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Each team reconciled their application of the codes for each transcript and presented any challenges treatment 100 blocked carotid artery purchase exelon 3mg, with reconciliation symptoms 3 days before period exelon 1.5mg line, for review by the full team medicine man movie generic exelon 1.5mg line. Coding meetings were held on a weekly basis to ensure that the codes were being used appropriately across teams and to discuss any modifications to the codebook symptoms 8dp5dt best 4.5 mg exelon. A primary and secondary analyst then constructed matrices to identify, compare, and develop linkages between conceptual categories and respondent groups. Using constant comparison methods, thematic domains were delineated as the analysis of text data continued [18]. Results Most lay participants (61%) were employed, 30% had a high school education or less, 76% had no history of clinical research participation, and approximately half (51%) were women. Among community leaders, 48% were African American, 55% were women, 73% had at least a college degree, and 34% had a history of clinical research participation (see Table 1). There was little variation in themes between responses from lay participants and responses from community leaders. Findings are presented across categories of race or ethnicity unless otherwise indicated. Finally, we consider how these perceptions can inform minority participation in genomics research that aims to improve health equity. Respondents often used physical characteristics, such as differences in body type and hair texture, as evidence of genetic variation. Participants understood genetics as being related to traits that are passed down through families and that contribute to physical characteristics, frequency of disease, and predisposition to disease. Genetics is viewed as being largely unchangeable and leading to inevitable health outcomes, and it is credited with being the reason why family members often experience the same health condition. One Latino male leader described genetics as follows: Genetics is an inheritance from your family. And diseases too, because they say "my grandmother had heart disease, my grandfather had diabetes," and you end up getting it until the third or fourth generation. Race and ethnicity were described as being associated with differing cultural norms and behaviors and with the creation of differential conditions under which genetic expression occurs. Racial and ethnic groups were often described as differing in diet and levels of physical activity, both of which were said to contribute to differences in disease outcomes. Diet included the type and amount of food consumed and how food is prepared; African Americans and Latinos were perceived as choosing less healthy food items and preparation techniques. A white lay female participant offered her perception of how dietary differences contribute to differential health outcomes: I think we are all predisposed to certain diseases based on your race. Genetics was seen as a key factor contributing not only to health outcomes but also to differences in predisposition across racial and ethnic groups. One African American male leader described this contribution by saying, "Genetics plays a large part in it. Participants acknowledged that there are variations in disease outcome by racial or ethnic group; however, respondents only discussed disease differences that exist for racial and ethnic minorities, and all but one of the examples given were for disparities experienced by African Americans. Although this perception was present for all 3 respondent groups, the proportion of respondents indicating that genetic differences are an underlying cause for differences in disease outcomes was nearly twice as great among white respondents as among African American or Latino respondents. Participants were familiar with the concept of genetics; however, there was an overwhelming lack of familiarity with the term genomics. Most participants (84% of African American respondents, 81% of white respondents, and 76% of Latino respondents) had not heard of the term. These social determinants included differential access to health care, education, fiscal resources, and even healthy food options. One African American male leader described the situation as follows: I think that by way of people not being in the same economic playing field as a lot of other ethnic groups, by them not having access because of economics, it leads people not to get early treatments, which leads to the progression of certain diseases, or getting a further developed disease that someone with insurance was able to get early treatment and be treated for certain things. Interactions between genes and the environment were also described as creating racial and ethnic differences in gene expression based on where groups live, including both the physical living conditions and how "place" affects accessibility to health-promoting services. Their health is going to be better, their health is not going to decline as fast as the ones who is not getting those same things. African Americans were viewed as being more likely to live in conditions that exacerbate the expression of existing genetic predispositions to poor health outcomes. These living conditions were said to include the presence of toxins, insects, and proximity to industrial waste. I would think that would have an effect on diseases and whether they may carry a genetic trait, but because of some of those disparities they may not be able to prevent them as best they could if they were in a more healthy environment. Not surprisingly, most African American and Latino respondents indicated concerns about research that aims to address health disparities (88% and 86%, respectively); however, most white respondents (81%) also cited concerns. Among those with concerns, the proportion of respondents whose concerns were directly tied to race was nearly twice as great among African American and Latino respondents as among white respondents. African Americans and Latinos spoke of mistrusting researchers and the government; these individuals also spoke of fearing medical abuses, the use of research to "promote" one race over another, genocide, and mistreatment or targeting of a particular race. Among one-third of Latinos, mistrust was closely tied to fears of deportation for family members who are undocumented immigrants. One African American female leader described historical and current concerns regarding this type of research: I think the fear is misusing the information; again, in our society we value different populations; the fear is that they could say, we only want 10% of this race to be born in a particular year because that is all we need or something. Genetic researchers and social scientists have traditionally found it difficult to synergize biological and environmental explanations for health outcomes and health disparities. Interestingly, when considering determinants of health outcomes, community participants readily acknowledged the contributions of both biology and the environment, as well as the necessary interconnectedness between the two. Almost all participants had a clear and largely accurate understanding of genetics. Only a few respondents had ever heard the term genomics, but they largely endorsed the concept that interactions between genes and the social and physical environment contribute to group differences in health outcomes. They offered in-depth discussions of various social determinants of health, and they addressed the ability of those social determinants to create conditions that could affect gene expression and subsequently lead to health disparities. Given the prevailing use of labels to describe scientific work, researchers may sometimes be misled about community understandings of science and may fail to recognize that many scientific concepts are well understood by communities even though certain terminology may be unfamiliar. Two main findings offer important insight for effectively engaging communities in genomic research in order to improve health equity. First, participants think that racial differences in physical appearance are evidence of genetic variation between racial groups, and this concept of race is part of their rationale for believing that racial and ethnic groups are genetically distinct. This belief prevails despite the fact that research has determined that there is significant genetic similarity between racial groups [19]. In fact, advances in research indicate that genetic differences in health have less to do with shared genomes among people with similar phenotypes, and more to do with shared geographic ancestry, which presents in a wide range of physical manifestations [20]. These findings are evidence that significant opportunities remain in translating clinical discovery to community understanding. Second, individuals across racial and ethnic groups in our sample described a hierarchy of genetic predisposition (which mirrors social hierarchy) to explain poor health outcomes, primarily among African Americans. White respondents more frequently cited genetic differences as the basis for disparate health outcomes. Respondents viewed this greater genetic predisposition to disease as being triggered and magnified by exposure to worse social conditions, resulting in poorer health outcomes in African American communities. The idea of hierarchy along racial lines is not new, and historically it was used to justify the structure and enforcement of social inequalities [1, 21]. Although respondents did White respondents discussed race-related concerns regarding the use of genomics research to "mark" or to racially profile minorities. Instead of using research findings to address health disparities, this type of profiling could be used to reinforce stereotypes or to deny access to health insurance. A few white respondents also raised concerns that genomic research that aims to address health disparities may provoke race-related sensitivities, including elevated racial tensions, or may even result in a racial or ethnic group being blamed for certain health outcomes. Despite such concerns and the potential for harm, participants also identified potential benefits of genomic research. Each racial or ethnic group described the value of the anticipated knowledge to be gained through such research. New knowledge could provide a better understanding of the role of the environment in health, how diseases manifest, and prevention strategies, and this improved understanding could provide a basis for better medical care. Both African American and white respondents discussed the value of "helping certain races" or helping those most affected by health inequities. Although the perception of genetic differentiation by race is misconceived, interesting considerations are raised by the prevalence of this perception-particularly among those most often positioned at the top of the social hierarchy. In both the community and the clinical research enterprise, underlying assumptions of genetic predisposition may further perpetuate social inequality, undermine the need for genomics-based health disparities research, and hinder engagement by a broad spectrum of necessary community participants [3, 22].
Patience Dock (Bistort). Exelon.
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The Maryland Healthy Smiles dental program is responsible for routine preventative services ombrello glass treatment cheap exelon 4.5 mg without prescription, restorative service and orthodontia symptoms vertigo best 3mg exelon. If you have questions about dental benefits for children and pregnant women call 855-934-9812 treatment urinary incontinence exelon 6 mg with amex. If a woman was determined eligible for Medicaid based on her pregnancy she is not eligible for abortion services 4 medications walgreens buy exelon 3mg with mastercard. We are required to assist women in locating these services and we are responsible for related services (sonograms, lab work), but the abortion procedure, when conditions are met, must be billed to Medicaid fee-for service. Priority Partners will assist members to access non-emergency transportation through the local health department. We will provide some transportation if necessary to fill any gaps that may temporarily occur in our network. Preauthorization, Referrals, Member Complaint, Grievance & Appeal Procedures 64 Physical/Occupational Therapy For members over 21 years of age, a preauthorization is required after the first 12 visits. The initial six visits require the referral to be faxed to the Care Management department in order for an authorization number to be generated. Speech Therapy For members over 21 years of age, all speech services require preauthorization prior to rendering services. For additional details, please refer to the Outpatient Referral & Preauthorization Guidelines at. For services provided by participating providers in-office (Place of Service 11), outpatient hospital (Place of Service 22), or ambulatory surgery centers (Place of Service 24) by specialties listed below, no notification or preauthorization is required. Referrals for all services must be made to participating Priority Partners providers. Specific surgical procedures may require review by the medical director for determination of coverage. Referrals which require medical review (preauthorization) may have the number visits and date spans changed per Johns Hopkins HealthCare policy. To refer a member using the form, the first copy should be given to the member, the second copy should be forwarded to the specialist and the third copy should be mailed directly to Priority Partners. Faxed Referrals the completed Maryland Uniform Consultation Referral form may be faxed directly to Priority Partners. Out-of-network referral requests, with appropriate clinical information, should be faxed to Care Management Medical Review at 410-762-5205. Late Referrals For the purposes of tracking and trending, referrals not requiring preauthorization submitted to Priority Partners after 180 days will be redirected to the Provider Relations department for educational purposes and must be submitted to appeals for review. Referral Extensions Referrals for specialty care can be extended for a number of visits, or beyond the original date of service by a phone, fax or written request. If the specialty services require medical review (preauthorization), clinical notes and/or treatment plans may need to be submitted with the request for additional visits to be authorized. Inpatient admissions which have not been preauthorized will be reviewed for medical necessity from the date of notification through discharge. If notification is not received within 48 hours of admission, or the next business day prior to notification, the admission will be denied unless there are documented extenuating circumstances. Once notification of an admission is received, and throughout the hospital stay, the utilization management staff will request clinical information on the patient to certify continued stay as an inpatient. If requested information is not received within two business days of the request, the days will be administratively denied for lack of clinical information. All elective admissions are reviewed to determine if the service could be provided in an ambulatory setting and meet the criteria. The care coordinator, based on consultation with the medical director, will notify the requesting provider of an adverse decision and discuss alternatives. The member must be eligible for Medicaid and enrolled in Priority Partners on each date of service. Even if the service is covered by the primary payer, the provider must follow our preauthorization rules. For these services, we will pay the provider and then seek payment from the other insurer. Members and providers will be notified in writing when services are denied partially or in full. The notification will include reasons for the denial, instructions on obtaining additional information, and the appeals process. Decisions about hiring, promoting or terminating practitioners or other staff are not based on the likelihood or perceived likelihood that they support, or tend to support denials of benefits. McKesson InterQual criteria will continue to be used to determine medical necessity for acute inpatient care. The policies described above will support preauthorization requirements, acute inpatient care, clinical-appropriateness claims edits and retrospective review. Federal and state law, as well as contract language, including definitions and specific contract provisions/ exclusions, take precedence over medical policy and must be considered first when determining eligibility for coverage. Visit the For Providers section of our website to download a Personalized Treatment Plan form under Communications Repository > Forms. Notification is a communication received from a provider informing Priority Partners of the intent to render covered medical services to a member. For services that are emergent or urgent, notification should be provided within 24 hours or by the next business day. Prospective means the coverage request occurred prior to the service being provided. Preauthorization Determination Time Frames For services that require preauthorization, Priority Partners will make a determination in a timely manner so as not to adversely affect the health of the member. The determination will be made within two business days of receipt of necessary clinical information, but no later than seven calendar days from the date of the initial request. Preauthorizations for high tech radiology and cardiology imaging services will be provided through the vendor eviCore healthcare. Priority Partners will not pay for any costs associated with admissions on the day before surgery unless specific medical justification is provided and approved. Inpatient Concurrent Review Each network hospital will have an assigned concurrent review clinician. The concurrent review clinician will conduct a review of the medical records electronically or by telephone to determine the authorization of coverage for a continued stay. Additional information may be requested in order to make a determination, and must be provided within 24 hours of the request. If the information is not received within the 24 hours, an administrative adverse determination. Exceptions to one-day-at-a-time authorizations may be made for confinements when the severity of the illness and subsequent course of treatment is likely to be several days. The request for this review must be made within two (2) business days of the verbal notification of intent to deny, and the review must take place within four (4) business days of verbal notification of denial. If a delay in service, treatment, procedure, or discharge is identified during the process of utilization review for an inpatient stay, and the delay will result in, or is anticipated to result in an overall extended length of stay, the hospital days resulting from the delay in service, treatment, procedure, or discharge will be denied. For preauthorization requirements for behavioral health services, please refer to the Beacon Health Options website at maryland. The request for this review must be made within three (3) business days of the fax notification of intent to deny, and the review must take place within five (5) business days of fax notification of denial.
No employee may threaten symptoms 7 weeks pregnant exelon 1.5 mg line, coerce medications diabetic neuropathy buy exelon 3 mg online, harass medicine hat college discount exelon 6mg with visa, retaliate medicine in ancient egypt quality 6 mg exelon, or discriminate against any individual who reports a compliance concern. The Corporate Compliance department reports substantiated allegations to the appropriate regulatory authorities who may, in turn, perform its own fraud and/or abuse investigation and take action against those who are found to have committed health care fraud and/or abuse. This legislation allows the government to bring civil actions to recover damages and penalties when healthcare providers submit false claims. Penalties can include up to three times actual damages and an additional $5,500 to $11,000 per false claim. Remuneration includes anything of value, directly or indirectly, overtly or covertly, in cash or in kind. The Red Flag Rule (Identity Theft Protection) requires "creditors" to implement programs to identify, detect, and respond to patterns, practices, or specific activities that could indicate identity theft. Current civil penalties are $5,500 for each false claim or statement, and an assessment in lieu of damages sustained by the federal government of up to double damages for each false claim for which the government makes a payment. The amount of the false claims penalty is to be adjusted periodically for inflation in accordance with a federal formula. Priority Partners does not participate with or enter into any provider agreement with any individual, or entity that has been excluded from participation in Federal health care programs, who have a relationship with excluded providers or who have been terminated from the Medicaid, or any programs by Maryland Department of Health for fraud, waste, or abuse. The provider must agree to assist [Priority Partners]as necessary in meeting our obligations under the contract with the Maryland Department of Health to identify, investigate, and take appropriate corrective action against fraud, waste, and abuse (as defined in 42 C. Additional Resources: To access the current list of Maryland sanctioned providers follow this link: mmcp. The Center has not only supported the team financially, but also stood behind it firmly throughout the entire period of this experience. Thus Carter Center has become the pioneer in the field of preparing teaching material and also in training a team of authors for future endeavors of the kind. In addition, the task would have been impossible without the directing of the Federal Democratic Republic of Ethiopia, Ministry of Education. It is also not out of place to thank the administration of Gondar University, Debub University and Jimma University for extending cooperation whenever it was needed. D) Associate professor of Biochemistry, Medical Faculty, Addis Ababa University and Ato. Daniel Seifu, Lecturer of Medical Biochemistry, Medical Faculty, Addis Ababa University for their highly professional editing and most helpful comments about many aspects of the text. Contemporary Biochemistry plays a crucial role in the Medical field, be it metabolic pathways, storage diseases, mechanism action of varied biomolecules or inter and intra cellular communications. A lecture note on Medical biochemistry integrates and summarizes the essentials of the core subject. Topics are carefully selected to cover the essential areas of the subject for graduate level of Health sciences. Conformation of biomolecules, structure and their relationship to biological activity 2. Molecular events in gene expression and regulation Enzymes: Body proteins perform a large number of functions. They direct the metabolic events and exhibit specificity toward substrates, regulate the entire metabolism. Thus, they play key role in the degradation and synthesis of nutrients, biomolecules etc. They assist to know damaged tissues, the extent of tissue damage, helps to monitor the course of the disease and used as a therapeutic means of diagnosing a vast array of diseases. Proteins are the molecular instruments in which genetic information is expressed, Hormones, Antibodies, transporters, the lens protein, the architectural framework of our tissues and a myriad of substances having distinct biological activities are derived. The type, nature and number of amino acids impart characteristic properties to the proteins. Acid base properties of amino acids are important to the individual physical and chemical nature of vi the protein. The structural organization of proteins could be primary, secondary, tertiary and quaternary. The unfolding and disorganization of the proteins results in denaturation, the process is mostly irreversible. Many amino acid derived peptides are of biological importance and special products formed from them are of critical importance to the body. They contain more than one hydroxyl group (polyhydric) In addition to aldehyde or ketone group. Carbohydrates can be classified in to Monosaccharide, disaccharide, and polysaccharides. Mono is the smallest sugar unit, disaccharide is made up of two monosaccharides joined by glycosidic linkages. Serve as cell membrane components and mediate some forms of communication between cells. The failure of Galactose and fructose metabolism due to deficient enzymes leads to turbidity of lens proteins (Cataract). People suffer from Diabetes if the insulin hormone is less or not functioning well, such people are prone to atherosclerosis, vascular diseases, and renal failure. Integrative Metabolism and Bioenergetics Oxygen is utilized for the conversion of glucose to pyruvate. The main breakdown product of pyruvate is acetyl CoA, which is the common intermediate in the energy metabolism of carbohydrates, lipid and amino acids. It enters central metabolic pathway, the Citric acid cycle in the mitochondrial matrix. Lipids are water insoluble, but can be extracted with non-polar solvents like Benzene, methanol, or ether. Some lipids act as storage molecules for example triglycerides stored in adipose tissue. Transport forms of lipids (Lipoproteins),are present in combination with proteins Building blocks of lipids are fatty acids. Some lipids like cholesterol lack fatty acids but are potentially related to them. Lipids are constituents of cell membrane and act as hydrophobic barrier that permits the entry/exit of certain molecules. Break down of fatty acid produce energy, excessive breakdown cause ketosis, ketoacidosis, coma and death. Such information is applied in the treatment of patients with high cholesterol levels. Vitamins and Minerals They are organic compounds required in small quantities for the functioning of the body. Generally they are responsible for the maintenance of health and prevention of chronic diseases. A third group includes trace elements, which are required in small amounts for example Fe, I, Zn, etc. The metabolic role and deficiency disorders are important for the students of health sciences. Vitamins and trace elements are particularly important for patients with gastrointestinal disorders, who are fed on artificial diets or parenteral nutrition. Hormones are synthesized in one tissue, secreted in to blood, transported as mobile messengers. They increase the rate of chemical reactions taking place within living cells with out changing themselves. Depending on the presence and absence of a nonprotein component with the enzyme enzymes can exist as, simple enzyme or holoenzyme 1. Simple enzyme: It is made up of only protein molecules not bound to any nonproteins. The protein component of this holo enzymes is called apoenzyme the non-protein component of the holo enzyme is called a cofactor.
Diseases
The C-2 keto group in the open chain form of fructose can react with the 5th carbon atom containing hydroxyl group to form an intramolecular hemiketal symptoms 2 weeks after conception order 3 mg exelon with mastercard. This five membered ring is called furanose because of its similarity to organic molecule furan Fig 2 symptoms 6 months pregnant cheap exelon 3mg free shipping. Glycosidic bond is formed when the hydroxyl group on one of the sugars reacts with the anomeric carbon on the second sugar medicine 93 7338 exelon 4.5mg mastercard. Maltose is hydrolyzed to two molecules of D- glucose by the intestinal enzyme maltase medications safe during pregnancy buy exelon 4.5mg fast delivery, which is specific for the - (1, 4) glycosidic bond. Structure of Maltose Lactose Lactose is a disaccharide of -D galactose and -D- glucose which are linked by -(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 -(1, 2) -Glycosidic bond Polysaccharides Most of the carbohydrates found in nature occur in the form of high molecular polymers called polysaccharides. Heteropolysaccharides, which contain two or more different kinds 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 -(1, 4) linkages Amylopectin consists of long branched glucose residue (units) with higher molecular weight. The branch points repeat about every 20 to 30 (1-4) linkages Glycogen Glycogen is the main storage polysaccharide of animal cells (Animal starch). Like amylopectin glycogen is a branched polysaccharide of D-glucose units in linkages, but it is highly branched. The branches are formed by -(1,6) glycosidic linkage that occurs after every 8 -12 residues. Cellulose is a linear unbranched homopolysaccharide of 10,000 or more D- glucose units connected by -(1, 4) glycosidic bonds. Humans cannot use cellulose because they lack of enzyme (cellulase) to hydrolyze the -(1-4) linkages. Figure: Structure of Cellulose 30 Dextrins these are highly branched homopolymers of glucose units with -(1, 6), -(1, 4) and -(1, 3) linkages. Since they do not easily go out of vascular compartment they are used for intravenous infusion as plasma volume expander in the treatment of hypovolumic shock. Hetero polysaccharides these are polysaccharides containing more than one type of sugar residues 1. The amino sugar may also be sulfated on carbon 4, 6, or on a monoacetylated nitrogen. The acidic sugar is either D-glucuronic acid or its carbon 6 epimer, L-uronic acid. Since they are negatively charged, for example, in bone, glycosaminoglycans attract and tightly bind cattions like ca++, they also take-up Na+and K+ 3. An example of specialized ground substance is the synovial fluid, which serves as a lubricant in joints, and tendon sheaths. Thrombin is an enzyme that acts on the conversion of plasma fibrinogen into the fibrin. Glycoproteins (Mucoproteins) Glycoprotiens are proteins to which oligosaccharides are covalently attached. They differ from the glycosaminoglycans in that the length of the glycoproteins carbohydrate chain is relatively short (usually two to ten sugar residues in length, although they can be longer), whereas it can be very long in the glycosaminoglycans. The glycoprotein carbohydrate chains are often branched instead of linear and may or may not be negatively charged. It also contains disaccharides: sucrose, lactose, maltose and in small amounts monosaccharides like fructose and pentoses. Liquid food materials like milk, soup, fruit juice escape digestion in mouth as they are swallowed, but solid foodstuffs are masticated thoroughly before they are swallowed. Digestion in Mouth Digestion of carbohydrates starts at the mouth, where they come in contact with saliva during mastication. Saliva contains a carbohydrate splitting enzyme called salivary amylase (ptyalin). Action of ptyalin (salivary amylase) It is - amylase, requires Cl- ion for activation and optimum pH 6-7. The enzyme hydrolyzes (1,4) glycosidic linkage at random, from molecules like starch, glycogen and dextrins, producing smaller molecules maltose, glucose and disaccharides maltotriose. Digestion in Stomach No carbohydrate splitting enzymes are available in gastric juice. Digestion in Duodenum Food reaches the duodenum from stomach where it meets the pancreatic juice. The enzyme hydrolyzes -(1,4) glycosidic linkage situated well inside polysaccharide molecule. Lactose lactase Glucose + Galactose Lactose Intolerance Lactose is hydrolyzed to galactose and glucose by lactase in humans (by - Galactosidase in Bacteria). Such patients suffer from watery diarrhea, abnormal intestinal flow and chloeic pain. Maltase the enzyme hydrolyzes the -(1,4) glycosidic linkage between glucose units in maltose molecule liberating two glucose molecules. Sucrose Glucose + Glucose Sucrase Glucose + fructose 34 Absorption of Carbohydrates Products of digestion of dietary carbohydrates are practically completely absorbed almost entirely from the small intestine. It is also proved that some disaccharides, which escape digestion, may enter the cells of the intestinal lumen by "pinocytosis" and are hydrolyzed within these cells. No carbohydrates higher than the monosaccharides can be absorbed directly in to the blood stream. Simple Diffusion this is dependent on sugar concentration gradients between the intestinal lumen. Hence fructose is not absorbed by simple diffusion alone and it is suggested that some mechanism facilitates its transport, called as" facilitated transport". Hence, to provide a given amount of energy, more glucose must undergo glycolysis under anaerobic as compared to aerobic. For discussion and proper understanding, the various reactions can be arbitrarily divided in to four stages. Uptake of Glucose by Cells and its phosphorylation Glucose is freely permeable to Liver cells. In other tissues, like skeletal muscle, cardiac muscle, diaphragm, adipose tissue etc. The reaction is catalyzed by the specific enzyme glucokinase in liver cells and by nonspecific Hexokinase in liver and extrahepatic tissues. The reaction is accompanied by considerable loss of free energy as heat, and hence under physiological conditions is regarded as irreversible. Conversion of Fructose 6phosphate to Fructose 1, 6 bisphosphate the above reaction is followed by another phosphorylation. A,B Aldolase B: occurs in liver and kidney the fructose- 6-p exists in the cells in "furanose" form but they react with isomerase, phosphofructokinase-1 and aldolase in the open-chain configuration. Reactions of this type in which an aldehyde group is oxidized to an acid are accompanied by liberation of large amounts of potentially useful energy. Oxidation of Glyceraldehyde 3phosphate to 1,3 bis phosphoglycerate Glycolysis proceeds by the oxidation of glyceraldehde-3-phosphate,to form1,3-bis phosphoglycerate. Dihydroxyacetone phosphate also forms 1, 3 - bisphosphoglycerate via glyceraldehydes-3phosphate shuttle. Conversion of 3- phosphoglycerate to 2- Phosphoglycerate 3-Phosphoglycerate formed by the above reaction is converted to 2-phosphoglycerate, catalyzed by the enzyme phosphoglycerate mutase. It is likely that 2,3 bisphosphoglycerate is an intermediate in the reaction and probably acts catalytically.
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