This document summarizes research on the roles of the amino acids glutamine and arginine in wound healing. It discusses how both are conditionally essential and have been shown to improve wound healing in studies of pressure ulcers, burns, and skin grafts through their effects on immune function, protein synthesis, and nitric oxide production. However, the results have been mixed, and more research is still needed to better understand how to individualize amino acid supplementation for different types of wounds and patients.
Glutamine and Arginine- Benefits and Contraindications in the Clinical SettingBrianna Carroll
This document summarizes the benefits and contraindications of glutamine and arginine supplementation in clinical settings. It discusses their roles in the body, depletion during illness or injury, recommended intake, food sources, and clinical significance for conditions like wounds, burns, and GI disorders. However, supplementation is contraindicated in certain populations like those with acute liver failure, sepsis, head trauma, or on continuous renal replacement therapy. Studies have shown risks for mechanically ventilated and critically ill patients.
Importance of nutrition in pregnancy and lactationAzam Jafri
The document discusses the importance of nutrition during pregnancy and lactation. It states that a mother's diet is a key determinant of pregnancy outcomes and a baby's health at birth and beyond is closely linked to the mother's nutrition during pregnancy. Inadequate energy and protein intake during pregnancy can result in issues like intrauterine growth restriction. The document promotes the nutritional supplement Amino Fuel 900 as providing proteins, fats, fiber and calories to meet increased nutritional needs during pregnancy and lactation in order to prevent malnutrition and support gestational weight gain and milk production.
This document summarizes research on the effects of various nutritional supplements on sleep. It finds that melatonin, a hormone that regulates sleep-wake cycles, has been shown to improve sleep onset, efficiency and duration when taken as a supplement. The B vitamins, especially B12 and thiamine, have also been linked to improved sleep and normal circadian rhythms, as deficiencies have been found in those with insomnia. Iron deficiency is also noted as a potential cause of sleep problems. The document reviews this research on supplements like melatonin and B vitamins that may positively influence sleep through effects on neurotransmitters, circadian rhythms and other brain and body systems involved in sleep regulation.
Vitamin K is an essential cofactor for the post-translational carboxylation of glutamate residues in several blood clotting factors and proteins involved in bone mineralization. This carboxylation, carried out by the vitamin K-dependent γ-glutamyl carboxylase, activates the proteins and allows them to bind calcium and participate in coagulation cascades and bone formation. Deficiencies in vitamin K or the carboxylated proteins it activates can lead to bleeding disorders or poor bone health.
Nitric oxide (NO) is an important vasodilator that improves circulation. In 1998, three Americans received the Nobel Prize in Physiology or Medicine for discovering NO's role in the cardiovascular system. NO dilates blood vessels, promotes angiogenesis, decreases swelling, and increases blood flow and nutrient delivery to cells. Diabetic patients have lower NO levels and circulation problems. Better circulation is critical for conditions like diabetes as it can decrease pain and support wound recovery. There is significant research supporting the benefits of NO in areas like falls prevention, wound healing, and pain relief.
Metabolism of Glutamate ,Aspartate ,Glutamine &Asparaginerohini sane
A lucid presentation on Metabolism of Glutamate , Glutamine ,Aspartate & Asparagine for MBBS, BDS , B. Pharm & Biotechnology students to facilitate self-study.
Nitric oxide (NO) is a gas that acts as a signaling molecule in various physiological processes. It is produced by nitric oxide synthase enzymes from arginine and oxygen. NO signals the dilation of blood vessels by diffusing into endothelial cells and increasing cGMP levels, which leads to smooth muscle relaxation. It also prevents platelet aggregation, acts as a neurotransmitter, and is involved in the immune response by assisting macrophages in killing bacteria. While NO is important for many functions, too much or too little production can be harmful and lead to conditions like hypertension or infection.
Nitric oxide is produced by endothelial cells and is important for regulating blood flow. It acts as a vasodilator to relax smooth muscle cells in blood vessels. The three main types of nitric oxide synthase produce nitric oxide, which has many roles in the body like supporting circulation, immune function, and reproduction. It is involved in processes like maintaining blood pressure and facilitating penile erection. Foods like peppers and dark chocolate contain compounds that can boost nitric oxide levels.
Glutamine and Arginine- Benefits and Contraindications in the Clinical SettingBrianna Carroll
This document summarizes the benefits and contraindications of glutamine and arginine supplementation in clinical settings. It discusses their roles in the body, depletion during illness or injury, recommended intake, food sources, and clinical significance for conditions like wounds, burns, and GI disorders. However, supplementation is contraindicated in certain populations like those with acute liver failure, sepsis, head trauma, or on continuous renal replacement therapy. Studies have shown risks for mechanically ventilated and critically ill patients.
Importance of nutrition in pregnancy and lactationAzam Jafri
The document discusses the importance of nutrition during pregnancy and lactation. It states that a mother's diet is a key determinant of pregnancy outcomes and a baby's health at birth and beyond is closely linked to the mother's nutrition during pregnancy. Inadequate energy and protein intake during pregnancy can result in issues like intrauterine growth restriction. The document promotes the nutritional supplement Amino Fuel 900 as providing proteins, fats, fiber and calories to meet increased nutritional needs during pregnancy and lactation in order to prevent malnutrition and support gestational weight gain and milk production.
This document summarizes research on the effects of various nutritional supplements on sleep. It finds that melatonin, a hormone that regulates sleep-wake cycles, has been shown to improve sleep onset, efficiency and duration when taken as a supplement. The B vitamins, especially B12 and thiamine, have also been linked to improved sleep and normal circadian rhythms, as deficiencies have been found in those with insomnia. Iron deficiency is also noted as a potential cause of sleep problems. The document reviews this research on supplements like melatonin and B vitamins that may positively influence sleep through effects on neurotransmitters, circadian rhythms and other brain and body systems involved in sleep regulation.
Vitamin K is an essential cofactor for the post-translational carboxylation of glutamate residues in several blood clotting factors and proteins involved in bone mineralization. This carboxylation, carried out by the vitamin K-dependent γ-glutamyl carboxylase, activates the proteins and allows them to bind calcium and participate in coagulation cascades and bone formation. Deficiencies in vitamin K or the carboxylated proteins it activates can lead to bleeding disorders or poor bone health.
Nitric oxide (NO) is an important vasodilator that improves circulation. In 1998, three Americans received the Nobel Prize in Physiology or Medicine for discovering NO's role in the cardiovascular system. NO dilates blood vessels, promotes angiogenesis, decreases swelling, and increases blood flow and nutrient delivery to cells. Diabetic patients have lower NO levels and circulation problems. Better circulation is critical for conditions like diabetes as it can decrease pain and support wound recovery. There is significant research supporting the benefits of NO in areas like falls prevention, wound healing, and pain relief.
Metabolism of Glutamate ,Aspartate ,Glutamine &Asparaginerohini sane
A lucid presentation on Metabolism of Glutamate , Glutamine ,Aspartate & Asparagine for MBBS, BDS , B. Pharm & Biotechnology students to facilitate self-study.
Nitric oxide (NO) is a gas that acts as a signaling molecule in various physiological processes. It is produced by nitric oxide synthase enzymes from arginine and oxygen. NO signals the dilation of blood vessels by diffusing into endothelial cells and increasing cGMP levels, which leads to smooth muscle relaxation. It also prevents platelet aggregation, acts as a neurotransmitter, and is involved in the immune response by assisting macrophages in killing bacteria. While NO is important for many functions, too much or too little production can be harmful and lead to conditions like hypertension or infection.
Nitric oxide is produced by endothelial cells and is important for regulating blood flow. It acts as a vasodilator to relax smooth muscle cells in blood vessels. The three main types of nitric oxide synthase produce nitric oxide, which has many roles in the body like supporting circulation, immune function, and reproduction. It is involved in processes like maintaining blood pressure and facilitating penile erection. Foods like peppers and dark chocolate contain compounds that can boost nitric oxide levels.
This document provides an overview of the role of nitric oxide (NO) in the body. It discusses NO's structure as a lipid-soluble gas that is synthesized from L-arginine by nitric oxide synthase (NOS) enzymes. The three main types of NOS - neuronal, endothelial, and inducible - are described. The roles of NO in various body systems like the nervous, circulatory, immune and digestive systems are summarized. NO functions as a neurotransmitter, vasodilator, and plays roles in platelet inhibition and host defense. Abnormal NO production can contribute to conditions like hypertension. NO donors and inhibitors that are used experimentally are also listed.
Glycine is a non-essential amino acid that is involved in many biochemical processes. It can be synthesized from serine, threonine, carbon dioxide, ammonia, and glyoxylate. Glycine is important for the synthesis of heme, purines, creatine, glutathione, bile acids, and hippuric acid. It is metabolized through the glycine cleavage system or converted to serine and then gluconeogenic precursors. Elevated glycine levels can cause neurological issues while deficiencies are associated with hyperoxaluria and kidney stone formation.
The document discusses the endothelium and the role of nitric oxide (NO) in the body. It defines the endothelium as the thin layer of cells lining blood vessels and lymphatic vessels. Endothelial cells release NO, previously called endothelium-derived relaxing factor (EDRF), which modulates blood vessel tone. NO is a gaseous signaling molecule synthesized from L-arginine by nitric oxide synthase (NOS). NO has many roles, including regulating circulation and the nervous, immune, digestive, and reproductive systems. It acts as a vasodilator, neurotransmitter, and plays roles in wound healing and apoptosis.
This document provides guidance on nutrition management for patients with spinal cord injuries. It discusses the importance of a multidisciplinary approach and frequent nutrition assessments in the acute phase to address changing needs. Enteral nutrition is preferred over parenteral nutrition when possible. In rehabilitation, energy needs are estimated at 22.7 kcal/kg for quadriplegia and 27.9 kcal/kg for paraplegia, while protein needs are 0.8-1.0 g/kg. In the community, annual assessments monitor for secondary conditions like metabolic syndrome. Body composition is best assessed through methods like BIA and DEXA rather than BMI, due to differences in people with spinal cord injuries.
Nitric oxide (NO) is involved in many physiological processes as a signaling molecule. It is synthesized endogenously through nitric oxide synthase enzymes and was named "Molecule of the Year" in 1992. NO regulates processes in the cardiovascular, respiratory, nervous, reproductive, immune, muscular and digestive systems. It acts as a vasodilator, neurotransmitter, and promotes smooth muscle relaxation. While NO has many beneficial functions, excessive amounts can also be toxic.
The document outlines 12 reasons to use the Kyäni Health Triangle nutritional products according to Dr. Abbas Qutab. The triangle consists of Kyäni Sunrise drink which provides vitamins and minerals, Kyäni Sunset vitamin E with omega-3, and Kyäni Nitro FX noni extract. The reasons given are that it provides a range of whole nutrients, antioxidants to protect against free radicals, supports cardiovascular, immune, brain and eye health, can help inflammation and aging, and benefits sexual health, blood sugar control, and the GI tract.
Primary intention healing occurs when a wound is closed within hours of injury through surgical or mechanical approximation of wound edges. Delayed primary healing allows time for wound debridement before closure to prevent infection. Secondary intention healing involves closure of full thickness wounds through wound contraction and epithelialization without surgical closure. Wound healing progresses through inflammatory, proliferative, and remodeling phases regardless of closure method and can move between phases based on intrinsic and extrinsic patient factors.
This study evaluated the protective effects of glutamine on intestinal permeability and bacterial translocation in rats receiving total parenteral nutrition (TPN) with endotoxemia. Thirty-four rats were divided into four groups: a control group, a TPN group, a trauma and endotoxemia group, and a trauma plus endotoxemia group that received glutamine in TPN. Glutamine supplementation was found to decrease intestinal permeability and bacterial translocation compared to the trauma and endotoxemia group as measured by urinary lactulose and mannitol levels and mesenteric lymph node cultures. This suggests glutamine protects intestinal barrier function in rats with endotoxemia receiving TPN.
This document presents information about glutamine in nutrition management. It discusses glutamine as the most abundant amino acid in the body, which can be synthesized and is not essential to the diet. It serves various functions including protein synthesis, acid-base regulation, and as an energy source. The document outlines glutamine producers, consumers, dietary sources, metabolism, medical uses including for cancer and HIV/AIDS patients, and roles in cellular protection, gut barrier function, immune modulation, and oxidative stress. The document also discusses glutamine supplementation for athletes to boost performance and recovery.
The document discusses receptor-mediated activation of nitric oxide (NO) synthesis by arginine in the vasculature. It first provides historical background on the discovery of NO and its role in vasodilation. It then presents evidence that arginine can activate NO synthesis through receptor-mediated mechanisms involving imidazoline/alpha-2 adrenergic receptors, G-proteins, and intracellular calcium signaling. Specifically, it shows that arginine and the endogenous agonist agmatine can directly stimulate NO production in endothelial cells, and this effect is blocked by receptor and G-protein antagonists. It also demonstrates that arginine and agonists elicit vasodilation through receptor-dependent mechanisms. This work helps
Glycine and serine are both non-essential amino acids that can be synthesized in the body. Glycine is the smallest amino acid and is important for muscle tissue, central nervous system function, and collagen formation. Serine participates in biosynthesis of other amino acids and metabolites and has structural and signaling roles in enzymes and neurotransmitters. Both amino acids share metabolic pathways and deficiencies can impact growth and development. Studies show glycine and serine may help with sleep, fight cancer cell growth, and reduce osteoarthritis symptoms.
Glycine is a simple amino acid that plays many important roles in the body. It is involved in the synthesis of collagen, creatine, glutathione, heme, purines, and other specialized products. Glycine can be synthesized from carbon dioxide and ammonia in the liver, from glyoxylate, serine, and threonine. It can be broken down through the glycine cleavage complex to produce carbon dioxide and ammonia, or through oxidation to glyoxylate. Glycine participates in many transamination, decarboxylation, and conjugation reactions throughout the body. Excessive consumption of glycine can lead to kidney stones due to oxalate accumulation.
Glycine is the simplest amino acid. It has several metabolic functions including the biosynthesis of heme, purines, creatine, glutathione, and as a conjugating agent. Glycine is also used as a neurotransmitter in the brainstem and spinal cord and is a constituent of proteins, often found where the polypeptide chain bends or turns. Key reactions involving glycine include its role in the rate-limiting step of heme synthesis through ALA synthase, incorporation into the purine ring, and synthesis of creatine through combination with arginine and subsequent phosphorylation. Glycine also functions in glutathione synthesis, free radical scavenging, amino acid transport, insulin inactivation, and enzyme activation through thiol groups
Nitric oxide (NO) is an endogenous signaling molecule generated from L-arginine by nitric oxide synthase. It is a key signaling molecule in the cardiovascular, nervous, and immune systems. NO activates guanylate cyclase, increasing cyclic GMP levels to cause smooth muscle relaxation and inhibit platelet aggregation. The physiological role of NO was discovered in the vasculature, where it was shown that endothelium-derived relaxing factor causing vasodilation was NO. NO has diverse functions and is involved in processes like neurotransmission, host defense, and inflammation.
synthesis and degradation of glycine is discussed. specialized products formed from glycine is described in detail. disorders associated with metabolism of glycine is also explained.
The document discusses amino acid catabolism and the relationships between organs in metabolizing and transporting amino acids and nitrogen. The intestine absorbs amino acids from food and releases byproducts like ammonium and alanine. The liver synthesizes proteins, breaks down amino acids, and performs gluconeogenesis and urea synthesis. Skeletal muscle breaks down branched chain amino acids and transports amino groups as alanine and glutamine to other organs. One clinical case describes a infant with high blood ammonium levels due to a genetic deficiency in ornithine transcarbamoylase, an enzyme in the urea cycle. Treatment with essential amino acids and sodium benzoate helped reduce ammonium levels.
This document summarizes the biosynthesis of amino acids from key metabolic precursors. It discusses 6 families of amino acid biosynthesis defined by their precursor: (1) α-ketoglutarate family (glutamate, glutamine, proline, arginine), (2) 3-phosphoglycerate family (serine, glycine, cysteine), (3) oxaloacetate family (aspartate, asparagine, methionine, threonine, lysine), (4) pyruvate family (alanine, valine, leucine, isoleucine), (5) phosphoenolpyruvate and erythrose 4-phosphate family (tryptoph
Presentasi Luka Bakar Minggu ke 2 PKL Arif Triyono
Tn SP berusia 30 tahun, seorang tamatan SLTP bekerja sebagai buruh bangunan, dan sedang menantikan kelahiran anak pertamanya.
Pada saat mengecat pagar sebuah kantor, tiba-tiba alat blower cat meledak disebabkan karena tabung gas pada alat tersebut bocor dan mengenai Tn SP di seluruh lengan dan kaki kanan, sebagian wajah dan kepala, dan sebagian dada. Kejadian tersebut berlangsung sekitar pukul 11.00 WIB. Pada pukul 12.20 WIB, yang bersangkutan baru dibawa ke IRD Rumah Sakit ‘Puri Sehat’ untuk dilakukan tindakan operasi debridement di IRD dengan GA (General Anestesi). Pasien mengalami luka bakar grade IIB dengan kondisi hipoalbumin dan sudah ditransfusi albumin 25% 100ml 30 tts/menit pada saat dilakukan debridement, namun kondisi tersebut tidak berubah. Berdasarkan instruksi dari dokter, pasien ini tetap diberikan infuse albumin hingga kadar albumin mencapai lebih dari 3 gr/dl.
Tn. SP jarang mengkonsumsi buah-buahan. Setiap hari Tn. SP minum kopi yatu pada pagi dan sore hari, sedangkan pada malam harinya minum kratingdaeng ditambah dengan telur ayam.
Senang makan makanan yang digoreng dan yang bersantan kental.
Setiap siang dan sore hari mengkonsumsi camilan berupa gorengan seperti weci, tahu isi, dan pisang goreng.
Hari pertama di RS Puri Sehat, Tn. SP diberikan makanan cair rumah sakit 1500 cc ditambah dengan 1 bungkus proten. Setelah operasi debridement, makanan yang diberikan adalah diet lunak, proten 2 bungkus/hr dan telur rebus 3 butir/hari
Dari hasil assessment awal didapatkan data-data sebagai berikut :
• TB = 167 cm, LILA = 25 cm
• Nadi : 112 x/menit, RR : 24 x/menit, suhu : 38,5⁰C, tekanan darah : 120/80 mmHg
• Leukosit : 12.700/ul, Natrium : 130 ml/mol, Hb : 10 gr/dl, albumin : 1,9 g/dl
• Infus : NaCl 0,9% 1500 cc/24 jam
Spices have various beneficial effects on blood sugar control and diabetes management. Cinnamon, fenugreek seeds, cumin seeds, turmeric, red chili, cloves, ginger, garlic, and licorice root (Glycyrrhiza glabra) can help lower blood glucose levels, reduce inflammation, improve insulin sensitivity, and manage cholesterol levels. Studies show consuming doses of 3-6 grams of cinnamon per day or adding fenugreek seeds to the diet can positively impact blood sugar and HbA1c levels over time. The active compounds in these spices are thought to stimulate insulin production and sensitivity.
David Bihari is an Intensivist from Prince of Wales Hospital in Sydney. He is particularly interested and passionate about nutrition in the critically ill, and has been involved in research in this area for many years. Here he talks about how we feed in ICU.
פירוט הרכיבים הטבעיים שנמצאים ב Cane תוסף תזונה טבעי המסייע לחולי סוכרת להגיע לאיזון ברמות הסוכר שלהם. Cane הוא תוסף תזונה מבית קיורהלייף, חברה הדואגת לאיכות חייהם של החולים במחלות כרוניות.
http://www.cane-curalife.com/
This is a presentation I done with 3 days in a rush for a presentation in a workshop. I hope it brings certain information to my blog users. From www.littlediet.info.
This document provides an overview of the role of nitric oxide (NO) in the body. It discusses NO's structure as a lipid-soluble gas that is synthesized from L-arginine by nitric oxide synthase (NOS) enzymes. The three main types of NOS - neuronal, endothelial, and inducible - are described. The roles of NO in various body systems like the nervous, circulatory, immune and digestive systems are summarized. NO functions as a neurotransmitter, vasodilator, and plays roles in platelet inhibition and host defense. Abnormal NO production can contribute to conditions like hypertension. NO donors and inhibitors that are used experimentally are also listed.
Glycine is a non-essential amino acid that is involved in many biochemical processes. It can be synthesized from serine, threonine, carbon dioxide, ammonia, and glyoxylate. Glycine is important for the synthesis of heme, purines, creatine, glutathione, bile acids, and hippuric acid. It is metabolized through the glycine cleavage system or converted to serine and then gluconeogenic precursors. Elevated glycine levels can cause neurological issues while deficiencies are associated with hyperoxaluria and kidney stone formation.
The document discusses the endothelium and the role of nitric oxide (NO) in the body. It defines the endothelium as the thin layer of cells lining blood vessels and lymphatic vessels. Endothelial cells release NO, previously called endothelium-derived relaxing factor (EDRF), which modulates blood vessel tone. NO is a gaseous signaling molecule synthesized from L-arginine by nitric oxide synthase (NOS). NO has many roles, including regulating circulation and the nervous, immune, digestive, and reproductive systems. It acts as a vasodilator, neurotransmitter, and plays roles in wound healing and apoptosis.
This document provides guidance on nutrition management for patients with spinal cord injuries. It discusses the importance of a multidisciplinary approach and frequent nutrition assessments in the acute phase to address changing needs. Enteral nutrition is preferred over parenteral nutrition when possible. In rehabilitation, energy needs are estimated at 22.7 kcal/kg for quadriplegia and 27.9 kcal/kg for paraplegia, while protein needs are 0.8-1.0 g/kg. In the community, annual assessments monitor for secondary conditions like metabolic syndrome. Body composition is best assessed through methods like BIA and DEXA rather than BMI, due to differences in people with spinal cord injuries.
Nitric oxide (NO) is involved in many physiological processes as a signaling molecule. It is synthesized endogenously through nitric oxide synthase enzymes and was named "Molecule of the Year" in 1992. NO regulates processes in the cardiovascular, respiratory, nervous, reproductive, immune, muscular and digestive systems. It acts as a vasodilator, neurotransmitter, and promotes smooth muscle relaxation. While NO has many beneficial functions, excessive amounts can also be toxic.
The document outlines 12 reasons to use the Kyäni Health Triangle nutritional products according to Dr. Abbas Qutab. The triangle consists of Kyäni Sunrise drink which provides vitamins and minerals, Kyäni Sunset vitamin E with omega-3, and Kyäni Nitro FX noni extract. The reasons given are that it provides a range of whole nutrients, antioxidants to protect against free radicals, supports cardiovascular, immune, brain and eye health, can help inflammation and aging, and benefits sexual health, blood sugar control, and the GI tract.
Primary intention healing occurs when a wound is closed within hours of injury through surgical or mechanical approximation of wound edges. Delayed primary healing allows time for wound debridement before closure to prevent infection. Secondary intention healing involves closure of full thickness wounds through wound contraction and epithelialization without surgical closure. Wound healing progresses through inflammatory, proliferative, and remodeling phases regardless of closure method and can move between phases based on intrinsic and extrinsic patient factors.
This study evaluated the protective effects of glutamine on intestinal permeability and bacterial translocation in rats receiving total parenteral nutrition (TPN) with endotoxemia. Thirty-four rats were divided into four groups: a control group, a TPN group, a trauma and endotoxemia group, and a trauma plus endotoxemia group that received glutamine in TPN. Glutamine supplementation was found to decrease intestinal permeability and bacterial translocation compared to the trauma and endotoxemia group as measured by urinary lactulose and mannitol levels and mesenteric lymph node cultures. This suggests glutamine protects intestinal barrier function in rats with endotoxemia receiving TPN.
This document presents information about glutamine in nutrition management. It discusses glutamine as the most abundant amino acid in the body, which can be synthesized and is not essential to the diet. It serves various functions including protein synthesis, acid-base regulation, and as an energy source. The document outlines glutamine producers, consumers, dietary sources, metabolism, medical uses including for cancer and HIV/AIDS patients, and roles in cellular protection, gut barrier function, immune modulation, and oxidative stress. The document also discusses glutamine supplementation for athletes to boost performance and recovery.
The document discusses receptor-mediated activation of nitric oxide (NO) synthesis by arginine in the vasculature. It first provides historical background on the discovery of NO and its role in vasodilation. It then presents evidence that arginine can activate NO synthesis through receptor-mediated mechanisms involving imidazoline/alpha-2 adrenergic receptors, G-proteins, and intracellular calcium signaling. Specifically, it shows that arginine and the endogenous agonist agmatine can directly stimulate NO production in endothelial cells, and this effect is blocked by receptor and G-protein antagonists. It also demonstrates that arginine and agonists elicit vasodilation through receptor-dependent mechanisms. This work helps
Glycine and serine are both non-essential amino acids that can be synthesized in the body. Glycine is the smallest amino acid and is important for muscle tissue, central nervous system function, and collagen formation. Serine participates in biosynthesis of other amino acids and metabolites and has structural and signaling roles in enzymes and neurotransmitters. Both amino acids share metabolic pathways and deficiencies can impact growth and development. Studies show glycine and serine may help with sleep, fight cancer cell growth, and reduce osteoarthritis symptoms.
Glycine is a simple amino acid that plays many important roles in the body. It is involved in the synthesis of collagen, creatine, glutathione, heme, purines, and other specialized products. Glycine can be synthesized from carbon dioxide and ammonia in the liver, from glyoxylate, serine, and threonine. It can be broken down through the glycine cleavage complex to produce carbon dioxide and ammonia, or through oxidation to glyoxylate. Glycine participates in many transamination, decarboxylation, and conjugation reactions throughout the body. Excessive consumption of glycine can lead to kidney stones due to oxalate accumulation.
Glycine is the simplest amino acid. It has several metabolic functions including the biosynthesis of heme, purines, creatine, glutathione, and as a conjugating agent. Glycine is also used as a neurotransmitter in the brainstem and spinal cord and is a constituent of proteins, often found where the polypeptide chain bends or turns. Key reactions involving glycine include its role in the rate-limiting step of heme synthesis through ALA synthase, incorporation into the purine ring, and synthesis of creatine through combination with arginine and subsequent phosphorylation. Glycine also functions in glutathione synthesis, free radical scavenging, amino acid transport, insulin inactivation, and enzyme activation through thiol groups
Nitric oxide (NO) is an endogenous signaling molecule generated from L-arginine by nitric oxide synthase. It is a key signaling molecule in the cardiovascular, nervous, and immune systems. NO activates guanylate cyclase, increasing cyclic GMP levels to cause smooth muscle relaxation and inhibit platelet aggregation. The physiological role of NO was discovered in the vasculature, where it was shown that endothelium-derived relaxing factor causing vasodilation was NO. NO has diverse functions and is involved in processes like neurotransmission, host defense, and inflammation.
synthesis and degradation of glycine is discussed. specialized products formed from glycine is described in detail. disorders associated with metabolism of glycine is also explained.
The document discusses amino acid catabolism and the relationships between organs in metabolizing and transporting amino acids and nitrogen. The intestine absorbs amino acids from food and releases byproducts like ammonium and alanine. The liver synthesizes proteins, breaks down amino acids, and performs gluconeogenesis and urea synthesis. Skeletal muscle breaks down branched chain amino acids and transports amino groups as alanine and glutamine to other organs. One clinical case describes a infant with high blood ammonium levels due to a genetic deficiency in ornithine transcarbamoylase, an enzyme in the urea cycle. Treatment with essential amino acids and sodium benzoate helped reduce ammonium levels.
This document summarizes the biosynthesis of amino acids from key metabolic precursors. It discusses 6 families of amino acid biosynthesis defined by their precursor: (1) α-ketoglutarate family (glutamate, glutamine, proline, arginine), (2) 3-phosphoglycerate family (serine, glycine, cysteine), (3) oxaloacetate family (aspartate, asparagine, methionine, threonine, lysine), (4) pyruvate family (alanine, valine, leucine, isoleucine), (5) phosphoenolpyruvate and erythrose 4-phosphate family (tryptoph
Presentasi Luka Bakar Minggu ke 2 PKL Arif Triyono
Tn SP berusia 30 tahun, seorang tamatan SLTP bekerja sebagai buruh bangunan, dan sedang menantikan kelahiran anak pertamanya.
Pada saat mengecat pagar sebuah kantor, tiba-tiba alat blower cat meledak disebabkan karena tabung gas pada alat tersebut bocor dan mengenai Tn SP di seluruh lengan dan kaki kanan, sebagian wajah dan kepala, dan sebagian dada. Kejadian tersebut berlangsung sekitar pukul 11.00 WIB. Pada pukul 12.20 WIB, yang bersangkutan baru dibawa ke IRD Rumah Sakit ‘Puri Sehat’ untuk dilakukan tindakan operasi debridement di IRD dengan GA (General Anestesi). Pasien mengalami luka bakar grade IIB dengan kondisi hipoalbumin dan sudah ditransfusi albumin 25% 100ml 30 tts/menit pada saat dilakukan debridement, namun kondisi tersebut tidak berubah. Berdasarkan instruksi dari dokter, pasien ini tetap diberikan infuse albumin hingga kadar albumin mencapai lebih dari 3 gr/dl.
Tn. SP jarang mengkonsumsi buah-buahan. Setiap hari Tn. SP minum kopi yatu pada pagi dan sore hari, sedangkan pada malam harinya minum kratingdaeng ditambah dengan telur ayam.
Senang makan makanan yang digoreng dan yang bersantan kental.
Setiap siang dan sore hari mengkonsumsi camilan berupa gorengan seperti weci, tahu isi, dan pisang goreng.
Hari pertama di RS Puri Sehat, Tn. SP diberikan makanan cair rumah sakit 1500 cc ditambah dengan 1 bungkus proten. Setelah operasi debridement, makanan yang diberikan adalah diet lunak, proten 2 bungkus/hr dan telur rebus 3 butir/hari
Dari hasil assessment awal didapatkan data-data sebagai berikut :
• TB = 167 cm, LILA = 25 cm
• Nadi : 112 x/menit, RR : 24 x/menit, suhu : 38,5⁰C, tekanan darah : 120/80 mmHg
• Leukosit : 12.700/ul, Natrium : 130 ml/mol, Hb : 10 gr/dl, albumin : 1,9 g/dl
• Infus : NaCl 0,9% 1500 cc/24 jam
Spices have various beneficial effects on blood sugar control and diabetes management. Cinnamon, fenugreek seeds, cumin seeds, turmeric, red chili, cloves, ginger, garlic, and licorice root (Glycyrrhiza glabra) can help lower blood glucose levels, reduce inflammation, improve insulin sensitivity, and manage cholesterol levels. Studies show consuming doses of 3-6 grams of cinnamon per day or adding fenugreek seeds to the diet can positively impact blood sugar and HbA1c levels over time. The active compounds in these spices are thought to stimulate insulin production and sensitivity.
David Bihari is an Intensivist from Prince of Wales Hospital in Sydney. He is particularly interested and passionate about nutrition in the critically ill, and has been involved in research in this area for many years. Here he talks about how we feed in ICU.
פירוט הרכיבים הטבעיים שנמצאים ב Cane תוסף תזונה טבעי המסייע לחולי סוכרת להגיע לאיזון ברמות הסוכר שלהם. Cane הוא תוסף תזונה מבית קיורהלייף, חברה הדואגת לאיכות חייהם של החולים במחלות כרוניות.
http://www.cane-curalife.com/
This is a presentation I done with 3 days in a rush for a presentation in a workshop. I hope it brings certain information to my blog users. From www.littlediet.info.
This document discusses the role of arginine-supplemented diets in critically ill patients. It summarizes the largest randomized controlled trial of an immunonutrition formula enriched with arginine, glutamine, antioxidants, and omega-3 fatty acids, which found no differences in outcomes. Subsequent analyses found no effect on mortality or infectious complications. However, some smaller studies found increased mortality in septic patients receiving arginine. Guidelines now recommend against the use of arginine-supplemented diets for critically ill patients based on the current evidence.
Presentasi Kanker Payudara Minggu Ke 1Arif Triyono
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As healthcare practitioners, we are well aware of the endless benefits of vitamin C in supporting immune health, antioxidant support, energy production, collagen formation, nervous system function and iron absorption. Faced with a huge array of vitamin C products, however, how can we be confident we’re recommending the best supplement to our clients?
During R&D for our latest addition to the Igennus Healthcare Nutrition synergistic range of supplements, we were impressed by both the high absorption of Ester-C and the unprecedented uptake and retention in immune cells. Ester-C boasts an impressive 10x higher bioavailability in leukocytes, whilst its pH neutral composition means it’s also gentle on the stomach.
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- The research that led to the production of Ester-C
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2. Audience will be able to:
◦ Review the medical nutrition therapy for wound
healing
◦ Identify the amino acids glutamine and arginine
◦ Recognize glutamine and arginines’ metabolic
role in wound healing
◦ Be familiar with the different studies that have
been done to establish these roles
Pressure Ulcers, Diabetic Ulcers, Skin grafts, and Burns
◦ Discover future outlooks on glutamine and
arginine in wound healing
3.
4. 20% protein loss within first two weeks of
injury
Increased energy needs
◦ 25-35 g/kg/d
Increased protein needs
◦ 1.5-2.0 g/kg/d
Additional vitamins and minerals
◦ Selenium, Vitamin C, Vitamin A, Vitamin E, Zinc
5. Most abundant amino acid (AA) in the plasma
Conditionally essential
Major metabolic fuel for intestinal mucosa
and cell proliferation
◦ Fibroblasts, lymphocytes, epithelial cells,
macrophages
Increases protein synthesis and
immunoglobulin a (IgA)
Synthesized in muscle
6. Conditionally essential
Beneficial in improving cardiovascular,
reproductive, pulmonary, gastrointestinal,
liver and immune functions.
Facilitates wound healing, enhances insulin
sensitivity, and maintains tissue integrity
Precursor for nitric oxide
7. Directly
◦ De novo synthesis
Citrulline
◦ Synthesized FROM glutamine
◦ Synthesis OF arginine.
Glutamine contributes 64% synthesis of arginine.
Arginine can be hydrolyzed by hepatic
arginase to urea and ornithine which
utlimately get converted to glutamine
8. Arginine and pressure ulcers
◦ spinal cord injury
Observational study
Dietitian involved
◦ Mini nutritional assessment
◦ Weekly rounds
Oral nutrition supplement
◦ Not exclusively arginine
Zinc and Vitamin C
Nutrition and Dietetics 2011 Dietitians Associations of Australia
9. 2.5-fold greater rate of pressure ulcer
healing for those who took supplement
◦ Non-compliance – GI upset, dislike taste;
Dietitian recorded monitored weekly intake
Wide Age range
No exclusion of wounds
Limited to one population
Stages not specified
10. Multicenter, multicountry, randomized,
controlled, double blind, parallel group trial
◦ 43 participants
◦ Age: 18-90 years
Stage III or Stage IV Pressure Ulcer
Excluded Diabetic Ulcers
◦ Also excluded patients on a dietary restrictive diet
Not specified
11. Standard Nutritional Diets and Wound Care
◦ Locally used protocols
Oral Nutrition Supplements
◦ Arginine, Zinc, Vitamin A, Vitamin C, Selenium,
Copper, Folic Acid
Suggests that healing could be multifactorial
Results
◦ Significant differences in the reduction of the ulcers
and the difference in PUSH scores
Most prominent in 1st weeks
12. Both Arginine and Glutamine
Observational Study
◦ 16 participants
Nutritional Supplement
◦ Arginine, Glutamine, Hydroxy-B-methylbutyrate
(HMB)
◦ Energy needs: 20-22% of high quality protein
Microalbuminuria – Kidney function
◦ Type II DM
13. Two Hypothesis
◦ Reduction in Albuminuria
◦ Arginine protects kidney
Results
◦ Supplement decreased microalbuminuria by 47%
◦ 6 months
Food ulcers healed after this time
Absence of randomization
◦ Role of HMB?
14. Prospective Study
Healthy adults - skin transplantation
◦ Reconstructive Surgery
Mechanisms of Arginine
◦ Compared healing
Surgical wounds and normal skin
Inducible Nitric Oxide
◦ Activated by arginine
15. Cells observed after supplementation
◦ PMNs and Marcrophages
Increased NO levels and wound tensile
strength
Arginine was increased in all wounds
Not increased in non-surgical wounds
◦ Fibroblasts
Increase in NO
More specific
◦ Arginine 2
16. Double Blind Control Study
Skin Graft
◦ 35 subjects
Intravenous Arginine
Wound healing evaluated at donor site
◦ Angiogenesis
◦ Reepithilialization
◦ Neutrophil influx
Plasma arginine AA concentrations measured
Burns 37 (2011)
17. Two groups comparable
◦ Age, nutritional status, metabolic and inflammatory
state
No differences found in arginine group or
placebo
Conclusion
◦ Arginine does not improve angiogenesis,
reepethilialization or neutrophil influx
18. Arginine and Glutamine
◦ No effect on pressure ulcers in elderly
Randomized control study
Dietitian involved in assessment
◦ 26% were at risk for malnutrition
Nutritional supplement
◦ Agrinine
Did not increase NO in this population
Did not enhance lympocyte proliferation
Lack of other vitamins and minerals
Did not provide immune benefit
19. Randomized, controlled double blind clinical
trial
Burn patients
◦ 30-75% total surface area burned
Glutamine Supplementation – enteral
nutrition and oral supplementation
◦ Glutamine granules and glycine
Nutrition
◦ All patients receiving the same amount of nitrogen
and energy
Did not specify grams or kcals/kg
20. Immune function improved in glutamine
groups
Hospital stay
◦ 9 days shorter fro supplemented group
Results
◦ Glutamine supplementation improves immune
function and facilitates wound healing
21. Arginine studied more than Glutamine
◦ Individalization
Mixed results
Bigger study groups needed for
generalization
◦ Nutritional supplements
Had more benefit
Vitamins, minerals, antioxidants
Most subjects were not malnourished in all studies
Wound healing
◦ Multifactorial
More studies needed
◦ Individualizing both amino acids
23. Peng, X., H. Yan, Z. You, P. Wang, and S. Wang. "Glutamine Granule-
supplemented Enteral Nutrition Maintains Immunological Function in
Severely Burned Patients." Burns 32.5 (2006): 589-93.
Stechmiller, Joyce K., Bobbi Langkamp-Henken, Beverly Childress,
Kelli A. Herlinger-Garcia, Jan Hudgens, Lili Tian, Susan S. Percival,
and Ruby Steely. "Arginine Supplementation Does Not Enhance
Serum Nitiric Oxide Levels in Elderly Nursing Home Residents With
Pressure Ulcers." 4 Apr. 2006. Web. 2 Dec. 2011.
<http://www.ncbi.nlm.nih.gov/pubmed/15788738>.
Debats, I.B.J.G., T.G.A.M. Wolfs, J.P.M. Cleutjens, and C.J. Peutz-
Kootstra. "Role of Arginine in Superficial Wound Healing in Man."
Web. 12 Dec. 2011.
<http://www.ncbi.nlm.nih.gov/pubmed/19638312>.
atti, Patrizio, Leonardo Masselli, Annalisa Pipicelli, and Annabel
Barber. "Effect of a Nutritional Supplement Used for Diabeic Foot
Ulcers on Microalbuminuria." Mediterranian Journal of Nutrition
Metabolism 9 (2011).
Editor's Notes
20% protein loss within first two weeks of injury Increased energy needs 25-35 g/kg/d Increased protein needs 1.5-2.0 g/kg/d depending on the severity of the injury Long-standing DM with a high rate of gluconeogenesis is in itself a catabolic condition, these subjects have a high rate of protein loss. Additional vitamins and minerals Selenium, Vitamin C, Vitamin A, Vitamin E, Zinc
Most abundant AA in the plasma Conditionally essential Initially classified as non-essential since it can be synthesized de novo , it is now considered conditionally essential in catabolic states. Major metabolic fuel for intestinal mucosa and cell proliferation Fibroblasts, lymphocytes, epithelial cells, macrophages Increases protein synthesis and immunoglobulin a (IgA) This contributes to maintain intestinal barrier Synthesized in muscle From nonessential amino acids and gucose, with much of the nitrogen coming from glucose.
Conditionally essential It is synthesized from glutamine, glutamate and proline via the intestinal renal axis Beneficial in improving cardiovascular, reproductive, pulmonary, gastrointestinal, liver and immune functions. Facilitates wound healing, enhances insulin sensitivity, and maintains tissue integrity Precursor for nitric oxide nitrous oxide synthase 2 (NOS2) gene transfer reversed impaired wound repair in NOS2 deficient mice Precursor derived from L-arginine NO has cytostatic, chemotactic, and vasodilatory effects during early wound repair, regulates proliferation and differentiation of several cell types, modulates collagen deposition and angiogenesis, and affects wound contraction.
Dierectly De novo synthesis Glutamine directly contributes to arginine de-novo synthesis through an intestine kidney pathway Citrulline Synthesized from glutamine Synthesis of arginine Citrulline, synthesized from glutamine, directly through glutamate and proline in the mitochondria of enterocytes, is released from the small intestine, escapes the liver and is extracted primarily by the kidney in which it is used for synthesis of arginine. glutamine contributes 64% to the synthesis of arginine from citrulline under postabsorptive conditions
Use of an arginine-enriched oral supplement in the healing of pressure ulcers in patients with spinal cord injuries: An observational study Observational Study 34 patients involved Average age 49 Dietitian in charge of all nutritional assessments BMI, weight history, clinical factors impacting nutritional status (bowel regimen, appetite, dentition, level of spinal chord injury and its impact on self feeding, diet history Supplement compliance and overall dietary intake. This study had no significant differences in age, baseline pressure ulcer scale for healing (PUSH) score, prevalence of under nutrition, gender, or type of spinal chord injury. Majority of patients were well nourished 3 of the 4 patients that were malnourished improved nutritional status throughout the study. Patients prescribed two 237 ml tetra packs per day of specialized wound healing supplement containing 9g of protein 500mg Vitamin C 30 mg Zinc
2.5-fold greater rate of PU healing for those who took the supplement While the study was not a randomized controlled trial, it examined the healing of PU in normal clinical practice and therefore presents a realistic picture of the likely benefit of nutritional intervention Good Study Wide age range Dietitian assessed patients Wound patients included – diabetics, osteomyelitis, and recovering surgery. Bad Study Could have compared the groups in one taking a supplement having extra protein vitamin C and zinc and another group with added arginine. Limited to one population Melbourn Victoria All stages of pressure ulcer taken into consideration Could have skewed numbers; patiens with lower pressure ulcers could have cured faster Prior intake of nutritional supplements (Ensure etc…) were not taken into consideration…patients could have already been taking supplement at home which could have also skewed results.
Specific nutritional Support accelerates pressure ulcer healing and reduces wound care intensity in non-malnourished patients. Multicenter, multicountry, randomized, controlled, double blind, parallel group trial Czech Republic, Belgium, The Netherlands, Curacao Age: 18-90 years Stage III or Stage IV Pressure Ulcer Revised by the European Pressure Ulcer Advisory Panel Classification system Excluded Diabetic Ulcers Also excluded were malnourished patients, those on pallative care, those using corticosteroids, and those on a dietary restrictive diet No protein, no CHO???
Standard Nutritional Diets and Wound Care Locally used protocols Oral Nutrition Supplements Arginine, Zinc, Vitamin A, Vitamin C, Selenium, Copper, Folic Acid Results Significant differences in the reduction of the ulcers and the difference in PUSH Conclusion: Present study showed that pressure ulcer healing can be accelerated in non-malnoursihed patients by providing a specific oral nutrition supplement enriched in Arginine, zinc, and antioxidants. This suggests that the benefits of this supplement reach beyond restoring caloric and protein deficiencies. Supplementation is also likely to improve the quality of life of patietns and sace cost by decreasing wound care. Good Study Broad range of patients: Can be generalized to different countries Limited to stage III and stage IV ulcers therefore, no bias to smaller pressure ulcers was present Wide age range can also generalize that it works for everyone Patients were excluded if they were taking supplement 2 weeks prior to admission to the hospital. Bad Study Exclusion of diabetic ulcers – sometimes the most prevalent Also not exclusive to arginine (glutamine not present) Small sample considering so many countries involved No dietitian monitored intake No specific details given as to what was the “standard nutritional protocol” followed
Both Arginine and glutamine Most recent study found that takes both of these amino acids into consideration Observational study 16 participants Average age of 63 years All patients suffered from nephropathy, rentinopathy and neuropathy Patients at a slightly overweight BMI (Normal) 25 Nephropathic diabetic who develops a foot ulcer usually is protein malnourished, even at a normal BMI. Average duration of DM in these patients was 11 years Nutritional Supplement Arginine, glutamine, HMB – two doses Individual Caloric needs supplying 20-22% of high quality protein per day Microalbuminuria – Kidney Function Type II DM Microalbuminuria is a hallmark of renal involvement in DM Condition defined as the passage of protein in the urine. Precursor of proteinuria and early mortality.
Two Hypothesis The reduction in microalbuminuria, the blend increased collagen deposition helped the reconstruction of the capillary basement in the kidney Arginine may have exerted a renoprotective effect demonstrated in different models of renal failure Anti inflammatory of arginine in muscle Results Supplement decreased microalbuminuria by 47% 6 months Foot ulcers healed but authors thought it would have had more of an improvement in microalbuminuria had the patients continued to take the supplement . Weakness of the study Absence of randomization Does not include any other wounds Does not focus on one amino acid What role does HMB play in wound healing 6 months is not a long time to fully see the effects this supplementation has on albuminuria but it did show that giving the supplement did help in healing wounds.
Prospective Study Healthy adults – Skin Transplantation Reconstructive surgery Excluded if patients had kidney or liver failure, pregnant, use of steroids or had DM Mechanisms of Arginine Compared healing Surgical wounds and normal skin Study provides insight in the mechanisms of arginine by showing expression of arginine metabolites and arginine metabolizing enzymes at different time prints during normal healing of surgical wounds compared with normal skin. Inducible nitric Oxide – derived from L-arginine NO has cytostatic, chemotactic, and vasodilatory effects during early wound repair, regulates proliferation and differentiation of several cell types, modulates collagen deposition and angiogenesis, and affects wound contraction. In the present study, iNOS was observed in macrophages, PMNs (Neutrophils), fibroblasts, epithelial and endothelial cells upon wounding. In contrast, these cells did not express iNOS in normal skin, indicating wounding activates arginine metabolism. All of these cells have specific functions during the complex process of healing and nitric oxide has been implicated as a mediator.
In summary, the finding support that arginine supplementation activates the cells most involved in wound healing In the future, arginine 2 over arginine 1 might be considered as a supplement
Neutrophil influx was assessed to evaluate the essential inflammatory phase of wound healing. Neutrophils generate NO Angiogenesis (new blood vessels from old blood vessels)– mediated through NO, through the induction of vascular endothelial growth factor.
Despite a significantly increased plasma arginine levels after supplementation, there was no benefit from supplementational arginine. Arginine supplementation might only affect wound healing when there is a depletion
Arginine and Glutamine No effect on pressure ulcers in elderly Randomized control study Dietitian involved in assessment 26% were at risk for malnutrition None malnourished Nutritional supplement Agrinine Did not increase NO in this population Possible that arginine was metabolized via arginase and not via NO synthase NO synthase is also down-regualted with age Did not enhance lymphocyte proliferation Lack of other vitamins and minerals
Randomized, controlled double blind clinical trial Burn patients Divided into two groups Both groups given same amount of nitrogen and energy Vitamins and minerals? 14 days 48 patients with severe burns 30-75% of surface area burned Glutamine supplementation Glutamine granules and glycine were provided All solutions packed the same way Neither the provider nor the patient knew if they were getting glutamine or not. Nutrition All patients receiving the same amount of protein
Patients receiving glutamine did better in maintaining immunologic function, blocking sepsis, accelerating wound repair, and reducing hospital stay 9 days shorter The study showed that is is possible to increase plasma concentrations of glutamines by providing glutamine granules via nutrition support, and could benefit burn patients Limitations Some of these granules were given through enteral nutrition Not known if other vitamins and minerals were aiding the healing process. What diets were being followed in hospital Were all patients given the same amount of vitamins and minerals as would be given in a premixed enteral formula? Burns 30-70% big gap Wound have been better to separate wounds in stages
Arginine is being more observed than glutamine. Studies that did individualize these amino acids had mixed conclusions Nutritional supplement's enhanced with other vitamins minerals and antioxidants had more benefit More studies are needed to determine if arginine and glutamine can be individually given to benefit Further studies could evaluate the healing effects of single nutrients (arginine or glutamine).