diabetes mellitus and cardiometabolic syndrome. While much attention has been focused on the lipid and cardiovascular disorders, few investigations have attempted to characterize the prevalence, incidence, etiology, mechanisms and management of glycemic disorders in HIV patients. In this review, we have focused specifically on a comprehensive assessment of dysglycemia in the context of HIV infection and HAART.

Berberine is a quaternary ammonium salt from the protoberberine group of isoquinoline alkaloids found in such plants as gender Berberis. Berberine is recognised to improve glucose and lipid metabolism disorders and preliminary clinical evidences suggest the ability of berberine to reduce endothelial inflammation improving vascular health, even in patients already affected by cardiovascular diseases, suggesting a possible interesting role of berberine and its metabolites in clinical practice. However, its physicochemical properties, pharmacokinetic, and metabolism are not fully elucidated and contradictory data have been reported. This review provides a summary regarding the pharmacological and biological features of berberine, with a focus on berberine as well as their pharmacologically active metabolites and the different mechanisms underlying their activities in order to clarify the correct use of berberine supplementation, alone or in association with other nutraceuticals, for th...

Lafontan M. Historical perspectives in fat cell biology: the fat cell as a model for the investigation of hormonal and metabolic pathways. For many years, there was little interest in the biochemistry or physiology of adipose tissue. It is now well recognized that adipocytes play an important dynamic role in metabolic regulation. They are able to sense metabolic states via their ability to perceive a large number of nervous and hormonal signals. They are also able to produce hormones, called adipokines, that affect nutrient intake, metabolism and energy expenditure. The report by Rodbell in 1964 that intact fat cells can be obtained by collagenase digestion of adipose tissue revolutionized studies on the hormonal regulation and metabolism of the fat cell. In the context of the advent of systems biology in the field of cell biology, the present seems an appropriate time to look back at the global contribution of the fat cell to cell biology knowledge. This review focuses on the very early approaches that used the fat cell as a tool to discover and understand various cellular mechanisms. Attention essentially focuses on the early investigations revealing the major contribution of mature fat cells and also fat cells originating from adipose cell lines to the discovery of major events related to hormone action (hormone receptors and transduction pathways involved in hormonal signaling) and mechanisms involved in metabolite processing (hexose uptake and uptake, storage, and efflux of fatty acids). Dormant preadipocytes exist in the stroma-vascular fraction of the adipose tissue of rodents and humans; cell culture systems have proven to be valuable models for the study of the processes involved in the formation of new fat cells. Finally, more recent insights into adipocyte secretion, a completely new role with major metabolic impact, are also briefly summarized.

The use of antipsychotic drugs for the treatment of mood disorders and psychosis has increased dramatically over the last decade. Despite its consumption being associated with beneficial neuropsychiatric effects in patients, atypical antipsychotics (which are the most frequently prescribed antipsychotics) use is accompanied by some secondary adverse metabolic effects such as weight gain, dyslipidemia and glucose intolerance. The molecular mechanisms underlying these adverse effects are not fully understood but have been suggested to involve a dysregulation of adipose tissue homeostasis. As such, the aim of this paper is to review and discuss the role of adipose tissue in the development of secondary adverse metabolic effects induced by atypical antipsychotics. Data analyzed in this article suggest that atypical antipsychotics may increase adipose tissue (particularly visceral adipose tissue) lipogenesis, differentiation/hyperplasia, pro-inflammatory mediator secretion and insulin re...

In humans, metabolic complaints may be associated with a failure in one of the body hormone or enzyme systems, a storage disease related to lack of metabolism of secretory products because of the lack of production of a specific enzyme, or the breakdown or reduced activity of some metabolic function. Some of these disorders also occur in poultry, as do other important conditions such as those associated with increased metabolism, rapid growth or high egg production that result in the failure of a body system because of the increased work-load on an organ or system. These make up the largest group of poultry diseases classified as metabolic disorders and cause more economic loss than infectious agents.

INTRODUCTION EXAMINATION of the mental state is essential in evaluating psychiatric patients.1 Many investigators have added quantitative assessment of cognitive performance to the standard examination, and have documented reliability and validity of the several "clinical tests of the sensorium".2*3 The available batteries are lengthy. For example, WITHERS and HINTON'S test includes 33 questions and requires about 30 min to administer and score. The standard WAIS requires even more time. However, elderly patients, particularly those with delirium or dementia syndromes, cooperate well only for short periods.4 Therefore, we devised a simplified, scored form of the cognitive mental status examination, the "Mini-Mental State" (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely. It is "mini" because it concentrates only on the cognitive aspects of mental functions, and excludes questions concerning mood, abnormal mental experiences and the form of thinking. But within the cognitive realm it is thorough. We have documented the validity and reliability of the MMS when given to 206 patients with dementia syndromes, affective disorder, affective disorder with cognitive impairment "pseudodementia"5T6), mania, schizophrenia, personality disorders, and in 63 normal subjects. DESCRIPTION OF THE MMS The MMS is shown in the appendix. Questions are asked in the order listed and scored immediately. The tester (psychiatric resident, nurse, or volunteer) is instructed first to make the patient comfortable, to establish rapport, to praise successes, and to avoid

Glycosylation plays a key role in a wide range of biological processes. Specific modification to a glycan’s structure can directly modulate its biological function. Glycans are not only essential to glycoprotein folding, cellular homeostasis, and immune regulation but are involved in multiple disease conditions. An increased molecular and structural understanding of the mechanistic role that glycans play in these pathological processes has driven the development of therapeutics and illuminated novel targets for drug design. This knowledge has enabled the treatment of metabolic disorders and the development of antivirals and shaped cancer and viral vaccine strategies. Furthermore, an understanding of glycosylation has led to the development of specific drug glycoforms, for example, monoclonal antibodies, with enhanced potency.

All patients were assessed clinically at Agia Sofia Hospital in Athens. They belonged to three unrelated families from different regions of Greece. Their parents were healthy and nonconsanguineous. All pregnancies and perinatal periods were uneventful. Their ...

The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental...

Many proteins in the cell are modified by phosphorylation. Protein phosphorylation can affect catalytic activity, localization of a protein in the cell, protein stability, and the ability of a protein to dimerize or form a stable complex with other molecules. There are several techniques available to find out whether or not a protein is modified by phosphorylation. To understand exactly why a particular protein becomes phosphorylated, it may be necessary to identify precisely which amino acid residues are phosphorylated. These residues can then be changed by site-directed mutagenesis, and the mutant protein can be examined for changes in activity, intracellular localization, and association with other proteins in the cell.

Refeeding syndrome describes a constellation of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved or severely malnourished. Patients can develop fluid and electrolyte disorders, especially hypophosphatemia, along with neurologic, pulmonary, cardiac, neuromuscular, and hematologic complications. We reviewed literature on refeeding syndrome and the associated electrolyte abnormalities, fluid disturbances, and associated complications. In addition to assessing scientific literature, we also considered clinical experience and judgment in developing recommendations for prevention and treatment of refeeding syndrome. The most important steps are to identify patients at risk for developing refeeding syndrome, institute nutrition support cautiously, and correct and supplement electrolyte and vitamin deficiencies to avoid refeeding syndrome. We provide suggestions for the prevention of refeeding syndrome and suggestions for treatment of e...

Abnormalities of calcium, magnesium and phosphorus are common in hospitalized patients. Infrequently patients might present in the outpatient settings with non-specific symptoms that might be due to abnormalities of divalent cation (magnesium, calcium) or phosphorous metabolism. Several inherited disorders have been identified that result in renal or intestinal wasting of these elements. Physicians need to have a thorough understanding of the mechanism of calcium, magnesium and phosphorous metabolism and diagnoses disorders due to excess or deficiency of these elements. Prompt identification and treatment of the underlying disorders result in prevention of serious morbidity and mortality.

Antipsychotic medications can induce cardiovascular and metabolic abnormalities (such as obesity, hyperglycemia, dyslipidemia and the metabolic syndrome) that are associated with an increased risk of type 2 diabetes mellitus and cardiovascular disease. Controversy remains about the contribution of individual antipsychotic drugs to this increased risk and whether they cause sudden cardiac death through prolongation of the corrected QT interval. Although some drug receptor-binding affinities correlate with specific cardiovascular and metabolic abnormalities, the exact pharmacological mechanisms underlying these associations remain unclear. Antipsychotic agents with prominent metabolic adverse effects might cause abnormalities in glucose and lipid metabolism via both obesity-related and obesity-unrelated molecular mechanisms. Despite existing guidelines and recommendations, many antipsychotic-drug-treated patients are not assessed for even the most easily measurable metabolic and cardi...

Copper is essential for many enzymatic reactions and in neurotransmitter biosynthesis. Its deficiency or its excess has consequences on many organs, especially the liver and the brain. The biochemical tests performed in case of suspicion of copper metabolism disorder are difficult to analyse. They include the measurement of serum ceruloplasmin, serum copper and 24h urinary copper excretion. The interpretation must take into account the clinical features. We distinguish mainly: (1) copper deficiency, acquired in malabsorption or in copper diet deficiency, or related to a genetic disease (Menkes disease); (2) copper overload, acquired or from a genetic origin (Wilson disease); (3) aceruloplasminemia, reducing ferroxidase activity leading to iron overload. It is important to diagnose these diseases as some of them have an effective treatment if it is started early enough.

The impact that ''Romanization" and the development of urban centers had on the health of the Romano-British population is little understood. A reexamination of the skeletal remains of 364 nonadults from the civitas capital at Roman Dorchester (Durnovaria) in Dorset was carried out to measure the health of the children living in this small urban area. The cemetery population was divided into two groups; the first buried their dead organized within an east-west alignment with possible Christian-style graves, and the second with more varied ''pagan'' graves, aligned north-south. A higher prevalence of malnutrition and trauma was evident in the children from Dorchester than in any other published Romano-British group, with levels similar to those seen in postmedieval industrial communities. Cribra orbitalia was present in 38.5% of the children, with rickets and/or Grant sponsor: AHRC (''Diasporas, Migration and Identities'' research programme).

Background The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavio...

Many proteins in the cell are modified by phosphorylation. Protein phosphorylation can affect catalytic activity, localization of a protein in the cell, protein stability, and the ability of a protein to dimerize or form a stable complex with other molecules. There are several techniques available to find out whether or not a protein is modified by phosphorylation. To understand exactly why a particular protein becomes phosphorylated, it may be necessary to identify precisely which amino acid residues are phosphorylated. These residues can then be changed by site-directed mutagenesis, and the mutant protein can be examined for changes in activity, intracellular localization, and association with other proteins in the cell.

Purpose A metabolic abnormality such as obesity is a major obstacle in the maintenance of the human health system and causes various chronic diseases including type 2 diabetes, hypertension, cardiovascular diseases, as well as various cancers. This study was designed to summarize the recent scientific knowledge regarding the anti-obesity role of curcumin (diferuloylmethane), which is isolated from the herb curcuma longa, known to possess antiinflammatory activities. However, little is known about its exact underlying molecular mechanisms in the treatment of obesity and metabolic diseases. Furthermore, cell cultures, animal models of obesity, and few human clinical and epidemiological studies have added the promise for future therapeutic interventions of this dietary compound. Methods An electronic search was performed using Science finder, Medline, Scopus, Google scholar and collected English language articles from 2000 to 2010, relating to the role of curcumin in obesity and metabolic diseases. Results Obesity has been classified as a growing epidemic and its associated metabolic disorders are considered a major risk to the health system. Curcumin interacts with specific proteins in adipocytes, pancreatic cells, hepatic stellate cells, macrophages, and muscle cells, where it suppresses several cellular proteins such as transcription factor NF-kB, STAT-3, Wnt/b-catenin and activates PPAR-c, Nrf2 cell signaling pathway. In addition, curcumin downregulates the inflammatory cytokines, resistin and leptin, and upregulates adiponectin as well as other associated proteins. The interactions of curcumin with several signal transduction pathways reverse insulin resistance, hyperglycemia, hyperlipidemia, and other inflammatory symptoms associated with obesity and metabolic diseases. Conclusion The modulation of several cellular transduction pathways by curcumin has recently been extended to elucidate the molecular basis for obesity and obesity-related metabolic diseases. These findings might enable novel phytochemical treatment strategies as well as curcumin translation to the clinical practice for the treatment and prevention of obesity-related chronic diseases. Furthermore, the relatively low cost of curcumin, safety and proven efficacy make it advisable to include curcumin as part of healthy diet.

P arenteral nutrition (PN) has been lifesaving therapy for patients with intestinal failure and one of the greatest discoveries of the twenty-first century. The first patient who received PN was discharged home in 1968 [1]. PN allows delivery of essential nutrients and prolongation of life in patients with nonfunctioning intestinal tract. Patients with permanent dysfunction of intestinal tract, such as short-bowel syndrome, severe Crohn's disease, radiation enteritis, or chronic pseudo-obstruction, may require PN for life. Other patients may require PN temporarily for such conditions as malignancy, severe acute pancreatitis, bone marrow transplantation, perioperative period, and enteric fistulas. It is estimated that approximately 40,000 patients receive PN every year . Several complications of PN have been recognized and some of them can be life threatening. Deficiencies of biotin, selenium, and essential fatty acid were discovered early in PN and eliminated. The complications of PN are divided into mechanical, infectious, and metabolic. Mechanical complications are related to insertion and care of the central venous catheter (CVC). Septic complications are the result of catheter-associated infections. Metabolic complications refer to high or low serum levels of any components of PN solution, liver disease, and metabolic bone disease. PN complications are associated with increased mortality and affect the quality of life of PN patients .