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Medical Instructor, University of Minnesota Medical School
Cl R O Cl Cl molecule is also possible: After hydrolysis blood pressure jumps from high to low buy metoprolol 25mg lowest price, the product is liberated prehypertension headaches purchase metoprolol 25mg on-line. The reaction is ortho blood pressure chart for dogs buy 50 mg metoprolol mastercard,para-selective so that, for example, the site of acylation can be regulated by the choice of temperature. Only sterically unhindered arenes are suitable substrates, since substituents will interfere with this reaction. O R Cl O Photo-Fries rearrangement Photo-Fries rearrangement exists that involves free radical reaction mechanism. This reaction is also pos-sible O O R h O- O - with deactivating substituents on the aromatic group. Gabriel Synthesis the Gabriel synthesis is named for the German chemist Siegmund Gabriel. Traditionally, it is a chemical reaction that convert primary alkyl halides into primary amines using potassium phthalimide the Gabriel reaction has since been generalized to include the alkylation of sulfonamides and imides, followed by deprotection to obtain amines. The monobrominated compound is much less nucleophilic, so the reaction stops at this stage. This acyl intermediate compound can undergo bromide exchange with unreacted carboxylic acid via the anhydride, which allows the catalytic cycle to continue until the conversion is complete. Hell-Volhard-Zelinsky reaction Treatment with bromine and a catalytic amount of phosphorus leads to the selective -bromination of carboxylic acids. Na Na O R N Br -NaBr the reaction is named after its discoverer: August Wilhelm von Hofmann. In the preparations of Anthranilic Acid from Phthalimide Nicotinic acid is converted into 3-Amino pyridine. Knoevenagel reaction the condensation of aldehyde/ketone with the compounds having active methylene group in the presence of basic catalyst to give, unsaturated carbonyl compound is called Knoevenagel Reaction. The reaction starts with the base catalysed methylene proton abstraction from dicarboxylic acid group and generate carbanion, the generated carbanion attack on the carbonyl carbon of aldehyde and ketone to hydroxy formation and then subsequently dehydration and decarboxylation yield, unsaturated carbonyl compound. The Mannich reaction is an example of nucleophilic addition of an amine to a carbonyl group followed by dehydration to the Schiff base. The Schiff base is an electrophile which reacts in the second step in a electrophilic addition with a compound containing an acidic proton. Instead of formaldehyde, other aliphatic or aromatic aldehydes or ketones can be employed. Reaction: In michael addition reaction carbanion always add to the,-unsaturated position of the,unsaturated carbonyl compound it is known as Michael addition rule. Hydroxide anion act as a base and removes the acidic -hydrogen giving the reactive enolate. Step 2: In this step, the carbanionic carbon attacks the conjugated ketone at the electrophilic alkene (C=C) in a O O. The enolate deprotonates a water molecule recreating hydroxide and the more favourable carbonyl group. The electron rich aromatic ring then attacks the iminium ion with loss of aromaticity. A deprotonation step restores aromaticity, which is followed by the release of a chloride ion to form another iminium intermediate. Salicyldehyde reaction mechanism Reimer Tiemenn reaction is an electrophilic substitution reaction. Wolff-Kishner reduction Condensation of the carbonyl compound with hydrazine forms the hydrazone, and treatment with base induces the reduction of the carbon coupled with oxidation of the hydrazine to gaseous nitrogen, to yield the corresponding alkane. In subsequent steps by loosing of two mole water and nitrogen molecule via carbanion intermediate it will generate alkane. R1 C R2 Aldehyde/ Ketone O + R4 Phosphorous Ylide Ph3 P+ C- R3 Wittig reactions are most commonly used to couple aldehydes and ketones to singly substituted phosphine ylides. Ylides: It may be defined as the group 15 and 16 of periodic table having positive charge directly attached to carbon containing negative charge (extra unshared pair of electron) due to p-d bonding is known as ylides. R1 C R2 Alkene C R4 Triphenyl Phosphene R3 + Ph3P O Reaction Mechanism: Nucleophilic Addition then Elimination In the mechanism the first step is an addition of the phosphorous ylide to the carbonyl icarbon of Aldehyde/ketone lead to the zwitterionic intermediate betaine.
The role of the surgical pathologist is to blood pressure chart by age and gender pdf buy genuine metoprolol identify the lesion as parathyroid in nature and to blood pressure medication foot pain purchase metoprolol 25mg without a prescription assess whether it is normocellular or hypercellular hypertension 30s purchase 50mg metoprolol with mastercard. Although easily accomplished in the majority of instances, rare examples of parathyroid hyperplasia/adenoma showing a follicular/trabecular arrangement may cause concern over the alternative diagnosis of a thyroid adenoma. This becomes more pertinent when the parathyroid lesion abuts into the thyroid gland or lies within the thyroid capsule. Even more problematic are situations in which clear cell parathyroid carcinomas are nonsecretory without an abnormality in mineral metabolism. In this situation, distinction from primary thymic metastatic carcinomas, non-Hodgkin lymphoma, and germ cell tumors is necessary. Parvovirus B19 infection has been implicated as a cause in spontaneous abortion in humans. Parvovirus B19 is also associated with erythema infectiosum (fifth disease) in children and acute arthritis in adults, as well as chronic hemolytic anemia, with some patients experiencing aplastic crisis. Reactivity Paraffin Cytoplasmic, Nuclear Visualization Control Stability Isotype Protocols Parvovirus-Infected Tissue Up to 36 mo. J Med Vir 39:97100 (1993) Analyte Specific Reagent: Analytical and performance characteristics are not established. It is found in most cases of mature and precursor B-cell non-Hodgkin lymphomas/leukemias. Members of this gene family typically encode proteins which contain a paired box domain, an octapeptide, and a paired-type homeodomain. This nuclear protein is involved in thyroid follicular cell development and expression of thyroid-specific genes. Mutations in this gene have been associated with thyroid dysgenesis, thyroid follicular carcinomas and atypical thyroid adenomas. The role of perforin-mediated cytotoxicity has been demonstrated in various autoimmune diseases. In addition, it seems that T-cell cytotoxicity against keratinocytes is mediated by perforin in some inflammatory skin diseases. Other authors suggest that perforin may have a dual role in alloimmune response (organ transplant applications). In mammalian cells, phosphohistone H3 is negligible during interphase but reaches a maximum for chromatin condensation during mitosis. This antibody has shown cross-reaction with human intestinal alkaline phosphatase. Anti-pneumocystis jiroveci reacts with an epitope on the organism which is resistant to formalin, picric acid, paraffin, as well as alchohol and xylene. No cross-reactivity has been demonstrated with other fungi or parasitic organisms. Reactivity Paraffin Membranous (Trophozoite) Visualization Control Stability Isotype Protocols P. Analyte Specific Reagent: Analytical and performance characteristics are not established. Podoplanin is selectively expressed in lymphatic endothelium as well as lymphangiomas, Kaposi sarcomas, and in a subset of angiosarcomas with probable lymphatic differentiation. Podoplanin has also been shown to be expressed in epithelioid mesotheliomas, hemangioblastomas, and seminomas. This antibody stains nuclei in breast, ovarian and endometrial epithelia, as well as myometrial nuclei. Reactivity Control Stability Isotype Paraffin Nuclear Visualization Breast Up to 36 mo. Prolactin plays a role in multiple processes including cell growth, reproduction, and immune function. Anti-prolactin is a useful marker in classification of pituitary tumors and the study of pituitary disease. This antibody recognizes primary and metastatic prostatic neoplasms and rarely tumors of nonprostatic origin. The antigen is a 33-34 kD glycoprotein that is restricted to epithelial cells of the prostate. It is expressed in the myeloid lineage and in immature as well as mature B-lymphocytes, with the exception of plasma cells. This antibody immunoreacts with approximately 90% of primary renal cell carcinomas and approximately 85% of metastatic renal cell carcinomas.
Nonsteroidal antiinflammatory drugs blood pressure 9870 discount 100 mg metoprolol visa, such as aspirin act by inhibiting the activity of the enzyme: (b) Cyclooxygenase (a) Lipoxygenase (c) Phospholipase A2 (d) Lipoprotein lipase 71 blood pressure 80 60 quality metoprolol 100 mg. Holoenzyme is (a) Functional unit of enzyme (b) Made of apoenzyme (c) Coenzyme (d) All of these 72 hypertension and heart disease purchase genuine metoprolol on line. Enzymes, which are produced in inactive form in the living cells, are called (b) Apoenzymes (a) Co-enzyme (c) Proenzymes (d) Isozymes 73. In reversible non-competitive enzyme activity inhibition (a) (b) (c) (d) Vmax value is increased Km value is increased Km value is decreased Concentration of active enzyme is decreased 75. The specificity of the enzyme is mostly dependent on (a) Glucose (b) Pyruvate (c) Xanthurenic acid (d) Thiamine pyro phosphate 76. The specificity of the enzyme is mostly dependant on (a) Co-enzyme (b) Apoenzymes (c) Proenzymes (d) Isozymes 77. Factors affecting enzyme activity is (b) pH (a) Temperature (c) Concentration (d) All of these 79. Glucose absorption is promoted by (b) Vitamin E (a) Vitamin A (c) Ascorbic acid (d) Thiamin 80. Zellweger syndrome occurs due to the: (a) Absence of peroxisomes (b) Deficiency of vitamin B12 (c) Deficiency of acyl CoA dehydrogenase (d) Overproduction of ketone 81. Ketosis is generally associated with the disease: (a) Nephritis (b) Diabetes Insipidus (c) Edema (d) Diabetes mellitus 82. One of the following amino acids is used as an antibiotic (b) Ornithine (a) Thyroxine (d) Azaserine (c) Homoserine 84. Sulfur-containing B-complex vitamin is (a) Biotin (b) Niacin (c) Pyridoxine (d) Riboflavin 3. One of the following vitamins is known as pellagra preventive factor of Goldberg: (a) Biotin (b) Niacin (c) Riboflavin (d) Pyridoxine 86. Adenylate cyclase is activated by (a) Insulin (b) Vitamin K (c) Prostaglandin E1 (d) Glucagon 87. Coenzyme A is derived from the vitamin: (b) Pantothenic acid (a) Niacin (c) Pyridoxine (d) Biotin 88. The non-protein, organic and low molecular weight substance, bound to an enzyme and essential for the activity of enzyme is known as (b) Coenzyme (a) Holoenzyme (c) Isoenzyme (d) Apoenzyme 92. When in enzyme inhibition Km value is unchanged and Vmax is value is decreased then it known as (a) Allostreric inhibition (b) Reversible non-competitive inhibition (c) Reversible competitive inhibition (d) Irreversible inhibition 93. If two monosaccharides differ from each other in their configuration around single specific carbon atom other than anomeric carbon they are known as (a) Epimers (b) Enediols (c) Stereoisomers (d) Optical isomers 94. Poisoning of morphine causes (a) Metabolic acidosis (b) Respiratory alkalosis (c) Metabolic alkalosis (d) Respiratory acidosis 96. One of the following amino acid is nonessential (a) Arginine (b) Valine (c) Glutamate (d) Lysine 98. The oxidation of glucose to pyruvate and lactate is known as (b) Gluconeogenesis (a) Glycolysis (c) Glycogenesis (d) Glycogenolysis 99. Citric acid cycle is also known as (a) Uronic acid cycle (b) Reductive pathway of carbohydrate (c) Krebs cycle (d) Synthesis of glucose from non-carbohydrate precursor 100. One of the following is oxidative pathway of glucose (a) Gluconeogenesis (b) Hexose mono phosphate shunt (c) Glycogenolysis (d) Lipogenesis 102. Glycolysis reaction is regulate by catalyze the irreversible reaction by all of the following enzyme except (a) Hexokinase (b) Phosphofructokinase (d) Phosphoglycerate kinase (c) Pyruvate kinase 104. In citric acid cycle citrate is convertinged in to isocitrate by (b) Isocitrate dehydrogenase (a) Aconitase (d) Succinate dehydrogenase (c) Citrate synthase 106. The enzymes of tricarboxylic acid cycle are located in (a) Cytosol (b) Mitochondrial matrix (c) Cytosomal fraction of the cell (d) Liver 108. All of the following are precursors for gluconeogenesis except (b) Pyruvate (a) Lactate (d) Glycerol (c) Acetyl Co-A 109. Glycogen synthesis is increased in one of the following conditions: (a) If insulin level is increased (b) If glucagon level is increased (c) If norepinephrine level is increased (d) If glucose level is increased 111.
Milder gingivitis cases respond well to blood pressure medication images discount metoprolol master card scaling and root planing arteriosclerosis obliterans safe metoprolol 25mg, with frequent oral hygiene reinforcement blood pressure of 100/70 discount metoprolol 25mg mastercard. Periodontal maintenance appointments may need to be more frequent when periodontal instability is noted. The clinician should recognize the intraoral effects of chronic regurgitation of gastric contents on intraoral tissues because this age group also is susceptible to eating disorders, namely, bulimia and anorexia nervosa. Perimylosis (smooth erosion of enamel and dentin), typically on the lingual surfaces of maxillary anterior teeth, varies with the duration and frequency of the behavior. Ongoing changes in the concentration of the gonadotropins and ovarian hormones occur during the monthly menstrual cycle (Figure 43-1). During the reproductive cycle, the purpose of estrogen and progesterone is to prepare the uterus for implantation of the egg. The effect of estrogen stimulates the egg to move down the fallopian tubules (ovulation) and stimulates proliferation of the stroma cells, blood vessels, and glands of the endometrium. The corpus luteum involutes, ovarian hormone levels drops, and menstruation ensues. It has been postulated that ovarian hormones may increase inflammation in gingival tissues and exaggerate the response to local irritants. Gingival inflammation seems to be aggravated by an imbalance or increase in sex hormones. Numerous studies have demonstrated in vitro and in vivo that sex hormones affect and modify the actions of cells of the immune system. In addition, evidence suggests that the interaction between estrogen and cells of the immune system can have nonimmune regulatory effects. Progesterone has been associated with increased permeability of the microvasculature, altering the rate and pattern of collagen production in the gingiva,52 increasing folate metabolism,70,90 and altering the immune response. During menses, progesterone increases from the second week, peaks at approximately 10 days, and dramatically drops before menstruation. Physiologic, experimental, and clinical data confirm differences in immune responses between the two sexes. A recent study reported higher gingival indices during ovulation and before menstruation despite reported increases in oral symptoms during menses. No significant hematologic laboratory findings accompany this, other than a slightly reduced platelet count and a slight increase in clotting time. When the progesterone level is highest (during luteal phase of cycle), intraoral recurrent aphthous ulcers,25 herpes labialis lesions, and candidal infections occur in some women as a cyclic pattern. Depression, irritability, mood swings, and difficulty with memory and concentration may be symptoms of neurotransmitter reduction. Patients are more sensitive and less tolerant of procedures, have a heightened gag reflex, and may have an exaggerated response to pain. Management Increased gingival bleeding and tenderness associated with the menstrual cycle require closer periodontal monitoring. For the patient with a history of excessive postoperative hemorrhage or menstrual flow, scheduling surgical visits after cyclic menstruation is prudent. Anemia is common, and appropriate consultation with a physician and recent laboratory tests, when indicated, should be maintained. These medications interact with some antibiotic and anti-fungals, and thus a review of their pharmacology is necessary. Fluoride rinses and trays, frequent periodontal debridement, and avoidance of mouthwashes with high alcohol content may reduce the associated gingival and caries sequelae. Fluoxetine was ranked the fifth most dispensed prescription (new and refills) in the United States in 1998, but when the patent was lifted its sales slowed. Gauze pads or cotton rolls should be moistened with a lubricant, chlorhexidine rinse, or water before placing them in the aphtha-prone patient. Careful retraction of the oral mucosa, cheeks, and lips is necessary in patients prone to aphthous or herpetic lesions. Because the hypoglycemic threshold is elevated, the clinician should advise the patient to have a light snack before her appointment.
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Extrapulmonary: this means conditions that affect the breathing mechanics and the support of the lungs blood pressure 8550 buy generic metoprolol pills. Conditions that weaken the muscles such as myasthenia gravis arteria 90 obstruida cheap 25mg metoprolol visa, and conditions that alter the supportive structure of the lungs such as scoliosis and ankylosing spondylitis hypertension updates 2014 cheap metoprolol 12.5mg without prescription. Interstitial: Anything that alters the interstitium can cause a restrictive lung disease. Lobar Pneumonia: Consolidation of infection to one area of the lobe, often the lower lobe. Atypical Pneumonia: Also known as interstitial pneumonia, presents with diffuse patchy infiltration localized to interstitial areas at the alveolar walls. Presentation is atypical in that the patient is less sick and slower to develop symptoms than with lobar pneumonia. It is elevated when a patient has pneumonia, decreased in effusion and obstruction, and completely absent in pneumothorax. When there is nothing in the lung cavity, such as with a pneumothorax, there is "hyperresonance". When there is fluid accumulation, such as when there is a pneumonia or effusion, there is decreased resonance (ie Dullness). Think of a drum with and without water inside to visualize what is inside the lung. A pneumothorax will push the trachea away from the affected side, while a bronchial obstruction will pull the trachea towards the side of the lesion. Leads to hemoptysis as the primary lung finding, with hematuria/anemia/ and crescentic glomerulonephritis as the kidney findings. Caused by anti-glomerular basement membrane antibodies, which produce linear staining on immunofluorescence. Depression occurs and suicide is somewhat common because patients are aware of their deterioration There is no treatment, only symptomatic management. The Berry aneurysm is seen at the bifurcation of the anterior communicating artery. Patient will experience all symptoms associated with dorsal column malfunction (lack of proprioception, ataxia during locomotion). This causes damage to the spinothalamic tract, which then results in a bilateral loss of pain and temperature sensation in the upper extremities in a "cape-like" distribution. Renal failure leads to a build-up of toxins and leads to the inability to excrete nitrogenous bases. Acute renal failure is usually due to hypoxemia, while chronic renal failure is usually caused by either hypertension or diabetes. These have a tendency to form "staghorn calculi" and get stuck in the urinary system. These stones are also produced when there are conditions of increased cell turnover, such as with leukemia. The following numbers describe the appropriate compensation dependent on each metabolic disturbance. Ultimately this is a condition that occurs as a result of purine metabolism disorder. The plaques that develop are known as "psoriatic plaques", and are caused by excessive production of skin and a faster skin cycle than normal skin. It is caused by IgG antibodies against the epidermal cell surface, causes breakdown of the cellular junction of the epithelial cell. The most common site of presentation is the skin, however it may affect the kidneys, cardiac, and gastrointestinal systems.