Handbook of Biochemistry Spotting Sahil Chhabra
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1Handbook of Biochemistry Spotting2
3Handbook of Biochemistry Spotting
Editor-in-Chief Namrata Chhabra MD Principal-in-Charge Professor and Head Department of Biochemistry Sir Seewoosagur Ramgoolam (SSR) Medical College Belle Rive, Mauritius Co-author Sahil Chhabra MBBS Research Associate Department of Anesthesiology and Perioperative Medicine University of Louisville Kentucky, USA Forewords Alpana Saxena Simmi Kharab Premlata Vadehra Sabeeha Moosa Vineeta Malhotra Kuldip Sodhi
4
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Handbook of Biochemistry Spotting
First Edition: 2016
9789352501434
Printed at
5Dedicated to
My parents
for their unconditional love,
life giving words, encouraging thoughts
and constant emotional support.6
7Contributors and Reviewers
8 9Foreword
This book is designed to provide a comprehensive review of biochemistry through a novel but highly commendable approach. It is intended to be a useful resource for students at a variety of levels in the health sciences. This approach emphasizes on understanding of biochemical mechanisms in a clinical context. Mastering this book will prepare the students for further challenges. Majority of the problems presented in the book involve, first, interpreting the information presented to arrive at a diagnosis, and then solving a problem based on that diagnosis. This will reinforce the clinical reasoning skills needed in the delivery of health care. I am confident this pattern of learning will be most welcomed and enjoyed by the students. I recommend this book with utmost enthusiasm and congratulate the authors for this excellent and novel endeavor.
Alpana Saxena MD
Professor and Head
Department of Biochemistry
Maulana Azad Medical College
New Delhi, India10
11Foreword
Many clinicians remember biochemistry, as one of the most challenging subjects in the medical school, or the class in which they struggle the most. For others, the mere mention of the word biochemistry conjures up images of structures of biomolecules and the steps of metabolic pathways. The reality of biochemistry, however, is far more exciting and rewarding, once these distressing images are dispelled. Indeed beyond this curtain, there lies a beautiful world of biomolecules. Through an intelligent and innovative approach, this book introduces the readers to this fascinating new world of biochemistry. Written and illustrated in a visually distinct and entertaining style, this book provides an insight to its readers about the role of biochemistry in the day-to-day life and in the disease processes.
This book contains a wealth of information that will inspire the young students to explore the fascinating and almost, infinite applications of biochemistry.
I appreciate and congratulate the young authors for their creativity and I am confident that the readers shall gain a broader perspective of the discipline of biochemistry through this book.
Simmi Kharab MD
Professor
Department of Biochemistry
Pandit Bhagwat Dayal Sharma Postgraduate Institute of
Medical Sciences
Rohtak, Haryana, India12
13Foreword
I have found the book comprehensive and up to date on the line of modern practice and teaching. It aims at describing the methods of investigations by which a correct diagnosis can be arrived at. For every medical student who comes in contact with a patient in the ward, the first question is “how to investigate this case”. The present work in this book, is intended to provide an Answer. I congratulate Dr Namrata Chhabra, for this awesome work. My best wishes are always with her.
Premlata Vadehra MD
Retired Professor
Department of Pathology
Government Medical College
Amritsar, Punjab, India14
15Foreword
Dr Namrata Chhabra is a widely respected Professor working as Head, Department of Biochemistry and Principal-in-Charge at SSR Medical College, Belle Rive, Mauritius. Her notable reputation precedes her and her sincere dedication and unfaltering support is obvious. She prides herself on skillful diligent planning and cares deeply about the student's conceptual understanding and learning experience. She uses a student-based approach which ensures students are well motivated and confident in the subject, construing an environment that harbors only academic excellence.
This book Handbook of Biochemistry Spotting, is a distillation of Dr Namrata's experience in teaching undergraduates and postgraduates alike, and is intended to provide such students with a thorough and informative grounding of the subject of biochemistry. In an attempt to achieve her goal of making biochemistry, simple, interesting and meaningful, she has designed a collection of clinical cases and each case is designed to introduce a clinically related issue. The logical explanations relate the clinical settings to the basic scientific data. I am sure this simplified approach will be highly appreciated and accepted by students and teachers on an international platform and continue to edify Dr Namrata's goal of conceptual teaching.
Sabeeha Moosa MBBS
Ex-Student, SSR Medical College
Belle Rive, Mauritius
Intern, Port Shepstone Provincial Hospital
South Africa16
17Foreword
I have a great pleasure in writing foreword for the book Handbook of Biochemistry Spotting. This book focuses on facts of medical biochemistry. The various aspects of biochemistry have been elaborated upon by using selected case studies.
Much to my delight, I found them to be stunningly illuminating in terms of breadth and depth of coverage of essentially the entire field of biochemistry. The structure of the book allows for easy selection of separate topics for reading. Congratulations and many thanks with gratitude to Professor Namrata Chhabra, for an outstanding treatise which will remain a classic in the field of biochemistry and hopefully serve to maintain its momentum and proliferation with new admirers and supporters.
Vineeta Malhotra MD
Retired Professor
Department of Pathology
Dayanand Medical College and Hospital
Ludhiana, Punjab, India18
19Foreword
This is clearly the first well-written book about medical biochemistry based on the pattern of objective-structured practical examination (OSPE). Objectivestructured practical examination assessments enable assessment of theoretical, practical and problem-solving skills at multiple stations. This book also comprises of similar sections. The first section introduction to laboratory covers all aspects of practical biochemistry, the second section provides clinical discussions based on theoretical concepts and the third and the most interesting section of self-assessment allows the students to apply their full range of knowledge, skills and abilities gained through this book. This book represents an extremely simplified presentation of biochemical facts. I am fully confident, this book will be extremely useful to medical students. I wish Professor Namrata Chhabra all the success.
Kuldip Sodhi MD
Professor
Department of Biochemistry
Maharishi Markandeshwar Institute of
Medical Sciences and Research
Ambala, Haryana, India20
21Preface
The principal objective of medical education is to produce medical personnel having sound clinical competence. Biochemistry being a basic subject plays an important role in paving the foundation for the clinical subjects. Biochemical approaches are often fundamental in illuminating the causes of diseases and in designing appropriate therapies. This book emphasizes on the applied aspect of biochemistry. The highlights of this book are real or constructed clinical problems solved by applying the fundamental concepts of biochemistry.
The traditional system of teaching biochemistry requires a major shuffle where the students learn to merely regurgitate the learned facts during an examination without realizing their real importance. In this script through my unconventional, but novel approach, I have attempted to simplify some of the demonstrated facts of biochemistry, by framing them into problems, so that while solving, students recognize the substantial intention of studying biochemistry. In this environment of curiosity, the students would examine their knowledge level and would heed towards knowing more to solve the problems. The motivation to solve the clinical problems would become the motivation to learn.
This book has been planned to proceed through sections. Since the judicious use of biochemical laboratory tests is an integral component of diagnosis and monitoring of treatment and a sound knowledge of biochemistry is essential for the interpretation of laboratory data, the first section is about introduction to clinical laboratory set up that includes introduction to commonly used glassware, equipment, reagents, and the normal laboratory reference levels of biochemical analytes. These introductions are essential prerequisites for arriving at a diagnosis.
This section is followed by discussion of commonly encountered clinical problems/diseases in the form of case studies providing the details of clinical manifestations, the mechanism involved in the causation of diseases and relevance of laboratory investigations in framing the diagnosis of diseases.22 This approach would help the students to develop lateral thinking in applying the concepts of biochemistry in solving the clinical problems.
Based on the similar concept, the second section also comprises of spot diagnosis that includes diagnosis of a disease or providing the immediate clue to the problem from the picture, graph, and biochemical test/set of laboratory investigations or from a short case study. The aim is to evaluate the clinical skills and spontaneity of the students in resolving the clinical problems.
Having worked through the details of this book, the students would be in a great capacity to solve the clinical problems and for their self-assessment the third section has been added including sample practice sessions with brief hints to assist the pupils.
In simple language with a clinical approach, the difficult and complicated facts of biochemistry have been eased out through this script. The text, although clinically relevant, is not meant to cover biochemistry in its totality. The intent of this book is not to describe clinical practice and management; rather it is to demonstrate how biochemistry can and does provide valuable insight for such practice and management. I am hopeful the students would not only enjoy the process of learning, but would also carry the clear concepts of biochemistry for their professional careers ahead.
Namrata Chhabra
23Acknowledgments
With high esteems and profound regards, I take the privilege to acknowledge my sincere gratitude to Mr RPN Singh, the Honorable Chairman of SSR Medical College, Belle Rive, Mauritius, for constant moral support and unconditional help at every step. I owe him a lifelong gratitude.
I am fully indebted to the Principal and Professor (Department of Anatomy), Dr (Mrs) S Shukla, my advisor and my role model, for invaluable guidance, and fervent personal interest from the very inception of the subject. She has been my inspiration and motivation for continuing to improve my knowledge and move my career forward.
It is a futile attempt searching for words to express my deep and sincere sense of gratitude and indebtedness to Dr NS Munshi and Dr NM Munshi, for their advancing encouragement and full support from time to time. Their wise and concrete suggestions and meticulous attention helped me to complete this work.
I am thankful to my worthy teacher Dr KS Sodhi, for carving another milestone in my academic journey. His painstaking efforts in suggesting, designing, advising and improving the script throughout the entire span of preparation enabled me to complete this work satisfactorily.
I express my feeling of reverence for Dr AK Lavania, for the moral support, eagerness and encouragement and for helping me by suggesting relevant sources of information throughout the course of the preparation of this book.
I am grateful to my department of biochemistry which deserves a special place for disciplining my professional life and contributing significantly to the preparation of this book. My special thanks to Mr Vishal and Mrs Devi, for assistance and suggestions.
From my inner core of heart, I want to mention special words of thanks to my children and co-authors, Dr Sahil and Dr Sarah, for their full support, flawless encouragement and contributions in this book. Their moral support and love helped me to tide over occasional moments of distress.24
All my efforts shall go in vain, if I do not thank my senior and junior colleagues and students of SSR Medical College, Mauritius, for their encouragement and moral support.
A special recognition is extended to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President) and Mr Tarun Duneja (Director–Publishing) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for showing faith in me to introduce the new concept of biochemistry spotting.
Above all, I am thankful to Almighty God, who enabled me to complete this project successfully.25
26Introduction
Biochemistry is a highly dynamic subject with a diversity of applications. Mastering the hard fundamental facts is extremely essential to realize the real essence of biochemistry. The students ‘learn to forget’ the concepts and understand their rightful importance in the clinical settings. The major gap between the basic science learning and the clinical trainings has been bridged by the unique theme of this book.
This book is based on reviewing clinical correlations of biochemical processes. To generate curiosity, the facts have been presented as clinical problems. The discussions are extremely instructive and very interesting. The textual matter is perfectly distributed into segments. The readers can use the information any time from any of the divisions. The beginning part is about the orientation of the readers to the tools of biochemistry laboratory. The second division is all about clinical discussions. The learning rule is different, but the main accent in each chapter is to establish a conceptual background. Visual, graphic and laboratory interpretations keep the readers engaged to explore the biochemical deviations. The spot questions, revise the entire course of biochemistry. The third section of self-assessment represents an extract of the whole book. The readers shall use the skills gained through this book to solve the problems and appreciate the process of stress-free learning.
I am sure this pattern of active learning would be most welcomed by the students and faculty all over the world.
Namrata Chhabra27