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CONTROL EXERCISES.
Session: exams CORRECTION + others notes prepared questions
by MT-Einstein
Name the following figure bellow Wet mount and Gram stain
A B
G
MINANI THEOBALD EINSTEIN PHARMACY 4 2018-2019
A. Health: state of complete physical, mental and social welfare and not only the
absence of disease or infirmity (WHO)
D. Food: Material, usually of plant or animal origin, that contains or consists of essential
body nutrients, (such as carbohydrates, fats, proteins, vitamins, or minerals) and is
ingested and assimilated by an organism to produce energy, stimulate growth, and
maintain life. Which one takes into the system to maintain life and growth, and supply
waste.
MINANI THEOBALD EINSTEIN PHARMACY 4 2018-2019
F. Balanced diet: A diet that which contains various groups of foods, such as energy
yielding foods, body building foods and protective foods in the correct proportions, so
that an individual obtains the minimum requirements in all nutrients.
H. Nutrients are chemical substances in foods that provide energy, form body
structures, and regulate body processes, and the body doesn’t produce them (Grosvenor
and Smolin).
I. Nutrition is a science that studies all the interactions that occur between living
organisms and food (Grosvenor and Smolin).
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Adequate diet
Moderate diet
Balanced diet and
Varied diet
Define
A. A balanced diet is one that contains the combinations of foods that provide the
proper proportions of nutrients.
B. Adequate diet is one that provides enough of the energy, nutrients, and fiber to
maintain a person’s health. A diet may be inadequate in only one area.
C. Moderate balanced diet is one of the keys to a healthful diet refers to eating any
foods in moderate amounts not too much and not too little. If a person eats too much or
too little of certain foods, health goals cannot be reached.
D. Varied balanced diet is one refers to eating many different foods from the different
food groups on a regular basis.
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CARBON STUCTURE
o Organics : carbohydates,fat,protein,vitamin
o Inorganic: minerals and water
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Lack of the necessary minimum amount of any nutrient leads to a state of malnutrition,
while a general deficiency of all nutrients produces under nutrition and, in extreme
cases, starvation.
AMINO ACID POOL
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4. Knowledge
5. Social status and
6. Convenience.
DETERMINANTS OF FOOD CHOICE ACCORDING TO GROSVENOR AND.
SMOLIN
1. Availability:
2. Personal and cultural preferences
3. Health concerns:
Digestion: The process of the breakdown of macromolecules of the food into smaller
units. It involves both chemical and physical processes occurring in different organs.
Digestive system: is the body system composed of organs that break down complex
food particles into smaller, absorbable products.
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Mouth
Esophagus
Stomach
Small intestine
Large intestine
Rectum
Pancreas
Liver
Gall bladder
Salivary gland
The most notorious are the trisaccharide raffinose and tetrasaccharide stachyose, found
in large quantities in legumes (peas and beans), especially soya beans. Fermented by
bacteria in the colon, they produce gases CO2, H2 and CH4, causing discomfort and
flatulence.
The content of oligosaccharides can be reduced by soaking and cooking.
GLYCCOGEN STORAGES: about 90g in the liver, plus 350g in the muscles
Hemicellulose
Pectic substances
Lignins
WHAT IS ACRYLAMIDE
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2. Second, it is possible to form acrylamide without the presence of sugars. When fats in
food are oxidized, unique 3-carbon molecules (including acrylic acid and acrolein)
can be formed
1. FRENCH FRIES
According to data provided by the FDA, French fries are the single biggest dietary contributor
to an average American's acrylamide load. It has been estimated that French fries account for
nearly a quarter of all the acrylamide in our diets. But beware: switching to roasted or baked
potatoes will not shield you from acrylamide, either. Both roasting and baking trigger the
process that leads to the formation of acrylamide in potatoes. Steamed and boiled potatoes, in
contrast, do not contain significant levels of this suspected human carcinogen.
Alternatives: Boiled, steamed and mashed potatoes
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2. PRUNE JUICE
Next up on our list of foods high in acrylamide is prune juice. Although prunes and prune juice
do offer some interesting health benefits (see Health Benefits of Prunes), prune juice ranks
relatively high on the acrylamide index. However, as most people do not consume prune juice
on a regular basis, it is not a major contributor to the overall acrylamide load of Western
consumers.
Alternatives: Freshly pressed fruit juice
3. SOME CEREALS
Breakfast cereals, such as corn flakes and all-bran flakes, are a major source of acrylamide in
an average American's diet. It has been estimated that 12% of the acrylamide in modern diets
come from cereals. However, there are huge differences between brands, products, and even
samples. Consequently, it is difficult to estimate exactly how much acrylamide your breakfast
cereal contained today. Therefore, if you are trying to follow a low-acrylamide diet and want
to be on the safe side, it is best to go for breakfast alternatives that are known to contain no
or little acrylamide such as porridge made from steel-cut oats.
Alternatives: Oatmeal made from steel-cut oats
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4. SOME BREADS
Some breads, especially crispbread and toasted bread, contain significant levels of acrylamide,
and it has been estimated that bread accounts for a fifth of an average American's dietary
exposure to the toxin. To reduce your intake of acrylamide from bread, remove the crust
before you eat your bread (especially if the crust seems exceptionally dark), and if you bake
your bread yourself, use recipes that call for low baking temperatures. For even more ideas,
check out the article Acrylamide Levels in Bread & How to Reduce Those Levels.
Alternatives: Bread with crust removed
alternative to roasted nuts, simply go for their raw counterparts. In addition to being virtually
free of acrylamide, raw un-salted nuts won't damage your heart with excess salt.
Alternatives: Raw, un-salted nuts
7. POTATO CHIPS
Potato chips – or crisps if you grew up in England – are one of the major sources of
acrylamide in the American diet. An estimated 11% of an average person's exposure to
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acrylamide from foods has been attributed to potato chips alone. Also other types of chips,
such as corn chips, are a significant source of acrylamide (see Acrylamide in Chips: Potato vs
Tortilla (Corn) Chips).
Alternatives: Bite-sized pieces of fresh vegetables (great for dipping)
In large intestine, dietary fibers go through partial bacterial fermentation and produce
gas and short chain fatty acids
Fermented by bacteria in the colon, they produce gases CO2, H2 and CH4,
causing discomfort and flatulence.
The content of oligosaccharides can be reduced by soaking and cooking.
SOURCES OF TG
TGs rich in cis mono or polyunsaturated fatty acids tend to be liquid at room
temperature
(E.g. sunflower oil, olive oil and fish oil).
Butter, palm oil and partially hydrogenated oils such as margarine
SOURCES OF PPL
Abundant sources of phospholipids include egg yolk, liver, soybean and peanuts.
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CLASSIFY LIPID
o Triglycerides
o Phospholipid
o Sterols
o Essential And Non Essential
Kwashiorkor :dry and fleshy skin, dry and brittle hair and change in the skin color
Marasmus: The hair is sparse and falls out easily. Marasmus can stunt brain development
and impair learning abilities
WATER IN COMPARTMENT.
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IMPORTANCE OF VITAMINS
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o Rich sources of vitamin A: liver, cod liver oil, egg yolk and milk fat.
o Average requirement of vitamin A for an adult is 750 mg RE or 2500 IU.
o Requirement is increased by about 10% during pregnancy
o Requirement is doubles during lactation
VITAMIN K
Main sources of this vitamin include milk, meat, fruits, and vegetables. Daily
requirement is from 1 to 2 mg / day.
Biotin OR B7 is the essential growth factor in many organisms
Some biotin is also synthesized in the lower gut
Refined cereal products, fruits and vegetables
THE VEGETARIAN ARE UNDER RISK OF MISSING VITAMIN B12 AND THEIR NEUROLOGICAL
FUNCTIONING AND BLOOD FORMATION GETTING AFFECTED
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VITAMIN B9
VITAMIN B6
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High intake of NaCl has been associated with high blood pressure but neither KCl nor
Na2CO3 have this effect. WHY?
Calcium, Phosphorus, Magnesium and fluoride: skeleton, forming the rigid
mineral support to the body.
About 60% is absorbed in the intestine, and this is negatively affected by
vitamin D deficiency
Inorganic Fe absorption is enhanced by the presence of ascorbic acid in the diet. On the other
hand, a number of substances impair the Fe absorption, including dietary fibre, phytate and
tannins
HYPOMAGNESAEMIA CAN OCCUR IN HUMANS AS A
• result of starvation,
• excessive vomiting,
• diarrhea or
• Excessive urinary loss.
CHROMIUM
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HOW DOES BODY CONTROL THE AMINO ACID WHEN EXCEED THE
NORMAL BODY REQUIREMNT
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SPECIFIC CONDITION
During pregnancy, there is weight gain, resulting from maternal and fetal tissues and fluids.
Women with the normal body weight gain about 12 to 18 kg during pregnancy, most of
which are gained during the second and third trimesters.
Birth, the baby of 3 kg has about 500g of proteins, 30g of calcium, 0.4g of iron and
different vitamins. This has a nutritional and dietary implication on the pregnant woman
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ST
THE 1 TRIMESTER OF PREGNANCY
What is going on pregnancy at?
30h
4day
2week
35day
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• Nearly 900g of protein is deposited in the fetus and maternal tissues during pregnancy.
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energy and other nutrients are higher during lactation than pregnancy
An average output of milk is between 600-800g/day
During pregnancy,
cells in the breast form milk producing cells,
Milk producing cells called lobules.
Placental hormones stimulate this.
After birth,
The hormone of prolactin stimulates the synthesis of milk.
Infant suckling stimulates the release of prolactin,
Allowing the production of more milk.
• For Fe, requirements are the same during pregnancy and lactation.
• For vitamins D and K other increase
Babies are born with minimal stores of vitamin K, so a new born should get a single
dose of vitamin K. Breast-fed infants from vegetarian mothers should get vitamin
B12 supplementation
The first 4-6 months of age, human milk fulfills the requirements in water.
Once the solid food is introduced, infants need additional water. Infants need 1.5 ml of
water/kcal.
4) Explain difference between moisture content and dry matter content, dry ashing and wet ashing?
(1.5 pts)
1. Moisture content are quantity of the free water that is contained in the sbces (food)
2. Dry matter content is the sbces remaining after complete removal of moisture (free water)
3. Dry ashing : is the process of igniting completely the organic sbces by the use of maffle furnace
at high temperature between 500-600 0 C remaining with the inorganic residues
4. Wet ashing : is the process of complete oxidizing/digesting the organic matter by using agent
such as sulphuric acid under heat and catalyst for purpose of remaining with inorganic residues
5) Explain the important distinctions between food quality and safety attributes? List them. (2pts)
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Food quality attributes: is the degree of excellence of food in terms of nutrients needed by
consumers and labelling to by the manufacture
Food safety attributes: is the characteristics of food to do not cause harms to the consumers
6) Give and briefly explain the criteria of selecting an analytical technique? (1.5 pts)
Accuracy
Precisions
Specificity and selectivity
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Sample size
Reagent
equipment
Cost
Speed (time)
Reliability and need
7) Give extraction methods for fat from food samples? Explain them briefly. (1.5 pts)
10.Give and explain briefly methods for analyzing proteins in food samples. Give also advantages and
disadvantages.(2pts)
Titratable acidity is the measurement of the total acid
11.Define and explain the important distinctions between titrable acidity and pH ? Give an example of
each if possible.(2 pts)
Titratable acidity
deals with measurement of the total acid concentration contained within a food.
Titratable acidity :Simple estimate of the total acid content of food
Titratable acidity : Better predictor of acid impact on flavor
EXAMPLE : Lactic acid in the milk, tartaric acid in rape fruit, citric acid in citrus fruit, acetic acid in
vinegar
PH : Depend on the strength of acid condition , Orange juice , soda PH=3, LEmon and vinegar with
PH=2
PH predict the growth of microorgnisms in the food
12. What are the frequent causes of food borne diseases? (2pts)
1. Insufficient cooking or re-heating of food
2. inadequate storage conditions
3. Cross-contamination in the food preparation areas
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4. Infected or colonized persons in charged of the preparation
13. Give the correct names of the following (2pts)
A. Organisms that can be transmitted to susceptible hosts and cause disease: pathogen
B. The entry and development or multiplication of infectious agents in the body of humans or
other animals
C. Disease caused by pathogenic organisms or toxins transmitted to humans by food
D. Transfer of harmful microorganisms or their microscopic stages (eggs, larvae) from one source
to another
Increasing / or prolonging the storage time of food by keeping its nutrients integrity
Avoiding the contamination of food by worsen microbe or bad microbe
Fight againsted food rancidity
Inhibitions methods
Salting, sugar use and drying : to reduce the water activity sun/air dry , electrical dry or freeze
drying
Fermenting and addition of acid : to decrease PH monosaccharide is more efficient in drying that
disaccharide
Uses of preservation: sodium benzoate
Chilling and freezing : reduce temperature arrest microbial growth and duplications 0-15 chilling
common 4-5 0-(-35) this is freezing: retard reactions and action of food enzymes
Smoking
Killing methods
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18. Cite different factors that influence the growth of microorganisms in a food
A. Physical chemical factors of food.: Intrinsic Factors : Ph, Water Activity,Antimicrobial Sbces,
Biological Structure,Nutrients And Moisture Contents.
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B. Environment factor1pt: EXTRINSIC FACTORS : RELATIVE HUMIDITY IN STORAGE AREA,
TEMPERATURE OF STORAGE , PRESENCE OF GASES IN ENVIRINMENT.
19. Meat and fish products are traditionally dried by adding table salt to it. Can you suggest why salting
enables the meat to be stored for a long time. (3pts)
Salting is used because most bacteria, fungi and other potentially pathogenic
organisms cannot survive in a highly salty environment, due to the hypertonic nature
of salt and salt reduce the water activity by osmosis processthat is not favr to microbial
growth
most often works through dehydration, removing many of the water molecules
that bacterianeed to live and grow.
The Z value: Is the number of degrees the temperature has to be increased in order to reduce the
thermal death time tenfold.
D VALUE Is the time required at any temperature to destroy 90% of the spores or vegetative cells of a
given organism.
From a ‘survivor curve’ the decimal reduction value can be calculated
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2 D-concept (12-D values): is the accepted standard requirement for sterilisation in the preservation
industry
21. Classify the microorganisms according to their shape on the bellow microscopic field. Under which
magnification do you visualize this picture? 3pts
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Mainly waterborne
infected food handler
sewage contaminated water used for irrigation of (unprocessed) produce
contact with faeces of wild animals
Thus need: GHP & Quality of water & Waste management (Global GAP) in fresh p
1. Cyclospora
1.Food safety in (raw) meat : Salmonella, Campylobacter sp., E.coli O157 & Viruses
2.Food safety in (raw) fruits & vegetables : Salmonella , E. coli O157 also virus & protozoa and Shigella
3.Food safety in (raw) seafoods : Salmonella,Norovirus,Vibrio, marine biotoxins
4.Food safety in dairy (including eggs) : Salmonella ,Listeria monocytogenes , B. cereus / Staph. Aureus
5.Food safety in processed food (smoked fish, meat) : Listeria monocytogenes , Bacillus cereus – Cl. Botulinum,
Staph. Aureus, Salmonella in low moisture foods, E. coli O157 in fermented
8. Food safety in catering/ institutional serving : Cl. Perfringens,Viruses, Sta aureus – B. cereus, Salmonella
9. Food Safety in water used in Primary Production/Food Processing: emerging attention
Q. EXPLAIN HOW CAN YOU PREVENT AND CONTROL THE FOOD BORNE ILNESS
1. Type of microorganis MS
2. Number of cells
3. Age of cells
4. The physiological state and Stage of growth
5. Growth temperature
6. Composition of the food product
B. Milk and milk products are the best dietary source of which mineral: CALCIUM
G. what are the good sources of vitamin D in our diet: cod liver oil, other fishes oil, liver and organ
meat, egg yolk and butter from animal
i. Minerals that are responsible for intra-extracellular osmolality of fluids: Na,K, and Cl
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j.In Parenteral Nutrition solution when dextrose, lipids and amino acids are used together:3-1
3. What are the effects of too much fat on an individual health? (10pts)
1) Overweight
2) Obesity
3) Cardiovascular disease
4) Anteroscelorisis
5) Hypertensions
6) Myocardial infractions
7) Strokes
8) Diabetes
9) Cancer development
Give the correct answer for the following multiple choices (10 pts):
4. If a product is high in trans fatty acids the first ingredient listed on the food label will be 5pts
A. omega 3 fatty acids
B. high fructose corn syrup
C. hydrogenated fat
D. Margarine
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5. What fatty acid is necessary for growth, reproduction and maintenance of the skin integrity?
A. Omega 3
B. Omega 6
C. Trans fatty acids
D. Polyunsaturated fatty acids
7.The following fatty acid play role in retina and brain functioning
a) Polyunsaturated fatty acid
b) Omeg 7 fatty acid
c) Omega 3 fatty and 6 fatty acids
d)Omega 3 fatty acids
A nutritional assessment is used to determine the nutritional status of a person or group of people.
Learn about the ABCDs of nutritional assessment:
FOOD LAW
REGULATION 178/2002
Article 6 : Food Law Is Science Based : Risk Analysis Carried Out Independently, Objectively And
Transparently Based On Scientific Evidence.
ARTICLE 7. Precautionary : Risk management in case of scientific uncertainty
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Q. WHAT ARE THE PRINCIPLES OF FOOD LAW
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Q. WHAT IS THE CODEX ALIMENTARIUS ??????
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Q. WHAT ARE GROUP OF FOOD
11 GROUP OF FOOD
Cereals
Pulses
Nuts and oilseed
Vegetable
Fruits
Milk and milk products
Eggs and poultry
Fat and oils
Sugars and others
carbohydrates
Condiments and spice
Beverages
Q. Discuss the MyPyramid of nutrition
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1. They offer more volume of food for fewer calories Thus diets are low in fat and energy, This providing a
healthy body weight and lowers the risk of obesity.
2. High intake of soluble fiber delays emptying of the stomach and smoothen the blood glucose response,
thus a low risk of type 2 diabetes.
3. Food Rich in fruits and vegetables contain antioxidants that protect against cell damage and prevent
cancer.
4. High fiber food attracts water and dilutes cancer-causing agents in the gastro-intestinal tract
5. Dietary fiber speeds up the passage of food, decreasing the risk of colon cancer.
6. Soluble fiber lowers the cholesterol level by binding the bile acids in the GIT and preventing their
reabsorption in the body, and thus contributing to the prevention of Cardiovascular Disease
7. Dietary insoluble fiber increases the water in the stool, thus preventing constipation, hemorrhoids and
diverticular disease.
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In the villi, absorbed monosaccharides pass through the intestinal mucosal cells and enter the liver
through the portal vein.
In the liver, fructose and galactose are converted to glucose.
Apart from the diabetes , Carbohydrate also may cause the dental carry
DHA is the major metabolite found in the human tissues, where it is concentrated in the
membrane phospholipids, especially in retina and brain.
Omega 6-----arachidonic-----skin integrity.
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FUNCTIONS OF PHOSPHOLIPID
Transport of lipids
Emulsifier
Components of cell membranes
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Most TGs, cholesterol and PLs join protein careers to form chylomicrons ones enter the lymph
system
Glycerol and medium and short chain FAs are absorbed directly into the blood stream.
MINANI THEOBALD EINSTEIN PHARMACY 4 2018-2019
Dietary fat begins to appear in the blood stream after 1 to 2 hours, and is clear by 10 hours.
-The lipids and other materials that build up in the intimal layer are called the plaque or atheroma
-Oméga-3 fatty acids (EPA and DHA) decrease the TGs, and thus have a cardio protective
effect.
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Develop obesity after pregnancy and at menopause : are in highly risk of developing obesity than man.
Histidine and Arginine are normally not essential for normal adult human beings, but are dietary essential for
infants and children, or during pregnancy and lactation.
o Digestion of proteins begins in the stomach, with protein denaturation and unfolding by HCl.
o HCl converts pepsinogen to the active pepsin, which hydrolyses dietary proteins into amino acids and
peptides.
o Amino acids and polypeptides pass into the small intestine, where the pancreas secretes trypsinogen
and chimotrypsinogen, enzymes converted into their active forms: trypsin and chimoyrypsin.
o In the small intestine, trypsin and chimotrypsin hydrolyze the remaining polypeptides into amino acids,
dipeptides and tripeptides.
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o After these small units pass accross the macrovilli membranes into the cells, the remaining dipeptides
and tripeptides are hydrolyzed into amino acids, which are absorbed into the blood stream. Any part
of the protein that is not digested in the small intestine continues and pass out of the body through
the feces.
MINANI THEOBALD EINSTEIN PHARMACY 4 2018-2019
Prevention of the urinary tract infection and the formation of kidney stones
Lubrication in different locations of the body, e.g synovial fluid and mucus
Metabolic processes in the cell
Regulation of the body temperature
Vit-B9: mega.anemia, neural tube defect,poor immune response: yeast and yeast extract and Dark
green vegeta
Pyridoxine or Vitamin B6 : dermatitis, glossitis, anemia, depression, confusion and
convulsions : fish, lean meat, wholegrain cereals, bananas and peanut butter
Vit-C : Scurvy : citrus fruits, tomato, strawberries, leafy vegetables and potatoes :
MINERAL
mineral is considered to be major, when the requirement is greater than 100mg/ day: Sodium;
potassium; chloride; calcium; phosphorus; magnesium and sulfur.
MINANI THEOBALD EINSTEIN PHARMACY 4 2018-2019
A trace mineral is the one that is required to the amount less than 100mg/day: : iron; zinc; selenium;
iodine; copper; fluoride; chromium; manganese and molybdenum
Adult skeleton contains about 1kg of calcium, deposited on an organic matrix of collagen, by cells
known as osteoblasts.
Selenium deficiency may lead to liver necrosis, muscular dystrophy, cardiomyopathy and
dilatation of the heart
Excess of Se may lead to difficulty breathing, weight loss, hair loss and dermatitis.
1. Acety coA from the carbohydarte is used mainly in the citric cycle
2. AcetylcoA from the fatty acid is mainly used in kreb cycle
3. Acetyl CoA is also used in the synthesis of FAs, cholesterol, and ketone bodies in the liver
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www.co
ursehero.com
SOURCES OF NUCLEIC ACID
All meats, including organ meats, and seafood contain high levels of nucleic acids. Meat extracts and
gravies are also notably high. Of these foods, organ meats such as liver have the most nuclei, and are
MINANI THEOBALD EINSTEIN PHARMACY 4 2018-2019
therefore highest in nucleic acids. Conversely, dairy products and nuts are considered low-nucleic
acid foods.
Q.WHAT ARE THE FACTORS THAT SHOULD AFFECT THE PREGNANCY OUTCOME
1. Nutritional status
2. Low socioeconomic status
3. Closely spaced and multiple births
4. Teenage pregnancy
5. Advanced maternal age
6. Inadequate prenatal care
7. Lifestyle factors
8. Body weight and weight gain
9. Prenatal ketosis
10. Caffeine consumption
11. Aspartame use
12. Listeria and toxoplasmosis infections.
Q.WHAT ARE THE DISADVANTAGES OF MOTHER MILK FROM THE COW MILK
AND HOW MUCH TIME EXPECTED THE INFANT STAY TAKING MOTHERMILK
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IN INFANCY
Calories needs in infancy are calculated as:
(89kcal x weight of an infant in kg) + 75 from 0-3 months
(89kcal x weight of an infant in kg) + 44 from 4-6 months
(89kcal x weight of an infant in kg) - 78 from 7-12 months.
Q. HOW LONG THE CHILD IS NOT ALLOWED TO BREASTFEED FOR HIV POSITIVE
IDENTIFIED MOTHERS AND WHAT CONDITIONS FOR INFANT FORMULAE TO BE
APPLIED
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Q.WHY DO ADOLESCENT GILRS AND BOYS NEED MORE IRONS IN THE
NUTRITIONAL PREPARTIONS
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Q.WHAT ARE THE EFFECTS FOR ELDERLY FOR CONSUMING LAW FAT DIET RICH
IN CARBOHYDRATES
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Q.DECREASE THE PROTEIN, MINERAL AND VITAMINS NUTRITION PROBLEMS IN
THE ELDER PEOPLE
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4. Psychological
1. Anxiety
2. Depression
3. The presence of dementia.
5. Social causes
1. the institutionalization of individuals (e.g. in hospitals, nursing homes)
2. poverty and famine
3. poor food hygiene
4. inappropriate food supplies
5. The early cessation of breastfeeding.
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o It is characterized by
o Changes in fat, protein and carbohydrate metabolism such as increased lipolysis,
gluconeogenesis and protein turnover, glucose intolerance and hyperinsulinemia,
hyperlipidemia, decreased plasma levels of branched-chain amino acids (BCAAs).
o Cancer cachexia: progressive weight loss, anorexia and persistent erosion of host
body cell mass, as a response to a malignant growth.
o Cancer cachexia : characterised by elevated levels of fibrinogen, are weakness, loss
of appetite, muscle atrophy and fatigue
Screening is essential, must be easy and fast and should be done as soon as patients are
admitted, in order to define and validate whether they are at risk of malnutrition and
what action should be taken.
The introduction of a malnutrition-screening tool for hospital outpatients can play a crucial role in
improving the detection of disease-related malnutrition.
o According to the latest European Society of Parenteral and Enteral Nutrition (ESPEN) guidelines for
nutritional screening, MUST is the most widely used screening tool for adults, mainly in the community,
but also in hospitals settings, where NRS-2002 is the most appropriate tool for undernutrition detection,
with an additional grading of severity of diseases.
o Both these tools have excellent reliability and a high level of validity.
o This tool is MNA, which includes physical and mental parameters and a dietary questionnaire, for the
detection of undernutrition among older people, even in the early stages.
MINANI THEOBALD EINSTEIN PHARMACY 4 2018-2019
MINANI THEOBALD EINSTEIN PHARMACY 4 2018-2019
One of several types of nutrients (e.g., iron, folic acid, iodine, selenium, vitamin C), particularly those
involved with anti-oxidant protection.
o Important anti-oxidants in the body that are reduced in children with kwashiorkor include
glutathione, albumin, vitamin E and polyunsaturated fatty acids.
o Therefore, if a child with reduced type one nutrients or anti-oxidants is exposed to stress (e.g.
an infection or toxin) he/she is more liable to develop kwashiorkor.
o One important factor in the development of kwashiorkor is aflatoxin poisoning.
Aflatoxins are produced by molds and ingested with moldy foods. They are
toxified by the cytochrome P450 system in the liver, the resulting epoxides
damage liver DNA. Since many serum proteins, in particular albumin, are
produced in the liver, the symptoms of kwashiorkor are easily explained.
o It is noteworthy that kwashiorkor occurs mostly in warm, humid climates that encourage mold
growth.
o Protein should be supplied only for anabolic purposes. The catabolic needs should be
satisfied with carbohydrate and fat.
o Protein catabolism involves the urea cycle, which is located in the liver and can easily
overwhelm the capacity of an already damaged organ.
o The resulting liver failure can be fatal
1.TYPE I DIABETES= Insulin Dependent Diabetes: Considered as Auto Immune or Immune Mediated or
idiopathic: beta cell loss is a T-cell mediated autoimmune attack.
MINANI THEOBALD EINSTEIN PHARMACY 4 2018-2019
WHY TYPE 1 DIABESTES IS CALLED JUVENILLE DIABETES : because it represents a majority of the
diabetes cases in children
2.TYPE 2 DIABETES : insulin resistance which may be combined with relatively reduced insulin
secretion, it is the matter of irresponsive of the insulin receptor, most common type occur
3.GESTATIONAL DIABETES
Like type 2 involving a combination of relatively inadequate insulin secretion and
responsiveness.it occur during pregnancy
Q.HOW THE BODY DEFEND FOR THE PRESENCE OF THE TYPE 2 DIABESTES
In the early stage of type 2 diabetes
The predominant abnormality is reduced insulin sensitivity.
At this stage hyperglycemia can be reversed by a variety of measures AND
medications that improve insulin sensitivity OR
Reduce glucose production by the liver.
Important factor in accelerating the hardening and narrowing of the arteries (atherosclerosis)
o Leading to strokes
o coronary heart disease
o And other large blood vessel diseases. (Macro vascular disease).
MINANI THEOBALD EINSTEIN PHARMACY 4 2018-2019
1. WHAT IS PARANTERAL AND ENTERAL NUTRITIONS
2. DISTUINGUISH TOTAL PARANTERAL FROM PERIPHERAL PARANTERAL
NUTRIONS
MINANI THEOBALD EINSTEIN PHARMACY 4 2018-2019
o To determine the non-protein calories (NPC) in a TPN prescription, add the dextrose calories to
the lipid calories without protein calories
o For example 1224 kcals (dextrose) + 720 kcals (lipid) = 1944 non-protein kcals
MINANI THEOBALD EINSTEIN PHARMACY 4 2018-2019
WHEN AND WHY CAN YOU USE STOMACH ENTERAL FEEDING TUBE
AND INTESTINE ENTERAL FEEDING TUBE
MINANI THEOBALD EINSTEIN PHARMACY 4 2018-2019