- Lactose in milk is broken down by lactase into glucose and galactose. Galactose is metabolized mainly in the liver.
- Galactose is converted to glucose through a series of reactions involving galactokinase, galactose-1-phosphate uridylyltransferase, and UDP-glucose 4-epimerase.
- Deficiencies in enzymes involved in galactose metabolism can cause galactosemia, a serious genetic disorder if galactose is not restricted from the diet.
Under normal dietary intake the majority of the ingested fructose is metabolized by the enterocytes of the small intestine primarily to glucose which is then delivered to the systemic circulation. In addition to glucose, the carbon atoms from dietary fructose are converted, by intestinal enterocytes, into several other metabolites including glycerate, glutamate, glutamine, alanine, ornithine, and citrulline.
However, diets containing large amounts of sucrose, high fructose corn syrup, or fructose alone, overwhelm the ability of the small intestine to metabolize it all and under these conditions a significant amount of fructose is then metabolized by the liver and to a lesser extent by other organs such as skeletal muscle.
Gluconeogenesis: Defined as biosynthesis of glucose from non-carbohydrate precursors
-Gluconeogenesis: an intro
-Thermodynamic Barriers (Each barrier detail explanation)
- Energetics of gluconeogenesis
-Substrates of gluconeogenesis (each substrate and pathway explained)
-Regulation of Gluconeogenesis, hormonal and transcriptional regulation
Under normal dietary intake the majority of the ingested fructose is metabolized by the enterocytes of the small intestine primarily to glucose which is then delivered to the systemic circulation. In addition to glucose, the carbon atoms from dietary fructose are converted, by intestinal enterocytes, into several other metabolites including glycerate, glutamate, glutamine, alanine, ornithine, and citrulline.
However, diets containing large amounts of sucrose, high fructose corn syrup, or fructose alone, overwhelm the ability of the small intestine to metabolize it all and under these conditions a significant amount of fructose is then metabolized by the liver and to a lesser extent by other organs such as skeletal muscle.
Gluconeogenesis: Defined as biosynthesis of glucose from non-carbohydrate precursors
-Gluconeogenesis: an intro
-Thermodynamic Barriers (Each barrier detail explanation)
- Energetics of gluconeogenesis
-Substrates of gluconeogenesis (each substrate and pathway explained)
-Regulation of Gluconeogenesis, hormonal and transcriptional regulation
Gluconeogenesis- Steps, Regulation and clinical significanceNamrata Chhabra
Gluconeogenesis- Thermodynamic barriers, substrates of gluconeogenesis, reciprocal regulation of glycolysis and gluconeogenesis, biological and clinical significance
Gluconeogenesis- Steps, Regulation and clinical significanceNamrata Chhabra
Gluconeogenesis- Thermodynamic barriers, substrates of gluconeogenesis, reciprocal regulation of glycolysis and gluconeogenesis, biological and clinical significance
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
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.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
3. • Lactose, present in milk & milk products.
• Principal dietary source of galactose.
• Lactase ( β-galactosidase ) of intestinal
mucosal cells hydrolyses lactose to galactose
and glucose.
• Galactose is also produced from lysosomal
degradation of glycoproteins & glycolipids.
4. • Galactose is metabolised almost exclusively
by the liver and therefore galactose
tolerance test is done to assess the functional
capacity of the liver
• UDP-galactose is the active donor of
galactose during synthetic reactions
5. • Step: 1
• Galactokinase reaction:
• Galactose is first phosphorylated by
galactokinase to galactose -1- phosphate
• Step: 2
• Galactose -1- phosphate uridyl transferase
• This is the rate limiting enzyme.
6. • Galactose 1-phosphate reacts with UDP-
glucose to form UDP-galactose & glucose 1-
phosphate, in the presence of the enzyme
Galactose 1-phosphate uridyl transferase
7. • UDP-galactose is an active donor of galactose.
• UDP-galactose is essential for the formation of
compounds like lactose, glycosaminoglycans,
glycoproteins, cerebrosides & glycolipids.
• Step: 3
• Epimerase reaction:
• UDP-galactose can be converted to UDP-
glucose by UDP hexose 4-epimerase
8. • Galactose is channeled to the metabolism of
glucose.
• Galactose is not an essential nutrient since
UDP-glucose can be converted to UDP –
galactose by the enzyme UDP-hexose 4-
epimerase and requires NAD+
• Galactose is not essential in diet
9. • Step: 4
• Alternate pathway:
• The galactose 1-phosphate
pyrophosphorylase in liver becomes active
only after 4 or 5 years of life
• The enzyme will produce UDP-galactose
directly which can be epimerized to UDP-
glucose.
10. Galactose
Galactose 1-phosphate
Glucose 1-phosphate
Glucose 6-phosphate
Glycolysis Glucose
Galactitol
UDP-Glucose
UDP-Galactose
Lactose GAGS
Glycolipids
Glycoproteins
NADP
ATP
ADP
Galactokinase
Gala-1-Pho-Uridyl transferase
E
p
i
m
e
r
a
s
e
Mutase
Synthase
Galactose Metabolism
11. Disorders of galactose metabolism
• Classical galactosemia:
• Due to deficiency of enzyme galactose 1-
phosphate uridyltransferase
• Rare congenital disease in infants
• Inherited as an autosomal recessive disorder
12. Salient features
• Due to the block in this enzyme, galactose 1-
phosphate will accumulate in liver.
• This will inhibit galactokinase as well as
glycogen phosphorylase
• It results in hypoglycemia.
• Galactose cannot be converted to glucose
• Increased galactose level increases insulin
secretion, which lowers blood glucose level.
13. • Galactose metabolism is impaired leading to
increased galactose levels in circulation
(galactosemia) & urine (galactosuria)
• Bilirubin uptake is less & bilirubin conjugation
is reduced.
• Unconjugated bilirubin level is increased.
14. • There is enlargement of liver, jaundice &
severe mental retardation – due to
accumilation of galactose & galactose 1-
phosphate.
16. Development of cataracts
• Causes:
• Excess of galactose in lens is reduced to galactitol
(dulcitol) by the enzyme aldose reductase
• Galactitol cannot escape from lens cells
• Osmotic effect of the sugar alcohol contributes to
injury of lens proteins & development of cataracts.
17. Galactokinase deficiency
• The defect in the enzyme galactokinase.
• Results in galactosemia & galactosuria
• Dulcitol or galactitol is formed.
• Absence of hepatic and renal complications.
• Development of cataracts very rare.
• Treatment:
• Removal of galactose & lactose from the diet.
18. Fructose metabolism
• Fructose is present in fruit juices & honey.
• Chief dietary source is sucrose.
• Sucrose is hydrolyzed in the intestine by the
enzyme sucrase.
• Fructose is absorbed by facilitated transport
and taken by portal blood to liver.
• It is mostly converted to glucose.
19. • Fructose is easily metabolized & a good
source of energy
• Seminal fluid is rich in fructose &
spermatozoa utilizes fructose for energy.
• In diabetics, fructose metabolism through
sorbitol pathway may account for the
development of cataract.
20. Fructose metabolism
• Fructose is phosphorylated to form fructose 6-
phospate, catalyzed by the enzyme
hexokinase
• Affinity of the enzyme hexokinase for
fructose is very low
Fructose Fructose -6-p Glucose-6-p
E.M pathway
ATP ADP
Hexokinase Isomerase
21. • Fructose is mostly phosphorylated by
fructokinase to fructose-1-phosphate
• Fructokinase is present in liver, kidney,
muscle and intestine.
• Hexokinase can also act on fructose to
produce fructose 1-phosphate.
22. • Fructose-1-phosphate is cleaved to
glyceraldehyde & dihydroxy acetone
phosphate (DHAP) by aldolase B
• Glyceraldehyde is phosphorylated by
triokinase to glyceraldehyde 3-phosphate,
along with DHAP enters glycolysis or
gluconeogenesis.
25. • It involves the conversion of glucose to
fructose via sorbitol
• Sorbitol pathway is higher in uncontrolled
diabetes
• The enzyme aldose reductase reduces glucose
to sorbitol in the presence of NADPH
• Sorbitol is then oxidized to fructose by Sorbitol
dehydrogenase and NAD+
27. • In uncontrolled diabetes, large amounts of
glucose enter the cells which are not
dependent on insulin
• The cells with increased intracellular glucose
levels in diabetes (lens, retina, nerve cells,
kidney etc) possess high activity of aldose
reductase and sufficient supply of NADPH.
28. • This results in a rapid & efficient conversion of
glucose to sorbitol
• The enzyme Sorbitol Dehydrogenase is either
low in activity or absent in these cells.
• Sorbitol is not converted to fructose.
• Sorbitol cannot freely pass through the cell
membrane and accumulate in the cells.
29. • Sorbitol-due to its hydrophilic nature-causes
osmotic effects leading to swelling of the cells.
• Pathological changes associated with
diabetes are due to accumulation of sorbitol.
30. • Essential fructosuria:
• Deficiency of the enzyme hepatic fructokinase.
• Fructose is not converted to fructose 1-
phosphate.
• Excretion of fructose in urine.
• Treatment: Restriction of dietary fructose
• Urine gives positive benedicts & seliwanoff’s
test
31. • An autosomal recessive inborn error.
• Due to defect in the enzyme aldolase-B.
• Fructose 1-phosphate, cannot be metabolised.
• Intracellular accumulation of fructose 1-
phosphate will inhibit glycogen
phosphorylase.
• Leads to accumulation of glycogen in liver &
associated with hypoglycemia
32. • Vomiting, loss of appetite, hepatomegaly &
jaundice.
• If liver damage progresses, death will occur.
• Fructose is excreted in urine.
• Restriction of dietary fructose.
33. • One or more hydroxyl groups of the
monosaccharides are replaced by amino groups
• E.g.D-glucosamine, D-galactosamine,
mannoseamine, sialic acid.
• They are present as constituents of GAG’s,
glycolipids & glycoproteins.
• Also found in some oligosaccharides &
antibiotics.
34. • The amino groups of amino sugars are
sometimes acetylated e.g.N-acetyl D-glucosamine
• Fructose 6-phosphate is major precursor for
glucosamine, N-acetylgalactosamine & NANA.
• N-Acetyl neuramic acid (NAN) is derivative of N-
Acetyl mannose & pyruvic acid.
• 20% of glucose is utilized for the synthesis of
amino sugars, which mostly occurs in the
connective tissues.