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class="vector-toc-numb">5</span> <span>Diagnosis</span> </div> </a> <button aria-controls="toc-Diagnosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Diagnosis subsection</span> </button> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> <li id="toc-Differential_diagnosis" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Differential_diagnosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1</span> <span>Differential diagnosis</span> </div> </a> <ul id="toc-Differential_diagnosis-sublist" class="vector-toc-list"> <li id="toc-Combined_malonic_and_methylmalonic_aciduria_(CMAMMA)_&_classic_methylmalonic_acidemia" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Combined_malonic_and_methylmalonic_aciduria_(CMAMMA)_&_classic_methylmalonic_acidemia"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1.1</span> <span>Combined malonic and methylmalonic aciduria (CMAMMA) & classic methylmalonic acidemia</span> </div> </a> <ul id="toc-Combined_malonic_and_methylmalonic_aciduria_(CMAMMA)_&_classic_methylmalonic_acidemia-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Treatment</span> </div> </a> <ul id="toc-Treatment-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Note" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Note"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>Note</span> </div> </a> <ul id="toc-Note-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item 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role="presentation"><tbody><tr><td class="mbox-image"><div class="mbox-image-div"><span typeof="mw:File"><a href="/wiki/File:Question_book-new.svg" class="mw-file-description"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/50px-Question_book-new.svg.png" decoding="async" width="50" height="39" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/75px-Question_book-new.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/100px-Question_book-new.svg.png 2x" data-file-width="512" data-file-height="399" /></a></span></div></td><td class="mbox-text"><div class="mbox-text-span">This article <b>needs additional citations for <a href="/wiki/Wikipedia:Verifiability" title="Wikipedia:Verifiability">verification</a></b>.<span class="hide-when-compact"> Please help <a href="/wiki/Special:EditPage/Malonic_aciduria" title="Special:EditPage/Malonic aciduria">improve this article</a> by 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Unsourced material may be challenged and removed.<br /><small><span class="plainlinks"><i>Find sources:</i> <a rel="nofollow" class="external text" href="https://www.google.com/search?as_eq=wikipedia&q=%22Malonic+aciduria%22">"Malonic aciduria"</a> – <a rel="nofollow" class="external text" href="https://www.google.com/search?tbm=nws&q=%22Malonic+aciduria%22+-wikipedia&tbs=ar:1">news</a> <b>·</b> <a rel="nofollow" class="external text" href="https://www.google.com/search?&q=%22Malonic+aciduria%22&tbs=bkt:s&tbm=bks">newspapers</a> <b>·</b> <a rel="nofollow" class="external text" href="https://www.google.com/search?tbs=bks:1&q=%22Malonic+aciduria%22+-wikipedia">books</a> <b>·</b> <a rel="nofollow" class="external text" href="https://scholar.google.com/scholar?q=%22Malonic+aciduria%22">scholar</a> <b>·</b> <a rel="nofollow" class="external text" href="https://www.jstor.org/action/doBasicSearch?Query=%22Malonic+aciduria%22&acc=on&wc=on">JSTOR</a></span></small></span> <span class="date-container"><i>(<span class="date">June 2020</span>)</i></span><span class="hide-when-compact"><i> (<small><a href="/wiki/Help:Maintenance_template_removal" title="Help:Maintenance template removal">Learn how and when to remove this message</a></small>)</i></span></div></td></tr></tbody></table> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Malonic aciduria</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data"><b>Malonyl-CoA decarboxylase deficiency</b>, <b>classic CMAMMA</b></td></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:Malonyl-CoA2.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/7c/Malonyl-CoA2.svg/220px-Malonyl-CoA2.svg.png" decoding="async" width="220" height="72" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/7c/Malonyl-CoA2.svg/330px-Malonyl-CoA2.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/7c/Malonyl-CoA2.svg/440px-Malonyl-CoA2.svg.png 2x" data-file-width="235" data-file-height="77" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data"><a href="/wiki/Malonyl-CoA" title="Malonyl-CoA">Malonyl-CoA</a></td></tr></tbody></table> <p><b>Malonic aciduria</b> or <b>malonyl-CoA decarboxylase deficiency</b> (<b>MCD</b>) is an <a href="/wiki/Autosome" title="Autosome">autosomal</a>-<a href="/wiki/Dominance_(genetics)" title="Dominance (genetics)">recessive</a><sup id="cite_ref-mcdar_1-0" class="reference"><a href="#cite_note-mcdar-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Inborn_error_of_metabolism" class="mw-redirect" title="Inborn error of metabolism">metabolic disorder</a> caused by a genetic mutation that disrupts the activity of <a href="/wiki/Malonyl-Coa_decarboxylase" class="mw-redirect" title="Malonyl-Coa decarboxylase">Malonyl-CoA decarboxylase</a>. This enzyme breaks down <a href="/wiki/Malonyl-CoA" title="Malonyl-CoA">Malonyl-CoA</a> (a fatty acid precursor and a fatty acid oxidation blocker) into <a href="/wiki/Acetyl-CoA" title="Acetyl-CoA">acetyl-CoA</a> and <a href="/wiki/Carbon_dioxide" title="Carbon dioxide">carbon dioxide</a>. </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Malonic_aciduria&action=edit&section=1" title="Edit section: Signs and symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The signs and symptoms of this disorder typically appear in early childhood. Almost all affected children have <a href="/wiki/Developmental_disability" title="Developmental disability">delayed development.</a> Additional signs and symptoms can include weak muscle tone (<a href="/wiki/Hypotonia" title="Hypotonia">hypotonia</a>), <a href="/wiki/Seizure" title="Seizure">seizures</a>, <a href="/wiki/Diarrhea" title="Diarrhea">diarrhea</a>, vomiting, and low blood sugar (<a href="/wiki/Hypoglycemia" title="Hypoglycemia">hypoglycemia</a>). A heart condition called <a href="/wiki/Cardiomyopathy" title="Cardiomyopathy">cardiomyopathy</a>, which weakens and enlarges the heart muscle, is another common feature of malonic aciduria. </p> <div class="mw-heading mw-heading2"><h2 id="Genetics">Genetics</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Malonic_aciduria&action=edit&section=2" title="Edit section: Genetics"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size mw-halign-left" typeof="mw:File/Thumb"><a href="/wiki/File:Autosomal_recessive_-_en.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/f1/Autosomal_recessive_-_en.svg/220px-Autosomal_recessive_-_en.svg.png" decoding="async" width="220" height="382" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/f1/Autosomal_recessive_-_en.svg/330px-Autosomal_recessive_-_en.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/f1/Autosomal_recessive_-_en.svg/440px-Autosomal_recessive_-_en.svg.png 2x" data-file-width="738" data-file-height="1283" /></a><figcaption>Malonic aciduria has an autosomal recessive pattern of inheritance.</figcaption></figure> <p>Malonic aciduria is caused by mutations in the <i><a href="/wiki/MLYCD" class="mw-redirect" title="MLYCD">MLYCD</a></i> gene, located on <a href="/wiki/Chromosome" title="Chromosome">chromosome</a> <a href="/wiki/Chromosome_16" title="Chromosome 16">16q23.3</a>.<sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> The gene encodes the enzyme malonyl-CoA decarboxylase. Within cells, this enzyme helps regulate the formation and breakdown of a certain group of fats called <a href="/wiki/Fatty_acid" title="Fatty acid">fatty acids</a>. </p><p>Many tissues, including heart muscle, use fatty acids as a major source of energy. Mutations in the <i>MLYCD</i> gene reduce or eliminate the function of malonyl-CoA decarboxylase. A lack of this enzyme disrupts the normal balance of fatty acid formation and breakdown. As a result, fatty acids cannot be converted to energy, which can lead to characteristic features of this disorder, such as low blood sugar and cardiomyopathy. By-products of fatty acid processing build up in tissues, which also contributes to the signs and symptoms of malonic aciduria. </p><p>Malonic aciduria is inherited in an autosomal recessive pattern.<sup id="cite_ref-mcdar_1-1" class="reference"><a href="#cite_note-mcdar-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> This means that the defective gene is located on an <a href="/wiki/Autosome" title="Autosome">autosome</a> (chromosome 16 is an autosome), and two copies of the defective gene - one inherited from each parent - are required to be born with the disorder. The parents of a child with an autosomal recessive disorder both carry one copy of the defective gene, but are usually not affected by the disorder. </p><p>Malonic aciduria is extremely rare, evidence suggests that it is caused by the abnormality in the protein transcription regulation.<sup id="cite_ref-:0_3-0" class="reference"><a href="#cite_note-:0-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Looking at the molecular basis, two distinct homozygous mutations are found to cause malonic aciduria in human. The first mutation is the transversion of gene from C to G causing a premature stop signal in the protein. The second mutation is a base pair insertion in the mature RNA that will eventually result in the protein truncation.<sup id="cite_ref-:2_4-0" class="reference"><a href="#cite_note-:2-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p><p>A research has also confirmed that the homozygous mutation which eventually leads to malonic aciduria is caused by the isodisomy of maternal UPD. This indicates that such disease is likely to be inherited from mother’s gene profile, not from paternal source.<sup id="cite_ref-:1_5-0" class="reference"><a href="#cite_note-:1-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Prevalence">Prevalence</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Malonic_aciduria&action=edit&section=3" title="Edit section: Prevalence"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>According to <a href="/wiki/Orphanet" title="Orphanet">Orphanet</a> (2006), the prevalence is less than 1 in 1,000,000.<sup id="cite_ref-:3_6-0" class="reference"><a href="#cite_note-:3-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p><p>In 1984, malonic aciduria was described for the first time in a scientific study.<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p><p>By 1999, only seven cases of malonic aciduria had been reported in human in Australia; however, this deficiency predominately occurs during childhood. Patients from the seven reported cases of malonic aciduria have an age range between 4 days to 13 years, and they all have the common symptom of delayed neurological development.<sup id="cite_ref-:2_4-1" class="reference"><a href="#cite_note-:2-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p><p>By 2006, 17 cases of malonic aciduria had been published in the literature worldwide, ranging in age from 8 days to 12 years.<sup id="cite_ref-:0_3-1" class="reference"><a href="#cite_note-:0-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p><p>By 2017, less than 30 cases were known in the literature.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Pathophysiology">Pathophysiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Malonic_aciduria&action=edit&section=4" title="Edit section: Pathophysiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Malonyl-CoA decarboxylase acts as a catalyst in the conversion of malonyl-CoA to acetyl-CoA and CO<sub>2</sub>.<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Without the enzymatic activity of malonyl-CoA decarboxylase, cellular malonyl-CoA increases so dramatically that at the end it is instead broken down by an unspecific short-chain acyl-CoA hydrolase, which produces <a href="/wiki/Malonic_acid" title="Malonic acid">malonic acid</a> and CoA. Malonic acid is a <a href="/wiki/Citric_acid_cycle" title="Citric acid cycle">Krebs cycle</a> inhibitor, preventing the cells to make <a href="/wiki/Adenosine_triphosphate" title="Adenosine triphosphate">ATP</a> through oxidation. In this condition, the cells, to make ATP, are forced to increase glycolysis, which produces lactic acid as a by-product. The increase of lactic and malonic acid drastically lowers blood <a href="/wiki/PH" title="PH">pH</a>, and causes both lactic and malonic aciduria (acidic urine). It is also speculated that the excess of mitochondrial malonyl-CoA increases the <a href="/wiki/Methylmalonic_acid" title="Methylmalonic acid">methylmalonic acid</a> level, which is due to an inhibitory effect on the <a href="/wiki/Methylmalonyl-CoA_mutase" title="Methylmalonyl-CoA mutase">methylmalonyl-CoA mutase</a>.<sup id="cite_ref-:4_10-0" class="reference"><a href="#cite_note-:4-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p><p>In the cytoplasm, malonyl-CoA acts as an inhibitor of the mitochondrial outer membrane enzyme <a href="/wiki/Carnitine_palmitoyltransferase_I" title="Carnitine palmitoyltransferase I">carnitine palmitoyltransferase I</a> (CPT1), which consequently inhibits <a href="/wiki/Beta_oxidation" title="Beta oxidation">fatty acid oxidation</a>.<sup id="cite_ref-:0_3-2" class="reference"><a href="#cite_note-:0-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> The inhibitory effect of cytoplastic malonyl-CoA on CPT1 varies, so it inhibits roughly 100-fold greater in cardiac and skeletal muscles than in the liver.<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p><p>Some common symptoms in malonic aciduria, such as cardiomyopathy and metabolic acidosis, are triggered by the high concentrations of malonyl-CoA in the cytoplasm. </p><p>Although we have not yet gained a clear understanding of the pathogenic mechanism of this deficiency, some researchers have suggested a brain-specific interaction between malonyl-CoA and CTP1 enzyme which may leads to unexplained symptoms of the malonic aciduria.<sup id="cite_ref-:1_5-1" class="reference"><a href="#cite_note-:1-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p><p>Research has found that large amount of malonyl-CoA carboxylase are detached in the hypothalamus and cortex of the brain where high levels of lipogenic enzymes are found, indicating that malonyl-CoA decarboxylase plays a role in lipid synthesis in the brain.<sup id="cite_ref-:0_3-3" class="reference"><a href="#cite_note-:0-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Disturbed interaction between malonyl-CoA and CPT1 may also contributed to abnormal brain development.<sup id="cite_ref-:0_3-4" class="reference"><a href="#cite_note-:0-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p><p>Malonyl-CoA decarboxylase plays an important role in the β-oxidation processes in both mitochondria and peroxisome.<sup id="cite_ref-:2_4-2" class="reference"><a href="#cite_note-:2-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Some other authors have also hypothesized that it is the Malonyl-CoA carboxylase deficiency induced inhibition of peroxisomal β-oxidation that contributes to the development delay.<sup id="cite_ref-:2_4-3" class="reference"><a href="#cite_note-:2-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Malonic_aciduria&action=edit&section=5" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Screening for elevated organic acids, especially malonic acid and methylmalonic acid and for high <a href="/w/index.php?title=Malonylcarnitine&action=edit&redlink=1" class="new" title="Malonylcarnitine (page does not exist)">malonylcarnitine</a>.<sup id="cite_ref-:3_6-1" class="reference"><a href="#cite_note-:3-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> The diagnosis can then be confirmed by determining the enzyme activity of malonyl-coA decarboxylase in cultured skin fibroblasts.<sup id="cite_ref-:3_6-2" class="reference"><a href="#cite_note-:3-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> Molecular genetic testing of the <i>MLYCD</i> gene may also be useful.<sup id="cite_ref-:3_6-3" class="reference"><a href="#cite_note-:3-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Differential_diagnosis">Differential diagnosis</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Malonic_aciduria&action=edit&section=6" title="Edit section: Differential diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading4"><h4 id="Combined_malonic_and_methylmalonic_aciduria_(CMAMMA)_&_classic_methylmalonic_acidemia"><span id="Combined_malonic_and_methylmalonic_aciduria_.28CMAMMA.29_.26_classic_methylmalonic_acidemia"></span>Combined malonic and methylmalonic aciduria (CMAMMA) & classic methylmalonic acidemia</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Malonic_aciduria&action=edit&section=7" title="Edit section: Combined malonic and methylmalonic aciduria (CMAMMA) & classic methylmalonic acidemia"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>By calculating the malonic acid to methylmalonic acid ratio in blood plasma, malonic aciduria can be clearly distinguished from <a href="/wiki/Combined_malonic_and_methylmalonic_aciduria" title="Combined malonic and methylmalonic aciduria">combined malonic and methylmalonic aciduria</a> (CMAMMA) and classic <a href="/wiki/Methylmalonic_acidemia" class="mw-redirect" title="Methylmalonic acidemia">methylmalonic acidemia</a>.<sup id="cite_ref-:5_13-0" class="reference"><a href="#cite_note-:5-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> The latter applies for both, vitamin B<sub>12</sub> responders and non-responders in methylmalonic acidemia.<sup id="cite_ref-:5_13-1" class="reference"><a href="#cite_note-:5-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> In malonic aciduria, the results of the ratio are greater than 1, as the malonic acid value is higher than the methylmalonic acid value.<sup id="cite_ref-:0_3-5" class="reference"><a href="#cite_note-:0-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> In CMAMMA, on the other hand, the result is less than 1 because the methylmalonic acid is higher than the malonic acid.<sup id="cite_ref-:4_10-1" class="reference"><a href="#cite_note-:4-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Malonic_aciduria&action=edit&section=8" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A research conducted in Netherlands has suggested that <a href="/wiki/Carnitine" title="Carnitine">carnitine</a> supplements and a <a href="/wiki/Low-fat_diet" title="Low-fat diet">low fat diet</a> may help to reduce the level of malonic acid in our body.<sup id="cite_ref-:1_5-2" class="reference"><a href="#cite_note-:1-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Note">Note</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Malonic_aciduria&action=edit&section=9" title="Edit section: Note"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>As both malonic acid and methylmalonic acid levels are elevated in malonic aciduria, it used to be referred to as <i>combined malonic and methylmalonic aciduria</i> (CMAMMA). Although ACSF3 deficiency was not discovered until later, the term <i>combined malonic and methylmalonic aciduria</i> has now become established in medical databases for ACSF3 deficiency.<sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Malonic_aciduria&action=edit&section=10" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Organic_acidemia" title="Organic acidemia">Organic acidemia</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Malonic_aciduria&action=edit&section=11" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-mcdar-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-mcdar_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-mcdar_1-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFMacPheeLoganMitchellHowells1993" class="citation journal cs1">MacPhee, G. 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style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q6744526" class="extiw" title="d:Q6744526">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: E72.8</li><li><b><a href="/wiki/Online_Mendelian_Inheritance_in_Man" title="Online Mendelian Inheritance in Man">OMIM</a></b>: <a rel="nofollow" class="external text" href="https://omim.org/entry/248360">248360</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=C535702">C535702</a></li><li><b><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a></b>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb33804.htm">33804</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/Orphanet" title="Orphanet">Orphanet</a></b>: <a rel="nofollow" class="external text" href="https://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=en&Expert=943">943</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Inborn_error_of_lipid_metabolism:_fatty-acid_metabolism_disorders" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Fatty-acid_metabolism_disorders" title="Template:Fatty-acid metabolism disorders"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Fatty-acid_metabolism_disorders" title="Template talk:Fatty-acid metabolism disorders"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Fatty-acid_metabolism_disorders" title="Special:EditPage/Template:Fatty-acid metabolism disorders"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Inborn_error_of_lipid_metabolism:_fatty-acid_metabolism_disorders" style="font-size:114%;margin:0 4em"><a href="/wiki/Inborn_error_of_metabolism" class="mw-redirect" title="Inborn error of metabolism">Inborn error</a> of <a href="/wiki/Inborn_error_of_lipid_metabolism" title="Inborn error of lipid metabolism">lipid metabolism</a>: <a href="/wiki/Fatty-acid_metabolism_disorder" title="Fatty-acid metabolism disorder">fatty-acid metabolism disorders</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Synthesis</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Biotinidase_deficiency" title="Biotinidase deficiency">Biotinidase deficiency</a> (BTD)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Degradation</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Fatty-acid_metabolism_disorder#Carnitine/transport" title="Fatty-acid metabolism disorder">Acyl<br />transport</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Carnitine" title="Carnitine">Carnitine</a></i> <ul><li><a href="/wiki/Carnitine_palmitoyltransferase_I_deficiency" title="Carnitine palmitoyltransferase I deficiency">CPT1</a></li> <li><a href="/wiki/Carnitine_palmitoyltransferase_II_deficiency" title="Carnitine palmitoyltransferase II deficiency">CPT2</a></li> <li><a href="/wiki/Systemic_primary_carnitine_deficiency" title="Systemic primary carnitine deficiency">CDSP</a></li> <li><a href="/wiki/Carnitine-acylcarnitine_translocase_deficiency" title="Carnitine-acylcarnitine translocase deficiency">CACTD</a></li></ul></li> <li><a href="/wiki/Adrenoleukodystrophy" title="Adrenoleukodystrophy">Adrenoleukodystrophy</a> (ALD)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Beta_oxidation" title="Beta oxidation">Beta<br />oxidation</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">General</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Acyl_CoA_dehydrogenase" class="mw-redirect" title="Acyl CoA dehydrogenase">Acyl CoA dehydrogenase</a></i> <ul><li><a href="/wiki/Short-chain_acyl-coenzyme_A_dehydrogenase_deficiency" title="Short-chain acyl-coenzyme A dehydrogenase deficiency">Short-chain</a> SCADD</li> <li><a href="/wiki/Medium-chain_acyl-coenzyme_A_dehydrogenase_deficiency" title="Medium-chain acyl-coenzyme A dehydrogenase deficiency">Medium-chain</a> MCADD</li> <li><a href="/wiki/Long-chain_3-hydroxyacyl-coenzyme_A_dehydrogenase_deficiency" title="Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency">Long-chain 3-hydroxy</a> LCHAD</li> <li><a href="/wiki/Very_long-chain_acyl-coenzyme_A_dehydrogenase_deficiency" title="Very long-chain acyl-coenzyme A dehydrogenase deficiency">Very long-chain</a> VLCADD</li></ul></li></ul> <ul><li><a href="/wiki/Mitochondrial_trifunctional_protein_deficiency" title="Mitochondrial trifunctional protein deficiency">Mitochondrial trifunctional protein deficiency</a> (MTPD): <a href="/wiki/Acute_fatty_liver_of_pregnancy" title="Acute fatty liver of pregnancy">Acute fatty liver of pregnancy</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Beta_oxidation#β-Oxidation_of_unsaturated_fatty_acids" title="Beta oxidation">Unsaturated</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/2,4_Dienoyl-CoA_reductase_deficiency" title="2,4 Dienoyl-CoA reductase deficiency">2,4 Dienoyl-CoA reductase deficiency</a> (DECRD)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Beta_oxidation#β-Oxidation_of_odd-numbered_chains" title="Beta oxidation">Odd chain</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Propionic_acidemia" title="Propionic acidemia">Propionic acidemia</a> (PCC deficiency)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/3-hydroxyacyl-coenzyme_A_dehydrogenase_deficiency" title="3-hydroxyacyl-coenzyme A dehydrogenase deficiency">3-hydroxyacyl-coenzyme A dehydrogenase deficiency</a> (HADHD)</li> <li><a href="/wiki/Glutaric_acidemia_type_2" title="Glutaric acidemia type 2">Glutaric acidemia type 2</a> (MADD)</li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">To<br /><a href="/wiki/Acetyl-CoA" title="Acetyl-CoA">acetyl-CoA</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Malonyl-CoA_decarboxylase_deficiency" class="mw-redirect" title="Malonyl-CoA decarboxylase deficiency">Malonic aciduria</a> (MCD)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Aldehyde" title="Aldehyde">Aldehyde</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Sj%C3%B6gren%E2%80%93Larsson_syndrome" title="Sjögren–Larsson syndrome">Sjögren–Larsson syndrome</a> (SLS)</li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Medicine" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Medicine" title="Template:Medicine"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Medicine" title="Template talk:Medicine"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Medicine" title="Special:EditPage/Template:Medicine"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Medicine" style="font-size:114%;margin:0 4em"><a href="/wiki/Medicine" title="Medicine">Medicine</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialties</a><br />and<br /><a href="/wiki/Subspecialty" title="Subspecialty">subspecialties</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Surgery" title="Surgery">Surgery</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cardiac_surgery" title="Cardiac surgery">Cardiac surgery</a></li> <li><a href="/wiki/Cardiothoracic_surgery" title="Cardiothoracic surgery">Cardiothoracic surgery</a></li> <li><a href="/wiki/Endocrine_surgery" title="Endocrine surgery">Endocrine surgery</a></li> <li><a href="/wiki/Eye_surgery" title="Eye surgery">Eye surgery</a></li> <li><a href="/wiki/General_surgery" title="General surgery">General surgery</a> <ul><li><a href="/wiki/Colorectal_surgery" title="Colorectal surgery">Colorectal surgery</a></li> <li><a href="/wiki/Digestive_system_surgery" title="Digestive system surgery">Digestive system surgery</a></li></ul></li> <li><a href="/wiki/Neurosurgery" title="Neurosurgery">Neurosurgery</a></li> <li><a href="/wiki/Oral_and_maxillofacial_surgery" title="Oral and maxillofacial surgery">Oral and maxillofacial surgery</a></li> <li><a href="/wiki/Orthopedic_surgery" title="Orthopedic surgery">Orthopedic surgery</a></li> <li><a href="/wiki/Hand_surgery" title="Hand surgery">Hand surgery</a></li> <li><a href="/wiki/Otorhinolaryngology" title="Otorhinolaryngology">Otolaryngology</a> <ul><li><small>ENT</small></li></ul></li> <li><a href="/wiki/Pediatric_surgery" title="Pediatric surgery">Pediatric surgery</a></li> <li><a href="/wiki/Plastic_surgery" title="Plastic surgery">Plastic surgery</a></li> <li><a href="/wiki/Reproductive_surgery" title="Reproductive surgery">Reproductive surgery</a></li> <li><a href="/wiki/Surgical_oncology" title="Surgical oncology">Surgical oncology</a></li> <li><a href="/wiki/Organ_transplantation" title="Organ transplantation">Transplant surgery</a></li> <li><a href="/wiki/Trauma_surgery" title="Trauma surgery">Trauma surgery</a></li> <li><a href="/wiki/Urology" title="Urology">Urology</a> <ul><li><a href="/wiki/Andrology" title="Andrology">Andrology</a></li></ul></li> <li><a href="/wiki/Vascular_surgery" title="Vascular surgery">Vascular surgery</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Internal_medicine" title="Internal medicine">Internal<br />medicine</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Allergy" title="Allergy">Allergy</a> / <a href="/wiki/Immunology" title="Immunology">Immunology</a></li> <li><a href="/wiki/Angiology" title="Angiology">Angiology</a></li> <li><a href="/wiki/Cardiology" title="Cardiology">Cardiology</a></li> <li><a href="/wiki/Endocrinology" title="Endocrinology">Endocrinology</a></li> <li><a href="/wiki/Gastroenterology" title="Gastroenterology">Gastroenterology</a> <ul><li><a href="/wiki/Hepatology" title="Hepatology">Hepatology</a></li></ul></li> <li><a href="/wiki/Geriatrics" title="Geriatrics">Geriatrics</a></li> <li><a href="/wiki/Hematology" title="Hematology">Hematology</a></li> <li><a href="/wiki/Hospital_medicine" title="Hospital medicine">Hospital medicine</a></li> <li><a href="/wiki/Infectious_diseases_(medical_specialty)" title="Infectious diseases (medical specialty)">Infectious diseases</a></li> <li><a href="/wiki/Nephrology" title="Nephrology">Nephrology</a></li> <li><a href="/wiki/Oncology" title="Oncology">Oncology</a></li> <li><a href="/wiki/Pulmonology" title="Pulmonology">Pulmonology</a></li> <li><a href="/wiki/Rheumatology" title="Rheumatology">Rheumatology</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Obstetrics_and_gynaecology" title="Obstetrics and gynaecology">Obstetrics and<br />gynaecology</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Gynaecology" title="Gynaecology">Gynaecology</a></li> <li><a href="/wiki/Gynecologic_oncology" title="Gynecologic oncology">Gynecologic oncology</a></li> <li><a href="/wiki/Maternal%E2%80%93fetal_medicine" title="Maternal–fetal medicine">Maternal–fetal medicine</a></li> <li><a href="/wiki/Obstetrics" title="Obstetrics">Obstetrics</a></li> <li><a href="/wiki/Reproductive_endocrinology_and_infertility" title="Reproductive endocrinology and infertility">Reproductive endocrinology and infertility</a></li> <li><a href="/wiki/Urogynecology" title="Urogynecology">Urogynecology</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Radiology" title="Radiology">Radiology</a> <ul><li><a href="/wiki/Interventional_radiology" title="Interventional radiology">Interventional radiology</a></li> <li><a href="/wiki/Neuroradiology" title="Neuroradiology">Neuroradiology</a></li> <li><a href="/wiki/Nuclear_medicine" title="Nuclear medicine">Nuclear medicine</a></li></ul></li> <li><a href="/wiki/Pathology" title="Pathology">Pathology</a> <ul><li><a href="/wiki/Anatomical_pathology" title="Anatomical pathology">Anatomical</a></li> <li><a href="/wiki/Clinical_pathology" title="Clinical pathology">Clinical pathology</a></li> <li><a href="/wiki/Clinical_chemistry" title="Clinical chemistry">Clinical chemistry</a></li> <li><a href="/wiki/Cytopathology" title="Cytopathology">Cytopathology</a></li> <li><a href="/wiki/Medical_microbiology" title="Medical microbiology">Medical microbiology</a></li> <li><a href="/wiki/Transfusion_medicine" title="Transfusion medicine">Transfusion medicine</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Addiction_medicine" title="Addiction medicine">Addiction medicine</a></li> <li><a href="/wiki/Adolescent_medicine" title="Adolescent medicine">Adolescent medicine</a></li> <li><a href="/wiki/Anesthesiology" title="Anesthesiology">Anesthesiology</a> <ul><li><a href="/wiki/Obstetric_anesthesiology" title="Obstetric anesthesiology">Obstetric anesthesiology</a></li> <li><a href="/wiki/Neurosurgical_anesthesia" title="Neurosurgical anesthesia">Neurosurgical anesthesiology</a></li></ul></li> <li><a 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