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Chemistry of Carbohydrates Classification and Structure Classification There are three major classes of carbohydrates • Monosaccharides (Greek tegretol 400 mg amex muscle relaxant pakistan, mono = one) • Oligosaccharides (Greek purchase tegretol american express spasms between shoulder blades, oligo= few) 2-10 monosaccharide units generic 400 mg tegretol mastercard muscle spasms youtube. The most abundant monosaccharides in nature are the 6-carbon sugars like D- glucose and fructose. One of the carbon atoms is double bonded to an oxygen atom to form carbonyl group. Structure of Glucose Open chain D-glucose α-D –glucose α-D –glucose (Fisher formula) (Haworth formula) Fig. Monosaccharides having aldehyde groups are called Aldoses and monosaccharides with Ketone group are Ketoses. Depending on the number of carbon atoms, the monosaccharides are named trioses (C3), tetroses (C4), pentoses (C5), hexoses (C6), heptoses (C7). No of carbon atoms Generic name Aldose family Ketose family 3 Triose Aldotriose Ketotriose Eg. Asymmetric Center and Stereoisomerism Asymmetric carbon is a carbon that has four different groups or atoms attached to it and having optically activity in solution. All the monosaccharides except dihydroxyacetone contain one or more asymmetric or chiral carbon atoms and thus occur in optically active isomeric forms. Monosaccharides with n number n of asymmetric centers will have (2 ) isomeric forms. The designation of a sugar isomer as the D- form or of its mirror images the L- form is determined by the spatial relationship to the parent compound of the carbohydrate family. When a beam of plane- polarized light is passed through a solution of carbohydrate it will rotate the light either to right or to left. Depending on the rotation, molecules are called dextrorotatory (+) (d) or levorotatory (-) (l). When equal amounts of D 25 and L isomers are present, the resulting mixture has no optical activity, since the activities of each isomer cancel one another. Epimers When sugars are different from one another, only in configuration with regard to a single carbon atom (around one carbon atom) they are called epimers of each other. The resulting six membered ring is called pyranose because of its similarity to organic molecule Pyran. This five membered ring is called furanose because of its similarity to organic molecule furan Fig 2. Glycosidic bond is formed when the hydroxyl group on one of the sugars reacts with the anomeric carbon on the second sugar. Maltose is hydrolyzed to two molecules of D- glucose by the intestinal enzyme maltase, which is specific for the α- (1, 4) glycosidic bond. Structure of Maltose Lactose Lactose is a disaccharide of β-D galactose and β-D- glucose which are linked by β-(1,4) glycosidic linkage. Lactose acts as a reducing substance since it has a free carbonyl group on the glucose. Since the anomeric carbons of both its component monosaccharide units are linked to each other. Structure of sucrose α-(1, 2) β-Glycosidic bond Polysaccharides Most of the carbohydrates found in nature occur in the form of high molecular polymers called polysaccharides. These are: • Homopolysaccharides that contain only one type of monosaccharide building blocks. Homopolysaccharides Example of Homopolysaccharides: Starch, glycogen, Cellulose and dextrins. It is especially abundant in tubers, such as potatoes and in seeds such as cereals. Starch consists of two polymeric units made of glucose called Amylose and Amylopectin but they differ in molecular architecture. Amylose is unbranched with 250 to 300 D-Glucose units linked by α-(1, 4) linkages Amylopectin consists of long branched glucose residue (units) with higher molecular weight.

Clean and sanitize the child’s surroundings buy 200mg tegretol fast delivery spasms before falling asleep, including anything the stool may have touched cheap tegretol 200mg on-line muscle relaxant tinidazole, as soon as possible (See Section 11) purchase tegretol 200 mg online spasms below breastbone. Pay special attention to sanitizing the diaper change area and to proper hand washing (See Appendices F, G & H). Contact your local public health ofce if you have questions or concerns about readmitting the child or if you suspect an outbreak of a communicable disease. Children may vomit because of problems not directly related to the bowel or stomach. If a child has one episode of vomiting, watch for other signs of illness and inform the child’s family at the end of the day. If no more vomiting occurs and there are no other signs of illness, the child may return to the child care program the next day. If more than one episode of vomiting occurs, or vomiting with other signs of illness such as fever or diarrhea, inform the family to pick up the child. Advise the family to consult their health care provider if the vomiting continues. Inform the family immediately if the child has severe abdominal pain with vomiting Advise the family to consult their health care provider as soon as possible. Exclude a child or staf until they completely recover and are symptom- free for at least 24 hours before returning to the child care program, unless the vomiting is determined to be by a non-infectious cause. As soon as possible and while wearing disposable gloves, clean and sanitize the area where the child vomited. Contact your local public health ofce if you have questions or concerns about readmitting the child or if you suspect an outbreak of a communicable disease. Guidelines for Communicable Disease Prevention 9 and Control for Child Care Settings 3. When registering a child, ask the parent about chronic or recurrent rashes, such as eczema and rashes caused by food allergies and other allergies. Rashes from Infections: Most infections that have a rash as a symptom are spread through coughing, sneezing, and breathing before the rash appears, for example, chicken pox and measles. Many children may be exposed to the infection before you are aware that there is a problem. If one child develops an illness and rash, watch for the early signs of illness in the other children. Rashes from Parasites: Parasites cause certain types of very itchy rashes on the scalp or skin—head lice, scabies, and pinworms. This is called an infestation rather than an infection, and therefore does not cause disease. These infestations are not a public health risk Parasites pass from one child to another by close physical contact or through contact with shared personal items—bedding, hats, and combs. Rashes caused by parasites are not associated with any symptoms of generalized illness such as fever or cough. If there are no other signs of illness, advise the family of a child with an unidentified rash to see a health care provider to determine its cause and treatment, if necessary. If possible, separate a child who has both a rash and a fever or other sign of illness from other children—other signs of illness including vomiting and diarrhea. Advise the family that the child cannot return until a health care provider sees the child and the child fully recovers. Contact your local public health ofce if you have questions or concerns about readmitting the child or if you suspect an outbreak of a communicable disease. Table 5: Open Cuts and Wounds Guidelines To safely deal with open or draining cuts and wounds in children or staf, follow these steps: 1. Make sure the cuts or wounds are covered with bandages or dressings, so that the drainage does not leak out. Throw away dirty or soiled bandages or dressings in a covered garbage can before anyone else can be exposed to them, and then wash your hands.

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People who work or receive care in health-care settings (as referenced above) are at higher risk for becoming infected with M purchase tegretol on line amex muscle relaxant tramadol. People who work or receive care in health-care settings are at higher risk for becoming infected with M cheap 200 mg tegretol with amex muscle relaxants yahoo answers. Depending on the environment buy genuine tegretol on line spasms quadriplegia, these tiny particles can remain suspended in the air for several hours. For most patients, infectiousness appears to decline rapidly after adequate and appropriate treatment is started; however, the rate of decline varies from patient to patient. Infectiousness appears to decline rapidly after adequate and appropriate treatment is started; however, the rate of decline varies from patient to patient. Their symptoms have improved clinically (for example, they are coughing less and they no longer have a fever); and 3. It is important to consider the environmental factors that enhance the probability that M. They have three consecutive negative sputum smears collected in 8- to 24-hour intervals (at least one being an early morning specimen). Inadequate local or general ventilation that results in insufcient dilution or removal of infectious droplet nuclei D. Environmental controls, which prevent spread and reduce concentration of droplet nuclei; and 3. Respiratory-protection controls, which further reduce risk of exposure in special areas and circumstances. Facility Risk Assessment Health-care and congregate settings should conduct an annual evaluation of the risk for transmission of M. Health-care and congregate settings should conduct an annual evaluation of the risk for transmission of M. Medium risk Should be used for facilities in Repeat testing should be done which the risk assessment has annually. Potential ongoing Should be temporarily assigned to Thesting should be repeated transmission any setting where there is evidence every 8 to 10 weeks until there of person-to-person transmission of is no evidence of ongoing M. Environmental Controls The second level of hierarchy is the use of environmental controls to prevent the spread and reduce the concentration of droplet nuclei and includes: • Primary environmental controls; and • Secondary environmental controls (Table 7. The second level of hierarchy is the use of environmental controls to prevent the spread and reduce the concentration of droplet nuclei. Ventilation is the movement and the replacement of air in a building with air from the outside or with clean, recirculated air. When fresh air enters a room, it dilutes the concentration of particles in room air, such as droplet nuclei. There are two types of ventilation: • Natural ventilation • Mechanical ventilation Natural Ventilation Natural ventilation relies on cross ventilation in a building designed for good air exchange; for example, the use of open doors and windows to bring in air from outside. Natural ventilation can be useful for nontraditional facility-based and congregate settings that do not have a central ventilation system. In these settings, waiting rooms, shelter dormitories, or other rooms in which people congregate should have an operable window, door, or skylight that is kept open as often as possible. If the direction of airfow is unknown, staf should sit near the fresh air source and clients should sit near the exhaust location (Figure 7. In addition to these environmental measures, cough etiquette and respiratory hygiene should be encouraged to further reduce risk (Figure 7. Mechanical ventilation consists of • Local exhaust ventilation; and • General ventilation. Local exhaust ventilation stops airborne contaminants before they spread into the general environment. Local exhaust ventilation includes the use of • External hoods; • Booths; and • Thents. Local exhaust ventilation should be used for cough-inducing and aerosol-generating procedures (Figure 7.

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Initial reports within one week of recognition buy tegretol 200mg with amex spasms stomach, updated weekly tegretol 200mg with amex muscle relaxant pills over the counter, final record within one week of completion 2 buy generic tegretol 200mg on line kidney spasms no pain. They should have permission to suspend their regular duties when the need arises, and promptly undertake the tasks of initiating outbreak investigation and response. The district outbreak plan should document the roles of individuals included in the outbreak team, and contain contingency plans in case particular team members are unavailable when an outbreak occurs. The core team is responsible for planning, co-ordinating and carrying out the outbreak investigation. In most circumstances, members of the core team will need to be able to make the outbreak their highest priority, at least in the initial phase. Outside the core team are individuals who can be called upon to act as advisors about specific aspects, but normally not to do the legwork required. However, the boundary between the core and outer teams is fluid, and during larger outbreaks outer team members may be required to have considerably more hands- on involvement than during small-scale outbreaks. A multidisciplinary composition of an outbreak team is, 27 however, a distinct advantage. The core outbreak team will usually require the following skills: outbreak management coordination skills (akin to project management) and relationship management skills administrative and secretarial skills environmental investigation skills statistical analysis skills questionnaire development skills data entry skills interviewer selection and training skills media and public communication skills knowledge of relevant legislation and regulations statutory authority to implement legislation and regulations. The following advisory skills may be required, and it is important to consider in the outbreak plan where these skills can be obtained from, if necessary. During the outbreak itself, some of these skills may need to be brought into the core outbreak team. Therms of reference for the outbreak team The terms of reference of the outbreak team should be agreed upon in advance, as much as possible, and be included in outbreak plans. Assembling materials required for an investigation Outbreak plan development provides an opportunity to list the materials that may be required at short notice during an actual outbreak, and to identify where these materials are kept. Materials may include: basic stationery a hand-held calculator a sampling kit containing documentation and materials for collecting and transporting laboratory specimens a camera reference books or databases on communicable diseases and toxic substances a computer installed with a basic statistical package (probably EpiInfo and EpiData), packages for word processing and graph preparation, and (preferably) e-mail capability sample questionnaires from previous outbreak investigations or studies a list of telephone numbers of potentially useful agencies and individuals a cell phone personal identification documents, particularly those providing evidence of statutory designations that may be required during the investigation or management of an outbreak. Unusual patterns among cases may include groups of cases with similar demographic characteristics, or with links to common risk factors, or cases with common laboratory subtypes. This informal reporting of suspected outbreaks is the most typical method for identifying common event outbreaks, and accounts for the largest proportion of outbreaks reported in New Zealand. A source of infection is rarely conclusively identified by an investigation of a single sporadic case of disease. Every sporadic case of illness should, however, be seen as part of an unrecognised outbreak potentially, and details should be documented with this in mind. Standardised interviews of a number of sporadic cases may be useful in generating hypotheses about possible common sources of illness among cases that did not previously appear to be associated. For each notified case, the relevant EpiSurv Case Report Form should be completed. A review of this information may reveal commonalities among cases and provide clues to a common source of infection. It is important, however, not to over-interpret these findings as commonalities may only indicate a high prevalence of the exposure or activity in the community. It is also important to appreciate the importance of and maintain links with the veterinary surveillance systems in this context. Laboratory-based reporting and surveillance Accurate and timely data are essential if we are to promptly identify and respond to important public health events such as pandemic influenza, or a similar emergent infectious agent with epidemic or pandemic potential. The Health Amendment Act 2006 was aimed at improving the Government’s ability to respond to an outbreak of pandemic flu or a similar highly infectious disease. It also introduced the requirement for laboratories to directly notify to medical officers of health test results indicating the possibility of a notifiable disease. The old legislation (prior to 18 December 2007) saw considerable variations in reporting rates and some under-reporting. The new legislative requirements aimed to improve the old system, and provided for direct laboratory notification of notifiable diseases. This is expected to support reporting by clinicians and result in more comprehensive and faster overall reporting of communicable diseases.

In thioesters purchase 100mg tegretol with visa spasms near sternum, the larger atomic size of S (as compared with O) reduces the Pi-electron overlap between C and S generic tegretol 100 mg line muscle relaxant effects, so that the C-S structure does not contribute significantly to resonance stabilization buy 400mg tegretol muscle relaxant parkinsons disease. Thus, the thioester is destabilized relative to an ester, so that its G of hydrolysis is increased. The lack of double-bond character in the C-S bond of acyl-CoAs makes this bond weaker than the corresponding C-O bond in ordinary esters, in turn making the thioalkoxide ion (R-S-) a 170 good leaving group in nucleophilic displacement reactions. Thus, the acyl group is readily transferred to other metabolites, as occurs, in fact, in the first reaction of the citric acid cycle. Vit C (Ascorbic Acid) Figure: Structure of Ascorbic Acid Vitamin C is a water-soluble vitamin. Collagen is unusual in its widespread modification of proline to hydroxyproline and lysine to hydroxylysine. Hydroxylysine residues in collagen serve to form attachment sites for polysaccharides. A symptom of extreme vitamin C deficiency, called scurvy, is the weakening of collagen fibers caused by the failure to hydroxylate proline and lysine. Fat Soluble Vitamins Ample reserves of fat soluble vitamins are stored in the tissues as they are not readily absorbed from the food. It is a generic term for a collection of three forms of Vitamins, retinol, retinal and retinoic acid (Retinoids) all of which are found from animal and plant sources. Pre-Albumin and specific binding proteins on cell surface membranes are involved in the uptake of Vitamin A ester from the plasma in to the tissues. These as well as their precursors are readily absorbed from the intestine via the lymphocytics. Pancreatic lipase liberates the free Vitamin from the ester during digestion, but it is re-esterified in the intestinal mucosa. Source: A rich source is Liver, but leafy vegetables and some fruits provide the largest amount of β-carotene Liver, egg yolk, butter and milk are good sources of β-carotene. Functions β-carotene has an antioxidant role and prevents the development of diseases in which the action of free radicals is implicated. Retinal: Vitamin A is necessary for vision mediated by the rod cells, so deficiency often presents as “Night blindness”, the first symptom of Vit. The visual pigment, rhodopsin is found in the rod-cells of the retina and is formed by the binding of 11-cis retinal to the apoprotein opsin. When rhodopsin is exposed to light it gets decomposed (bleached), retinal dissociate and isomerized and reduced to all-trans retinol. This reaction is accompanied by conformational change and elicits a nerve impulse perceived by the brain as light. The All-trans –retinol in the absence of light is converted back to 11-cis retinol by isomerase present in the cytoplasm of the rod cells. This recombines with scotopsin and rhodopsin to generate another cycle of action on exposure to light. Vit A deficiency Vit A affects growth and differentiation of epithelial cells leading to defective epitheliazation, a condition affecting the cornea of the eye. Severe Vit A deficiency leads to progressive keratinization of the cornea and possibly permanent blindness. Vit A deficiency predisposes to gastrointestinal and respiratory tract infections. Plasma [Vitamin A] may be decreased in states of severe protein deficiency,due to lack of its carrier protein. Low plasma [Vitamin A]has been shown to be associated with an increased risk of developing cancer. Effect on Skin The deficeiency causes dryness and roughness of skin developing keratosis of hair folliciles with concomitant deficiency of Vit-B complex. Osteoclastic activity is also hampered, causing defective bone formation Effect on general Metabolism Zinc is necessary to maintain normal plasma concentration of Vit A. This vitamin is also necessary for the conversion of trioses to glucose perhaps indirectly through adrenal cortex that synthesizes hormones concerned with Gluconeogenesis. The first pro-vitamin D3 (chloecalciferol) with rupture of the bond between C9 and C10. It is a photolytic process involving no enzyme and slows down with aging because of the decrease of 7- dehydrocholesterol.

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