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And Ethiopia is one of the developing countries where by the prevalence is increasing from time to time order methocarbamol 500 mg with visa. Numerous environmental events have been proposed to trigger the autoimmune process in genetically susceptible individuals methocarbamol 500mg line; however, none has been conclusively linked to diabetes. For this new change of the pattern of prevalence of diabetes many factors were considered as the culprit. Among the factors that aid the increment of the prevalence diabetes even in the developing, countries the following are some: 1. Most people are living in very hectic environment where by the housing condition is predominated with substandard housing condition that doesn’t usually meet the physiological and psychological requirement of the dwellers. People are more ignorant about the healthy style of nutrition at the family and community level in particular and at large respectively. Many jobs are becoming sedentary rather than exercise/movement demanding and in turn these furnish the ground for the people to become more obese. Physical exercise is not taken as a routine life activity among the people especially living in developing country where the living places are not comfortable to make exercises at continual basis. Diabetes in Africa: some of the factors related to the development of diabetes in Africa include: • Genetic Factors: Family history • Environmental Factors: such as infection, dietary changes. The environmental health officers will take great share of tasks of advocacy on proper nutrition so that obesity can be attacked. Construction of standard housing with local materials will be advocated and technically commented and regularly inspected by environmental Health officers. Thus the requirements of physiological and psychological health of the dwellers will be met and this consequently will alleviate the potential stressful environment. Environmental health officers technically suggest comments and follow its implementation to make the working places more comfortable. The environmental health officers are most needed here to apply their expertise knowledge of housing and institutional sanitation, nutrition and food hygiene and safety, environmental chemistry. Post – test First try to look and do the pretest again, then keep on attempting the following questions. Thus, today there has been a strong commitment from the government side to realize the policy and protects the public health. It is one part of the strategies of national health policy to train the health extension workers as a front line community health personnel in the regional health institutions with the intent that after the end of their training they will go near to the community that is rural areas and they fight with the nation public health challenges together with their professional colleagues in the interdisciplinary approach. It provides basic information on different aspects of diabetes so that they participate in early case detection, case management and prevention of complications as front line health workers. Directions for using the module Before starting to read this module, please follow the instruction given below. Self- Monitoring of glucose Many patients (especially those with type 1(insulin- dependent diabetes mellitus)) now regularly monitor their own blood glucose concentrations on the advice of their health care provider, using reagent test strips and reflectance meter. Several companies manufacture reagent test strips for monitoring blood glucose, and most of these companies make reflectance meters to be used to electronically read the test result. The strips used for these tests are impregnated with the enzyme glucose oxidase, enzyme peroxidase and an indicator to give a color change that is detectable. Urine Glucose determinations Chemical screening tests for glucose (dextrose) are generally included in every routine urinalysis. The occurrence of glucose in the urine indicates that the metabolic disorder diabetes mellitus should be suspected, although several other conditions result in glycosuria (glucosuria). It is possible to use both enzymatic technique and oxidation- reduction technique to determine urine glucose 2. Glucose oxidase will oxidize glucose to gluconic acid and at the same time reduce atmospheric oxygen to H2O2. The hydrogen peroxide formed will, in the presence of the oxidized form, which is indicated by the color change of an oxidation- reduction indicator. Note: The glucose oxidase, peroxidase and the reduced form of the Oxidation- Reduction indicator are all impregnated on to a dry reagent strip. After one minute read the result by matching the color on the strip with the color on the reagent strip container 7. Determination of ketone bodies in urine ketone bodies are a group of three related substances: acetone, aceto acetic acid, and β – hydroxyl butyric acid. When ever fat (rather than carbohydrate) is used as the major source of energy, ketosis and ketonuria may result. The two out standing causes of ketone accumulation are diabetes mellitus and starvation In diabetes mellitus, the body is unable to use carbohydrate as an energy source and attempts to compensate by resorting to fat catabolism, which results accumulation of ketone more than normal, that the body is unable to utilize it. The clinical result is an increased concentration of ketones in the blood (ketonemia) and in the urine (ketonuria. After collecting the urine sample from the patients, transfer into a clean, dry and free of disinfectant test tube 2. Read the result by comparing the color produced with the standard on the strip container Note acetone and aceto acetic acid can be detected by different dip stick tests, but there is no reagent strip test for β - hydroxyl butyric acid 115 4.

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Ketogenic order 500 mg methocarbamol with mastercard, Glucogenic and Glucogenic-Ketogenic amino acids Ketogenic and Glucogenic amino acids are as indicated in the chart except Leucine and Lysine which are exclusively ketogenic cheap methocarbamol 500mg on line. Non-Standard Amino Acids In addition to the 20 standard amino acids, proteins may contain non- standard (proteogenic) amino acids, which are normally components of proteins but created by modification of the standard amino acids. Among the non – standard amino acids 4 – hydroxyproline a derivative of proline, 5- hydroxylysine derivative of lysine where both are found in collagen, a fibrous protein of connective tissues. Non – Proteogenic Amino Acids These amino acids occur in free or combined state, unlike in proteins,and play important roles in metabolism in plasma, free amino acids are usually found in the order of 10 to 100 μ mol/L, including many that are not found in proteins. Antibiotics - gramicidin and antimycin D γ-aminobutryric acid - which acts as an inhibitory neurotransmitter D - Alanine - a component of vitamin, panthothenic acid, are some of the non- proteogenic amino acids. Monoamine and monocarboxylic acids are ionized in different ways in solution, depending on the pH of solution. The titration curve plot has two distinctive stages each corresponding to the removal of one proton from glycine. Each of the two stages resembles in shape the titration curve of monoprotic acid (such as acetic acid). The peptide bond and its characteristics Proteins are macromolecules with a backbone formed by polymerization of amino acids in a polyamide structure. These amide bonds in protein, known as peptide bonds formed by linkage of α - carboxyl group of one amino acid with α- amino groups of the next amino acid by amide bonds. In peptides, the amino acids are joined covalently through peptide bonds, and are formed on partial hydrolysis of much longer polypeptides. The C - N single bond in the peptide linkage has ~ 40% double bond character and C = O double bond has ~ 40% single bond character. The C - N of a peptide linkage is relatively rigid and cannot rotate freely, a property of supreme importance with respect to the three dimensional conformation of polypeptide chains. In amide linkage of the peptide bond due to the substantial double bond character there exists little twisting. As a result the group of atoms in the peptide bond exist in the cis or trans nature of the peptide bond. It was found out that the trans configuration is usually favored in order to minimize the steric interaction between bulky R groups on adjacent -carbon atoms. In fact as much as 10% of glucose consumption, by erythrocytes, may be mediated by the pentose phosphate pathway. Glutathione is virtually present in all cells often at high levels and can be thought as a kind of redox buffer, which probably helps to maintain. With its redox function it can also be used to remove toxic peroxides that are formed in the course of growth and metabolism under aerobic condition. Conjugation of drugs by glutathione is often a preliminary reaction catalyzed by cytochrome P450, rendering substances to be more polar and assist their excretion as shown in the figure 5. Besides Carbon, Hydrogen and Oxygen, they also contain Nitrogen, and sometimes, Sulfur and Phosphorous. Protein containing foods are essential for living organism, because protein is the most important biological molecules in building up and maintenances of the structure of body, giving as much energy as carbohydrates in the course of metabolism in the body. Many of the body proteins perform innumerable chemical reactions constantly taking place inside the body. Proteins are the molecular instruments in which genetic information is expressed; hormones, antibodies, transporters, muscle, the lense protein, antibiotics, mushroom poisons, and a myriad of other substances having distinct biological activities are derived. Definition Proteins are macromolecules with a backbone formed by polymerization of amino acids in a polyamide structure. Classification Even though there is no universally accepted classification system, proteins may be classified on the basis of their composition, solubility, shape, biological function and on their three dimensional structure. Simple protein: Yields only amino acids and no other major organic or inorganic hydrolysis products i. Solubility a) Albumins: These proteins such as egg albumin and serum albumin are readily soluble in water and coagulated by heat. Fibrous proteins In these protein, the molecule are constituted by several coiled cross-linked polypeptide chains, they are insoluble in water and highly resistant to enzyme digestion. Globular proteins: These are globular or ovoid in shape, soluble in water and constitute the enzymes, oxygen carrying proteins, hormones etc. On their Biological Functions: Proteins are sometimes described as the "workhorses" of the cell because they do So many things Like: Enzymes: kinases, transaminases etc. The amino acid composition of a peptide chain has a profound effect on its physical and chemical properties of proteins. Proteins rich in aliphatic or aromatic amino groups are relatively insoluble in water and more soluble in cell membranes (can easily cross the cell membrane).

In some cases purchase 500mg methocarbamol mastercard, prophylaxis could be indicated when a current epidemic is caused by a strain which is not repre- sented in the vaccine buy methocarbamol 500mg without a prescription. Of the two available drug classes, the adamantanes (amantadine, rimantadine) re- cently came under pressure when the global prevalence of adamantane-resistant influenza viruses was found to have significantly increased from 0. During this period, oseltamivir or zanamivir should be selected if an antiviral medication is used for the treatment and prophylaxis of influenza. Epidemic Treatment In uncomplicated cases, bed rest with adequate hydration is the treatment of choice for most adolescents and young adult patients (Hoffmann 2006b). If rimantadine and amantadine are used, it is important to reduce the emergence of antiviral drug-resistant viruses. The newer neuraminidase inhibitors are licensed for treatment of patients aged 1 year and older (oseltamivir) or 7 years and older (zanamivir). They are indicated in patients with uncomplicated acute illness who have been symptomatic for no more than 2 days. Pandemic Prophylaxis The problem with a new pandemic influenza strain is that there is no hiding place on earth. Virtually any single human being will eventually become infected with the new virus, be it the beggar from Paris or the President of a wealthy western country. If you don’t get the virus during the first wave of the pandemic, you’ll probably get it during the second. If a novel pandemic influenza strain takes over as the driver of influenza disease in humans, everyone needs to mount a protective antibody response against the virus – simply because the virus is bound to stay with us for many years. Antibodies will provide some protection against the new influ- enza strain, but to develop antibodies you have to either be infected or vaccinated. Once a new virus has been shown to be effectively transmitted among humans, it will take approximately 6 months to start the production of the corresponding vac- cine. Thereafter, vaccine supplies will be exquisitely inadequate, and years will be needed to produce enough vaccine for 6. In addition, production capacities are concentrated in Australia, Canada, France, Germany, Italy, Japan, the Netherlands, the United Kingdom, and the United States, and vaccine distribution can be expected to be controlled by the producing nations (Fedson 2005). It is therefore reasonable to assume that the vast majority of people living today will have no access to either vaccine or antiviral drugs for many, many months. With no vaccine available or vaccine arriving too late, individuals might wish to work out strategies to deal with a pandemic situation. Indeed, there is conflicting evidence about the most adequate moment for getting infected: • In the 1918 epidemic, the first wave which occurred during the spring months, was less deadly than the second, autumn wave (Barry 2004). It is reasonable to believe that people infected during the first wave had some protection during the second wave. Cities struck later generally suffered less, and individuals in a given city struck later also tended to suffer less. Thus, the West Coast American cities, hit later, had lower death rates than the East Coast cities; and Australia, which was not hit by the second wave until 1919, had the lowest death rate of any developed country (Barry 2004). A commonly observed phenomenon in infectious diseases is that pathogens become less virulent as they evolve in a human population. An additional advantage of this choice is that several months after the start of the pandemic, the initial chaos the health systems will inevitably face during a major outbreak, will have at least partially resolved. The most extreme option of avoiding influenza would be to flee to remote areas of the globe – a mountain village in Corsica, the Libyan Desert, or American Samoa (Barry 2004). If the direct and unprotected con- frontation with the new virus becomes inevitable, some protection is still possible: face masks (but: will masks be available everywhere? Global Management 33 Pandemic Treatment We don’t know whether the next pandemic influenza strain will be susceptible to the currently available antiviral drugs. If it is caused by a H5N1 virus, the neura- minidase inhibitors oseltamivir and zanamivir may be critical in the planning for a pandemic (Moscona 2005). Even in countries which have stockpiled oseltamivir, distribution of a drug that is in short supply will pose considerable ethical problems for treatment. Global Management The management of an influenza outbreak is well-defined for epidemics, and less well-defined for pandemics. Vaccine production is a well-established procedure: throughout the year, influenza surveillance centres in 82 countries around the world watch circulating strains of influenza and observe the trends. Pre- dicting the evolutionary changes of the viral haemaglutinin is not easy and not al- ways successful. In years when the anticipated strain does not match the real world strain, protection from influenza vaccine may be as low as 30 %. Managing uned- ited situations requires some appreciation of the magnitude of the problems that lie ahead. The impact on human health may be highly variable and is expressed in the number of • infected individuals • clinically ill individuals • hospitalised patients • deaths. It is generally assumed that during the first year of the next pandemic 2 billion peo- ple will become infected with the new virus and that half of them will have symp- toms. Less accurate are the estimates of the number of people that will require hos- pitalisation and the death toll. During the 1957 and 1968 pandemics, the excess mortality has been estimated at around one million deaths each.