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Atherosclerosis medicine during pregnancy primaquine 7.5 mg cheap, coronary artery disease treatment 4 addiction order primaquine with mastercard, Tuberous xanthoma Corneal arcus Restriction of fat intake medicine reminder alarm order cheapest primaquine and primaquine. High incidence of vascular disease Associated with diabetes symptoms jaw bone cancer purchase primaquine without prescription, heart disease, obesity. In summary, ghee and coconut oil, within normal limits, neither decrease nor increase cholesterol levels. But it is to be noted that consumption of ghee (any oil in general), increases the total fat intake as well as calorie intake. Tangier disease It was first described in patients from Tangier island in NorthWest Africa. Manifestations are large orange yellow tonsils, muscle atrophy, recurrent peripheral neuropathies and atherosclerosis. Abeta lipoproteinemia All apo-B containing lipoproteins are reduced since microsomal triglyceride transfer protein is defective. Secondary hyperlipidemias Serum cholesterol Diabetes increased Nephrotic syndrome increased Hypothyroidism increased Biliary obstruction Pregnancy Alcoholism Oral contraceptives increased normal normal normal Serum triglyceride increased increased increased normal increased increased increased Table 25. Thromboembolic episodes in these vessels lead to ischemic heart disease and cerebrovascular accidents. Eruptive xanthomata are small yellow nodules associated with deposition of triglycerides. Tuberous xanthomata are yellow plaques containing triglycerides and cholesterol, found mainly over the elbows and knees. Xanthelasma are lipid deposits under the periorbital skin and contain mainly cholesterol. Deposits of lipids in cornea lead to corneal arcus; indicating hyper cholesterolemia. Hyperlipidemias, in the order of highest to lowest incidence, are described below. Patients seldom survive the second decade of life due to ischemic heart disease (Table 25. It may be associated with diabetes mellitus, obesity and impaired glucose tolerance. Beta lipoprotein floats on ultra-centrifugation and a broad beta band is observed on electrophoresis (see Table 25. Hypertriglyceridemia, usually secondary to other disorders like obesity, excessive alcohol intake, renal failure, pancreatitis, etc. Fluid distribution between intravascular and tissue spaces is controlled by oncotic pressure exerted by serum albumin (see Chapter 28). Carrier proteins/transport proteins are necessary for the transport and modulation of blood levels of functional form of trace elements like iron, copper, lipids and hormones (see Chapter 28). Bile acids produced are used in the intestine to absorb lipid nutrients (fatty acids, fat-soluble vitamins) from the gut and also play a major role in the regulation of cholesterol in the blood. Cholesterol forms the precursor of steroid hormones, bile acids and 7-dehydro cholesterol. Coagulation factors produced by the liver are essential for normal clotting mechanism. Biochemical tests are of immense value in diagnosis and monitoring of liver diseases. Carbohydrates: glycolysis; glycogen synthesis; glycogen breakdown; gluconeogenesis b. Jaundice 302 Textbook of Biochemistry; Section C: Clinical and Applied Biochemistry Box 26. If not, glucose can be stored as glycogen within the liver or it can be converted into more stable storage form as triglycerides. Amino Acid Metabolism Proteins break down in the intestine and absorbed as amino acids which then reach liver by portal vein. A small portion of acetyl CoA is converted to ketone bodies (acetone, acetoacetic acid and beta hydroxy butyric acid).

Generation of One-Carbon Groups the one-carbon groups are contributed to the onecarbon pool by amino acids medications list generic 7.5mg primaquine with mastercard. During the conversion of choline to glycine medicine lake montana 15mg primaquine for sale, these methyl groups are recovered (Chapter 15) symptoms prostate cancer generic primaquine 7.5 mg mastercard. Interconversion of One-Carbon Groups the different one-carbon groups are interconvertible as shown in Figure 14 treatment lead poisoning order primaquine american express. Blood urea level is increased where renal function is inadequate Details of causes of uremia is given in Chapter 27. Urea level in blood may be theoretically increased when protein intake is very high. However in usual conditions, this will be only within the upper limit of the normal values. This is one of the few reactions in human metabolism, where B12 acts as a coenzyme. Utilization of One-carbon groups A summary of the generation and utilization of onecarbon group is shown in Figure 14. Transmethylation reactions including creatine, choline and epinephrine synthesis 9. Glycine amino transferase can catalyze the synthesis of glycine from glyoxylate and glutamate or alanine. The reactions are readily reversible, when the enzymes are together called Glycine synthase. Formation of glycine from threonine 184 Textbook of Biochemistry; Section B: General Metabolism. Glucogenic Pathway Glycine is mainly channelled into the glucogenic pathway by getting first converted to serine. Special Metabolic Functions of Glycine Glycine may be used for the biosynthesis of the following compounds. Creatine and Creatine Phosphate the word creatine is derived from the Greek term, kreas, which means flesh. First step: the amidino group of arginine is transferred to glycine to form guanido acetic acid, catalysed by amido transferase (Step 1. The stored creatine phosphate in the muscle serves as an immediate store of energy in the muscle. Fourth step: the creatine phosphate may be converted to its anhydride, creatinine (Step 4. The blood level of creatine and creatinine and Chapter 15; Simple, Hydroxy and Sulfur Containing Amino Acids 185. Cause of oxaluria Glycine + Benzoyl CoA Benzoyl glycine (hippuric acid) + CoA the conjugation occurs in liver and so it is an index of liver function. In moderate levels glycine inhibits neuronal traffic; but at high levels it causes over-excitation. Glycine as a Constituent of Protein Glycine is seen where the polypeptide chain bends or turns (beta bends or loops). Creatinine level in blood is a sensitive indicator of renal function (Chapter 27). But in muscular dystrophies, the blood creatine and urinary creatinine are increased. Synthesis of Purines the whole molecule of glycine is incorporated into the purine ring (C4, C5 and N7) (Chapter 39). Synthesis of Glutathione Glutathione is a tripeptide formed from glutamic acid, cysteine and glycine. The functions of glutathione are described in the section on metabolism of cysteine. Glycocholic acid and glyco-chenodeoxy-cholic acid are the main conjugated bile acids. Glycine is used for detoxification of benzoic acid to form hippuric acid (Chapter 37). Formation of serine 186 Textbook of Biochemistry; Section B: General Metabolism 1. The steps involve dehydrogenation, transamination and removal of phosphate group. Increased excretion of oxalates is observed (upto 600 mg/day, compared to a normal of 50 mg/day).

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When 14C-labelled glucose is administered symptoms 8 weeks cheap generic primaquine canada, the metabolites can be traced to different organs medications diabetic neuropathy purchase primaquine 7.5 mg with amex. Administration of 15N-labelled glycine was followed by appearance of the label in different compounds like hemoproteins symptoms liver disease buy genuine primaquine, nucleic acids medicine used for pink eye buy primaquine 7.5mg without a prescription, and creatinine. Control mechanisms Metabolic pathways may also be studied by creating perturbances to the system, such as: a. Food materials are converted into the building block precursors of cellular macromolecules. These building blocks are later made into macromolecules, such as proteins, nucleic acids, polysaccharides, etc. Regulation through the action of allosteric enzymes, which increase or decrease the activity under the influence of effector molecules. Catabolic (degradation) pathways, where energy rich complex macromolecules are degraded into smaller molecules. Energy reserves of man Stored fuel Weight (in gram) Energy equivalent (in kilo calories) Glycogen in liver Glycogen in muscle Glucose in body fluids Fat in adipose tissue Protein in muscle 70 120 20 15,000 6,000 280 480 80 135,000 24,000 Chapter 8; Overview of Metabolism 85 Table 8. Carbohydrate metabolism is centered around glucose, and is mainly used for provision of energy to the body (Chapter 9). Lipid metabolism is centered around fatty acids, which are also used for provision of energy (Chapter 11). However, most of the amino acids are eventually transaminated, the carbon skeletons are oxidized. Carbohydrate, lipid and amino acid metabolisms are interrelated and details are given in chapters in the Section B of this book. Amphibolic pathways are seen at cross-roads of metabolism, where both anabolic and catabolic pathways are linked. Stages or Phases of Metabolism the degradation of foodstuffs occurs in three stages. In the first stage, digestion in the gastrointestinal tract converts the macromolecules into small units. The reducing equivalents are mainly generated in the mitochondria by the final common oxidative pathway, citric acid cycle. This is the tertiary metabolism or Internal respiration or cellular respiration. Moreover, the organs are able to adapt to metabolic alterations in fed state and starvation. The approximate percentage of storage form of energy (total fuel reserve) present in a normal human body is, fat 85%, glycogen 1%, and proteins 14%. Fat stores are mobilized actively only on prolonged fasting, even though adipose tissue fat is undergoing turnover on a daily basis. Caloric homeostasis is maintained regardless of whether a person is well fed, fasting, or in a state of starvation. Similarly metabolic profile of various organs and tissues change to adapt to physiological and pathological states, so that caloric homeostasis is maintained unless extreme conditions set in. The reciprocal regulation of glycolysis and gluconeogenesis is the major deciding factor in the flux of metabolic intermediates through these pathways. Enery Utilization of Average Person the energy consumption varies based on life style in adults. Approximately 300 g of carbohydrates (1200 Kcal or 4800 kJoules), 70 g of proteins (294 Kcal or 1190 kJ) and 80 g of fats (720 kcal or 2960 kJ) are consumed by a person with a sedentary life style. Therefore, about 60% calories are derived from carbohydrates, 15% from proteins and rest from fats. The energy reserves provide energy in between meals and after overnight fasting (glycogenolysis and gluconeogenesis). Metabolic alterations in brain 86 Textbook of Biochemistry; Section B: General Metabolism ii.

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Equipment for emergency endotracheal intubation should also be kept at this location medicine 2015 song buy primaquine 7.5 mg with mastercard. Individuals requiring a short course of artificial ventilation with an Ambu bag in this contaminated area are at risk of contaminated air entering their lungs during artificial ventilation medicine januvia purchase primaquine with visa. Because emergency endotracheal intubation would be performed in a contaminated area symptoms mononucleosis cheap primaquine 7.5mg overnight delivery, certain measures must be followed to prevent further contamination of the patient medicine wheel order 7.5mg primaquine visa. Operator should decontaminate his gloves immediately prior to performing intubation. Prior to securing the tube with tape or a tube holder, be sure that this area of the skin has been decontaminated. An M291 dry decontamination kit is excellent for this purpose, as its dry, black decontamination material will dramatically show what skin area has been decontaminated. Ventilatory resistance postintubation will be normal for individuals intoxicated with biologicals, radiologicals, lung-damaging agents, and cyanides unless they have pre-existing airway disease. Nerve agent exposure will tremendously increase both the airway resistance and airway secretions. A dose of atropine is frequently necessary prior to intubation to deal with this problem. Unlike some protocols for radiological decontamination in which a light coating of water is used to coagulate the radioactive dust to prevent spreading, do not wet the clothing prior to removal. Additionally, this technique will only serve to spread liquid contamination of chemical agent to a greater degree. Approximately 75 m downwind (and ideally downhill and downstream) from this site should be a contaminated clothing and equipment dump where these items would be stored in doubled, clear plastic bags that are clearly marked with bar-coded patient identification. At least two lanes should be used for patient decontamination-an ambulatory decontamination lane subdivided into two lanes according to gender to address privacy issues. Here, ambulatory 684 Chemical Warfare Agents: Chemistry, Pharmacology, Toxicology, and Therapeutics patients can be decontaminated with showers supplying low pressure, high volume warm water, and gently washing (avoid scrubbing, which abrades skin) with a liquid, nonparticulate, noncaustic soap. In World War I, large numbers of decontamination showers were set up in field hospitals. Careful attention should be paid to the use of warm (>658F), not cool or cold water (United States Army Soldier and Biological Chemical Command, 2002). Although conduction, convection, and radiation all contribute to heat loss or gain, evaporative cooling is by far the most efficient method of heat loss known. Evaporation of cool or cold water from the surface of the skin creates huge losses of body heat that can quickly lead to the development of hypothermia. Ambulatory decontamination is best achieved using a ``buddy system'; that is, one individual will wash the other and then switch places. Ideally, one individual would stand with his or her arms extended at about a 458 angle from his or her side with legs separated like an upside down letter ``V. These include the scalp and hair, behind the ears, inside the ear canal, nostrils, the axilla (armpit), the naval (belly button), groin, between buttock checks, under fingernails, back of the knee, between toes, and under toenails (New Jersey State Police, course 06013). At the end of the ambulatory decontamination process, towels must be provided for drying off, clean clothing should be provided as well. Black colored, plastic trash bags work well for this as (a) black absorbs heat best of all colors, (b) plastic has excellent heat retention properties, (c) they are readily available and inexpensive, and (d) they provide patient modesty. Furthermore, in cold weather situations, shelter from the external environment must be provided to prevent further heat loss. The dilution factor of the large quantity of water would keep it nontoxic for many tens, if not hundreds of thousands, of people. Decontamination of nonambulatory patients is best accomplished using a setup that looks and functions identically to an automatic car wash for humans. This litter possesses a honeycombed weave that creates 40% open surface, allowing liquids to pass through the litter easily. The litter is then rolled along a commercially available roller mechanism (like those used at super markets, etc.

It may allow calcium inflow into the cells treatment effect definition order cheap primaquine on line, leading to cellular metabolic activation treatment lead poisoning buy primaquine on line. Peripheral neuropathy 606 treatment syphilis buy 15 mg primaquine with mastercard, very commonly seen in diabetes mellitus symptoms acid reflux purchase primaquine 7.5 mg mastercard, is associated with inositol metabolism. During the voyage of Vasco da Gama, around the cape of Good Hope to India in 1498, he lost two-third of the crew due to scurvy. The French explorer, Jacques Cartier, in 1536, during the voyages to discover eastern parts of Canada, was laid up with scurvy. A friendly native gave an extract from the leaves of spruce tree, which produced remarkable cure to scurvy. These observations led to compulsory rationing of lime or lemon juice to all the crew of the British Royal Navy from 1795 onwards. However, it helped to eliminate scurvy from the British Navy, while opponents continued to suffer. No wonder, in course of time, Britain had the colonies in which the sun never set. Zilva and associates, in 1928, showed that the antiscorbutic factor present in lemon juice is a reducing 408 Textbook of Biochemistry; Section D: Nutrition. The factor was isolated in 1930 and named as "Hexuronic acid" by Albert Szent-Gyorgi (Nobel prize, 1937). The staple diet of primates contains fruits and vegetables rich in ascorbic acid, and so the gene deletion will have no deleterious effect in primates. Oxidation of ascorbic acid yields dehydro ascorbic acid, which is oxidized further to oxalic acid through diketo-Lgulonic acid. Most of the oxalates in urine are derived from ascorbic acid, and the rest from glycine metabolism. A low level in blood is noted in women taking contraceptive pills and also in chronic alcoholics. Chemistry of Vitamin C It is water soluble and is easily destroyed by heat, alkali and storage. The structural formula of ascorbic acid closely resembles that of carbohydrates. The strong reducing property of vitamin C depends on the double-bonded (enediol) carbons. Biosynthesis of Ascorbic Acid in Animals Most animals and plants can synthesize ascorbic acid from glucose. Vitamin C: Structure and catabolism Chapter 34; Water Soluble Vitamins 409 ferric iron to ferrous state, which is preferentially absorbed. Hemoglobin metabolism It is useful for re-conversion of met-hemoglobin to hemoglobin. Folic acid metabolism Ascorbic acid is helping the enzyme folate reductase to reduce folic acid to tetrahydrofolic acid. Phagocytosis Ascorbic acid stimulates phagocytic action of leukocytes and helps in the formation of antibodies. Anti-oxidant property As an anti-oxidant (Chapter 20), it may prevent cancer formation. Hemorrhagic tendency In ascorbic acid deficiency, collagen is abnormal and the intercellular cement substance is brittle. So capillaries are fragile, leading to the tendency to bleed even under minor pressure. Reversible oxidation-reduction It can change between ascorbic acid and dehydroascorbic acid. Most of the physiological properties of the vitamin could be explained by this redox system. Hydroxylation of proline and lysine Ascorbic acid is necessary for the post-translational hydroxylation of proline and lysine residues.

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