Managing diabetes and cholesterol with dietary fiber

06/27/14 1
NAMRATA CHHABRA- BIOCHEMISTRY FOR
MEDICS

SPOT QUESTION-1
A 28-year-old man complains of a rash on his
sun exposed skin, diarrhea and loss of balance.
His Urinanalysis results are significant for an
increase in neutral amino acid level. The patient
is diagnosed with Hartnup’s disease, a defective
transport of neutral amino acids in the kidney.
Which of the following amino acids would have
been found in the urine sample?
A. Lysine
B. Tryptophan
C. Arginine
D. Histidine
E. Glutamate
06/27/14 2
MEDICS

ANSWER- SPOT-1
• The correct answer is-Tryptophan, which is the only
neutral amino acid in the given options. Lysine,
Arginine and Histidine are positively charged (basic
amino acids), whereas Glutamic acid is a negatively
charged amino acid (acidic amino acid ).
• Hartnup disease is an absorption defect, transporter
deficiency leads to reduced absorption of tryptophan,
which is an essential amino acid , as well as a precursor
of niacin and neurotransmitters. The patients of
Hartnup disease manifest both the symptoms of
tryptophan(neurological) as well as niacin deficiencies
(pellagra).
06/27/14 3
MEDICS

SPOT QUESTION-2
A 67-year-old man suffers from congestive
heart failure. He is taking Digoxin, which
helps the heart to beat more strongly and
regularly. Digoxin is an ester that contains a
sugar component and a non sugar
(aglycone) component attached via oxygen.
What is the chemical nature of Digoxin?
A. Glycoprotein
B. Glycoside
C. Oligosaccharide
D. Polysaccharide
E. Disaccharide
06/27/14 4
MEDICS

ANSWER- SPOT QUESTION -2
The correct option is Glycoside.
Digoxin is a cardiac glycoside.
Glycosides contain a sugar and a non sugar
component (aglycone) linked together by O-
Glycosidic linkage)
06/27/14 5
MEDICS

SPOT QUESTION-3
A protein rich nutrient has been checked
for the quality of its protein. Hopkin Cole
color reaction has come out as negative
while all other color reactions for different
amino acids are positive?
Which amino acid is lacking in the diet?
What is your interpretation about the
quality of the given protein?
06/27/14 6
MEDICS

ANSWER- SPOT QUESTION-3
• Hopkin cole reaction is a confirmatory test for
Tryptophan.
• Negative Hopkin cole reaction signifies
absence of tryptophan in the given protein.
• Since other color reactions are positive, hence
the given protein is deficient only in
tryptophan (only one essential amino acid is
lacking)
• It is thus a class II or incomplete protein.
06/27/14 7
MEDICS

SPOT QUESTION-4
A 54- year-old female who is 68 inches tall and weighs
198 Ib, has reported to the medical emergency
complaining of “tight pressure like band of pain’’ across
her chest, associated with shortness of breath,
sweating, and a sense of light headedness.
The symptoms appeared following a heated argument
with the neighbor. She has a history of high blood
pressure and elevated serum cholesterol.
Blood biochemistry has revealed abnormal enzyme
profile and high serum total cholesterol, suggestive of
Acute Myocardial infarction (Acute M.I.).
What is the range of serum total cholesterol in the
normal health?
Mention any two functions of cholesterol.
06/27/14 8
MEDICS

ANSWER SPOT QUESTION-4
• The serum total cholesterol in normal health
ranges between 150-220 mg/dl.
• Cholesterol is a component of biological
membranes, myelin sheath and is required for
propagation of nerve impulse.
• It is a precursor of vitamin D; bile salts and is
also required for the formation of steroids,
and sex hormones.
06/27/14 9
MEDICS

SPOT QUESTION-5
A chronic Alcoholic with impaired liver
functions has reported to the medical O.P.D.
His serum sample has been sent to the
laboratory for total proteins estimation.
What do you expect out of the levels of serum
total proteins; should they be normal, higher
or lower than normal?
What is the normal reference range for
serum total proteins?
Mention any two conditions in which the
(Albumin: Globulin)
A: G ratio is reversed.06/27/14 10
MEDICS

ANSWER SPOT QUESTION-5
• Alcoholics are commonly malnourished, and in the
presence of alcoholic liver disease(as in present situation)
• The serum total protein level should be lower than normal.
• The normal serum total plasma protein ranges between 6-
8 G/dl.
• The A: G (Albumin to Globulin) ratio is reversed in
conditions of hypoalbuminemia and
hypergammaglobulinemia such as Protein energy
malnutrition, liver and renal disorders, chronic diarrhea,
chronic infections, leukemias, lymphomas and in HIV
infection.
06/27/14 11
MEDICS

SPOT QUESTION-6
A 23 year old female has been brought to the emergency. She
was found semiconscious in her hostel room. Her friends have
revealed that she was not taking anything from the last two days
after her break up with her boyfriend. She was in good health
previously. Physical examination reveals low blood pressure and
feeble pulse. Chest and CVS examination are normal. No
abnormality has been detected in the abdomen.
Blood chemistry reveals low blood glucose levels.
What is the significance of low blood glucose, which organ is
most affected in this state?
What is your opinion about normal reference range of blood
glucose?
06/27/14 12
MEDICS

ANSWER - SPOT QUESTION-6
• Glucose is a universal source of energy.
• It is a preferred source of energy for
brain and the sole source of energy for
cells lacking mitochondria such as red
blood cells.
• These are the cells most affected.
• Brain is the most affected organ.
• In normal health blood glucose ranges
between 60-90 mg/dl.
06/27/14 13
MEDICS

GLASS WARE
Identify the glass ware (A) and (B)
Mention the use of each of them
A B
06/27/14 14
MEDICS

GLASS WARE
A- is a funnel, It is used to transfer substances into
containers that have narrow mouths. Some
funnels act as filters, either because of their
design of because filter paper or a sieve is placed
on the funnel.
B- is a watch glass, they can serve as lids for flasks
and beakers. Watch glasses are used for holding
small samples for observation under a low-power
microscope. They are also used for evaporating
liquid off of samples.
06/27/14 15
MEDICS

GLASS WARE
Identify the glass ware (A) and (B). Mention the
use of each of them
A B
06/27/14 16
MEDICS

GLASS WARE
A- is a glass pipette, Pipettes are droppers
calibrated to deliver a specific volume. Some
pipettes are marked like graduated cylinders.
Other pipettes are filled to a line to reliably
deliver one volume again and again.
B- A stirring rod or stir rod is a piece of
laboratory equipment used to mix chemicals
and liquids for laboratory purposes.
06/27/14 17
MEDICS

REAGENTS
Which of the two displayed reagents (A and B) is used for
the inversion test for sucrose?
What is the use of other reagent?
A B
06/27/14 18
MEDICS

REAGENTS
Reagent B – Concentrated HCl is used for the
inversion test, a confirmatory test for sucrose.
Reagent A – Concentrated sulphuric acid is used
for the Molisch test.
06/27/14 19
MEDICS

EQUIPMENT
A 34-year-old female has been admitted in the
emergency department with Atrial fibrillation.
Blood sample has been drawn for estimation of
serum electrolytes.
Which of the two displayed equipment (A or
B)should be used for this estimation?
What is the use of second equipment?
06/27/14 20
MEDICS

EQUIPMENT
• Equipment -A is a colorimeter and equipment
B is a photo electric flame photometer.
• Equipment- B is used for measurement of
electrolytes
A B
06/27/14 21
MEDICS
A

EQUIPMENT
A 56- year -old chronic smoker has developed worsening cough
with purulent sputum and has been admitted to the hospital
because of difficulty in breathing. He is drowsy and cyanosed
His arterial blood gas analysis is as follows;
p CO2 70 mm Hg
HCO3
-
26 mmol/L
P O2 50 mm Hg
The symptoms and blood gas analysis are suggestive of
Respiratory acidosis. Blood pH levels remains to be confirmed.
Which of the two displayed equipment (A or B)should be used
for this estimation?
What is the use of the second displayed equipment in the
clinical laboratory?
06/27/14 22
MEDICS

EQUIPMENT
Equipment B- Digital pH meter can be used for the determination of
pH.
Equipment A is a spectrophotometer, commonly used for the
measurement of transmittance or reflectance of solutions.
A B
06/27/14 23
MEDICS

SPOT QUESTION
The patients of diabetes
mellitus are advised to
supplement with dietary fiber.
How does dietary fiber help
these patients?
What is the nutritive value of
dietary fiber?
06/27/14 24
MEDICS

ANSWER - SPOT QUESTION
• Dietary fiber promotes utilization of glucose,
inhibits absorption of dietary cholesterol and
thus regulates blood glucose and serum
cholesterol levels, which are high in diabetics.
• It promotes peristalsis, provides roughage ,
thus relieves constipation, and also protects
from piles and colon cancers.
• It has no caloric value since it can not be
digested.
06/27/14 25
MEDICS

SPOT QUESTION
A child develops chronic diarrhea and liver inflammation in
the early infancy when the mother begins using formula that
includes the corn syrup.
Evaluation of the child demonstrates sensitivity to fructose in
the diet.
Most of the unutilized dietary fructose is either converted to
glucose or is reduced to sugar alcohols in the body.
Name the sugar alcohol/s obtained from reduction of
fructose.
Which dietary substance containing fructose should be
avoided when feeding or treating this child?
06/27/14 26
MEDICS

ANSWER- SPOT QUESTION
• Fructose upon reduction
produces sorbitol and mannitol
since a new asymmetric carbon
atom is generated upon
reduction at C-2. Sorbitol and
mannitol are C-2 epimers.
• Fructose rich food items that can
be avoided are Table sugar,
honey, fruit, juices and corn
syrup etc.
06/27/14 27
MEDICS

CASE STUDY
A 16-year-old man hospitalized in a state of coma after an automobile
accident, was started on intravenous hyper alimentation. Although a
complete vitamin mixture was present in the solution, fat was omitted in
the diet because of solubility problem.
After 3 months, the patient developed skin lesions, hair loss and a fatty
liver.
Plasma lipid analysis revealed normal cholesterol level but a very low level
of Arachidonic acid.
24- Hour urine analysis indicated a low excretion of prostaglandin
metabolites.
What is the biochemical basis of clinical manifestations?
What is the basis of low excretion of prostaglandin metabolites?
06/27/14 28
MEDICS

DISCUSSION- CASE STUDY
• The patient has exhibited signs
of essential fatty acid deficiency
since the fats are omitted in the
diet.
• Low prostaglandins are due to
low Arachidonic acid.
• Arachidonic acid is a precursor
of Eicosanoids, since plasma
arachidonic acid is low, there is
les synthesis and hence there is
less excretion of prostaglandins
in the urine.
06/27/14 29
MEDICS

SPOT IDENTIFICATION
Identify the structure; mention the names of the biomolecules
having this structure.
06/27/14 30
MEDICS

ANSWER- SPOT IDENTIFICATION
• It is beta pleated sheet structure, a secondary
structure of proteins.
• Beta keratin, silk fibroin, carbonic anhydrase
and flavodoxin predominantly contain beta
pleated sheet structure.
06/27/14 31
MEDICS

SPOT IDENTIFICATION
The individual reaction catalyzed by Enzyme E1 and E2 is
shown below-
1) Comment on the class of enzyme and
2) Give examples of each of the class of enzymes (E1 and E2)
E1
E2
06/27/14 32
MEDICS

SPOT IDENTIFICATION
• E1- is a Hydrolase- All proteolytic enzymes are
hydrolases
• E2 is a Transferase Example- Transaminase,
Methyl transferase
06/27/14
MEDICS
33

Identify and draw the crystals
State the clinical situation if the above said
substance is excessively excreted in urine ?
06/27/14 34
MEDICS

OSAZONE CRYSTALS
• These are lactosazone crystals
(powder puff).
• Lactosuria is the term used to
denote excessive excretion of
lactose in urine and that occurs in
conditions of Lactose Intolerance.
• The undigested lactose is
absorbed by pinocytosis that goes
to systemic circulation to get
excreted through urine.
06/27/14 35
MEDICS

CASE STUDY
A 54- year-old woman who was bed bound in a
nursing home began to develop swelling of her
left leg. She was evaluated with venous Doppler
ultra sound and was found to have a deep vein
thrombosis. She was immediately started on
heparin to prevent the clot from further
enlarging
What is the chemical nature of heparin ?
What is the mechanism of action of heparin ?
06/27/14 36
MEDICS

DEEP VEIN THROMBOSIS
06/27/14
MEDICS
37

CASE STUDY- DISCUSSION
• Heparin is a sulfated mucopolysaccharide
• It is an anticoagulant widely used in clinical
practice.
• Binding of Heparin to antithrombin produces
conformational changes which promote the
binding of the latter to “thrombin” which is
inhibited, thus fibrinogen is not converted to
fibrin and the coagulation is inhibited.
06/27/14 38
MEDICS

PLASMA PROTEIN
ELECTROPHORESIS
Identify peak E and mention two important functions of
the biomolecule that occupies this region
06/27/14 39
MEDICS

PLASMA PROTEIN
ELECTROPHORESIS
• The “E” peak is of gamma globulins
• The gamma globulins are increased in various
acute and chronic infections, liver diseases,
multiple myeloma , HIV infection and various
cancers.
• “A” peak is of Albumin
• ‘B” alpha-1
• “C” of Alpha-2
• “D” is of Beta globulins.06/27/14 40
MEDICS

CASE STUDY
A 48- year-old man presented with short history
of severe low backache, loss of weight and
diminished appetite. X-ray skull showed
punched out lesions. Serum electrophoresis
revealed an abnormal band between β globulins
and γ globulin region.
What is the probable diagnosis ?
Which specific protein is detected in urine of
such patients ?
06/27/14 41
MEDICS

CASE DISCUSSION
• It is a case of multiple myeloma, a cancer of
plasma cells. The symptoms and
electrophoretic pattern are typical of multiple
myeloma.
• Bence jone’s proteins are excreted in a patient
suffering from multiple myeloma.06/27/14 NAMRATA CHHABRA- BIOCHEMISTRY FOR
MEDICS
42

FURTHER READING
• Follow the link- Biochemistry for medics-
Lecture notes by -Professor(Dr.) Namrata
Chhabra
http://www.namrata.co/
06/27/14 43
MEDICS

Managing diabetes and cholesterol with dietary fiber

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (8)

Similar to Managing diabetes and cholesterol with dietary fiber

Similar to Managing diabetes and cholesterol with dietary fiber (20)

More from Namrata Chhabra

More from Namrata Chhabra (20)

Recently uploaded

Recently uploaded (20)

Managing diabetes and cholesterol with dietary fiber