48. Essential Biochemistry For Medicine

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48. Essential Biochemistry For Medicine

 

 

CATEGORY: Medical & Medicine – 500 Courses

COURSE NUMBER: 48

FEES: 555/- INR only

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BOOKS/ MANUALS: Pages

Syllabus

1 Nutritional requirements 1
1.1 Carbohydrates and sugars 1
1.2 Glycogen 2
1.3 Glycaemic index 3
1.4 Lipids 3
1.5 Proteins and amino acids 6
1.6 Biological value 7
1.7 Other energy sources 7
1.8 Vitamins 8
1.9 Minerals 11
2 Metabolism and energy 13
2.1 A metabolic strategy 13
2.2 Carbohydrate metabolism (catabolic) 14
2.3 Glycolysis 15
2.4 Tricarboxylic acid cycle (TCA cycle – Krebs cycle – citric
acid cycle) 17
2.5 Oxidative phosphorylation 17
2.6 Brown adipose tissue and heat generation 17
2.7 Glycogenolysis 18
2.8 Carbohydrate metabolism (anabolic) 20
2.9 Gluconeogenesis 20
2.10 Glycogenesis 20
2.11 Fatty acid catabolism 22
2.12 Amino acid catabolism 23
2.13 Blood glucose homeostasis 24
2.14 Glucokinase and hexokinase 27
2.15 Glucose transporters 27
2.16 Diabetes mellitus 28
2.17 Type 1 diabetes 29
2.18 Type 2 diabetes 30
2.19 Insulin/Glucagon effects on metabolism 32
2.20 Hyperglycaemia and associated pathology 33
2.21 Glycation 33
2.22 The polyol pathway 35
3 Regulating body weight 37
3.1 Obesity 37
3.2 Weight regulation 37
3.3 Controlling food intake 38
3.4 Pre-gastric factors 38
3.5 Gastrointestinal and post-absorptive factors 39
3.6 Enteric nervous system 39
3.7 The central nervous system 40
3.8 Long-term control 41
3.9 CNS factors 41
3.10 Lifestyle changes 42
3.11 The basics of dieting 44
3.12 Medical and surgical treatment 45
4 Digestion and absorption 47
4.1 The gastrointestinal tract 47
4.2 Gastric acid production 48
4.3 Proton pump inhibitors 50
4.4 Helicobacter pylori 51
4.5 The small intestine 52
4.6 The gastrointestinal barrier 52
4.7 Paneth cells 53
4.8 The enteric endocrine system 54
4.9 The pancreas 55
4.10 Absorption in the small intestine: general principles 55
4.11 Crossing the gastrointestinal barrier 57
4.12 Absorption and secretion of water and electrolytes 58
4.13 Pathophysiology of diarrhoea 59
4.14 Rehydration therapy 60
4.15 Absorption of sugars and amino acids 60
4.16 Absorption of amino acids and peptides 62
4.17 Absorption of lipids 63
4.18 Absorption of minerals and metals 63
4.19 Malabsorption syndromes 65
4.20 Steatorrhoea 70
4.21 Lactose intolerance 70
4.22 Glucose–galactose malabsorption 70
4.23 Coeliac disease 71
4.24 Crohn’s disease 71
4.25 The large intestine 71
5 Synthesis, mobilisation and transport of lipids and lipoproteins 75
5.1 Fatty acid synthesis 75
5.2 Long-term control of fatty acid synthase 77
5.3 Triacylglycerols 77
5.4 Mobilisation of lipid stores 78
5.5 Transport of lipids 78
5.6 Intestinal uptake of lipids 78
5.7 Chylomicrons 79
5.8 Apolipoproteins 79
5.9 Export of fat from the liver 82
5.10 Role of HDL in lipid metabolism 82
5.11 Apoprotein classes 84
5.12 LDL receptors 84
5.13 Disorders of lipoprotein metabolism 85
5.14 Alzheimer’s disease 85
5.15 Pharmacologic intervention 85
6 The liver 91
6.1 General overview 91
6.2 Storage diseases 91
6.3 Glycogen storage diseases 92
6.4 General liver metabolism 92
6.5 Production and excretion of bile 93
6.6 Pattern and control of bile secretion 96
6.7 Clinical significance of bile secretion 97
6.8 Cholesterol metabolism 97
6.9 Regulating cholesterol synthesis 97
6.10 Regulating sterol synthesis 98
6.11 Drug metabolism 99
6.12 Breakdown of haem (Haemoglobin) 102
6.13 Bilirubin 102
6.14 Jaundice 104
6.15 Protein metabolism – albumin 104
6.16 Protein metabolism – nitrogen metabolism and
the urea cycle 105

6.17 The urea cycle 109
6.18 Regulation of the urea cycle 109
6.19 Urea cycle defects 111
6.20 Neurotoxicity associated with ammonia 111
7 Alcohol metabolism and cirrhosis 113
7.1 The alcohol dehydrogenase system 113
7.2 The microsomal cytochrome P450 system 115
7.3 The peroxisome catalase system 115
7.4 The consequence of alcohol intake 115
7.5 Short-term metabolic consequences of alcohol intake 116
7.6 Long-term consequences of chronic alcohol intake 116
7.7 Cirrhosis of the liver 118
7.8 Complications of cirrhosis 118
8 Protein structures 121
8.1 Protein primary structure 121
8.2 Peptide bonds 121
8.3 Protein interactions 121
8.4 Levels of protein structure 123
8.5 Types of protein structure 123
8.6 The α-helix 124
8.7 The β-sheet 124
8.8 Protein folding 124
8.9 Carbohydrates and lipid association with protein 125
8.10 Disruption of the native state 126
8.11 Incorrect protein folding and neurodegenerative disease 126
8.12 The study of proteins 126
8.13 Defects in protein structure and function 127
8.14 Glycolipid degradation 128
8.15 Protein receptor defects 129
8.16 Transformation and carcinogenesis 129
9 Enzymes and diagnosis 131
9.1 Enzyme nomenclature 131
9.2 Catalytic mechanism 132
9.3 Lowering the activation energy 132
9.4 Reactions, rates and equilibria 133
9.5 Michaelis–menten kinetics 134
9.6 Lineweaver–burk 134
9.7 Isoenzymes 135
9.8 Enzyme inhibitors 136
9.9 The control of enzyme activity 137
9.10 Allosteric enzymes 138
9.11 Covalent modification of enzymes 138
9.12 Control proteins 139
9.13 Enzymes in medicine 140
9.14 Biomarkers and enzymes in diagnosis 142
9.15 Enzymes in the diagnosis of pathology 143
9.16 Liver-function tests 144
10 The kidney 147
10.1 Nephron structure 147
10.2 Kidney function 147
10.3 Diuretics 150
10.4 Anti-diuretic hormone 151
10.5 Aquaporins 151
11 Haemostasis 153
11.1 Blood vessel trauma 153
11.2 Blood coagulation 154
11.3 The coagulation cascade 154
11.4 The tissue factor (TF) pathway 154
11.5 The contact activation pathway 155
11.6 The common pathway 156
11.7 Amplification of the clotting process 156
11.8 Co-factors in coagulation 156
11.9 Regulators of coagulation 157
11.10 Breaking down the clot 158
11.11 Disorders of haemostasis 159
11.11.1 Platelet disorders 159
11.11.2 Disorders of coagulation 159
11.12 Pharmacology of haemostasis 160
12 Bone metabolism and calcium homeostasis 167
12.1 Mineral density test 167
12.2 Osteoblasts 167
12.3 Osteoclasts 168
12.4 Bone structure 168
12.5 Composition of bone 169
12.6 Collagen 169
12.7 Bone disorders 170
12.8 Contributing factors to bone disorders 171
12.9 Treatments of bone disorders 172

12.10 Calcium homeostasis 172
12.11 Endocrine regulation of [Ca2+]ECF 172
12.12 Parathyroid hormone 173
12.13 Vitamin D 174
13 Intracellular signalling 175
13.1 Hormones 175
13.2 The hierarchical nature of hormonal control 176
13.3 Hormone synthesis and secretion 178
13.4 Hormonal control 179
13.5 Types of chemical messenger 181
13.6 Intracellular signalling and signal transduction 182
13.7 Cell-surface and intracellular receptors 182
13.7.1 Cell-surface receptors 182
13.7.2 Intracellular receptors 185
13.8 Second messengers 187
13.9 The glucagon receptor 190
13.10 The gastrin receptor 190
14 Inflammation 193
14.1 The acute inflammatory response 193
14.2 Leukocyte transmigration 194
14.3 Chronic inflammation 196
14.4 Mediators of inflammation 197
14.5 Acute-phase proteins 197
14.6 Patterns of acute and chronic inflammation 199
14.7 Inflammatory disorders 199
15 The immune response 209
15.1 Leukocytes 209
15.2 Innate immunity 209
15.2.1 The complement system 210
15.2.2 Complement deficiency 211
15.2.3 Natural killer cells 213
15.3 Passive immunity 213
15.4 Acquired immunity 213
15.4.1 The humoral immune response 213
15.4.2 The clonality of B-cells 214
15.4.3 Antibodies 214
15.4.4 The Cell-mediated immune response 216
15.4.5 Antigen-presenting cells 219
15.4.6 Interaction of APCs with T-cells 219
15.4.7 Major histocompatibility complex (MHC) 219
15.4.8 Autoimmunity 221
15.4.9 Tolerance 222
15.4.10 Overcoming tolerance 223
15.4.11 Treating autoimmune disease 224
16 Mitochondrial dysfunction 231
16.1 Mitochondrial DNA 231
16.2 Non-Mendelian inheritance 231
16.3 Mitochondrial cytopathies 232
16.4 Common symptoms of mitochondrial dysfunction 234
16.5 Mitochondria and ageing 234
16.6 Diagnosis of mitochondrial myopathies 235
17 Nerve and muscle systems 237
17.1 Nerves 237
17.2 The nerve message 237
17.3 Diseases of the nervous system 240
17.4 Specific neural disorders 241
17.5 Muscle types 246
17.6 The neuromuscular junction 247
17.7 Neuromuscular disease 248
17.8 Sarcomeres and focal adhesions 249
17.9 Dystrophin 250
17.10 Intrinsic cardiomyopathy 251
17.11 Metabolic diseases of muscle 252
18 The cytoskeleton 255
18.1 Actin filaments/microfilaments 255
18.2 Intermediate filaments 255
18.3 Microtubules 256
18.4 Spectrin 256
18.5 Alzheimer’s disease 257
18.6 Amyotrophic lateral sclerosis 258
18.7 Synapsins 258
19 Genes and medicine 259
19.1 Chromosomes 259
19.2 Chromosome banding 259
19.3 Karyotypes 260
19.4 The spectral karyotype: fluorescence in situ
hybridisation (FISH) 260
19.5 Gene mutations 262
19.6 Genetic disorders 262
19.7 Gene testing 263
19.7.1 Advantages and disadvantages of
gene testing 264
19.8 The human genome project 264
19.8.1 How do we compare to other organisms? 265
19.9 Gene therapy 265
19.9.1 Current status 266
19.9.2 Some ethical questions 267
19.10 The next step: functional genomics 267
19.11 Pharmacogenomics 268
19.12 Genetic engineering: recombinant DNA technology 270
19.12.1 The tools and terminology of the
genetic engineer 270
19.12.2 Transferring genes 271
19.12.3 Genetic markers 272
19.13 The polymerase chain reaction (PCR) 272
19.14 Complementary DNA (cDNA) 273
19.15 DNA probes 273
19.16 DNA sequencing 274
19.17 Genetic engineering applications 276
19.18 Commercial gene products 276
19.19 Gene therapy 278
19.20 Controlling gene expression 278
19.21 Transcription factors 280
19.22 Response element 281
19.23 Genes and cancer: the cell cycle 281
19.23.1 Checkpoints and cell-cycle regulation 282
19.23.2 Initiation of cell division and differentiation 283
19.23.3 Genes controlling the cell cycle 283
19.24 Viruses and cancer 284
19.25 Apoptosis 285
19.26 Caspases 285
20 Antibacterial drug resistance 291
20.1 Horizontal gene transfer 291
20.2 Penicillin resistance 292
20.3 Sulphonamide resistance 294
20.4 Bacterial efflux pumps 296
20.5 Pseudomonas aeruginosa 297
20.6 Vancomycin 297
20.7 Staphylococcus aureus 298
20.8 Clostridium difficile 298
Index 299

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