By G. Tuwas. Cabrini College.
The core lipid is surrounded by phospholipids similar to those found in cell membranes purchase pyridium 200 mg line, which increase the solubility of chylomicrons in lymph and blood discount pyridium 200mg with visa. ApoB-48 is attached and required for release from the epithelial cells into the lymphatics effective 200 mg pyridium. Chylomicrons leave the lymph and enter the peripheral blood pyridium 200mg without a prescription, where the thoracic duct joins the left subclavian vein, thus initially bypassing the liver. The chylomicron remnant is picked up by hepatocytes through the apoE receptor; thus, dietary cholesterol, as well as any remaining triglyceride, is released in the hepatocyte. When a cell is repairing membrane or dividing, the cholesterol is required for membrane synthesis. Bile acids and salts are made from cholesterol in the liver, and many other tissues require some cholesterol for steroid synthesis. They contain apoA-1 used for cholesterol recovery from fatty streaks in the blood vessels. This receptor is expressed at high levels in hepatocytes and the steroidogenic tissues, including ovaries, testes, and areas of the adrenal glands. The atherosclerotic lesion represents an inflammatory response sharing several characteristics with granuloma formation, and not simple deposition of cholesterol in the blood vessel. Endothelial dysfunction increases adhesiveness and permeability of the endothelium for platelets and leukocytes. Local inflammation recruits monocytes and macro phages with subsequent production of reactive oxygen species. Initially the subendothelial accumulation of cholesterol-laden macro- phages produces fatty streaks. As the fatty streak enlarges over time, necrotic tissue and free lipid accumulates, sur- rounded by epithelioid cells and eventually smooth muscle cells, an advanced plaque with a fibrous cap. The plaque eventually begins to occlude the blood vessel, causing ischemia and infarction in the heart, brain, or extremities. Eventually the fibrous cap may thin, and the plaque becomes unstable, leading to rup- ture and thrombosis. Vitamin E is a lipid-soluble vitamin that acts as an antioxidant in the lipid phase. Vitamins C and A lack this protective effect despite their antioxidant properties. Factors contributing to the hyper- lipidemia are: Decreased glucose uptake in adipose tissue Overactive hormone-sensitive lipase (Chapter 16, Figure 1-16-1) Underactive lipoprotein lipase Hyperlipidemia Secondary to Diabetes A 20-year-old man was studying for his final exams and became hungry. He drove to the nearest fast food restaurant and ordered a double cheeseburger, extra large French fries, and a large soda. About an hour later, he developed serious abdominal distress, became nauseated, and was close to fainting. Upon his arrival at the emergency room, tests showed that he was hyperglycemic, as well as hypertriglyceridemic. Additional information revealed that he was diabetic, and he recovered quickly after the administration of insulin. One of the important regulatory functions of insulin in adipose tissue is promoting lipoprotein lipase activity by increasing transcription of its gene. Therefore, the consequence in diabetes is abnormally low levels of lipoprotein lipase and the inability to adequately degrade the serum triglycerides in lipoproteins to facilitate the uptake of fatty acids into adipocytes. Cholesterol deposits may be seen as: Xanthomas of the Achilles tendon • Subcutaneous tuberous xanthomas over the elbows • Xanthelasma (lipid in the eyelid) • Corneal arcus Homozygous individuals 0/106) often have myocardial infarctions before 20 years of age. Abetalipoproteinemia (a Hypolipidemia) Abetalipoproteinemia and hypobetalipoproteinemia are rare conditions that nevertheless illustrate the importance of lipid absorption and transport. Because chylomicron levels are very low, fat accumulates in intestinal enterocytes and in hepa- tocytes. Most de novo synthesis occurs in the liver, where cholesterol is synthesized from acetyl- CoA in the cytoplasm.
Which of the following tests best differentiates enzymes order pyridium 200 mg mastercard, found in most strains of S pyridium 200 mg overnight delivery. Microbiology/Evaluate laboratory data to make identifications/Gram-negative bacilli/2 19 pyridium 200mg with mastercard. Escherichia order pyridium 200 mg amex, Edwardsiella, and Enterobacter include Leminorella, Rahnella, and Tatumella. Blood is present in the stools of patients biological characteristics/Gram-negative bacilli/2 infected with Shigella as a result of invasion and 20. Young children may also fluid and electrolyte loss preceded by bloody stools exhibit bloody stools when infected with 2–3 days before is characteristic of shigellosis but Campylobacter. Cold enrichment of feces (incubation at 4°C) in phosphate-buffered saline prior to subculture onto enteric media enhances the recovery of: A. Which group of tests, along with colonial Answers to Questions 22–26 morphology on primary media, aids most in the rapid identification of the Enterobacteriaceae? Indole, oxidase, MacConkey, and blood agar on MacConkey agar is distinctive, showing flat, plates pink (lactose-positive) colonies with a ring of bile precipitation. Which group of tests best identifies the Morganella urease, and deaminate phenylalanine. Which group of tests best differentiates Enterobacter Citrate 95 0 aerogenes from Edwardsiella tarda? Both species are usually identifications/Gram-negative bacilli/2 motile and arginine dihydrolase positive. Enterobacter sakazakii can best be differentiated from Enterobacter cloacae by which of the following characteristics? Members of the genus Cedecea are best Answers to Questions 27–31 differentiated from Serratia spp. Positive phenylalanine deaminase Cedecea, negative for Serratia) and gelatin hydrolysis D. B Biochemical differentiation is essential because identifications/Gram-negative bacilli/2 Citrobacter isolates may give a false-positive agglutination test with Salmonella grouping 28. Microbiology/Apply knowledge of fundamental biological characteristics/Gram-negative bacilli/2 29. However, catheterized urine sample from a nursing home Morganella can be differentiated from Proteus spp. Te lactose-negative isolate tested positive based upon H2S, indole, ornithine decarboxylase, for indole, urease, ornithine decarboxylase, and and xylose fermentation. Indole Microbiology/Evaluate laboratory data to make identifications/Gram-negative bacilli/2 31. Which of the following organisms, found in normal fecal flora, may be mistaken biochemically for the genus Yersinia? Microbiology/Apply knowledge of fundamental biological characteristics/Gram-negative bacilli/2 7. Why might it be necessary for both pink Answers to Questions 32–35 (lactose-positive) and colorless (lactose-negative) colonies from an initial stool culture on 32. Most Shigella strains are lactose positive these strains can be serotyped or sent to a reference B. It ferments D-sorbitol slowly or not at all and appears as colorless colonies on Microbiology/Evaluate laboratory data to make MacConkey–sorbitol agar. Which agar that is used for routine stool cultures best agar for the isolation of Yersinia strains because is the medium of choice for the isolation of it inhibits growth of other coliforms, but it is not Yersinia strains from stool specimens? Some serotypes of Microbiology/Select methods/Reagents/Media/ Yersinia may be inhibited on more selective media, Gram-negative bacilli/2 such as Salmonella–Shigella or Hektoen. Which organism is sometimes mistaken for inhibits the growth of gram-negative bacteria. A bloody stool cultured from a 26-year-old woman after 3 days of severe diarrhea showed 35. Shigella and 2 non–lactose-fermenting colonies Campylobacter cause bloody diarrhea because they Hektoen enteric agar: many blue-green colonies invade the epithelial cells of the large bowel; Campylobacter blood agar and C.
It is possible that anti-A buy pyridium 200 mg cheap,B from the Rh-negative blood mother is attaching to the baby’s red cells purchase pyridium 200 mg on line, causing a C pyridium 200mg cheap. Therefore discount pyridium 200mg, the baby’s Rh-positive blood Rh type is unknown and the mother would be a D. An elution procedure followed by a 4+ 0 4+ 0 2+ panel performed on the eluate would help to identify the antibody. Screen cells and a panel performed on a patient’s serum showed very weak reactions with inconclusive results. Antigen typing the patient’s red cells Blood bank/Apply principles of special procedures/ Antibody identification/3 168 Chapter 4 | Immunohematology 16. A 33-year-old maternity patient is drawn for a type red cells from two O-positive donor units show and screen at 36 weeks’ gestation. Anti-A Anti-B Anti-A, B Anti-D A cells B cells 1 What action should be taken next? Wash the patient’s red cells and repeat the Blood bank/Select course of action/Incompatible forward grouping crossmatch/3 B. Warm the patient plasma at 37°C for 10 minutes Blood bank records are checked and indicate that and repeat the reverse grouping 5 years ago this patient had an anti-Jkb. Antigen type units for the Jkb antigen and only crossmatch units negative for Jkb Answers to Questions 16–19 C. This indicates the possibility 4 Jkb-negative units of a high-frequency alloantibody or a warm Blood bank/Apply principles of laboratory operations/ autoantibody. A positive autocontrol indicates an autoantibody is present; a negative autocontrol and 18. A 56-year-old patient diagnosed with colon cancer positive screen cells indicates an alloantibody. A panel coated the patient’s red cells, and is directed against study is done and shows 10 cells positive as well as screening cells and donor cells. B A patient with a history of a significant antibody like anti-Jkb must receive blood that has been completely history of receiving 2 units of blood approximately 1 month ago. Issue O-negative cells performed to adsorb out the autoantibody and leave Blood bank/Evaluate laboratory data to determine best potential alloantibodies in the patient’s serum that course of action/Panel study/3 will need to be identified before transfusion of blood to the patient. An autoadsorption cannot be performed due to the fact that any alloantibodies would be absorbed by circulating donor cells from a month prior. Warming the plasma at 37°C will dissipate the antibody, preventing its reactivity with P1 antigen on the A1 cells. An O-negative mother with no record of any Answer to Question 20 previous pregnancies gives birth to her first child, a B-positive baby. C In this case, the maternal anti-A,B is probably coating positive and the negative control is negative. Te baby Anti-A,B from an O person is a single entity that cannot appears healthy but develops mild jaundice after be separated. Which formula correctly describes the relationship Answers to Questions 1–5 between absorbance and %T? All of these options Multiplying the numerator and denominator Chemistry/Identify basic principle(s)/Instrumentation/2 by 100 gives: 2. D Beer’s law states that A = a × b × c, where a is the Beer’s law/1 absorptivity coefficient (a constant), b is the path 4. A A solution transmits light corresponding in Spectrophotometry/2 wavelength to its color, and usually absorbs light of wavelengths complementary to its color. A green-colored solution would show highest red solution transmits light of 600–650 nm and transmittance at: strongly absorbs 400–500 nm light. A solution that is green would be quantitated using a wavelength that it absorbs strongly, such as 450 nm. A Visible spectrophotometers are usually supplied and adjusting the readout to zero %T with the with a tungsten or quartz halogen source lamp.
Does clinical case Motivational Interviewing: Preparing People management improve outpatient addiction for Change proven 200 mg pyridium, 2d ed discount pyridium 200mg free shipping. Journal of Exchange cheap pyridium 200mg on line, Center for Substance Abuse 264 Appendix A Treatment pyridium 200mg for sale, November 2000. A gas chromatographic- ìThere is a balm in Gileadî: Religion and positive ion chemical ionization-mass spectro- substance abuse treatment. Phases of ment of necrotising fasciitis caused by Group treatment: A practical approach to A Streptococcus. Journal of Pain and Symptom Addiction: Close to Home [5-part television Management 14(5):261ñ263, 1997. Department of Health and Human new light on the state of drug abuse treatment Services, 2005. National Center on Addiction and Substance Dual diagnosis: A review of etiological theo- Abuse. Effective Developing and Implementing a W orkplace medical treatment of opiate addiction. Integrating Behavioral Absence of antibody to human immunodefi- Therapies W ith Medication in the Treatment ciency virus in long-term, socially rehabilitat- of Drug Dependence. Natural killer cell activity Pharmacologic treatment of heroin- and lymphocyte subsets in parenteral heroin dependent patients. Annals of Internal abusers and long-term methadone mainte- Medicine 133(1):40ñ54, 2000. Metabolism of and Experimental Therapeutics methadone and levo-alpha-acetylmethadol 250(2):606ñ610, 1989. Imipramine treatment of opiate- Pharmacology and Experimental dependent patients with depressive disorders: Therapeutics 298(3):1021ñ1032, 2001. Does therapeutic threshold of Disulfiram treatment for cocaine dependence methadone concentration in plasma exist? New York: American Association for atic desensitization for heroin addicts in the Treatment of Opioid Dependence, 2002. Induction simulationómoderate to Successful pain management for the recover- high tolerance [slide presentation]. Journal of Analytical Toxicology agement and cognitive-behavioral approaches 23(5):313ñ322, 1999a. Archives of General Psychiatry Addiction and Substance Abuse at Columbia 57(4):395ñ404, 2000. Anger Transtheoretical therapy: Toward a more Management for Substance Abuse and integrative model of change. Psychotherapy: Mental Health Clients: A Cognitive Theory, Research and Practice Behavioral Therapy Manual. Pathologie-Biologie (Paris) use of buprenorphine-benzodiazepine combi- 50(9):568ñ575, 2002. Journal of Psychoactive Drugs American Journal of Public Health 27(2):151ñ159, 1995. Maternal-infant azepine dependence among heroin users in transmission of hepatitis C virus infection. Archives Methadone Treatment for Opioid of General Psychiatry 43(8):739ñ745, 1986. Journal of Substance Abuse Treatment Medical Journal of Australia 173:484ñ488, 19(1):7ñ14, 2000a. Importance of identifying Disorders and Addictions: Evidence on cocaine and alcohol dependent methadone Epidemiology, Utilization, and Treatment clients. Journal of Pediatrics neglected: Cognitive processing of cues in 101(2):192ñ196, 1982. Mount Sinai follow-up of a methadone medical mainte- Journal of Medicine 67(5ñ6):388ñ397, 2000. Mount Sinai The impact of a brief motivational interven- Journal of Medicine 67(5ñ6):412ñ422, 2000. Principles of pain treatment in Drug and Alcohol Dependence 51(1ñ2): the addicted patient. A nationwide survey of urinaly- seronegative drug users in a methadone main- sis practices of methadone maintenance clin- tenance program.