Definition
Classification
Introduction
Types of WATER SOLUBLE vitamin
Public health significance
Dietary goals
Dietary guidelines
Vitamin C
the B Vitamins
Thiamin (Vitamin B1)
Riboflavin (Vitamin B2)
Niacin (Vitamin B3)
Pantothenic Acid
Vitamin B6
Folic Acid
Vitamin B12
Nutritional programmes in india
Vitamin D- Introduction , source, synthesis of vitamin D in body, absorption of vitamin D in the body , action of vitamin D,
vitamin D deficiency & toxicity, Dietary reference value,
Chemistry of Vitamin K, Biochemical role of Vitamin K, Recommended dietary allowance of Vitamin K, Dietary sources of Vitamin K, Deficiency symptoms of vitamin K, Hypervitaminosis of vitamin K, Toxicity of Vitamin K
Water soluble vitamins are the group of vitamins being readily soluble in water and does many functions in our body. The presentation includes the sources, functions and deficiency of each water soluble vitamins and are available according to the RDA given by ICMR.
Biotin (vitamin b7) biological functions, clinical indications and its techn...rohini sane
An illustrative presentation on Biotin (Vitamin B7), clinical indications and technological applications for Medical, Dental, Pharmacology & Biotechnology students to facilitate easy- learning.
Definition
Classification
Introduction
Types of WATER SOLUBLE vitamin
Public health significance
Dietary goals
Dietary guidelines
Vitamin C
the B Vitamins
Thiamin (Vitamin B1)
Riboflavin (Vitamin B2)
Niacin (Vitamin B3)
Pantothenic Acid
Vitamin B6
Folic Acid
Vitamin B12
Nutritional programmes in india
Vitamin D- Introduction , source, synthesis of vitamin D in body, absorption of vitamin D in the body , action of vitamin D,
vitamin D deficiency & toxicity, Dietary reference value,
Chemistry of Vitamin K, Biochemical role of Vitamin K, Recommended dietary allowance of Vitamin K, Dietary sources of Vitamin K, Deficiency symptoms of vitamin K, Hypervitaminosis of vitamin K, Toxicity of Vitamin K
Water soluble vitamins are the group of vitamins being readily soluble in water and does many functions in our body. The presentation includes the sources, functions and deficiency of each water soluble vitamins and are available according to the RDA given by ICMR.
Biotin (vitamin b7) biological functions, clinical indications and its techn...rohini sane
An illustrative presentation on Biotin (Vitamin B7), clinical indications and technological applications for Medical, Dental, Pharmacology & Biotechnology students to facilitate easy- learning.
This is a simple powerpoint presentation about vitamins. Done by year 1 medical students at the University of Science and Technology, Sana'a, Republic of Yemen. (2007/2008)
This presentation is ment to train Paramedicals & persons seeking health information. It is enjoyable to learn What & How about Vitamin A & its Role in Human Body. it educate general people in very palatable forms.
Vitamin a presentation, Vitamin A Deficiency, Vitamin A toxicityDhruvendra Pandey
This presentation contains Importance of vitamin A, Sources of Vitamin A, Absorption,Transport and Excretion of Vitamin A, Vitamin A Deficiency, Vitamin A Toxicity, Required dose of Vitamin A, Nutrition, Nutrition deficiency
Essential Textbook of Biochemistry For Nursing (B.Sc.Nursing & PBN)Tapeshwar Yadav
I have relished teaching Biochemistry during my more than Ten years teaching experience in a medical, dental, nursing and health science colleges. It was because of constant inspiration from my students that I could come up with Essentials Textbook of Biochemistry for Nursing book, which hopefully would meet the inadequacies the students face in other books. In this age when the concepts in this subject are constantly changing, this book attempts to summarise the fundamentals and current state of knowledge in Biochemistry.
Biochemistry has been primarily written for the students of B.Sc. Nursing & Post Basic of Nursing (PBN) in such a way that it will also be suitable for General Medicine, Radiography, Physiotherapy, Ayurveda, Optometry, Dental and Nursing. This book can also be used as Reference for B.Sc. MLT, Bachelor of Pharmacy (B. PHARMA), Bachelor of Public Health (BPH), Bachelor of Physiotherapy (BPT), B. Ophthalmology, Bachelor of Radiography (BRT) and Biomedical Engineering students of Tribhuvan University, Purbanchal University, Kathmandu University and Pokhara University. Similarly, it will be equally useful for all the teachers, academic writers and those who are involved directly or indirectly in teaching and practising Health Sciences.
This is a basic book on Essential Textbook of Biochemistry for Nursing. The book thoroughly discusses some of the major concepts of Biochemistry and provides adequate information to help the students understand its implications in various areas of the subject. Furthermore, the book aims at equipping the students with practical cum theoretical skills. The book covers almost all the topics which have been prescribed in the Syllabus.
This is an introductory course to Biochemistry and is about medical biochemistry including the biochemical processes of - digestion & absorption of foods, metabolism of different kinds of foods & their disturbance effects in our body together with the physiological roles of different kinds of vitamins & enzymes.
The book consists of Theory as well as Practical portion. The author has tried his best to make all the concepts of each unit as lucid and simple as required for the students with supportive examples, samples, diagrams, clinical disorders and practical works. The ultimate purpose of this book is to equip the reader with comprehensive knowledge in Biochemistry with reference to basic as well as clinical aspects.
At last, I have made every effort to make the book error free, I am under no illusion. I expect constructive comments and suggestions from learners and teachers who use this book which will obviously help me in improving the future edition of the book.
Amino acids are a group of organic compounds containing two functional groups amino and carboxyl. The amino group (-NH2) is basic while the carboxyl group (-COOH) is acidic in nature.
The plasma in the liquid medium of blood (55%) in which the cell components namely Erythrocytes, Leucocytes and Platelets are suspended.
If anticoagulated blood is centrifuged, the plasma separates out as a supernatant while the cells remain at the bottom.
Plasma consists of water electrolytes metabolites nutrients proteins and hormones.
Most of the plasma proteins are synthesized in the liver.
Plasma proteins are separated by electrophoresis.
The word protein is derived from the Greek word ‘Proteios’ which means holding the first place. Berzelius (Swedish chemist) suggested the name proteins to the group of organic compounds that are important to life.
Proteins are the most abundant organic molecules of the living system.
They occur in every part of the cell and constitute about 50% of the cellular dry weight.
Proteins form the fundamental basis of structure and function of life.
Out of the total dry body weight, 3/4th are made up of proteins.
Proteins are used for body building; all the major structural and functional aspects of the body are carried out by protein molecules.
Proteins are high molecular weight polypeptides containing α-amino acids joined together by peptide linkage (-CO-NH).
The endocrine system consists of a network of ductless glands that secrete chemicals (called hormones) that affect the function of specific organs within the body, thus regulating many of the intricate functions of the body itself.
These ductless glands secrete their hormones directly into the bloodstream, as opposed to releasing them externally through ducts (as do the sweat glands and the oil glands).
The field of medicine that deals with the study of the endocrine system and the treatment of the diseases and disorders of the endocrine system is known as endocrinology.
The physician who specializes in the medical practice of endocrinology
is known as an endocrinologist.
Carbohydrates are the most abundant organic molecules in nature.
They are commonly known as saccharides or sugars.
They are primarily composed of the elements carbon, hydrogen and oxygen.
The name carbohydrate literally means “hydrates of carbon”.
Carbohydrates are widely distributed in nature in plants and animals.
The most important carbohydrate found in plants is starch.
It occurs abundantly in roots, tubers, vegetables and grains. The carbohydrate found in animals is glycogen.
It is a storage form of carbohydrate present in liver and muscles, which serves as important sources of energy for vital activities.
This field combines biology as well as chemistry to study the chemical structure of a living organism
Biochemistry is a basic science which deals with chemical nature and chemical behaviour of living matter and with the reactions and processes they undergo.
“The branch of science dealing with the study of all the life processes such as control and coordination within a living organism is called Biochemistry”
Medical parasitology : study of parasites that infect human, diseases caused by them, clinical picture, their diagnosis, treatment and prevention as well as controls.
It involves drug development, epidemiological studies and study of zoonoses.
To know various terms related to parasitology.
To know about general parasites and parasitic infections.
To get knowledge about laboratory diagnosis and its importance.
To gain idea about general epidemiological aspects of parasites that affect human.
Apply basic methods of specimen collection , preservation and processing in lab.
To prevent ourselves from these infections and apply control measures.
Microbiology is the study of
living organisms of microscopic
size which includes bacteria ,
Fungi , Algae , Protozoa and Viruses. It is concerned with the forms, structure , reproduction , physiology , metabolism and classification.
Principle Of Microbiology
Medical microbiology deals with the causative agent of the infectious disease of the human , the ways in which they produce disease in the body and essential information for diagnosis and treatment.
Hematology is the branch of medicine, that is concerned with the study of blood, blood forming organs and blood diseases. It includes study of etiology, diagnosis, treatment, prognosis and prevention of blood diseases .
After the completion of this presentation we will know about:
What is hematology and its purpose.
hematology laboratory.
Blood and its compositions and collections
Hematology lab equipment's
Some hematological tests , disease and hazards too.
Biochemistry is the study of the structure and function of biological molecules such as proteins, nucleic acids, carbohydrates and lipids.
Biochemistry is the study of the chemistry of living things. This includes organic molecules and their chemical reactions.
Biochemistry deals with body substance like enzymes, carbohydrates, amino acids, fats, proteins, hormones, DNA, RNA, pigments etc.
The major objective of biochemistry is the complete understanding of all chemical processes associated with living cells at the molecular level. Some of the objectives can be listed as follows:
1. Isolation, structural elucidation and the determination of mode of action of biomolecules.
2. Identification of disease mechanisms.
3. Study of in born errors of metabolism.
4. Study of oncogenes in cancer cells.
5. The relationship of biochemistry with the genetics, physiology, immunology, pharmacology, toxicology etc.
Biochemistry is related to almost all the life sciences and without biochemistry background and knowledge, a through understanding of health and well-being is not possible.
It is a well known fact that metal ions have a profound effect on cellular processes
The importance or the role that ions play in cellular activity can be gauged by the fact that most cells maintain a very critical Na+ & k+ balance between the extracellular and the intracellular spaces.
Any distribution in this critical balance is to the cellular metabolism through a drastic change in the osmotic pressure resulting in cellular swelling.
An ISE operates an exactly the same principles as a PH electrode
In fact, a PH electrode is a type of ion selective electrode sensitive to hydrogen ion.
Just like a PH electrode, the electrode body contains a reference solution and an metal reference electrode
Safety cabinets are intended to protect a laboratory worker from aerosols and airborne particles.
They will not protect the person from spillages and the consequences of mishandling and poor technique.
Aerosol particles of less than 5 µm in diameter and small droplets of 5–100 µm in diameter are not visible to the naked eye.
The laboratory worker is generally not aware that such particles are being generated and may be inhaled or may cross contaminate work surface materials.
BSCs, when properly used, have been shown to be highly effective in reducing laboratory-acquired infections and cross-contaminations of cultures due to aerosol exposures. BSCs also protect the environment.
Most BSCs use high efficiency particulate air (HEPA) filters in the exhaust and supply systems.
The exception is a Class I BSC, which does not have HEPA filtered supply air.
The application of knowledge, techniques and equipment to prevent a personal laboratory and environmental exposure to potentially infectious agents or biohazard is known as biosafety.
Biosafety defines the containment conditions under which infectious agents can be safely manipulated.
The objective of containment is to confine biohazard and to reduce the potential exposure of the laboratory worker, persons outside of the laboratory, and the environment to potentially infectious agents.
A pipette (also called a point or a pipettor) is a laboratory instrument used to transfer a measured volume of liquid.
Pipettes are commonly used in chemistry and molecular biology research as well as clinical biochemistry tests.
Pipettes come in several designs for various purposes with different levels of accuracy and precision, from single piece flexible plastic transfer pipettes to more complex adjustable or electronic pipettes.
A pipette works by creating a vacuum above the liquid-holding chamber and selectively releasing this vacuum to draw and dispense liquid.
Safe Use and Storage of Chemicals and ReagentsTapeshwar Yadav
Even in the smallest laboratory, dangerous chemicals are used directly or incorporated into stains and reagents.
Hence the correct handling and storage of hazardous chemicals is essential to prevent injury and damage.
In addition to this, to reduce accidents caused by chemicals, labeling is very important.
Laboratory Hazards, Accidents and Safety RulesTapeshwar Yadav
Injury, damage and loss by fire can be minimized when laboratory staff:
Understand how fires are caused and spread;
Reduce the risk of fire by following fire safety regulations at all times;
Know what to do if there is a fire in their laboratory;
Know how to use fire fighting equipment;
Know how to apply emergency First Aid, for burns.
Revised Curriculum of Certificate in Medical Laboratory Technology(CMLT) by C...Tapeshwar Yadav
This curriculum of 3 years Certificate in Medical Laboratory Technology is designed to produce middle level skilled laboratory personnel equipped with knowledge, skills and attitudes of medical laboratory with a view to provide diagnostic, curative, preventive and promotive laboratory services to the community. Such technicians collect specimens, process, and perform tests to analyze body fluids, tissue, and other substances. The graduates perform lab procedures and maintain instruments. The graduates are expected to perform tests that help other healthcare professionals such as physicians to detect, diagnose, and treat diseases.
The program extends over three academic years. The first year course focuses on basic science and foundational subjects, the second year course focuses on theory and practical parts of basic medical laboratory subjects. Simultaneously the third year is given to the application of learned skills and knowledge in the comprehensive practical settings, in hospitals and medical laboratory. The graduates will have career opportunities in hospitals, diagnostic laboratories, clinics, industry and physicians' offices, research centers, blood bank, crime investigating laboratories etc. It is based on the code of conduct of Nepal Health professional Council.
Clinical Pathology is the application of laboratory techniques to find out the cause of disease. Clinical pathology laboratory involves all aspect of the medicine ranging from the field of biochemistry, microbiology, Parasitology, haematology, immunology and cytogenetics etc. Clinical pathology laboratory perform qualitative and quantitative analysis of body fluid such as urine, blood, CSF, sputum, other body fluid such as synovial fluid, peritoneal fluid, pericardial fluid and plural fluid. These determinations are useful in diagnosing various clinical conditions such as diabetes mellitus, jaundice, gout, hyperlipidemia, pancreatitis, rickets, etc. The clinical pathological tests are very useful in determining the severity of diseases of many organs such as liver, stomach, heart, kidneys, brain as well as the endocrine disorders and related status of acid-base balance of the body. The clinical pathology tests, in relation to the various clinical conditions can be applicable for:-
1) Reveal the causes of the diseases
2) Screen easy diagnosis
3) Suggest effective treatment
4) Assist in monitoring progress of a pathological condition and
5) Help in assessing response to therapy
Modern medicine says that: Your practice of medicine will be as good as your understanding of pathology.
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
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
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.
Follow us on: Pinterest
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
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.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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.
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.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
3. VITAMINS
• “VITAMIN” means “vital for life”
• VITAMINS are *Micronutrients*
which are necessary for everyday healthy
functioning of the body.
* Nutrients
required in very
small amounts -
mg or µg
* Nutrients
required in very
small amounts -
mg or µg
4. VITAMINS -
Two main categories
Water soluble
C
&
B-complex
Fat Soluble
A
D
E
&
K
9. ASCORBIC ACID (VITAMIN-C)
Anti scorbutic factor, Hexuronic acid.
Chemistry :- White, Crystaline, Odourless with
acid taste.
10. Highly water soluble in Nature.
Empirical formula=C6H8O6.
Structural formula Resembles that of
Carbohydrate.
11.
12. Acidic Properties, due to Enolic Hydroxy groups.
L-Ascorbic acid undergoes oxidation to form
dehydro ascorbic acid.
Both are biologically active.
13. D-Form is inactive.
Oxidation of vitamin-c is rapid
in presence of Copper.
14. Sources :-
Amla(Indian Goose Berry)700mg/100g.
Guava :- 300 mg/100 G.
Green leafy vegetebles.
Absorption :- From intestine not stored in
Body.
15. Ratio of Ascorbic/Dehydro Ascorbic acid is 15 :1
in many tissues.
On hydration Dehydroascorbic acid is converted
to oxalate (via) DiketoGulonic acid.
16. Functions :-
Metabolisms Enzymes
1) Collagen Hydroxylation of
Lysine/Proline.
(Hydroxylase)
2) Tyrosine a) P-HPP Hydroxylase.
b) Homogentisate oxidase
c) Dopamine βHydroxylase.
18. 7) Bone formation vitamin-C play important role.
8) Iron Absorption Fe3+
Fe2+
9) Meth-hemoglobin Hemoglobin.
10) Antioxidant property spare the
vitamins-A and E.
19. 11) Prevents formation of cataract.
12) Reduces risk of Coronary heart diseases
and cancer.
13) Vitamin-C enhances synthesis of
immunoglobulins and increased Phagocytic
action.
20. • Deficiency :- Scurvy.
• Infants 6-12 months, due to weaning from milk-
dietary defect.
• Infantile scurvy Barlow’s Disease.
22. Deficiency test :-
• Sphygmomanometer cuff is placed on the fore
arm, inflated and pressure kept for 5 minutes.
• Petechiae is observed under skin.
• May be rough and dry, pigmented due to
abnormality of Tyrosine metabolism.
23. • Load test :-
• Give 500mg of vitamins-C orally.
• Check urinary- vitamin-C level after 5 hours.
24. • Load test :-
• Normal people 100mgs appear in urine.
• Moderate deficiency <20 mg.
• Severe deficiency <5mg.
25. • RDA :-
• 70 mg for normal people.
• >100 mg in case of Pregnancy & Lactation.
26. Thiamin
• Anti Beri-Beri or anti neuritic vitamin.
• Chemistry :- Pyrimidine ring and thiazole ring are
held by a Methylene bridge.
32. • Absorption:
• In duodenum.
• Active transport (low Thiamin levels).
• Passive transport (high B1 levels).
33. Oxidative Decarboxylation Reactions
1) Pyruvate dehydrogenase
Pyruvate+ CoASH + NAD
+
TPP Acetyl CoA + CO2
+ NADH+H
+
Biochemical FunctionsBiochemical Functions
34. Oxidative Decarboxyation Reactions
2) α-Keto-Glutarate Dehydrogenase
α KG + CoASH+ NAD
+
TPP Succinyl CoA
+ CO2+NADH+H
+
Important in CHO/energy metabolism.
Biochemical FunctionsBiochemical Functions
35.
36.
37. 2) Transketolase :- (HMP-Pathway)
Ribose-5-(P) Sedoheptulose-7-(P)
+ +
Xylulose-5-(P) Transketolase Glyceraldehyde-3(P)
+ TPP-Mg
+2
+
Erythrose-4-(P) Fructose-6-(P)
RBC transketolase activity is a measure of
Thiamin deficiency.
38. • Oxidative decarboxylation of branched chain
amino acids by α- keto acid dehydrogenase.
• TPP or Thiamin triphosphate help in nerve
impulse transmission by ion translocation or
synthesis of Acetylcholine.
43. • Wernicke-Korsakoff syndrome :-
• Cerebral Beri-Beri-Mainly due to nutrition
deficiency.
• Encephalopathy-Nystagmus, cerebellar ataxia.
• Affinity of TPP towards transketolase.
44. • Alcoholic Polyneuritis:- Observed in
chronic alcoholics.
Polyneuritis Motor and Sensory defects
Old age and Pregnancy thiamin deficiency.
• RDA:- 1.0-1.5 mg.
45. • Explanations for deficiency symptoms:-
•
Pyruvate x Acetyl CoA.
Lactate dehydrogenase
Lactate
• Pyruvate, Lactate levels rise in blood, tissues
and urine in BERI-BERI causing vasodilatation
edema.
46. • Branched- chain α-ketoacids rise in blood and
urine in BERI-BERI as TPP is coenzyme.
• Decline in transketolase activity in BERI-BERI,
elevates Pentose levels in blood, urine .
Estimation of erythrocyte transketolase activity
has a diagnostic value for B1 activity.
47. • Energy production from glucose is depressed
in nerve tissue and heart in BERI-
BERI,leading to neuronal inflammations,
leisons,lassitude and cardiac failure.
• Neurological symptoms are due to decline in
Beri-Beri may be due to decline direct role of
TPP in nerve impulse transmission.
48. Riboflavin = B2
• First vitamin among B-complex group to
be isolated in a pure state.
• Vitamin is synthesized by all green plants
and most of the micro-organisms.
49. • Lactoflavin-Milk, Hepatoflavin-liver, Ovoflavin-
Egg, Verdoflavin-Grass are chemically identical
to Riboflavin.
• Warburg-isolated yellow enzyme is essential for
cellular respiration.
• Coloured heat stable pigment decomposes in
the presence of visible light.
59. • Riboflavin deficiency :-
• Its rare, occur with other vitamin deficiencies.
• Cheilosis A disorder of the lips often due to
riboflavin deficiency and other B-complex
vitamin deficiencies and characterized by
fissures, especially in the corners of the mouth
60. • Inflammation at angles of mouth – Angular
stomatitis.
• Lingual papillae atrophy and magenta colored
tongue - Glossitis
• Seborrhic dermatitis:- inflammation of
sebaceous glands of skin.
70. Chief functions:-
– Theraputic uses :- Nicotinic acid for
lowering the plasma cholesterol.
– The main coenzymes are two they are
1) NAD+
and 2) NADP+
.
– NAD
+
(Nicotinamide adenine dinucleotide)
and NADP
+
(its phosphate form) used in
oxidation-reduction reactions of various
metabolisms.
71. • Primary function of coenzymes is to remove
hydrogen from substrates.
• AH2 + NAD
+
NADH + H
+
+ A
Hydrogen ion
72. • NAD
+
Reactive site is carbon atom 4 and
NADP
+
nitrogen atom of Nicotinamide ring.
• Rest of the molecule binds to apoenzyme.
• Oxidized form Reduced form
NAD
+
NADH + H
+
NADP
+
NADPH + H
+
• These coenzymes participate in the oxidation
and reduction series of reactions.
73. • NAD
+
dependent reactions
Glycolysis :-
a) Glyceraldehyde-3-phosphate dehydrogenase.
b) Lactate dehydrogenase.
TCA cycle :-
a) Pyruvate dehydrogenase.
b) Isocitrate dehydrogenase.
c) α-Ketoglutarate dehydrogenase.
d) Malate dehydrogenase.
74. • NAD
+
dependent reactions
• Aminoacid catabolism :-
a) Branched chain α-Ketoacid dehydrogenase
b) Glutamate dehydrogenase
• Fat metabolism ;-
a) β-Hydroxy acyl CoA dehydrogenase
b) β-Hydroxy butyrate dehydrogenase
82. Dementia
• Delerium – Impairement of
memory.
• With cerebral, spinal lesions,
irritability and anxiety.
83. Cause of deficiency :-
• Maize rich diet where Niacin is in bound,
not useful.
• Sorghum rich diet Leucine inhibits
Quinolinate Phoshoribosyl transferase.
90. Absorption :- All forms of B6 are absorbed
from intestine.
Pyridoxal + ATP Pyridoxal phosphate+ADP
Kinase (Major)
Pyridoxamine +ATP Pyridoxamine phosphate+ADP
(Minor)
4-Pyridoxic acid
(End product)
91. Functons :-
Part of coenzymes PLP (pyridoxal phosphate)
and PMP (pyridoxamine phosphate) used in
amino acid and fatty acid metabolism.
Transamination reaction (transaminase).
Aspartate+αKG
AST
Oxaloacetate+Glutamate
Alanine+αKG
ALT
Pyruvate+Glutamate
92. Heme biosynthesis (ALA synthase).
Carbohydrate metabolism .
PLP is a part of muscle phosphorylase
(Glycogenolysis).
Lipid metabolism-Formation of sphingo lipids
and myelin sheath.
Neurotransmitter Synthesis.
5-Hydroxy Tryptophan Serotonin
Conversion of tryptophan to niacin.
96. • Deficiency :-
Severe B6 deficiency is characterized by
increased excretion of xanthurenic acid in urine.
Tryptophan
3- OH Kynurenine
PLP X Xanthurenic acid excreted in urine
3-OH Anthranilate Quinolinate QPRT NMN
NAD
+
and NADP
+
97. • Deficiency :-
Neurological symptoms are present since
biological amine synthesis is decreased.
Mental confusion, Irritability, Nervousness,
Depression.
98. Hypochromic Microcytic anemia due to
decreased synthesis of Hb.
De-myelination of nerves lead to peripheral
neuritis.
Commonly observed during lactation and
alcoholism.
99. RDA :- Daily Value set at 2 mg
• 1.3 mg for adults
• 1.7 mg for men over 50
• 1.5 mg for women over 50
• Average intake is more than the RDA
108. THF mainly functions as a carrier for one carbon
groups.
The one carbon group may be carried on N5
or
N
10
or both of tetrahydrofolate.
109. They are Methyl(-CH3), Methylene(=CH2)
Methenyl(=CH-), Formyl(-CH=O), Fomimino (-
CH=NH).
All one carbon groups are inter convertible.
-CHO +H2 -CH2OH -H2 -CHO
110.
111. Sources of one carbon groups :-
Serine is the major source.
Other sources are Glycine, Tryptophan &
Histidine.
112. • Fate of one carbon groups :-
• N
5
, N
10
methylene THF provides methylene group
to :
a) Uracil to form thymine. Thymine is important for
DNA synthesis.
b) Glycine to form serine.
113. • N
5
methyl THF provides the methyl group to
Homocysteine to form methionine. This reaction
needs cobalamin.
• N
5
, N
10
methenyl THF provides C8 of Purine ring.
• N
5
formyl THF provides C2 of Purine ring.
• Purines are components of nucleic acids.
114. • N5
-formyl tetrahydrofolate is also called
Citrovoram factor folinic acid, is used
as a supplement to folic acid, more
effective than folic acid in anti-cancer
treatment.
115. Factors causing folate deficiency :-
1) During pregnancy.
2) Defective absorption a) Sprue
b) Coeliac disease
3) Resection of jejunum.
4) Anticonvulsant drugs will inhibit intestinal
enzyme– Folate absorption decreases
5) During excessive hemolytic reaction.
117. • Macrocytic Anemia :-
• Hb accumulates in RBC precursors.
• Reticulosis :- Abnormal RBC trapped in spleen
and destroyed, leads to decreased RBC life
span
• Peripheral smear :- Macrocytic type.
• Daily 300-500 µg of folate will improve the
blood picture in the first condition.
118. Pancytopenia all blood cells are affected.
Leucopenia decreased WBC.
Thrombocytopenia decreased platelets.
Impaired growth.
119. • Neural Tube Defects
– Malformation of the central nervous system that
forms very early in the pregnancy (often even
before woman realizes she is pregnant.
• Spina bifida- Spine develops outside of the
body.
• Anencephaly- Entire brain and skull above
the ears is missing.
122. Folacin
• Only known way to prevent these congenital
malformations is adequate Folacin intake prior
to pregnancy
• Adequate folic acid intake can reduce the risk
of Neural tube defects by up to 75%.
123. • Assessment of Folate deficiency :-
1). Normal serum folate = 20 ng /ml.
2). Histidine load : 2-15g.
(FIGLU excretion) test :-
Histidine -----> Formiminoglutamic acid-
X Excreted in urine
Glutamate
3). Peripheral blood picture.
THF
Formyl THF
126. Chemistry :- 4 Pyrrole ring co-ordinated with cobalt
atom is called as corrin ring.
4-Pyrroles substituted + Cobalt
Corrin ring
Dimethyl benzimidazole + Ribose-5 (P)+ Amino
isopropanol
Cobalamin
129. Diet
Vitamin B12 attached to proteins
Stomach Proteolytic enzymes
Proteins
B12 intrinsic factor of castle
GP (Molecular weight 50,000)
Complex of Intrinsic factor and B12
NOTE:- GP=Glycoprotein secreted by Gastric perietal
cells
130. • Intrinsic factor-B12 complex passes on ileum
of gut, where it is absorbed.
• Binding of complex and entry of B12 into
mucosal is mediated by calcium ions .
131. Plasma10% TC-II
B12 Mucosal cell Methyl B12 90% Trans cobalamin-I TC-I-B12
Other tissues TC-II-B12
Methyl B12 Deoxyadenosyl B12
• TC-I B12 Only water soluble vitamin stored in body about 2 mg in liver
which is useful till 2-3 years
132. Sources
• Animal products
– Meat, poultry fish, shellfish.
– Milk, cheese.
– Eggs.
– Not present in the vegetables.
– Intestinal micro organisms synthesize B12 in
human colon but it is not absorbed through
the mucosa.
134. • Coenzymes:-
• Vitamin B12 exists in two coenzyme forms.
1) Methyl cobalamin
2) 5’-deoxy adenosyl cobalamin.
135. Coenzymes of vitamin B12 :-
Cobalamin + Methyl tetrahydo folate
in Cytoplasm
Methyl-cobalamin + Tetrahydro folate.
136. Functions :-
Participates in Methionine biosynthesis:-
Homocysteine + N
5
Methyl tetrahydrofolate
Methyl transferase
Methylcobalamin
Methionine + Tetrahydrofolate(important for
haemopoiesis)
Methionine is a Lipotropic factor which prevents the
fatty liver.
137. • Methionine is an important factor for the
formation of phospho lipids, later found in the
structure of myelin sheath.
• Isomerism of L-Methyl melonyl coA Succinyl
coA by methyl melonyl coA mutase with the help
of 5’deoxy adenosylcobalamin in odd chain fatty
acids metabolism.
138. • In some bacteria :- Cobalamin derivatives useful
for Ribose Deoxyribose
DNA synthesis
139. • Deficiency :-
• Decreased vitamin B12 intake, this may occur
among vegetarians.
• Atrophy of gastric mucosa lack of intrinsic
factor, this give rise to a condition Pernicious
anemia above 60 years of age.
• Pernicious anemia :- Low Hb levels, decreased
number of erythrocytes.
140. • Auto antibodies against gastric parietal cells.
• Anti bodies against intrinsic factors.
• Defctive absorption as in Sprue or regional
enteritis.
• Drugs induced vitamin B12 deficiency.
Anticonvulsants, Phenformin, Neomycin,
Cholestyramine, Para-aminosalycylic acid.
141. • Deficiency manifestations :-
• B12 deficiency
N
5
Methyl THF No formation of THF
• This condition is called folate trap or
• Methyl trap Decreased folate co-enzymes
Reduced nucleotide and DNA synthesis
Megaloblastic anemia.
• Megaloblastic anemia is a macrocytic hypochromic
anemia.
142. Neurological manifestations :- It is
due to lack of myelin sheath due to deficiency of
methionine and disturbance in the metabolism of
odd chain fatty acids.
It includes sub-acute combined degeneration of
spinal cord :-
143. Sensory and Motor tracts are effected.
Paresthesia of extremities.
Alterations of reflexes.
Loss of memory.
Peripheral neuritis leads numbness, tingling and
weakness of extremities.
144. Treatment :- Megaloblastic anemia can be
treated with folate alone.
But lesions cannot improved.
So 100-1000µg of B12 is given intramuscularly.
145. • Assessment of B12 deficiency :-
B12 serum – Radio immuno assay (RIA).
increased methyl malonic acid excretion in urine
(i.e Methylmalonic aciduria).
Peripheral blood and bone-marrow morphology.
Check for Achylia gastrica.
150. • Storage :-
• After absorption, Biotin is stored in liver as
Biocytin (Biotinyl-5-Adenylate)
• Biotin functions as a component of multi-subunit
enzymes that catalyze carboxylation reactions.
152. Enzyme Pathway Reaction
catalyzed
Propionyl CoA
Carboxylase
Amino acids-
1).Valine, Isoleucine,
Threonine.
2). Odd chain fatty
acid metabolisms.
Propionyl CoA
Methyl melonyl CoA
Acetyl CoA
Carboxylase
Fatty acid
synthesis
Acetyl CoA
Malonyl CoA
β-Methyl
crotonyl CoA
carboxylase
Leucine
catabolism
β-Methyl crotonyl
COA
β-Methyl glutaryl
CoA
153.
154. Deficiency :-
• The deficiency occurs in sulfonamide treatment
also, causes destruction of intestinal flora.
• Deficiency of holocarboxylase synthetase in
children. The enzyme responsible for
attachment of biotin for carboxylase enzyme.
156. Avidin :-
• Raw egg white – contains Avidin- Glycoprotein
had high affinity to Biotin.
• Intake of raw egg white (un-boiled) may cause
Biotin deficiency-(20 Raw eggs/day for
prolonged time).
• Avidin is heat labile, boiling of egg will neutralize
inhibitory activity.
157. Leiner’s disease :-
• Occurs in breast fed young infants with
persistent diarrhoea.
• Low Biotin in human milk leads to deficiency.
163. Functions :-
Coenzyme A (CoA SH):- Synthesized from
cysteine, Pantothenic acid, AMP and
phosphate.
Functions of Coenzyme A :- It has a terminal
thiol group (-SH).
• Thiol group act as carrier of acyl or acetyl and
succinate group.
165. α-Ketoglutarate Suyccinyl coA Gluconeogenesis
Activation of aceto acetate
ODD chain Fatty acids Porphyrins
Energy
Threonine, Valine, Isoleucine Drug metabolism
166. Deficiency :-
• Rare in humans. However “burning feet syndrome”
soldiers of second world war- Paresthesia in
lower extremities, staggering gait.
• Sleeplessness :- Linked to this vitamin deficiency.
• This syndrome observed in prison camps,
• Chronic alcoholic famine, renal dialysis patients.
170. • Non-B Vitamins
• Controversial other dietary compounds
• Still under scientific investigation
• May be “conditionally” essential
• Supplements NOT necessary
• Widespread in foods.
172. Functions:-
• Participates in the formation of lecithin and
sphingomylein.
• Lipotropic action (prevents the fatty liver)
• Helps in the formation of acetyl Choline.
• Involved in the one carbon metabolism due to
the presence of three methyl groups.
• By oxidation it is converted into Betaine.
173. • Inositol(Hexahydroxy cyclohexane):-
• Also called as myoinositol or mesoinositol.
• It is sugar alcohol derived from glucose.
• Lipotropic factor.
• It is a component of phospholipid, phosphatidyl
inositol-Part of cell membrane structure.
• Acts as a second messenger for some hormones.
174. Lipoic acid(6,8 dithio octanoic acid):-
• Sulphur containing fatty acid.
• Fat as well as water soluble.
• Exist in oxidized and reduced form.
• As an antioxidant it reduces free radicals.
• Reduces the insulin resistance.
175. Biochemical functions :-
• Decarboxylation reactions
• Pyruvate PDH Acetyl coA
• Keto glutarate SDH Succinyl coA
177. Conclusions
1. Vitamins are derived from a variety of
foods. That is why variety is so important.
2. Vitamin deficiencies rarely occur.
3. If they do, it is usually in conjunction with
severe illness, stress, or trauma that is
superimposed on prolonged inadequate
intake.
4. If there is deficiency, usually several
vitamins (especially in the case of B
vitamins) are involved.
178. 5. Toxicity is also rare but a possibility
– Toxicity is rarely associated with food
– Toxicity results from supplements
6. Vitamin imposters are used
179. Variety is the Key
Vitamins are
derived from
a variety of
foods.