Inhibitors are chemicals that reduce the rate of the enzymatic reactions,
They are usually specific and work at low concentrations,
They block the enzyme, but they do not usually destroy it,
Many drugs and poisons are inhibitors of enzymes in the nervous system,
Inhibitors of the catalytic activities of enzymes provide both pharmacologic agents and research tools for the study of the mechanism of enzyme action.
Active sites of the enzyme is that point where substrate molecule bind for the chemical reaction. It is generally found on the surface of enzyme and in some enzyme it is a “Pit” like structure
The active site is a three-dimensional cleft formed by groups that come from different parts of the amino acid sequence
The active site takes up a relatively small part of the total volume of an enzyme
Active sites are clefts or crevices
Substrates are bound to enzymes by multiple weak attractions.
The specificity of binding depends on the precisely defined arrangement of atoms in an active site.
Inhibitors are chemicals that reduce the rate of the enzymatic reactions,
They are usually specific and work at low concentrations,
They block the enzyme, but they do not usually destroy it,
Many drugs and poisons are inhibitors of enzymes in the nervous system,
Inhibitors of the catalytic activities of enzymes provide both pharmacologic agents and research tools for the study of the mechanism of enzyme action.
Active sites of the enzyme is that point where substrate molecule bind for the chemical reaction. It is generally found on the surface of enzyme and in some enzyme it is a “Pit” like structure
The active site is a three-dimensional cleft formed by groups that come from different parts of the amino acid sequence
The active site takes up a relatively small part of the total volume of an enzyme
Active sites are clefts or crevices
Substrates are bound to enzymes by multiple weak attractions.
The specificity of binding depends on the precisely defined arrangement of atoms in an active site.
A comprehensive coverage of Enzymes including basics, mechanisms of enzyme catalysis, enzyme inhibition and clinical applications, mostly based on Stryer- Biochemistry. The slides were intended for MBBS teaching, but should benefit the students of Biochemistry and allied sciences.
Prepared in Sept 2015
Medicine Lvl 1 Biochemistry: ENZYMES AND BIOENERGETICSPaula Marie Llido
Medicine Lvl 1 Biochemistry: ENZYMES AND BIOENERGETICS SGD 9 compiled by Paula Marie M. Llido
-Enzymes
-Major Classes of Enzymes
-Factors affecting enzymes
-Michaelis Menter and Hill Equation
-Enzymes for Clinical Diagnosis
-Glycolysis
-Krebs Cycle
-Oxidative Phosphorylation
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
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Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
1. Enzyme
Dr. Farhana Atia
Assistant Professor
Department of Biochemistry
Nilphamari Medical College, Nilphamari
Email: farhana.atia@gmail.com
2. ENZYMES
Enzymes are
– colloidal,
– heat labile,
– organic catalyst (biocatalyst),
– protein in nature (except rybozyme),
– Non dialyzable
– Catalyze biochemical reaction.
Substrate: Bind & react with enzyme at its
active site
Product: Fate of substrate
3. Enzyme has two site-
• Active site: Substrate binds here
• Allosteric site : Another site which can alter the
enzyme action. Inhibitor/ stimulator binds here
4. IUB Classification
Class Reaction catalyzed
Oxidoreductases oxidation-reduction
Transferases transfer of moieties such as glycosyl,
methyl, or phosphoryl groups
Hydrolases hydrolytic cleavage of C-C, C-O, C-N bond
Lyases cleavage of C-C, C-O, C-N bond by atom
elimination, generating double bond
Isomerases geometric / structural changes within a
molecule
Ligases/
synthetase
joining together of two molecules coupled
to the hydrolysis of ATP
5. According to location
1. Plasma specific enzyme/ Functional enzyme
– Present in plasma & act continuously. E.g.
Lipoprotein lipase, Plasminogen
2. Nonfunctional enzyme
1. Secretory enzyme: Digestive enzyme
2. Intracellular enzyme
• In plasma: Present in very small amount & not
perform any function
• Level increased in blood after tissue damage
• AST, ALT
6. Many enzyme contain small non protein molecule & metal
ions that participate directly in substrate binding / catalysis,
termed prosthetic group, cofactor, coenzyme
Apoenzyme
Coenzyme
Prosthetic
group
Metal ion
Cofactor/
Non protein
part
Holoenzyme
Protein
part
7. Coenzyme: Heat stable, low molecular weight, non protein,
organic compound required for enzyme activity, usually
derived from vit B complex
Vitamin Coenzyme
B1-Thiamine Thiamine pyrophosphate (TPP)
B2-Riboflavin Flavin adenine dinucleotide (FAD)
Flavin adenine mononucleotide (FMN)
B3-Niacin Nicotinamide adenine dinucleotide (NAD)
NADP
Biotin Enzyme bound Biotin
B5-Pantothenic acid Coenzyme A
B6-Piridoxine Pyridoxal phosphate (PP)
B12-Cobalamin Methylcobalamin
Deoxyadenosylcobalamin
Folic acid THF (Tetrahydrofolic acid)
9. Isoenzyme/ Isozyme
• Physically distinct variant of
same enzyme which catalyze
the same reaction
• Common clinically important
enzyme
– LDH: Lactate dehydrogenase
– CPK/ CK: Creatinine
phosphokinase
– ALP: Alkaline phosphatase
10. Isoenzyme Subunit High level found in
LDH 1 HHHH Myocardium, RBC
LDH 2 HHHM Myocardium, RBC
LDH 3 HHMM Brain, Kidney
LDH 4 HMMM Skeletal muscle
LDH 5 MMMM Liver, Skeletal muscle
CK 1 BB Brain
CK 2 MB Myocardium
CK 3 MM Skeletal muscle
ALP Bone, Liver, Placenta
11. Factors affecting enzyme activity
In laboratory In vivo/ biological system
1. pH 1. Substrate concentration
2. Temperature 2. Allosteric effector
3. Substrate concentration 3. Covalent modification
4. Enzyme concentration 4.Induction & repression of
enzyme synthesis
5. Time & Product
concentration
12. pH
• Optimum pH (5-9), at which
enzyme activity is maximum
• Exception
– Alkaline phosphatase >9
– Pepsin : 1-3
Temperature
• The reaction rate increases with
temperature to a maximum level,
then abruptly declines
• Optimal temperature :40- 50 °C
• Denatured above 60oC
13. Substrate concentration
• Increase velocity of enzyme
as the substrate
concentration increase up to
enzyme saturation
Enzyme concentration
• Directly proportional to the
rate of reaction (provided
sufficient substrate is
present)
Time & product concentration
• Initially linear, than plateau
14. Allosteric
effectors
Substrate that non
covalently bind with
enzyme other than
the active site
May be-
• Positive effector: ↑
enzyme activity
• Negative effector: ↓
enzyme activity
• Homotrophic effector:
substrate itself act as
effector. Usually +ve effector.
• Heterotrophic effector:
Different from substrate.
Usually negative effector.
15. Covalent modification:
• Many enzyme may be
regulated by covalent
modification by addition or
removal of phosphate group
• Most enzymes are activated
& are some inactivated by
phosphorylation
• Glycogen synthase + PO₄
↓ enzyme activity
• Glycogen phosphorylase +
PO₄ ↑ enzyme activity
Induction & repression
of enzyme synthesis:
Insulin
• Induce all enzyme of
glycolysis
• Repress enzyme of
gluconeogenesis
16. • The Michaelis-Menten equation is a quantitative
description of the relationship among the rate of
an enzyme- catalyzed reaction [v1], the
concentration of substrate [S] and two constants,
Vmax and km (which are set by the particular
equation).
• The symbols used in the Michaelis-Menten
equation-
– reaction rate [v1]
– maximum reaction rate (V max)
– substrate concentration [S]
– Michaelis-Menten constant (Km)
Michaelis-Menten Kinetics
17. Michaelis-Menten
equation
• Equation states that when [S] equals Km, the initial
velocity is half-maximal.
• Equation also reveals that Km is a constant and may be
determined experimentally from—the substrate
concentration at which the initial velocity is half-maximal
18. • The Michaelis constant Km is the substrate
concentration at which vi is half the maximal
velocity (Vmax/2) attainable at a particular
concentration of enzyme
• It is specific and constant for a given enzyme under
defined conditions of time , temperature and p H
• Km determines the affinity of an enzyme for its
substrate, lesser the Km higher the affinity and vice
versa
• Km value helps in determining the true substrate
for the enzyme.
Km and its significance
19. Enzyme inhibition
• Inhibitor: Any substrate that can inhibit or diminish
the velocity of an enzyme catalyzed reaction.
Enzyme
inhibition
Reversible
Competitive
Non-
competitive
Irreversible
20. Reversible inhibitors:
• Bind with an enzyme by non-covalent bond
Competitive inhibitors:
• Structurally similar to substrate (structural analog)
• Occupies active site
• Compete with substrate for active site
• Action can be reversed by ↑ [substrate]
• Vmax same, Km ↑
• In TCA cycle succinate (S) & malonate (I) compete
for succinate dehydrogenase
• NSAIDs used as competitive inhibitor of
cycloxygenase & prevent PG synthesis
21. Non-competitive inhibition:
• Bind enzymes at sites distinct from the
substrate-binding site
• No structural resemblance to the substrate
• Binding of the inhibitor does not affect binding
of substrate
• Formation of both EI and EIS complexes is
possible
• Vmax ↓, Km same
• Cyanide inhibits cytochrome oxidase
• Fluoride inhibits Enolase and hence glycolysis
22.
23. Irreversible inhibition
• Binds with active site of
enzyme by covalent bond
• Permanently inactivate
enzyme
• Vmax ↓, Km same
• OPC (organo
phosphorous compound)
irreversibly inhibit acetyl
cholinesterase
24. Enzyme specificity
• Act on particular bond or group in closely
related substrate
• Proteolytic enzyme act on peptide bond
Relative/
group
specificity
• Acts on specific substrate
• Urease acts on urea
• Carbonic anhydrase on H₂CO₃
Absolute
specificity
• Acts on only one isomer
• Glucose oxidase acts on β-D-anomer of glucose
• Glucokinase acts on D-glucose
Optical/
stereo
specificity
25. Clinical importance of enzyme
Maintain normal physiology
Diagnosis of disease
Prognosis of disease
Treatment of disease by administration of enzyme or
inhibiting enzyme
Laboratory use
26. Maintain normal physiology
• Total internal environment of human body is
maintained by enzyme otherwise severe disaster
occur
– Na⁺K⁺ ATPase activity
• Without enzyme food can not be digested, absorbed
& metabolized and maldigestion, malabsorption
occur
• Enzyme deficiency can cause disease
– Inborn error of metabolism (PKU- phenyl ketonuria)
– Glycogen storage disease
– G6PD- glucose 6 phosphatase deficiency hemolytic
anemia
27. Diagnosis of disease
• Use of enzyme as diagnostic tool
– Non-functional enzyme released after specific tissue injury
which indicate disease of that organ/ tissue
– Acid phosphatase ↑in Carcinoma prostate
– ALT ↑ in hepatitis
• Isoenzyme determination is very important in case of
MI
– CK₂ ↑ sharply 4-8 hrs after pain & becomes normal within
48-72 hrs
– LDH₁, LDH₂ ↑ 48 hours after infarction & persist 7-10 days
• ELISA employ as a disease indicator (ELISA- enzyme
linked immuno-sorbent assay)
28. Prognosis of disease
• By serial assessment of we can evaluate
prognosis of disease
• Serum ALT for viral hepatitis
Laboratory use
• Clinical analyzer use enzyme as reagent
• Glucose oxidase & peroxidase – used in
estimation of blood glucose
29. Therapeutic use
Therapeutic agent-
• Streptokinase for clot lyses in MI
• Aspirin inhibit cycloxygenase in infection
• Allopurinol inhibit xanthine oxidase in
treatment of gout