Viral Delivery Systems And Its Effects

Viral Delivery Systems And Its Effects
Viral delivery systems composed of adenovirus, retrovirus and many more. Viruses are highly
efficient in introducing their DNA into cells. Therefore, it is a good idea to use virus to introduce
foreign gene into cells. Genetic modification has been applied on these viruses to transfer
therapeutic genes into desired cells by removing the essential genes that allow it to replicate,
assemble or even infect. However, viral delivery system has exhibit certain issues. The main
problem with adenoviral vectors is the T and B– cell mediated inflammatory response resulting from
immune cells in the early stage. Moreover, there is limited transduction in dividing cells and cells
with little or no expression of attachment and internalization receptors. Besides, Ad has been
delivered straight to the primary tumours due to short blood circulation times. A study has been
made which is (Therapeutic targeting of chitosan–PEG–folate–complexed oncolytic adenovirus for
active and systemic cancer gene therapy) to overcome the issues of systemic delivery of Ad to
increase its effectiveness; surface of Ad has been coated with cationic polymer chitosan by ionic
crosslinking (Ad/chitosan). Then, folic acid (FA) or polyethylene glycol (PEG) was used to
conjugate with the surface of Ad/chitosan, resulting in Ad/chitosan–FA, Ad/chitosan–PEG, and
Ad/chitosan–PEG–FA nanocomplex. These nanocomplexes have good eliciting folate receptor
(FR)–selective cancer cell killing efficacy. To evaluate cancer cell
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There Was Highly Statistical Significant Difference Between
There was highly statistical significant difference between cirrhotic variceal group and cirrhotic non
variceal group regarding serum albumin, Prothrombin time(PT), and platelet count.(table2)
variceal group regarding child score, platelet count spleen diameter, Portal vein diameter (PVD) and
spleen diameter (table 2)
variceal group regarding to presence of ( spider naevi, ascites, encephalopathy, jaundice and ...
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,platelet count at cutoff less than 74000 mm3 is significant in prediction of variceal bleeding risk
with sensitivity 82.5% and specificity 55%. and platelet count/spleen diameter ratio (PC/SD) at
cutoff 851.6 is significant in prediction of variceal bleeding risk with sensitivity 45% and specificity
90%.(table 5)
Table (1) : Comparison between variceal Patients (group[A] cirrhotic patient with history of variceal
bleeding , group[B] cirrhotic patient with esophageal varices but no history of

The Crime Of Dengue Fever
ABSTRACT
Introduction: Dengue can present with a diverse clinical spectrum. The intensity of hepatic
involvement in children with dengue infection varies from soft injury to severe injury by means of
jaundice and liver cell failure. Even if liver is not a most important objective limb, liver involvement
is a renowned aspect.
Objective: To evaluate hepatic involvement in dengue fever in children.
Study Design: Prospective observational study.
Place and Duration of Study: Study was conducted in the Department of Pediatrics, Holy Family
Hospital Rawalpindi from August 2014 to October 2015.
Methods: All suspected dengue patients upto 12 years of age were screened and only serologically
confirmed cases by dengue IgM capture ELISA were ... Show more content on Helpwriting.net ...
Hepatic association in dengue in children has high fatality rate and spectrum varies from jaundice to
rise of liver enzymes.
Key Words: Dengue in children, hepatomegaly, hepatic dysfunction.
INTRODUCTION
Dengue fever is caused by arthropod born viruses.1 It is the most common mosquito born, arboviral
infection in many tropical and sub–tropical regions of the world. The incidence has increased 30–
fold with increasing geographic expansion to new countries and in the present decade from urban to
rural settings.2
According to world health organization (WHO) approximately 50–100 million infections occur
yearly and mostly among children.3 Dengue virus is widespread and it hit the highest point in post
monsoon phase and floods make the state terrible in Pakistan.4 Evidence suggests that in Pakistan,
overall burden of disease and its severity is on the rise.5 Extraordinary manifestations linking liver
and central nervous system in dengue infection has been reported.7,8 The extent of liver
involvement in children with dengue infection varies from mild injury with rise of transaminases to
severe injury with jaundice and liver cell breakdown.9–12 The frequency of liver involvement is
more in dengue shock syndrome (DSS) and dengue hemorrhagic fever (DHF).7,9–15 Before time
identification and timely initiations of suitable supportive treatment can reduce the morbidity and
death. A large amount of the statistics reported on irregular hepatic

Hemodialysis
Dialysis
The kidneys are important organ in the body. It helps regulate extracellular fluid and excrete waste
products from the body. The kidneys also function to control blood pressure, produce erythropoietin,
activate vitamin D, and regulate acid–base balance. When the kidneys fail to function, or work as
they should, dialysis is needed. Dialysis restores internal homeostasis by osmosis, diffusion, and
ultrafiltration. It can sustain life for people who have acute and chronic renal failure. There are two
different types of dialysis, hemodialysis and peritoneal dialysis. Hemodialysis is a dialysis that uses
an artificial membrane as the semipermeable membrane through which the patient's blood circulates.
The access for hemodialysis is accomplished by ... Show more content on Helpwriting.net ...
Depending on the dialysis treatment used, protein and other essential electrolytes are either removed
or retained. It is essential to monitor laboratory values and to perform proper assessments to assure
the patient is receiving the best care possible. Peritoneal dialysis tends to extract protein. Knowing
this, a patient who is on peritoneal dialysis would be on a high protein diet to compensate for this
loss. Potassium is usually individualized depending on laboratory values and the extent of the
disease. A patient undergoing hemodialysis should maintain a daily allowance intake of two to three
grams per day, whereas a patient using peritoneal dialysis is not restricted of potassium. Sodium
level should be maintained and monitored throughout dialysis. While sodium intake is
individualized, considerations must be taken to limit high sodium diets such as processed foods,
canned foods, and cured meats. When the kidney function deteriorates, phosphorus is retained
causing hyperphosphatemia. Since phosphate is found in many protein food sources, phosphate
binders are essential to control

Evaluation Of Open Reduction And Internal Fixation Of...
Evaluation of perioperative variations in the levels of inflammatory markers in open reduction and
internal fixation of maxillofacial fractures INTRODUCTION
Infectious complications are commonly encountered following ORIF (Open reduction and internal
fixation) ever since it has been adopted as a treatment modality for maxillofacial fractures. Early
detection of infection can be difficult in the postoperative phase as many signs and symptoms may
actually mimic a SIRS (Systemic inflammatory response syndrome).
There is a wealth of literature supporting the use of various inflammatory markers in diagnosis and
monitoring of treatment of infectious complications in post–operative patients[1–4]. Various authors
have studied markers including (Total leucocyte count) TLC, CRP(C–reactive protein), AST
(Aspartate Transaminase) and ALT (Alanine Transaminase) in patients with SIRS and sepsis [5].
Behaviour of inflammatory markers and their correlation to infection in the postoperative phase
have been evaluated in various disciplines of surgery. However, similar studies in maxillofacial
surgery have been found to be very scarce. We therefore designed a study to evaluate perioperative
variations in the levels inflammatory markers in Open Reduction and Internal Fixation (ORIF) of
maxillofacial fractures.
An attempt was made to establish an acceptable range of variations in the values of inflammatory
markers in ORIF and co–relate these variations to the length of surgery, type of

Lab Report
Patient #1 will need several lab and diagnosis test ran on the current medication list. A CBC and
culture & sensitivity test is needed for the Vantin to determine if still needed for bacterial infection.
Potassium level along with renal function, bicarb and pH level should be monitored for mineral and
electrolyte replacement of potassium Chloride. Furosemide (Lasix), which is a diuretic, is being
administered 40mg PO daily. Electrolytes, renal function, hepatic function, glucose levels along
with uric acid level should be checked before therapy begins. Also, check for decrease in potassium,
sodium, calcium and magnesium. Patient #1 is on several benzodiazepines Librium 25mg Q8h,
Ativan 1mg every 1–2hrs orally as needed. And Serax 15mg ... Show more content on
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Assessment of lung sounds, blood pressure and pulse, along with notation of color and character of
sputum production. Instruct patient to rinse mouth after use and practice proper oral hygiene. Lab
test required for Atorvastatin (Lipitor) a lipid lowering drug is evaluation of triglycerides and
cholesterol levels before therapy. Liver function should also be monitored, if serious liver injury
occurs such as hyperbilirubinemia or jaundice, discontinue use. Obtain assessment of diet history
including fat consumption. Celecoxib may cause an increase in AST & ALT levels. Also can cause
hypophosphatemia and rise in BUN. Assess swelling in joints and allergy to sulfonamides, aspirin,
or NSAID's. Monitor range of motion as well. Aspirin and Chopidogrel (Plavix) act as anti–platelet
and should be stopped 5–7 days prior to surgery if possible. With Plavix monitor bleeding time as
well as CBC with differential and platelet count during therapy. It may also cause an increase in
bilirubin, hepatic enzymes and total cholesterol. Assess for signs and symptoms of stroke, peripheral
vascular disease or MI. Glipizide and Metformin are both anti diabetic medications for type 2
diabetes. Glucose monitoring daily and renal functions should be test should be monitored
periodically. Observe and assess for hypoglycemia (sweating, hunger, weakness, dizziness,
tachycardia,

Amylase : Human Amyylase The Hydrolysis Of Starme
Amylase
Amylase is an enzyme which catalyzes the hydrolysis of starch into carbohydrates. These enzymes
are classified into alpha amylases, beta amylases and gamma amylases based on the type of bonding
present in the structure. Every amylase is a glucoside hydrolase and acts on α–1,4–glycoside bonds.
It comprises about 25 % of enzyme industry due to its wide range of uses. α–amylase are calcium
containing enzymes which helps in hydrolyses of α–1,4 glyosidic linkages present in starch of low
molecular weight compounds such as glucose, Maltose etc. These enzymes are present in
microorganisms, plants, humans and other mammals. In humans it is present in pancreatic juice and
saliva.
Alpha amylase can be produced by bacteria such as Bacillus subtilis, Fungi Aspergillus, Penicillium
etc. This enzyme can be produced commercially by submerged fermentation and by solid state
fermentation. Later process is promising one in which production of alpha amylase depends on
factors such as moisture content, particle size, thermal treatment time and temperature. After the
production of crude enzyme, it needs to be purified which is major requirement of clinical and
pharmaceutical industry.
Human α–amylase is secreted from salivary, mammary, lacrimal glands and from pancreas. Activity
of α–amylase follows double displacement mechanism and depends upon two essential cofactors.
They are chloride and calcium ions. Deficiency in one of the either ions will restrict the functions of
this enzyme.

The Field Of Veterinary Medicine
What are different careers in the field of Veterinary medicine? How do these jobs use chemistry?
Why is chemistry so important to veterinarians? What arguments are there about veterinary
medicine?
Different careers in the field of Veterinary medicine There are several different career paths that you
can take with a veterinary degree, but there are six main areas of veterinary medicine that include:
Private practice, Teaching and research, Industry, etc.
First off is Private practice, which is the most common and what most people will think of when
talking about veterinary medicine. These are the veterinarians that would regularly perform check–
ups on small and large animals, test them for infectious diseases, diagnose them and perform any
medical or surgical treatments needed. This also includes veterinary technicians (vet techs) who
work alongside the veterinarians, perform certain procedures and tests, and sometimes specialize in
surgery or anesthesia.
Secondly there's Teaching and research. This field allows for continuous advancement in medicine
allowing both humans and animals to live longer and (hopefully) healthier lives. It has also come up
with some important findings like isolating viruses and other pathogens such as Salmonella, and
learning to control different diseases such as Malaria and Yellow fever.
Lastly is Industry. This includes veterinarians that work in pharmaceutical and biomedical research
to test, develop and supervise the

Symptoms And Treatment Of Auto Immune Disorders
A rare disorder characterized by the presence of reversible precipitation of immunoglobulins in the
blood upon exposure to decreased temperature 1
Cryoglobulins, which precipitate when blood temperature is cooled below 37°C, are occasionally
present in the blood in low levels without any symptoms, especially with advancing age or in the
presence of auto–immune disorders; in cryoglobulinemia, circulating cryoglobulins in serum can
cause a systemic inflammatory syndrome characterized by fatigue, arthralgia, purpura, neuropathy
and glomerulonephritis. At other times, they are a purely laboratory phenomenae detected when the
test tube is cooled down under laboratory conditions but no of clinical significance import. 3, 2
CLASSIFICATION
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○ Ulcerated lesions of the lip, mucosa membranes or palate and cutaneous lesions of the head or
neck are common in Type
I cryoglobulinemia
○ Raynaud 's phenomenon (blood vessel spasms cause change of color of hands and/or feet with
cold temperatures or strong emotions) and acrocyanosis may also be seen in some patients
○ Edema may be present, especially in the ankles or legs
○ Hepatomegaly or splenomegaly may be apparent on palpation
○ Other possible clinical signs
– Hypertension
– Fever
CAUSES AND RISK FACTORS
Causes
Cryoglobinemia
○ It can be idiopathic or caused by certain conditions
– Infection – hepatitis C virus is the most common
– Cancers of the blood or the immune

M. W Patient Case
M.W Patient is a 40–year old African–American female, 20 weeks gestation by LMP/sonogram
presenting for pre–natal visit with headaches. She has had headaches for the past few days. She
reports that she has been generally in good health and denies any previous major illness, injuries and
hospitalizations.
Medical History and Physical Examination M.W's weight and BMI were 210 and 34.9 respectively.
Her vital sign readings were as follows: temperature 96oF, blood pressure 140/80 mm Hg, pulse 82
bpm, and respiration 18bpm. She appeared in good condition, but a little anxious because of the
headaches. After completing the normal pre–natal check–up and routine tests, M.W. was
interviewed regarding nature of the headaches and when it started. According ... Show more content
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M.W was given the following recommendations on a daily basis:
Use calcium supplementation to reduce the risk of high blood pressure in her pregnant condition.
Take a blood pressure a minimum of three times daily in the least stressful environment using a
home device.
Rest lying down on the left side to take the weight of the baby off her major blood vessels.
Consume less salt and drink a minimum of 8 glasses of water daily
Use salt as needed for taste
Exercise regularly and elevate feet several times during the day
Avoid drinking alcohol and beverages containing caffeine
Increase daily protein–intake and reduce the amount of fried foods and junk food.
Evaluation and

Essay On Primary Research
Highlighting Primary Research article 1 The objective of the study was to exam the lipid lowering
capabilities of plant stanols and sterols on people with primary hypercholesterolaemia at a dose of
1.8g daily.1 The supplement was combined with therapeutic lifestyle changes (TLC) and
administered to patients for six weeks. This study was a double–blind, randomized, placebo
controlled cross over trial. Information about the recruitment of the participants was not included in
the study. The participants underwent five week lead in diet with a single blind placebo. The
participants then received, randomly, either the supplement or the placebo for six weeks followed by
an additional six weeks of the opposite treatment. The participants ... Show more content on
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Lipid levels were assessed at the one week prior to the beginning of the intervention period, at the
beginning of the intervention period and at weeks five, six, eleven and twelve. The independent
variable is the stanol and sterol supplement and the dependent variable is the change in lipid levels.
The results were that the 1.8g supplementation of stanols and sterols significantly decreased low–
density lipoprotein cholesterol, non–high density lipoprotein cholesterol and total cholesterol values,
but there was no significant change in high density lipoprotein or triglyceride value (p=0.05). There
was an increase in calories consumed during the active portion and a slight decrease during the
control portion. Changes to other lab values, body weight and vital signs were not significant
(p=0.056). There were no serious side effects from the supplement, only minor effects to the
respiratory system and one report of increased apatite. In conclusion Supplementation of 1.8g of
plant stanols and sterol could be very beneficial to people with hypercholesterolemia because of its
cholesterol lowering effects. This may reduce the risk of cardiovascular disease if used long–term.
This study could have been improved by increasing the number of participants and increasing the
ethnic and age diversity of the

Notes On Medicinal Properties Of Ayurvedic Medicines With...
Medicinal Properties: Guna (Qualities) – Laghu (light to digest) Ruksha (dry) Rasa (Taste) –
Kashaya (astringent) Tikta (bitter) Vipaka (post–digestive taste) – pungent Veerya (Sheeta) –
Coolant Effect on tridosha – balances kapha and pitta dosha Dosage – Decoction 50–100 ml;
powder 3–6 gm Pterocarpus marsupium uses: Keshya – improves hair strength, promotes hair
growth Medohara – reduces fat and cholesterol levels Rasayana – anti–ageing, causes cell and tissue
rejuvenation Indicated in: Raktapitta – bleeding disorders such as nasal bleeding, heavy periods etc.
Krumi – worm infestation Visarpa – herpes Kushta – skin diseases Shvitra – leucoderma, vitiligo
Meha – diabetes, urinary tract infections Gala dosha – throat disorders Raktamandala – ring worm
infestation Ayurvedic medicines with Beejak as ingredient: Asana manjishtadi taila – for treatment
of headache and eye disorders Asana cladi taila – for treatment of headache, ear and eye disorders
Asana vilwadi taila – for treatment of headache, ear and eye disorders Narasimha Rasayan – for
treatment of weakness, weight gain, hair growth and rejuvenation Classical Categorization: Susruta
– Salaasaradi gna Vabhata – Asanadi Gana Kaiyadeva Nighantu – Oshadhi Varga Dhanvantari
Nighantu – Amradi Varga Bhavaprakasha – Vatadi Varga Rajanighantu – Prabhadradi Varga
Pharmacological activities: 1. Analgesic Activity In an investigation, PM leaves were successively
extracted with petroleum ether, ethyl

How Aminotransferases Are Enzymes Involved On Catalyzing...
Introduction:
Aminotransferases are enzymes involved in catalyzing reactions between amino acid and α–keto
acid. Amino acid such as L–glutamate contains an amine group whereas α–keto acid such as
pyruvate contains a keto group. The amine group of L–glutamate is exchanged with the keto group
of α–keto acid resulting in the α–keto acid becoming an amino acid and the amino acid becoming a
keto acid. Aminotransferase catalyzes the reaction of transferring α–amino group of L–glutamate to
pyruvate in exchange for the α–keto group of pyruvate where L–alanine and α–ketoglutarate are
formed. Aminotransferases are specific for the amino acid formed and reactions catalyzed by
aminotransferases are reversible. Aminotransferase used in the formation of alanine is called
glutamate–pyruvate aminotransferase (GPT) where in the formation of aspartate, glutamate–
oxaloacetate aminotransferase (GOT) is used. (Vroon, D., & Israili, Z, 1990)
In part 1, the aim is to examine the specificity as well as the catalytic activity of GPT in freshly
minced beef heart extract by incubation and chromatographic assays (paper chromatography and
thin layer chromatography) respectively. Paper chromatography is used to separate and identify
individual amino acid components. Amino acid components migrate vertically at different rates
according to their attraction for mobile non–water phase in comparison to their attraction for
stationary water phase. Therefore, hydrophobic amino acid migrate faster than

Critical Care Experience Report ( Micu )
Critical Care Experience Report (MICU) Patient is a 58 year old female admitted and brought in by
ambulance on February 16, 2017 due to PEA (pulseless electrical activity) arrest at home. This
patient has a history of hypertension, diabetes type 2, chronic obstructive pulmonary disease
(COPD) and found to have a mild pulmonary hypertension with possible interstitial lung disease,
mixed connective tissue disease, peripheral neuropathy and bipolar disorder. According to patient's
spouse, the night before the incident, the patient was acting like her usual self and went to sleep
around 2330 with her oxygen in place. She was found unresponsive and had foaming at the mouth
and was gasping for air. Her code status did not require resuscitation ... Show more content on
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Additionally, her medications included chlorhexidine liquid for mouth care, Colace for bowel care,
famotidine for prevention of gastric acid, folic acid, thiamine and multiple vitamins due to patient
being on enteral feeding and nothing by mouth, gabapentin for peripheral neuropathy, heparin for
prevention of thrombus formation, hydralazine for management of hypertension, Furosemide/Lasix
for diuresis to remove extra fluid from tissues and bloodstream thereby reducing swelling and
promote breathing for management of pulmonary hypertension. Moreover, her medications also
included regular insulin for blood glucose management, albuterol for respiratory management,
melatonin for promotion of rest and sleep, methylprednisolone sodium for interstitial lung disease
management, quetiapine/Seroquel for agitation's role in tachypnea and Clindamycin/Cleocin as
prophylactic for infection prevention. She also completed a course of Cefepime antibiotic from
2/17–2/21 and Vancomycin from 2/17–2/19. Furthermore, the patient also had an
electroencephalogram in 2/21 and her result showed consistency with her clinical diagnosis of a
moderate–severe encephalopathy. Chest x–ray on 2/21 showed increasing mild pulmonary edema
but with continued diuresis with Lasix 20 mg every 6 hours with a target of –2L over a 24 hour
period, her chest x–ray on 2/22 showed improving atelectasis changes on left retro–cardiac area and
resolution of previous pulmonary

Acute Lymphoblastic Leukemia ( All )
Acute lymphoblastic leukemia (ALL), a malignant disorder of lymphoid progenitor cells, is the most
common hematological malignancy affects children, accounting for 25–30% of all childhood
cancers with peak prevalence between the ages of 2 and 5 years [1]. The causes of pediatric acute
leukemias are still not well known, the identification of causes and prevention/early intervention is
clearly a worthwhile goal [2]. Previous studies have demonstrated that the interaction between
genetic background, lifestyle, and these environmental factors play a critical role in the development
of ALL in children [3]. MicroRNAs are a class of small (17–25 nucleotides) single–stranded
noncoding RNAs that function as a sequence–targeted modifiers of gene expression through
translational repression [4]. The miRNAs are important key regulators of normal hematopoiesis and
their disruption could lead to leukemogenesis [5]. Mutations like single–nucleotide polymorphisms
located in microRNA binding sites can cause disruption in microRNA–target interactions, leading to
deregulation of the target gene expression [6]. One of these SNPs is the one found within the miR–
502 binding site in the 3′–UTR of the SET8 gene. SET8 (also known as PR–SET7; located on
chromosome 12q24.31) encodes a histone H4–Lys–20–specific methyltransferase which plays an
important role in cell cycle–dependent transcriptional silencing and mitotic regulation [7]. There are
about 129 variants of the SET8 gene

A Short Note On Hepatitis And Its Effects
HEPATITIS A:
It is a liver infection caused by Hepatitis A virus which is highly contagious. Hepatitis A viruses
cause the disease termed hepatitis A. Hepatitis A virus can be transmitted to others by contaminated
stools (feces), foods prepared by an infected person, contaminated water, and close personal contact
(for example, touching hands, sex), with an infected person but not by sneezing ,cough, hugging
(without skin contact) or by being near an infected person. Hepatitis A diagnosed by commonly
available blood tests .once Hepatitis A is affected you cannot get it again. Most of the people
infected with Hepatitis A recover completely. Hepatitis A infection never causes a long–term
(chronic) infection.
Symptoms of Hepatitis A:
1. Weakness
2. Fever
3. Loss of appetite
4. Vomiting
5. Joint aches and Pains
6. Fatigue
7. Jaundice (dark urine, pale–colored feces, skin and yellowish eyes.
8. Diarrhea
9. In blood stream bile is removed and excreted through urine
Structure:
The hepatitis A virus is a Picorna virus. Picorna virus is non–enveloped and contains a single–
stranded RNA packaged in a protein shell. And it is having only one serotype of the virus. But
multiple genotypes exist.
Testing for Hepatitis A:
The time between exposure to the virus and the development of symptoms that is incubation period
varies from 15 to 50 days, with an average of 30 days. Hepatitis A virus is excreted for up to two
weeks before the onset of symptoms. Therefore, people with hepatitis A should

Statin Research Paper
Statins (also known as 3–hydroxy–3–methylgutaryl coenzyme A reductase inhibitors) are widely
prescribed cholesterol–lowering drugs for the treatment of dyslipidemia and cardiovascular disease.
Although they are considered to be drugs with a very good safety profile, there are many concerns
that their adverse effects might compromise their proven beneficial effects due to their extensive
usage.
Even though more aggressive lipid lowering with potent statins in high doses can reduce rates of
non–fatal events and need for interventions, the incremental mortality benefits are still vague, and
their use is associated with a higher rate of drug related adverse effects.
Common adverse effects
Clinical experience shows that statin therapy may be ... Show more content on Helpwriting.net ...
Several widely used statins (such as lovastatin, atorvastatin and simvastatin) are metabolized by the
cytochrome P450 (CYP)3A4 pathway.
Co–administration of statins with cyclosporine, erythromycin, niacin or fibrates carries an increased
risk for myopathy. Cyclosporin and erythromycin interact with statins via the CYP3A4 pathway and
by interfering with OAT1B1 – a membrane transporter that helps regulate drug influx to the liver.
Certain drugs, such as calcium channel blockers, are considered weaker CYP3A4 inhibitors and
appear to increase statin rhabdomyolysis risk to a lower degree. Furthermore, grapefruit juice and
pomegranate juice inhibit CYP3A4 and have been presumptively linked to statin rhabdomyolysis.
In conclusion, statins are the mainstay of lipid–lowering therapy, with multiple studies confirming
that low–density lipoprotein reduction leads to improvements in cardiovascular morbidity and
mortality. Adverse effects and interactions associated with their use are outweighed by their proven
benefits in clinical event

Bacopa Monnieri In Cancer
Bacopa monnieri in cancer
From the studies of Panneerselvam Janani et al, it is very clear that bacoside A is effective to prevent
DEN–induced hepatocellular carcinoma by quenching lipid peroxidation and enhancing antioxidant
status through free radical scavenging mechanism and having the potential of protecting endogenous
enzymatic and non–enzymatic antioxidant activity. (Panneerselvam Janani et al). Bacoside A co–
treatment has been able to enhance the antioxidant enzymes to near normal when compared to tumor
bearing rats. Hence, bacoside A exhibits its chemopreventive effects against DEN–induced
carcinoma by decreasing the level of lipid peroxidation and enhancing the antioxidant status
probably through its free radical scavenging and having ... Show more content on Helpwriting.net ...
The antioxidant and tumor inhibiting property of Brahmi were studied in 3– methylcholanthrene
induced fibrosarcoma rats (Rohini et al., 2004). The levels of the antioxidant enzymes such as
glutathione peroxidase, superoxide dismutase, catalase and glutathione, the rate of lipid peroxidation
(LPO) were determined in the liver and kidney tissues. Sarcoma induction in rats resulted in a
marked increase in the rate of LPO and a decrease in the antioxidant enzyme status. Furthermore,
tumor markers such as lactate dehydrogenase, alanine transaminase, aspartate transaminase, creatine
kinase, and sialic acid showed an upregulated expression in the serum. Brahmi supplementation
enhanced the antioxidant enzyme status, reduced the rate of lipid peroxidation and downregulated
tumor development markers. Among the five crude samples such as the whole plant of Bacopa
monniera (L.)Wettst and four different fractions (petroleum ether, CHCl3, EtOAc, and n–BuOH
fractions) of the methanol extract, n–BuOH fraction was noted to have the highest antitumor activity
as per bioassay–guided methods conducted by Peng et al. The dammarane triterpene saponins
isolated from n–BuOH fraction, bacopaside É (1) and bacopaside VII (3), had

Lmbar Postlaminectomy Syndrome Case Studies
DOI: 03/11/2009. Patient is a 60–year–old male truck driver who sustained a work–related injury to
his back when he tried to catch a box from falling. He is status post two back surgeries on
07/06/2009 and has reached Maximum Medical Improvement as of 06/19/2012.
AME dated 6/19/2012 future medicals recommends access to follow up visits for monitoring of his
condition with continued provision of pharmacologic agents as prescribed by the managed by the
designated primary treating physician. In the setting of symptom flare–ups, re–instatement of brief
courses of traditional physical therapy/chiropractic treatment/acupuncture/massage therapy would
be beneficial in restoring to baseline function, not anticipated to exceed the requirement of 10 to 14
sessions of all modalities combined per calendar year. Yearly ... Show more content on
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Treatment plan includes repeating aspartate aminotransferase (AST), alanine transaminase (ALT)
blood test in 8 weeks to monitor enzyme levels and liver function.
He was prescribed with the following: Neurontin 600mg 3 tablets daily #90 as it decreases
numbness, improves walking and activity tolerance and has no side effects; Zanaflex 4mg, 1 tablet
daily as needed #5; Zohydro 10mg, 1 tablet daily #30 with 1 refill as it decreases pain from 9/10 to
6/10, improves walking and activity tolerance, no side effects, no abuse or aberrant behavior,
consistent urine drug screen, signed medication agreement and receives pain medication from a
single provider; Norflex 100mg, 1 tablet daily as needed #25 with 1 refill as it relieves muscle
spasm episodes which allows for increase in walking, exercise, and activities of daily living; Vistaril
25 mg decreased to 1 tablet at bedtime #25 as it improves sleep and increases daytime activity
tolerance (2 months supply). Patient will follow–up in 2

Diagnosis Of Hepatitis B Virus
Diagnosis of hepatitis B virus:
Patients with CHB should have full history and physical examination with special consideration on
risk factors for coinfection, alcohol use and family history of HBV infection and liver cancer
(AASLD, 2016).
(i) Hepatitis B core antigen
There are different types of antibodies which reflect several stages of immune response. HBc Ag can
stimulate production of antibodies from two classes, known as immunoglobulin "M" (IgM) and
immunoglobulin "G" (IgG):
IgM antibodies directed against HBcAg, which indicating HBV infection within the last six months.
IgG antibodies directed against HBcAg, which indicating HBV infection more than six months.
Patients with CHB tend to be positive for HBsAg ... Show more content on Helpwriting.net ...
Increases in alanine aminotransferase levels are particularly marked during acute infection, although
even in chronic hepatitis, alanine aminotransferase levels are commonly two or three times higher
than the upper limit of normal (Ryder and Beckingham, 2001). Patients infected with the HBeAg–
negative mutant strain of HBV are particularly prone to flares in alanine aminotransferase levels
(Bonino and Brunetto, 2003).
The levels of other liver enzymes can also increase as the immune system damages hepatocytes. As
a result, clinicians measure levels of several enzymes in a series of 'liver function tests'. In many
cases, patients do not develop symptoms of hepatitis despite showing markedly elevated liver
enzymes. There can be a number of causes of elevated liver enzymes, such as herbal remedies,
alcohol or other drugs, but they are usually a good surrogate for active liver disease (Ryder and
Beckingham, 2001). (v) HBV DNA levels
The most accurate and sensitive way to assess the number of viral particles (the viral load) within
the body is to directly measure levels of HBV DNA within the blood (Ganem

Potential Cardioprotective Effects Other than LDL Lowering
Potential Cardioprotective Effects Other than LDL Lowering
Cardioprotective effect of statins is ascribed by lowering LDL–C and improving the lipid profile as
reflected in plasma cholesterol levels.
Statins and Endothelial Function
Vascular endothelium plays a role in both vasoconstriction and relaxation, while
hypercholesterolemia by modulating arterial tone adversely affects this process. However,
endothelial function is improved by statin therapy due to production of the vasodilator nitric oxide.
Statins and Plaque Stability
The degree of rupture and thrombosis that is caused by plaques is more profound than the stenosis
they cause. Plaque stability is affected by statin in a variety of ways. They inhibit monocyte
infiltration into the artery wall and also inhibit macrophage secretion of matrix metalloproteinases
which degrade extracellular matrix components and thus weaken the fibrous cap of atherosclerotic
plaques in vitro.
Statins also by inhibiting proliferation of smooth muscle cells and enhancing apoptosis modulate the
cellularity of the artery wall.
Statins and Coagulation
The most compelling evidence of a non–lipid–lowering effect of a statin is the rosuvastatin–
mediated reduction in venous thromboembolic events, a prespecified endpoint, in JUPITER. This
trial demonstrated a 43% reduction in venous thromboembolic events in patients treated with
rosuvastatin, 20 mg daily, compared with placebo during a median follow–up period of 1.9 years
(Glynn et al., 2009).

The Use Of Fenugreek Seeds As Previously Reported
SFSE–G was prepared and characterized from the hydroalcoholic extract of fenugreek seeds as
previously reported [15]. Two peaks namely peak A (trigoneoside Ib) (76%), and peak B (vicenin–1)
(15%) were observed in HPLC at RT = 2.2 min and 3.2 min respectively. The corresponding
compounds were isolated and characterized using TLC, 1HNMR, and 13CNMR analysis.
After an overnight fasting, liver fibrosis was induced by intratracheal administration of BLM
hydrochloride (Biochem Pharmaceutical Industries Limited, India, 6 IU/kg in 0.9% NaCl) under
anesthesia with 60 mg/kg ketamine hydrochloride and 5 mg/kg xylazine [16]. The rats in the normal
and sham control group were subjected to the same procedure, but BLM was substituted by saline.
The rats were randomly divided into following groups (n = 12) as follows:
Group I: Normal group: (N): Rats did not undergo any surgery and did not receive BLM. They were
administered a single daily dose of distilled water (10 mg/kg), p.o. for 28 days.
Group II: Sham control group: (S): Rats were undergone surgery and received saline. They were
administered a single daily dose of distilled water (10 mg/kg), p.o. for 28 days.
Group III: BLM control group: (BLM): Rats were undergone surgery and received the intratracheal
administration of BLM. They were administered a single daily dose of distilled water (10 mg/kg),
p.o. for 28 days.
Group IV: Methylprednisolone (10 mg/kg) treated group: [MP (10)]: Rats were undergone surgery
and receive the

HELLP Syndrome Case Study
t A twenty–year–old patient came into the doctor at 26 weeks gestation displaying preeclampsia. The
patient was transferred to Sanford where she had the baby two days later. Following the birth, she
developed HELLP syndrome like symptoms. The reason why as small population of women develop
HELLP syndrome is largely unknown, but us believed to be caused by abnormal vascular
development or genetic variation. HELLP syndrome has also been known to be confused with acute
fatty liver of pregnancy (AFLP) or thrombotic thrombocytopenic purpura due to their
symptomology being similar. There are short–term treatments for HELLP syndrome, but only true
treatment is to give birth to the child. Currently there is no preventative measures except to not get
pregnant.
Introduction
The following case study analyzes a female patient ... Show more content on Helpwriting.net ...
Alterations in the TLR 4 gene are common in preeclampsia patients and even more with those with
HELLP syndrome, leading an autoimmune related disorder and sever hypertensive disorder during
pregnancy. The hypertension can lead to liver damage and proteinuria.7,8
The vascular endothelial growth factor genes are responsible for endothelial cell proliferation,
promoting cell migration, inhibiting apoptosis and induces permeabilization of blood vessels
prompting permeabilization of blood vessels. The over formation of blood vessels such as in the
placenta of HELLP syndrome patients, could lead to hypertension and possibly liver issues.9
The FAS gene is responsible for the regulation of programmed cell death or apoptosis. A single
nucleotide substitution of the FAS gene has been associated with an increased risk of developing
HELLP syndrome. This is most likely due to the stress from the pregnancy causing an over
production of this gene in the liver causing liver cell necrosis, increasing the liver

Sickle Cell Disease: A Brief Summary
In this article, it talks about cholera outbreaks in Vietnam again. Cholera is contagious that causes
diarrhea. It often happens in poor and high populated counties that have a difficult time getting safe
to drink water such as Vietnam. From 1979 to 1996, there was high amount of people in Vietnam
with cholera. In 1997 there was vaccination for it so the amount decreased, however in 2006 the
amount of people affected increased again. The cause was linked to food and unsanitized water from
the river– the main source of water. They collected water samples from patient's houses, indoor
water, wastewater, fresh water, and drinking water. Patients who reported that they had acute
diarrhea would be sent to a cholera center to make sure they do spread ... Show more content on
Helpwriting.net ...
The first phase is to find any extreme and dangerous side effects of the drugs. In this phase,
researchers use healthy volunteers or patients with diseases. During this phase, the researchers are
also trying to find out the drug is metabolized and expelled from the body. Phase two is trying to
determine the effectiveness of the drug on a patient. During this stage, researchers add different
drugs or a placebo to see how well the new intervention works. Phase three is continuing to
determine its effectiveness and how safe it is. There are changes of doses and different population in
this phase. The fourth stage happens after the study is approved by the FDA. In this stage, the drug
is allowed to be marketed, but the researchers are required to continue finding information about its
safety, effectiveness, and what it should be used

Aspartate Aminotransferase
The hindrance of serum alanine and aspartate aminotransferases (SALT and SAST) by anandamide
in vitro was contemplated. The outcomes demonstrated that both SALT and SAST were intensely
restrained by anandamide and the enzymes regained their strength by dialysis, showing that the
inhibitory impact of anandamide is reversible. The hindrance of both SALT and SAST by
anandamide was observed to be moderate and demonstrated the normal for a first request response
up to 30 minutes. The rate constants portraying this inhibition, in particular: the binding constant
(KB) (90 µM and 255 µM for SALT and SAST individually) and bimolecular inhibition constant ki
(533 and 571 (M. min)–1 for SALT and SAST respectively) were resolved. kcat (rate ... Show more
content on Helpwriting.net ...
(12)
The aim of this work is to study the effect of anandamide on the activities of SALT and SAST as
these two enzymes are of great value as liver function tests.
Kinetic measurements were carried out to evaluate its inhibitory power, such as bimolecular
inhibition constant, affinity constant, amidation rate as well as the type of inhibition of SALT and
SAST by anandamide.
MATERIALS AND METHODS
Chemicals were purchased from Aldrich chem. Co. England. Fresh human serum (obtained from
Medical Research Institute Blood Bank) was used as source of the enzymes. The enzymes SALT
and SAST activities were assayed by the method of Reitman and Frankel.(13) In this method; the
keto acid formed were measured colourimetricaly after combination with 2,4–dinitrophenyl
hydrazine, then the hydrazone formed was measured at 530

Enzyme Lab Report
Introduction
The independent research project will be include a series of tests with different enzyme sources to
discover the reaction time of each source. The enzyme sources will be bananas (ripe/regular), nuts
(peanut/almonds), liver, and pineapple. Tests will be done to find the reaction rate on the enzymes
and record results that are provided by a gas pressure sensor.
Research
Scientists already know that long strands of amino acids make up a protein and most enzymes
consist of 20 amino acids bonded together, and each enzyme has a different sequence or code of
amino acids that makes up a certain protein. Scientists also know that the function of the enzyme is
determined by the grouping of amino acids. They also know that enzymes are extremely ... Show
more content on Helpwriting.net ...
A substrate is a substance which is acted upon by an enzyme. An enzyme and a substrate together
are commonly nicknamed "the key and the lock." The "lock" gets it's name from the 3D structure of
an enzyme, the "key" is named for specifically fitting into only that "lock" (enzyme). Catalase is
used to break down hydrogen peroxide into water and oxygen molecules. This process of breaking
down molecules is necessary for preventing cell damage. Cell damage can be harmful in many
different ways so that is why this enzyme is essential to have otherwise there might be a mutation
from lack of cells or damaged cells.
When an enzyme and a substrate come together it reacts by creating a chemical reaction. The
enzymes lowers the activation energy. For example, if a runner has to jump over a 3 meter high bar
(comparing the runner to a substate) if an enzyme acts upon the runner it would seem like the runner
only has to jump over a 2 meter high bar.
The hypothesis is if the enzyme source of the enzyme is animal/plant, rich in nutrients/not rich in
nutrients then the plant enzymes high in nutrients will will react fastest. This is because foods that
are ripe or have more sugar/nutrients have not been converted to starch yet so the enzyme is still rich
within the

Toxic Shock Syndrome Essay
A 12–year–old girl presents as a transfer from an inpatient unit with a five day history of fever and
rash. Initial symptoms included soreness under the left axilla associated with chills and low–grade
temperatures of 100.5° F. Repeated visits to multiple physicians yielded a diagnosis of viral
syndrome due to non–specific findings on examinations and a negative radiograph of the left
shoulder and negative rapid flu test. The soreness progressively worsened with rapid development of
a red, sunburn–like rash spreading from the axilla to the torso. Development of this rash coincided
with abrupt onset of fever up to 103.5° F, headache, chills, and several episodes of vomiting the day
of admission. She was admitted and started on piperacillin/tazobactam ... Show more content on
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First, Group A streptococcus can also cause a toxic shock syndrome with clinical presentation
identical to STSS. For this reason it is vital that empiric treatment of suspected toxic shock
syndrome provides coverage for staphylococcus and streptococcus until the specific organism is
identified. This also means that all attempts to identify the cause of the toxic shock syndrome should
be undertaken as soon as toxic shock syndrome is suspected so that therapeutic interventions can be
optimized. This includes obtaining blood culture and any suspected lesions caused by staphylococci,
as well as removing and culturing any foreign bodies. Once all cultures have been obtained
intravenous treatment with high doses of a beta lactamase–resistant antistaphylococcal antibiotic
(such as nafcillin or a first generation cephalosporin) or vancomycin (in a community with a high
prevalence methicillin resistant staphylococcal aureus or if the patient is allergic to penicillin) in
combination with clindamycin is recommended. Clindamycin has been shown to reduce production
of TSST–1 by up to 90%. Once identity and susceptibilities of organisms is known the IV antibiotic
coverage can be narrowed and continued until the patient is afebrile for 72 hours. The patient can
then be switched to appropriate oral therapy to complete a 10–14 days course of antibiotic

Rhabdomyolysis Case Study
Infections were found to induce Rhabdomyolysis in patients with localized infections like erythema
to patients with sepsis and no direct muscle infection. Viral infections have been found in the
development of Rhabdomyolysis like influenza A and B viruses. In 2009, Rhabdomyolysis
associated with influenza A/H1N1 was reported in a pediatric patient. The patient had showed
symptoms of rhabdomyolysis with myoglobinuria, hyperkalemia, cardiac dysfunction and
compartment syndrome from this influenza A virus (Naruhiko et. al, 2009). The 8–year–old boy was
admitted into the hospital in November of 2009 with complaints of severe leg pain, hypotension,
and hypothermia. Six days before prior to developing these symptoms, the young boy had an onset
of ... Show more content on Helpwriting.net ...
Acute kidney injury have developed in 33% of patients suffering from this skeletal muscle
syndrome (Torres et. al, 2015). Skeletal muscle tissues release toxins that can cause buildup within
the kidneys. The large amount of toxins that were accumulated within the kidneys are serum
creatine kinase, creatinine, potassium, and calcium as well as myoglobin (Chatzizisis et. al, 2008).
The accumulation of myoglobin is nephrotoxic to the kidneys. Hypovolemia is another factor that
leads to renal hypo perfusion (Chatzizisis et. al, 2008). Baywater and Beall first discovered how
Rhabdomyolysis induce acute renal failure in 1941 after following the progress of 4 victims had
developed acute renal failure in London in 1940. Some decades later, they found out that
nephrotoxic effect from myoglobin was released by muscle cells and was responsible for ruptured
muscle cells (Chatzizisis et. al, 2008). About 10–40% were estimated in the cases of
Rhabdomyolysis lead to acute renal failure (Chatzizisis et. al,

Statins Therapy
The nursing problem relating to the proper management of the cardiovascular disease and ensuring
that administration of statins therapy leads to the desired impact is observed mainly among the
patients having heart and liver diseases in the health centers. Statins are the group of drugs that help
in lowering the levels low–density lipoprotein in one's blood. The statins are responsible for
blocking the substances that form cholesterol in the liver (Shehata et al, 2015). The recent incidents
related to the effectiveness of the statins prompts the researchers to conduct the interventional
studies to establish whether the statin drugs cause the increase of the liver diseases among patients
(Shehata et al, 2015).The statin drugs ensure that any excess cholesterol within the body is
converted ... Show more content on Helpwriting.net ...
The patients facing the liver diseases are also include to identify whether the statin therapy
contributes to increased levels of their illness.
Intervention for the problem is adoption of statin therapy as the remedy to help in the reduction of
cardiovascular disease related mortality rates. The management of the disease is highly beneficial to
the people most vulnerable to developing the disease. The efficient monitoring of the liver function
tests among the patients is highly recommended to ensure the proper management among the
patients experiencing the liver disease (Shehata et al, 2015).
The standards supervised process that would not involve the establishment the significant liver test
conducted which acts as a control group for the patients is used for comparison. The nitrates used by
the cardiovascular patients as drugs to manage the disease would be administered to the patients for
comparison with the stating therapy and the

Signet-Ring Cell Adenocarcinoma Case Summary
A Case of Signet Ring Cell Adenocarcinoma–Unique presentation with Concurrent Non–
gastrointestinal Malignancy.
Authors: Sandar Linn1, Hernan A. Lopez–Morra1, Sofia Nigar1, Juan Tejada1, Nami S Haeri1,Shah
Giashuddin2,Jonathan Chow2, Mahesh K. Krishniah1, Sury Anand1.
1 Division of Gastroenterology, Department of Internal Medicine, the Brooklyn Hospital Center,
Brooklyn, NY.
2 Department of Pathology, the Brooklyn Hospital Center, Brooklyn, NY.
Abstract:
Background: Signet–ring cell adenocarcinoma (SRCC), the histological variant of ampullary
carcinoma, is an extremely uncommon malignancy. To our knowledge, this report is the first case of
SRCC with concurrent non–gastrointestinal malignancies.
Case Report: A 66 year old male with history of prostate cancer, anglioblastoma multiforme
presented with jaundice and abdominal pain. Endoscopic retrograde cholangiopancreatography
(ERCP) and Endoscopic Ultrasound (EUS) suggested a duodenal tumor at ... Show more content on
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90% of SRCC take place in the stomach [1]. SRCC is extremely uncommon in the ampulla of Vater,
and only 32 previous cases have been described in the literature [3].
Because of its uncommon entity, the histological genesis of SRCC is still mysterious. While
previous authors suggested that the tumor came from the ectopic gastric mucosa located at the
ampullary region since most of SRCC are found in stomach [9, 10], others declared that SRCC
occurs from the gastric–type metaplastic epithelium [1] which appeared possibly due to the elevated
acidity since the metaplastic changes were are usually observed at the duodenal bulb in peptic ulcer
patients [10]. However, Our case did not support both theories like the other case because it did not
show any gastric mucosa around the tumor nor peptic ulcer found in EGD

Questions On Materials And Methods
2– Materials and methods 1. Snails B. alexandrina snails (8 – 10 mm) from Medical Malacology
Laboratory, Theodor Bilharz Research Institute (TBRI), Giza, Egypt were used. Pieces of
polyethylene sheets were put into the aquaria to collect egg masses. 2. Synthetic insecticide: Match
5% EC: Lufenuron 5% EC (Registration No., 609) was purchased from Syngenta (AGRO–Egypt).
3. Bioassay tests: 3.1. Molluscicidal screening: A stock solution of 1000 ppm was prepared from the
insecticide on the basis of W/V using dechlorinated tap water. To calculate LC50 and LC90, Series
of concentrations were prepared and ten B. alexandrina snails were placed in beakers for each
concentration (WHO, 1983) and another group in dechlorinated water as control. Three replicates
were prepared for each group and control, then, snails' mortality was recorded. 3.1.1. Collection of
hemolymph: To collect the hemolymph, a small portion of the shell which situated directly above
the heart of snails was removed and a capillary tube was inserted into the heart (Nduka and
Harrison, 1980). a– Total hemocytes count: The number of cells was counted using a Bürker– Turk
hemocytometer (Van der knap et al., 1981) by using 10 µl of hemolymph of each group. b–
Differential hemocytes count: Hemocytes monolayers were prepared according to the method of
Abdul–Salam & Michelson (1980). c– Biochemical Assays: Activities of aspartate aminotransferase
(AST) and alanine aminotransferase (ALT) in

The Second Parasitic Infection After Malaria
Schistosomiasis is the second parasitic infection after malaria (kiros et al., 2014) and is a standout
amongst the most pervasive and disregarded illnesses of tropical and subtropical areas (rizk and aly,
2015). B. alexandrina snails are the intermediate host of Schistosoma mansoni (le Clec'h et al. 2016)
with high prevalence in Egypt (el–Sheikh et al., 2012). Control of B. alexandrina upsets the life
cycle of the parasite (el–Sherbini et al., 2009) and contains a critical component in coordinated
methodologies for lessening the spread of schistosomiasis (rocha–Filho et al., 2015). Manufactured
molluscicides is an imperative part in the incorporated schistosomiasis control programs. The high
cost of these molluscicides and their negative effect on the earth being poisonous to creatures of
land and water (salem et al., 2014; world health organization, 2014), have stimulated interest for
quest for plant molluscicides (otarigho and morenikeji, 2012; kiros et al. 2014). The medicinal
plants represent the main source of molluscicidal agents for B. alexandrina control (el–Sherbini et
al., 2009) as these plants are less costly, less unsafe to the earth and having a high level of
degradability (salawu and odaibo, 2011; rocha–filho et al., 2015). Moringa oleifera Lamarck
(Family: Moringaceae) is an important medicinal plant referred as a miracle tree (radovich, 2009). It
is discovered broadly dispersed in both tropical and

Hip Fracture Essay
Title
Serum N–terminal propeptide of type 1 collagen (P1NP) in Elderly Patients with Hip Fracture:
Relationship with Sociodemographic and Clinical Characteristics, Other Parameters of Bone and
Mineral Metabolism, and Short–term Outcomes
Stackpool,T.
Advanced Trainee in Geriatric Medicine, the Canberra Hospital
Abstract
Introduction: The relationships between serum N–terminal propeptide of type 1 collagen [P1NP], a
marker of bone formation, with metabolic and clinical factors have rarely been determined and
remain unclear.
Aims: To evaluate in patients with a hip fracture the association between serum P1NP concentration
(on admission) and clinical characteristics as well as short–term outcomes.
Materials and Methods: ... Show more content on Helpwriting.net ...
A further multivariate regression analysis revealed that the lowest tertile of serum P1NP
concentration (≤29.3µg/L) was found to be significantly associated with nursing home residence (P–
value 0.034) after adjustment for age, gender and presence of hypertension; and also to be inversely
associated with ALP (P–value 0.000), OC (P–value 0.000) and β–CTX (P–value 0.001) after
adjustment for age, gender, ALP, OC, and β–CTX.
Conclusions: In elderly patients with a hip fracture, serum P1NP concentration had an inverse
relationship with age, GGT, and markers of inflammation such as CRP and NLR; and a positive
relationship with the bone turnover markers OC and β–CTX, ALP, and may predict prolonged length
of hospital stay and new nursing home discharge.
What is Known in Regards to Serum N–terminal propeptide of type 1 collagen (P1NP)
Predominantly produced by osteoblasts and minor amounts synthesised by the liver
Recommended as a marker of bone formation by international institutions.
Serum P1NP concentrations decrease after administration of bisphosphonates and selective
oestrogen receptor modulators, and increase with teriparatide therapy.
Higher P1NP concentrations are associated with myocardial infarction in elderly male patients, and

The Effect Of Cardiovascular Disease On The Underlying...
As population is aging, liver cirrhosis is progressively predominant, and more elderly population
with already diagnosed liver disease will be seen by geriatricians. It very useful to understand
predictive factors for survival in cirrhotic patients in order to help with therapeutic decision–making,
including allocation for liver transplantation (Fox et al., 2011).
There are associations between cardiovascular disease (CVD) and liver cirrhosis. The effect of
cardiovascular diseases on the underlying liver disease is well–recognized. The management is vital
in the long term care of patients with liver cirrhosis, particularly whom considered for liver
transplantation. CVD in cirrhotics may happen as a part of a systemic disease that incorporates the
liver e.g.: Wilson 's disease, or a systemic disease which does not include the liver e.g.:
atherosclerosis and coronary artery disease, or as a limited cardiovascular disease without related
hepatic or systemic affiliation (Karasu et al., 2004).
Cardiovascular function is often affected in patients with liver cirrhosis and this has an association
with degree of liver dysfunction defined by Child–Pugh score or the Model for End Stage Liver
Disease (MELD) score. That CVD process is marked by changes known as "the hyperdynamic
syndrome". Studies found that this syndrome occurs in more than 30% of patients with cirrhosis
(Karasu et al., 2004).
Renal dysfunction has been the focus of much research in different patient populations. This

Acetaminophenol Research Paper
Acetaminophen (N–acetyl–p–aminophenol, abbreviated as APAP) is one of the most widely used
analgesic, antipyretic, and anti–inflammatory drugs worldwide [1]. While generally considered to be
safe for humans at a maximum recommended daily dose of 4,000 milligrams (mg) per healthy adult
[2], at higher concentrations this drug can cause serious adverse effects, especially toxicity to the
gastrointestinal, renal, and hepatic systems [1]. Moreover, APAP poisoning, either by accidental or
intentional overdose, is a frequent problem in current medical practice. For example, it is the
paramount cause of acute liver failure in the Western Europe, the United States, Canada, and
Australia [3]. Therefore, an extensive body of literature dealing with acetaminophen ... Show more
content on Helpwriting.net ...
Linoleic acid is as an additional source of arachidonic acid, and therefore, this compound also serves
as a key player in eicosanoid biosynthesis [11,12]. The cyclooxygenase enzymes convert
arachidonic acid via the cyclic pathway of eicosanoid biosynthesis to prostaglandin H2, which is
further metabolized to prostaglandins (e.g., PGE2, PGF2α, PGD2, PGI2) and thromboxane, many of
them with pro–inflammatory properties [13,14]. There are three types of cyclooxygenases, sharing
60% of their primary structure: COX–1, which is generally localized in the endoplasmic reticulum;
COX–2, which is found on the nuclear envelope [14,15]; and COX–3, which occurs only in the
cerebral cortex [16]. In the healthy liver, COX–1 and COX–2 work together to induce the
inflammation state, and when needed, to reinstate the normal hepatic function [17,18]. At hepatic
level, these cyclooxygenases are abundantly expressed during liver injury, cirrhosis, and induced
tumorigenesis [19], suggesting the involvement of eicosanoids in the pathogenic mechanisms of
liver injury. They are expressed by the liver macrophage–like Kupfer cells, identified by the
macrophage marker ED2 (CD168) and these cells are sites of intense eicosanoid production and
signaling [20]. Still, in spite of all these data, little knowledge exists about the interplay between
APAP treatment and cyclooxygenase–mediated signaling pathway in the liver. It is known, though,
that COX–2 overexpression in the mouse liver induces chronic hepatitis by inducing a persistent
inflammatory reaction involving macrophages that causes a persistent increase in the hepatocyte
death, which reinforces the inflammatory reaction and thus further death of hepatocytes

Case Study 43 Choledocholithiasis
Case Study 43 Choledocholithiasis Scenario T.B. is a 65–year–old retiree who is admitted to your
unit from the emergency department (ED). On arrival you note that he is trembling and nearly
doubled over with severe abdominal pain. T.B. indicates that he has severe pain in the right upper
quadrant (RUQ) of his abdomen that radiates through to his mid–back as a deep, sharp boring pain.
He is more comfortable walking or sitting bent forward rather than lying flat in bed. He admits to
having had several similar bouts of abdominal pain in the last month, but "none as bad as this." He
feels nauseated but has not vomited, although he did vomit a week ago with a similar episode. T.B.
experienced an acute onset of pain after eating fish and chips ... Show more content on
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He reports that on a scale of 1 to 10, his pain has decreased from a 10 to a 4 in an hour. What other
methods could be used to help T.B.'s pain? Anticholinergics can be used to decrease secretion and
counteract smooth muscle contraction to help with comfort levels of T.B. Also attempting to use
none medication therapy such as massage, or relaxation techniques can be used to relieve pain. What
data charted in the assessment are consistent with CBD obstruction? Presenting with jaundice, pain,
clay colored stool, nausea, vomiting, pain triggered by high fat content meal, tender upon palpation,
and fatigue are all findings that are consistent with CBD. CASE STUDY PROGRESS At 2330 T.B.
spikes a temperature of 38.6° C (tympanic). His SaO2 on 2 L O2/NC is now 90%, so you
immediately increase the flow rate to raise his O2 saturation. You inform the on–call surgeon, and
she orders a STAT chest x–ray (CXR) and a broad–spectrum antibiotic–imipenem and cilastatin 500
mg IV q6h (check renal function; this medication must be dose adjusted if patient has renal
impairment, or there is an increased risk for seizure). What actions need to be completed before
starting the antibiotic? Before administration of any medication the patients chart should be looked
at and varify that the patient has no allergies that could be related to said treatment or anything
similar in their medical history. Also obtaining a baseline set of vitals prior to medication
administration

Compare And Contrast The Effects Of Khat And Liver
Khat and liver;
The effect of khat on liver can be considered as herbal induced liver injury but the big dilemma is
whether the insult is due to the active components themselves or the added fertilizers and pesticides.
Unfortunately no studies are available comparing the effect of khat on liver disease in both
conditions. Amphetamine is known to exert different forms of hepatotoxicity in–vivo and in–vitro
when tested on hepatocytes (Carvalho et al., 1997; Vitcheva et al., 2009).
In the short–term (3 months) Catha edulis induced cytotoxic effects on the cells of liver and kidney,
but seems the liver to be adapted in the long–term (6 months) with this toxicity (Al–Habori, 2005).
The liver has ... Show more content on Helpwriting.net ...
Other causes of liver injury were excluded and all had similar histopathological findings
characterized by multilobular necrosis; two of them had a background of chronic liver disease.
Unfortunately, all patients had resumed chewing khat before their second visit resulting in further
liver damage, a high concentration of cathinone was identified in a sample of damaged liver tissue
from one patient. Five patient developed fulminant or subfulminant hepatic failure and underwent
orthotopic liver transplantation, (Chapman et al., 2010).
Three case series from the United Kingdom and Netherlands reported severe liver injury due to khat
use (Stuyt et al., 2011). Studies in Somalian khat chewer's patients in UK have revealed many cases
of acute idiopathic severe liver damage (Peevers et al., 2010). Another study has shown a high
prevalence of cryptogenic liver disease among Somalian khat chewers. Moreover, some of them
who had autoimmune antibodies like SMA failed to respond to therapy with immunosuppressants
and those who stop khat chewing recovered markedly and needed no for more immunosuppressants
(Bajubair,

Sprague-Dawley Male Rats
MATERIALS AND METHODS Animals: Nine Sprague–Dawley male rats aged 50 days, and
weighing 605 ± 7.2 g were purchased from Samtako Bio Co. (Osan, Korea). Upon arrival, rats were
fed a basal purified diet (standard rodent chow) and housed in individual cages on pine shavings
under controlled conditions of light (12h light/12h dark), temperature (22 ± 2 °C) and humidity (50
± 20%). All experimental procedures were performed according to the national institute guidelines
for animal care and use approved by the animal ethics committee of Chungnam National University
(approval letter no. CNU–00659). After a week acclimation period, rats (9) were divided into three
diet groups based on the EVA concentration for 11 weeks. The control diet (n = 3) comprised
standard rodent chow (SeoulFeed Co. Ltd, Incheon, Korea) ground into powder using a laboratory
mill. Diet 2 (low–dose, n = 3) was made mixing 3 mg EVA powder/kg b.w with standard rodent
chow, and the third diet (high–dose, n = 3) was made mixing 15 mg EVA powder/kg b.w with
standard rodent chow. Rats had free access to drinking water during the entire experimental period.
... Show more content on Helpwriting.net ...
The upper portion (100 g) of the velvet antler was sliced and ground into a fine powder. Meanwhile,
velvet antler water was separated from the finely ground powder by lyophilization

Brunner's Gland Hamartoma
Brunner's gland hamartoma is an uncommon benign lesion which is most commonly found in the
bulb of the duodenum. It is often a small lesion which is asymptomatic. Most are found incidentally
during upper gastrointestinal series or esophagogastroduodenoscopy. Symptoms are often
hemorrhage or duodenal obstructive symptoms which are mainly due to ulceration of the lesions.
Histologically, Brunner's gland hamartoma consists of components of Brunner's gland cells,
containing glandular, adipose and muscle cells. In this study we report a case of a 30–year–old man
presenting with upper gastrointestinal bleeding and obstructive symptoms due to a giant Brunner's
gland hamartoma in the duodenal bulb. The hamartoma was removed successfully by endoscopic
resection without significant complications. Microscopically, the lesion was found to be entirely
composed of variable Brunner's glands and adipocytes. Key Words: Brunner's gland, Hamartoma,
Gastrointestinal Bleeding Case report ... Show more content on Helpwriting.net ...
His background was hypertension, diabetes mellitus and hypercholesterolaemia. He was initially
seen in a primary clinic and underwent esophagogastroduodenoscopy where a duodenal
subepithelial lesion was found. He was diagnosed with lipoma by endoscopic ultrasonography. He
was treated conservatively and subsequent abdominal ultrasound and colonoscopy findings were
normal. The patient received 8 units of blood transfusion twice for iron deficiency anemia.
However, the patient did not improve over three months, and had ongoing dizziness and nausea. He
was then referred to this hospital for further investigation of gastrointestinal bleeding and known
duodenal lesion. The patient denied weight loss or use of non steroidal anti–inflammatory drugs
(NSAIDs). His height and weight were 180.9 cm and 145.8 kg, with a body mass index (BMI) of
44.5

Viral Delivery Systems And Its Effects

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