Medical Eng-lish

Biochemistry

INTEGRANTS ARANCIBIA CASTRO KRU-

ZKERRY

DIAS GUEVARA EDUARDO

LOZANO BURGA YENNY

PEDEMONTE MURILLO ELKI

ROQUE VEGA KARIN

VENCES MIJAHUNCA MI-

GUEL ANGEL

BIOCHEM-ISTRY

What is?

Is the study of chemical processes in living or-ganisms, governs all liv-ing organisms and living processes.

Much of biochemistry deals with the structures and functions of cellular components such as proteins, carbohydrates, lipids, nucleic acids and other biomolecules.

Today the main focus of pure biochemistry is in understanding how biological molecules give rise to the processes that occur within living cells which in turn relates greatly to the study and understanding of whole organisms.

As an experimental science of biochemistry requires numerous instrumental techniques that enable the development and expansion, some of them are used daily in any laboratory and others are very exclusive.

BASIC BIOCHEM-ICAL TECH-NIQUES.

• Subcellular fractionation, including multiple techniques

• Centrifugation• Chromatography• Electrophoresis• radioisotope techniques• PCR

• Flow cytometry• Immunoprecipitation• ELISA• Electron Microscope• X-ray Crystallography• Nuclear magnetic

resonance• Mass Spectrometry

THERAPEUTIC APPLICA-TIONS

The most known is the use of radioiodine (Iodine-131) in the treatment of hyperthyroidism and differentiated thyroid cancer.

RADIOISOTOPIC IMMUNOPRECIPITATION

Is a technique that uses specific antibodies to a protein to remove these proteins from the solution. Examples include protein A, protein G, Zysorbin, or adding a second antibody to the solution.

Medical Diagno-sis In medicine,

diagnosis or clinical propaedeutic is the procedure by which a disease is identified or any condition of health-disease.The medical diagnosis is based symptoms, signs and findings of additional tests to determine what disease a person suffers.

Diagnostic Tools

Symptoms Signs

Physical Examinatio

n

Supplementary

Examinations

 Example:

SYMPTOMSphysical experiences are re-

ported by the patient . Not be observed

painFatigue

The sings are findings in the patient and are detected by the doctor. Can be seen

SIGNS

Example:Fe-ver

Ede-ma

PHYSICAL EXAMINATION

It consists of various maneuvers performed by the doctor in the patient

Inspection

percusion

Auscultation

Palpation

INSPECTION• is the method of physical

examination is done by sight.

PALPATION• is the process of examining the body using

the sense of touch. Provides information on shape, size, texture, surface moisture, tenderness and mobility.PERCUSION

• is a method that is tapped certain body parts during a physical examination with fingers, hands or small instruments to assess the size, consistency, borders and presence or absence of fluid in the body's organs.

AUSCULTATION

is to listen, either directly or through instruments like the stethoscope, normal or pathological sounds produced by the human body.

SUPPLEMENTARYEXAMINATIONS

They are a setof studies that providevaluablein-formation tomedical analysis,and either to con-firmor givemore certaintyto the diagnosis of a disease.

Biopsy

Ultrasound

Radiograph

Biopsy: procedure in which tissue samples under a microscope to

observe.

Radiograph: noninvasive procedure, which shows soft and solid structures

of the body.

Ultrasound: uses sound waves to create images

of internal oraganos.

IMPORTANCE OF BIOCHEMIS-TRY IN MEDICAL DIAGNOSTIC

Diagnosis and Treat-ment of

Tuberculous Pleural Effusion in 2006

Tuberculous (TB) pleural effusion occurs in approximately 5% of patients with Mycobacterium tuberculosis infection. The HIV pandemic has been associated with a doubling of the incidence of extrapulmonary TB .

The definitive diagnosis of TB pleural effusions depends on the demonstration of:

The diagnosis can be established in a ma-jority of patients fromthe clinical features

pleural fluid examinationincluding cytologyBiochemistryBacteriologypleural biopsy

acid-fast bacilli in the sputum

pleural fluid

pleural biopsy specimens.

EpidemiologyA total of nine million new cases and ap-proximately two million deaths from TB were reported in 2004

Although the African region has the highest estimated incidence (356 per 100,000 population per year)

the majority of patients with TB live in the most populous coun-tries of the Asian subcontinent

PathogenesisTB pleural effusions can manifest as primary or reactivated disease.

is considered the initial event in the pathogenesis of primary TB pleural effu-

sions.

• predominantly from:

increased capillary permeability and • secondarily from:

impairment of lymphatic clear-ance of proteins and fluid from the pleural space.

because of occlusion of

pleural stomata

DiagnosisThe definitive diagnosis of TB pleural effusions depends: demonstration of M tuberculosis in:

sputumpleural fluidpleural biopsy specimens.

others:

demonstration of clas-sical TB granulomas in the pleura

and elevated adenosine deaminase (ADA)

IFN-_ levels in pleural fluid.

Sputum Examination

Tuberculin Skin Test

patients with pleural TB with-out concomitant pulmonary dis-

ease.

Are: sputum nega-

tive and

Therefore:

no contagious.

Positive: evidence in the diagnosis of TB pleural effusions in areas of low prevalence.

Negative: could result from the following: anergy secondary to

immunosuppression recent infection; sequestration of purified

protein derivative-reactive T-lymphocyte in pleural space.

Thoracocentesis

• A TB pleural effusion is typically clear and straw colored

• it can be turbid or serosanguinous

• Pleural fluid pH is usually between 7.30 - 7.40

Pleural Fluid

Examination

• in patients with HIV coinfection, the yield of pleural fluid microscopy is 20%

• Culture requires a minimum of 10 to 100 viable bacilli

Pleural Fluid Smear and Culture

ADA (adenosine deaminase)

• catalyzes the conversion of adenosine and deoxyadeno-sine to inosine and deoxyinosine with the release of am-monia.

• several studies have explored the usefulness of estimation of ADA activity in the diagnosis of TB pleural effusions

pleural fluid ADA level 70 IU/L is highly suggestive of TB, while a level 40 IU/L virtually excludes the diagnosis.

Produced by T-lymphocytes, Several studies have found elevated concentrations of INF in TB pleural ef-fusions, which is related to increased production at the disease site by effector T cells.

IFN-GAMMA

Polymerase chain reaction (PCR) is based on amplification of mycobacterial DNA fragments. Advantages of PCR include rapid diagnosis, improved specificity and sensitivity, and no requirement of intact immunity.

PCR

OTHER DIAGNOS-TIC TEST

The utilization of immunodiagnostics is hindered by its low sensitivity. The Table lists the details regarding various studies using immunologic markers in the diagnosis of TB pleural effusions. Further studies are required to address the clinical utility of these markers.

INMUNODIAG-NOSIS

TREAT-MENT

The patients with extensive or bilateral pleural effusions and sputum positivity are given treatment under category I (treated during intensive phase with four drugs: isoniazid, rifampin, pyrazinamide, and ethambutol for 2 months followed by continuation phase of 4 months with isoniazid and ri-fampin).

ANTITUBERCULO-SIS

DRUGS

Corticosteroids through their antiinflammatory action may has-ten fluid resorption and prevent pleural adhesions during heal-ing. Three randomized trials have investigated the possible role of adjunctive oral corticosteroids in TB pleural effusion. A dose of 0.75 to 1 mg/kg/d was used for a period ranging from 4 to 12 weeks.

CORTICOSTE-ROIDS

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