Anonymous
10-19-2004, 09:28 PM
22:40:21 [hutals] i was hoping that lorena would post it, but i'll post it if she doesn't.
22:40:34 [dr_yasir] tell me how to post i will do it
22:40:40 [jwls29] ok...she's gone
22:40:47 [jwls29] i don't know how
22:40:55 [jwls29] goodnite
22:41:11 [hutals] yep, i was just checking to see if she posted it.....i dont see it so i will post it.....nite
22:43:39 hutals exits from this room
22:43:45 [dr_yasir] ok i am leaving to so bye every one
23:35:38 malumed007 enters this room
23:38:57 crusher exits from this room
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04:55:49 soni_pande enters this room
16:16:26 emmanueljoshua enters this room
16:17:05 [emmanueljoshua] hello
16:17:25 [emmanueljoshua] anybody here?
19:59:32 hutals enters this room
20:03:04 jwls29 enters this room
20:03:25 [hutals] hey jwls
20:03:26 ninadnashua enters this room
20:03:27 >[ninadnashua] Welcome to our chat. Please obey the net etiquette while chatting: try to be pleasant and polite.
20:03:37 [jwls29] hi hutals
20:03:48 [hutals] hey nina
20:04:01 [jwls29] hi nina
20:04:29 [ninadnashua] hi
20:05:14 Lorena enters this room
20:05:35 [Lorena] hi everyone
20:05:51 [jwls29] hi lore
20:07:28 [hutals] hey lor
20:08:07 [Lorena] hi jwls hutals ninad
20:08:37 [hutals] i guess ppl will show up late again tonight. i didnt get a chance to post an announcement on other site, so i hope that wont affect attendance tonight
20:09:24 [ninadnashua] hi lorena
20:10:12 [Lorena] we can start if you want
20:11:07 [jwls29] we should start
20:11:31 [hutals] ok, i'm sure other will join later
20:11:57 [hutals] so we're starting with nutrition and then moving to neoplasia....right?
20:12:30 [Lorena] right
20:12:30 [hutals] top 3 causes of death in u.s.?
20:12:56 [Lorena] MI, cancer, stroke
20:13:32 [jwls29] agree
20:13:35 [hutals] heart dz, cancer, stroke is right....good job lor. high fat, low fiber diets contribute to this
20:14:11 [hutals] what is main difference between anorexia nervosa and bulemia?
20:14:32 [jwls29] in anorexia they are underweight
20:14:43 [jwls29] in bulimia they are not necessarily underweight
20:14:48 [Lorena] body weight , in anorexia nervossa is less 15% and bulimia they can be normal or overweight
20:14:53 [jwls29] in anorexia they have distorted body image
20:15:08 [jwls29] not necessarily so in bulimia
20:15:09 [Lorena] agree
20:15:22 [hutals] body image is the main difference where anorexics have disrorted image of themselves regardless of how little they weight. bulemics can have normal body weight and even a little increased
20:15:28 [hutals] good job
20:16:02 [hutals] which one will have osteoporosis? what causes it?
20:16:24 [Lorena] anorexia
20:16:36 [jwls29] anorexia...lack of estrogen
20:16:42 [Lorena] they have decreased strogen
20:17:07 [hutals] anorexics have osteoporosis from the estrogen lack. they will also have secondary amenorrhea from this
20:17:22 [hutals] very good again
20:17:37 [Lorena] how does strogen regulates this? just to remember
20:17:45 [hutals] what is most common cause of death in anorexics?
20:18:02 [jwls29] arrhythmias
20:18:09 [Lorena] cardiac arrythmias
20:18:28 [hutals] yep, cardiac arrythmias
20:18:54 [jwls29] b/c of the loss of body fat there is a decrease in GnRh secretion which leads to low FSH/LH causing low estrogen levels
20:19:22 [hutals] agree with jwls
20:19:34 [Lorena] strogen regulates IL1 (inhibitory) which is the osteoclast activating factor
20:19:45 [Lorena] yes very good
20:20:12 [hutals] same reasoning behind osteoporosis in post menopausal women i think
20:20:31 [Lorena] yes
20:20:31 [jwls29] yes
20:20:43 [hutals] what type of electolyte disturbances seen in bulemics?
20:21:14 [jwls29] hypokalemic metabolic alkalosis
20:21:17 [Lorena] hypokalemia with metabolic acidosis
20:21:29 [jwls29] b/c of the vomiting
20:21:32 [ninadnashua] hypokalemic metabolic alkalosis
20:21:41 [Lorena] sorry alkalosis
20:21:50 [hutals] yep, all correct
20:22:27 [hutals] just one more tid bit on this.....don't give buproprion to bulemics because it can cause seizures
20:22:29 [Lorena] what does alkalosys causes in the Oxygen Hb curve?
20:22:54 [ninadnashua] left sift
20:22:57 [hutals] left shift
20:23:09 [Lorena] thank you huts, didnt know that
20:23:11 [jwls29] agree
20:23:33 [Lorena] yes good
20:23:47 [hutals] i didnt either until i got it wrong on q bank
20:24:39 [hutals] what is considered obese as far as BMI? what about morbidly obese?
20:24:58 [jwls29] >30 bmi
20:25:09 [jwls29] and for morbidly >40
20:25:09 [Lorena] more than 30BMI obese, morbidity is more than 40
20:25:22 [Lorena] how to calculate BMI?
20:25:29 [hutals] yep, both right
20:25:56 [hutals] kg / m squared
20:26:04 [Lorena] yes
20:26:05 [jwls29] weight in kg/height in meters squared
20:26:13 [Lorena]
20:26:50 [hutals] most common complication in obesity?
20:27:07 [jwls29] hypertension
20:27:07 [Lorena] hypertension
20:27:28 [hutals] yep, HTN
20:27:50 [hutals] first treatment of choice for obesity?
20:28:07 [hutals] think cheap as papi says....hint
20:28:15 [jwls29] behavior modification
20:28:27 [Lorena] behavior modification
20:28:33 [jwls29] low calorie diet and exercise
20:28:44 [hutals] yep, behavior modifications like diet and excercise
20:29:15 [hutals] difference between kwashiorkor and marasmus?
20:29:46 [jwls29] kwarshiorkor is decreased protein intake,diet mostly cbh
20:29:58 [Lorena] kwashiorkov decreaed proteins in diet
20:30:00 [jwls29] marasmus is decreased caloric intake
20:30:20 [hutals] kwash is dec protein and marasmus is dec total calories.....good.....which is worse? which has pitting edema?
20:30:21 [Lorena] agree
20:30:46 [Lorena] kwarshiorkov is worse, it has pitting edema for hypoalbuminemia
20:31:06 [jwls29] kwarshiorkor has pitting edema b/c of hypoalbuminemia
20:31:14 [Lorena] why do they have fatty liver?
20:31:32 crusher enters this room
20:31:34 [hutals] if you have dec albumin (protein), you will have pitting edema.....very good......kwash is worse
20:31:38 [jwls29] decreased synthesis of apolipoproteins
20:31:51 [crusher] hello everybody
20:31:55 [jwls29] hi crusher
20:31:58 [hutals] dec apolipoprotens
20:32:03 [Lorena] hi crush
20:32:03 [hutals] hey crush
20:32:15 [crusher] he lorena
20:32:21 [crusher] hey hutal
20:32:27 [Lorena] explain why they have red hair
20:32:41 [jwls29] copper deficiency
20:32:52 [hutals] copper deficiency
20:33:05 [crusher] lack of copper
20:33:21 [Lorena] yes, what does copper do?
20:33:42 [crusher] coper is a co factor
20:34:17 [crusher] for the synthesis of collagen
20:34:32 [hutals] tyrosinase relationship
20:34:49 [Lorena] yes, copper is cofactor for lysil oxidase, it stabilizes collagen
20:35:26 [hutals] i guess tyrosinase relationship would be for the skin depigmentation....oops
20:35:38 [hutals] what vits are likely to be dec in pt with cystic fibrosis? why?
20:36:00 [crusher] allfat soluble vit
20:36:01 [jwls29] a,d,e,k
20:36:08 [jwls29] fat soluble vitamins
20:36:14 [Lorena] fat soluble proteins because cystic fibrosis causes malabsorption
20:36:29 [hutals] pancreatic malabsorption of fat sol vits.....ADEK....very good
20:36:38 [jwls29] yes
20:37:33 [crusher] cos in where these vitamins absorb???
20:37:50 [Lorena] what vit defficiency may be defficient in a ptient with Chron's disease?
20:38:20 [hutals] B12 i think
20:38:42 [Lorena] yes very good hutals
20:38:43 [crusher] where does fat solu vit reabsorb
20:38:54 [hutals] reabsorp of vits are in prox small intest
20:38:57 [crusher] b12 absorb in terminal ileum
20:39:05 [hutals] b12 is in term ilieum
20:39:22 [jwls29] agree
20:39:28 [Lorena] small intestine except vit B12 in terminakl ileum-the most common affected site in Chrons
20:39:48 [hutals] what is the leading cause of blindness worldwide? 2nd? what about in u.s.?
20:39:50 [crusher] what is basic differnec of anorexia and Bulemin by definition
20:40:11 [crusher] us is Dibetes.
20:40:23 [hutals] body image
20:40:42 [jwls29] worlwide it's trachomata
20:41:10 [hutals] us is diabetes. worldwide 1. trichomonis 2. vit A def
20:41:27 [Lorena] thanks hutals
20:41:51 [hutals] isnt that crazy, we can prevent millions of blindness cases with a simple vit pill???
20:42:01 [crusher] its body weight and distorted body image ..anorexia= less than 15% ideal wt n distored image while bulemia both normal
20:43:16 [Lorena] do you remember the serotypes hutals for trachoma?
20:43:18 [hutals] which vit can cause birth defects
20:43:21 [hutals] ?
20:43:41 [Lorena] def folic acid
20:43:46 [crusher] i think vit A overdose
20:44:09 [jwls29] vit a overdose is cerebral edema and papilledema
20:44:17 [jwls29] agree with lorena
20:44:49 [hutals] the answer i was looking for, i think step 1 provided it as a real question, was vit a in the form of retinoic acid given for treatment of acne
20:45:08 [crusher] folate def gluteal with neural tube defect
20:45:10 [jwls29] ah ok
20:45:10 acestep1 enters this room
20:45:39 [jwls29] hi ace
20:45:43 [acestep1] hi guys
20:45:54 [hutals] hey ace
20:45:55 [acestep1] hi jwls
20:46:00 [crusher] hello ace
20:46:09 [Lorena] hi ace
20:46:09 [acestep1] hey hutals
20:46:21 [acestep1] hi lor
20:46:33 [acestep1] hi crush
20:46:42 [Lorena] ok, but in that case they would specify if an overdose or a defficiency in a vitamin
20:46:51 [hutals] i cant remember the serotypes of the top of my head
20:47:34 [acestep1] agree . 1 more pt it treats a wbc cancer as well
20:48:04 [acestep1] i think a-l
20:48:10 [jwls29] ace, can you change your color,please?
20:48:13 [Lorena] serotypes a to C for trachoma
20:48:14 [hutals] i cant remember the question that was given to us, but it said something like which vitamin can cause birth defects? i guess both could depending on choices given and wording
20:48:18 [crusher] follicular hyperkeratosis secondry to squamous metaplasia inhair follicles linked to which vit def
20:48:26 [Lorena] i just looked
20:48:38 [acestep1] oops im really sorry
20:48:51 [hutals] i was way off....i was thinking it was a number instead of letters
20:48:54 [jwls29] vit c
20:48:54 [Lorena] vit A
20:48:56 [acestep1] is it ok now?
20:49:04 [hutals] thanks lor
20:49:13 [acestep1] oh ok
20:49:15 [jwls29] lorena is right
20:49:21 [crusher] lorena ur rite its VIT A def
20:49:21 [Lorena] thank you for bringing that up, now we know
20:49:31 [jwls29] i was thinking of perifollicular hemorrhage which is vit c
20:49:40 [jwls29] better ace, thanks
20:49:54 [acestep1] k:0
20:50:05 [acestep1]
20:50:33 [hutals] what is the most imp source of vit D?
20:50:47 [acestep1] sunlight?
20:51:00 [jwls29] agree with ace
20:51:10 [ninadnashua] ya
20:51:10 [Lorena] sun, UBV
20:51:11 [crusher] squmous metaplasia of straitified columnar epith of of bronchiloes linked to which vit def
20:51:20 [jwls29] vit a
20:51:24 [hutals] yep, sunlight. what about colostrum.....is this a good source of vit D?
20:51:29 [crusher] agree sun light
20:51:33 [acestep1] vit a
20:51:35 [Lorena] agree with jwls
20:52:07 [crusher] i thinlk not its lack vitD.
20:52:10 [hutals] is that vit a crush?
20:52:17 [acestep1] i think yes- hutals
20:52:28 [crusher] yes u all right its vit A
20:52:33 [Lorena] no, not a good sourse of vit D
20:52:43 [jwls29] agree with crusher and lorena
20:53:13 [Lorena] thats hy they recommedn to expose the baby to the sunlight
20:53:21 [hutals] believe it or not, vit D is absent in colostrum of milk. in fact, it is not even in cows milk normally, but is added
20:53:55 [jwls29] where are vitamin d receptors located
20:53:55 [acestep1] ok 1 pt i think if vitA def then u get all kinds of resp d/s like colds ( recurrent) , pneumonitis n lung ca
20:54:46 [crusher] which two reactions in vit D synthesis require Ohlation
20:55:05 [Lorena] small intestine, kidney , osteoblasts
20:55:25 [crusher] agree with lorena
20:55:36 [jwls29] yes
20:55:49 [hutals] crush...is that hydroxylation?
20:56:03 [crusher] yes hyroxylation
20:56:19 [hutals] took me a while to get that one
20:56:36 [Lorena] hepatic and renal hydroxilations before it is 1,25 dihydrocholecalciferol
20:56:51 [hutals] 25 OD D3
20:57:02 [jwls29] 25 hydroxylation occurs in the liver and 1,25 hydroxylation occurs in the kidney
20:57:03 [crusher] one in the live by 25 oHlase and other in kidney by alpha 1 hyroxylase
20:57:06 [acestep1] chol- 25oh chol ( liver) n 1,25 chol- kiney
20:57:13 [hutals] oops thats 25-OH-D3
20:58:25 [Lorena] so in apatient with renal failure, is it effective to give over the counter vit D?
20:58:29 [hutals] what is the most common cause of vit D deficiency?
20:58:56 [acestep1] nosunlite
20:59:02 [hutals] nope lor, because they cant convert it without functioning kidney
20:59:13 [crusher] lack of sunlight
20:59:14 [acestep1] no sunlight imean
20:59:33 [Lorena] yes hutals
20:59:36 [acestep1] agree with hutals
21:00:10 [hutals] that is a cause of vit D deficiency, but MCC according to golijan is chronic renal failure
21:00:15 [Lorena] the same happens with patient with liver insufficiency or cirrhosis
21:00:43 [hutals] other causes?
21:00:44 [acestep1] colostrum is def in which other vit?
21:01:32 [crusher] lab value dec ca inc P inc,,patient patient on renal dialysis what could be the cause
21:01:45 [hutals] vit k??
21:01:50 [Lorena] vit K ace
21:02:31 [crusher] lab value dec ca inc P inc PTH ,, patient on renal dialysis what could be the cause
21:02:48 [crusher] yes dec vit k
21:03:19 [Lorena] renal insufficiency , high phosphate because parathormone is trying to compensate the hypocalcemia
21:03:24 [hutals] chronic renal failure
21:04:39 [acestep1] sorry guys my comp froze. yes v good vita k
21:05:00 [crusher] its cos of lack of alpha 1 Oh lase def cos of renal failure..sec Hpterparthyroism
21:05:00 [hutals] other causes of vit D def include poor diet, malabsorption, liver dz, drugs enhancing p450, hypoPTH, genetic dzs
21:05:10 [acestep1] vit k imean
21:05:40 [hutals] ace, i thought u were just building the suspense
21:05:46 [Lorena] thanks crush
21:06:05 [acestep1] lol . no hutals .
21:06:17 [acestep1]
21:06:19 [hutals] big game hunter presents with headaches....what might be the cause?
21:06:52 [Lorena] ate bear liver-overdose of vit A
21:07:00 [crusher] agree
21:07:33 [acestep1] agree
21:07:33 [jwls29] agree
21:07:37 [hutals] rule out papilledema from inc cranial pressure due to hypervit A tox from eating bear liver.....very good
21:07:47 [crusher] in bone on which cells does pth receptors located
21:08:15 [hutals] osteoblasts
21:08:39 [Lorena] agree
21:09:21 [hutals] what are vit K dependent factors?
21:09:27 sweta_med enters this room
21:09:30 [crusher] yes osteoblast which secrete interleukin 1 which then linked it to osteoclast ,,result in CALCIUM release by activation of PTH
21:09:46 [sweta_med] hi everyone
21:09:46 [hutals] hey sweta
21:09:47 [crusher] 2 7 9 10
21:10:01 [Lorena] hi sweta
21:10:03 [jwls29] protein c and protein s
21:10:07 [sweta_med] are u discussind nutrition
21:10:22 [crusher] yes sweta
21:10:34 [Lorena] what vitamin overdose can cause the deff of another vitamin?
21:10:34 [hutals] yep sweta
21:10:37 [hutals] 2,7,9,10, prot c/s
21:11:06 [hutals] vit E can dec vit k
21:11:22 [crusher] wht will happen to bone reabsorption with inc or dec vit D
21:11:39 [Lorena] good hutals
21:11:46 [acestep1] wow i didnt know tht
21:12:05 [sweta_med] it will increase
21:12:07 [crusher] and osteocalcien another factor form in liver
21:12:22 [sweta_med] with decrease vit d
21:12:40 [acestep1] agree with sweta
21:13:01 [crusher] there is inc bone reabsorption in both inc or dec vit D
21:13:03 [Lorena] bothj decreased or increased will result in loss of bone
21:13:41 [hutals] lor, correct me if i'm wrong, but i think that vit E tox causes bleeding which will basically use up vit k factors and that is how it will have an effect....am i understanding that correctly?
21:13:55 [sweta_med] what would be the cause
21:14:53 [acestep1] ok .yes cuz vit d also cuzes bone resorption by activating osteoclasts in addition to inc the s. intestine absp n kidney absp
21:14:59 [hutals] child presents to ER after eating rat poison. what is intial treatment? why?
21:15:05 [crusher] most common cause of vit D def?
21:15:21 [Lorena] vit E toxicity decreases synthesis of vit K factors, and will result in bleeding but after some days because you still have some coagulation factors around
21:15:22 [hutals] the cause of what sweta?
21:15:37 [hutals] crush, chronic renal failure
21:15:53 [acestep1] vit k - hutals?
21:16:02 [hutals] ok, thanks lor
21:16:03 [Lorena] vitamin K
21:16:07 [sweta_med] the bone resorption in vit d deficiency would be due to PTH
21:16:16 [crusher] yes good hutal renal failure n dc alpha i ohlase def
21:16:16 [Lorena] you are welcome
21:16:34 [jwls29] vitamin k
21:16:57 [hutals] yes, its vit k given IM
21:17:06 [crusher] other cause of vitD def are.....alcolism..liver damage...celiac dis
21:17:17 [hutals] because rat poison contains warfarin
21:17:42 [sweta_med] should heparin be given
21:18:48 [crusher] what would be valus of ca ,P and alk Phosphatse in rickets and osteomalacia????
21:18:50 [hutals] heparin would cause further bleeding, so i dont think it would be good to give it
21:19:13 [hutals] no, i am wrong...sorry
21:19:42 [crusher] rat poision conatin warfarin...anticoagulat so >>>>>>bleeding
21:20:12 [sweta_med] CA and p is lowand alkaline phos is high
21:20:18 [crusher] no donot give heparin............another anticoagiulant
21:20:40 [Lorena] when you want to anticoagulate a patient (post MI for example) you give heparin and warfarin, but not in a warfarin overdose in a normal patient
21:21:00 [hutals] sweta, i'm confused by your question....should hep be given in case of child with rat poison (warfarin).....if that is the question than no because it can cause further bleeding
21:21:33 acestep1 enters this room
21:21:37 [sweta_med] ok but its in the <a target=new HREF=http://www.amazon.com/exec/obidos/external-search?tag=valuetheplace-20&keyword=Goljan&mode=books>Goljan</A> notes that heparin and warfarin shoould be given together
21:21:39 [hutals] but if you mean why give hep with warfarin normally it is because hep will work right away whereas warfarin will take longer
21:22:07 [crusher] sweta u r right in osteomalcia n oricj=ket its deminerlization so dec ca and P. n inc alk phosphate
21:22:49 [sweta_med] i got that thanks
21:23:20 [hutals] yes sweta, they can be given together if you want to prevent clots, but not if you have warfarin toxicity like with child taking rat poinson
21:24:10 [Lorena] in what other disorders is alkaline phosphatase increased?
21:24:31 [sweta_med] tumors of the bone
21:24:45 [crusher] what are the level of Ca.P and alk P in osteoporosis
21:25:18 [ninadnashua] normal
21:25:22 [acestep1] any bone forming patho - lor
21:25:40 [Lorena] yes
21:25:52 [crusher] osteochonroma..sarcoma etc lor
21:25:53 [acestep1] agree with nina
21:26:09 [crusher] yes all normal in osteoporosis
21:26:21 [Lorena] good question crush
21:26:27 [hutals] liver dz, kid normal to be elevated
21:27:21 [hutals] what vit supplement should be given to TB pt be treated?
21:27:31 [acestep1] b6
21:27:39 [Lorena] agree
21:27:41 [sweta_med] pyridoxine
21:27:41 [crusher] b6
21:27:58 [hutals] why B6.....which drug causing deficiency?
21:28:14 [crusher] isoniazid i think lower down b6
21:28:21 [acestep1] otherwise b6 is amde by n. flora i think
21:28:36 [acestep1] made by n.flora
21:28:49 [hutals] Isonizaid (INH) used to treat TB can cause deficiency of B6.....good job
21:28:51 [acestep1] agree with crusher
21:28:52 [Lorena] yes isoniazid
21:28:53 [sweta_med] birth contol pills also
21:29:30 [hutals] yes sweta....also alcoholism and pregnancy
21:29:37 [sweta_med] what are the ymotoms
21:29:45 [sweta_med] ji mean symptoms
21:29:59 [Lorena] sideroblastic anemia, cheilosis, stomatitis
21:30:22 [sweta_med] peripheral neuropathy,
21:30:27 [hutals] sideroblastic anemia, convulsions
21:30:37 [hutals] neuropathy
21:31:19 [hutals] interesting.....convulsions seen in both B6 deficiency and toxicity
21:31:19 [ninadnashua] what is brown bowel syndrome
21:31:47 [sweta_med] the deposition of lipofuscin
21:31:52 [Lorena] what else cause sideroblastic anemia?
21:32:13 [ninadnashua] ya in cystic fibrosis
21:32:17 [jwls29] seen in CF and due an increase in liprofuscin from increased lipid peroxidation
21:32:18 [acestep1] lead
21:32:20 [Lorena] agree with sweta but dont remember secondary to what?
21:32:34 [Lorena] thanks
21:32:36 [ninadnashua] ya
21:32:40 [hutals] lead
21:32:45 [Lorena] yes ace very good
21:32:54 [ninadnashua] vit e
21:33:10 [ninadnashua] defieceincy
21:33:16 [acestep1] thanks
21:33:22 [sweta_med] yes agree
21:33:44 [hutals] eating raw eggs can cause a deficiency in what?
21:33:55 [acestep1] biotin
21:34:08 [sweta_med] biotin
21:34:14 [ninadnashua] true
21:34:16 [Lorena] yes
21:34:31 [hutals] yep biotin.....what is a sign that can be seen with this?
21:35:06 [Lorena] alopecia
21:35:07 [acestep1] dont remb
21:35:14 [ninadnashua] mcc of vitk defeieiency
21:35:15 [sweta_med] alopecia
21:35:21 [hutals] alopecia is right
21:35:40 [hutals] antibiotics
21:35:50 [acestep1] antibiotics?
21:35:57 [sweta_med] antibiotics
21:35:40 [hutals] antibiotics
21:35:50 [acestep1] antibiotics?
21:35:57 [sweta_med] antibiotics
21:36:18 [jwls29] i have to go...goodnight all....see you tomorrow
21:36:30 [ninadnashua] ya
21:36:33 [sweta_med] bye jwls
21:36:38 [Lorena] see you tomorrow jwls
21:36:46 [acestep1] bye jwls
21:36:46 [hutals] nite jwls
21:36:55 [acestep1] tc
21:36:57 [jwls29] bye
21:37:12 [sweta_med] what essential amino acid is needed for niacin formation
21:37:29 [Lorena] tryptophan
21:37:41 [acestep1] ok . 1 q y in b6 def u see neuropathy
21:37:49 [sweta_med] yes
21:37:53 [acestep1] agree with lor
21:38:03 [hutals] tryptophan
21:38:08 [hutals] patient eating lots and lots of corn can have what symprtoms?
21:38:17 [Lorena] what if the patient has phenylketonurya? what aminoacid then?
21:38:19 [sweta_med] pellagra
21:38:37 [acestep1] b6 - fits
21:38:49 [sweta_med] aspartic acid
21:38:56 [Lorena] pellagra the 5 D's
21:38:58 [acestep1] tyrosine
21:39:05 [hutals] ace, i think because B6 involved in neurotransmitter synthese
21:39:21 [crusher] tyrosine
21:39:27 [Lorena] yes ace good job
21:39:56 [Lorena] and crush
21:39:57 [hutals] hmmmm.....i only know of 4 D's.....diarrhea, dementia, dermatitis, death
21:40:00 [acestep1] no d-ALA accumulatesn it is neurotoxic i think
21:40:15 [acestep1] thanks lor
21:41:06 [Lorena] the 5 D is D-ehydrogenases for the ez that requiere niacin as cofactor
21:41:09 [crusher] in wilson disearw what level of ceruloplasin free cU and total copper,explain also plz???
21:41:21 [hutals] ok, thanks lorena
21:41:26 [acestep1] k
21:41:49 [sweta_med] i want to know the question crusher
21:42:22 [hutals] in wilsons, you will have low ceruloplasim, low total copper, and high free copper
21:42:37 [crusher] in wilson diseae wht the level of ceruloplasmin,,Free Cu+2,total cu?
21:42:48 [acestep1] dec ceruloplasm- genetic defect - inc free cu which binds 2 liver n hepatotoxic
21:43:35 [acestep1] and is hepatotoxic imean cirrhosis
21:44:14 [ninadnashua] total cu les but free more
21:44:30 [Lorena] low total copper because you only measure the bound one hutals?
21:44:59 [acestep1] dm pts lack which trace element
21:45:00 [sweta_med] whta are the symptoms of zn deficiency
21:45:07 [crusher] wilson Dz is AR diseas in which there is DEFECTIVE EXCRETION CU into BILE ..from chronic levr dz.DEc ceruloplasim(low copper level)Bcoz synthesis in liver......inc free cupper that deposit in eye give kaysers fleisher rings
21:45:35 [acestep1] agree
21:45:51 [sweta_med] yes aree
21:46:06 [Lorena] poor wpund healing, taste decreases and anosmia
21:46:10 [crusher] but i donot understand why total dec n free inc can some one explain?
21:46:31 [sweta_med] yes lor
21:46:32 [acestep1] agree - lor
21:46:53 [acestep1] dm pts lack zn
21:47:18 [sweta_med] rash around the mouth , growthn ertardation and hypogonadism
21:47:24 [acestep1] which trace element will dec hyeprglycemia
21:47:56 [Lorena] chromium
21:48:22 ggg enters this room
21:48:23 [acestep1] v good lor
21:48:42 [Lorena] chromium increases glucose uptake by insulin
21:48:55 [Lorena] thanks ace
21:48:59 [acestep1] trace element for hair colour?
21:49:12 [acestep1] yes
21:49:14 [hutals] low ceruloplasmin levels with subsequent increase in free copper in blood. But that will be less total copper (bound) which is the one that is measured. but dont be fooled because the free is the one that really matters
21:49:34 [ninadnashua] thiamine defeceiency related to what
21:49:34 [Lorena] copper?
21:50:08 [crusher] sweta zinc >>>ans
21:50:12 [acestep1] execellent lor
21:50:24 [hutals] hey ggg
21:50:29 [acestep1] excellent imean
21:50:31 [Lorena] thiamine deficiency is common in alcoholics
21:50:35 [sweta_med] copper
21:50:48 [crusher] korsakof physosis,,wernikes enceph...ninad
21:50:53 [acestep1] agree. also dry n wet berri berri
21:51:04 [crusher] cu related to hair changes
21:51:04 [ggg] hi all
21:51:06 [ninadnashua] yes also atp defeieceiency
21:51:13 [sweta_med] nystagmus, confusion, ataxia
21:51:38 [acestep1] alos memory loss
21:51:50 [ninadnashua] ya wet dry beriberi
21:51:57 [acestep1] yes - crush
21:52:11 [hutals] pt given IV glucose and develops wernicke's encephalopathy.....why?
21:52:22 [ninadnashua] ya
21:52:26 [Lorena] also seen in kwarshirokor-red hair for lack of copper
21:52:27 [acestep1] no b1
21:52:45 [acestep1] agree with lor
21:52:48 [sweta_med] glucoses uses up the thiamine
21:53:05 [Lorena] glucose precipitated thiamine deficiency because it was used in glycolysis a cofactor for pyruvate dehydrogenase
21:53:10 [sweta_med] for pyruvate formation
21:53:19 [crusher] agree
21:53:30 [acestep1] i think in alco u need b1 pyrophos
21:53:31 [hutals] always infuse IV thiamine before giving pt glucose because glucose is converted to pyr and pyr to acetyl CoA which uses up thiamine and precipitates attack.....excellent
21:53:33 [crusher] two reactions require thiamine as a co factor
21:53:58 [sweta_med] pyrvate dehydroge
21:54:19 [acestep1] 3 i think
21:54:19 [sweta_med] and alpha keto glutarate dehydro
21:54:26 [Lorena] actually 3 reactions
21:54:43 [acestep1] n transketolase?
21:54:46 [sweta_med] also alpha keto acid dehdrogenase
21:54:54 [hutals] pyr DH, alpha ketoglutarate DH, alpha keto acid DH
21:54:57 [crusher] transketolase and pyruvate to acetyl coa...(tender loving care for nancy) co factors.
21:55:00 [Lorena] also tranketolase in HMP shunt
21:55:21 [crusher] very good all
21:55:21 [hutals] RBC transketolase
21:55:32 [acestep1] agreee
21:55:34 [Lorena] excellent crush
21:55:58 [ninadnashua] ya
21:56:04 [hutals] we should probably discuss a little neoplasia....what do you think?
21:56:04 [crusher] if there is def of thiamine what will happen in reaction of pyruvate to acetyl coa..what product will form?
21:56:26 [Lorena] NADH
21:56:40 [acestep1] lactate?
21:56:43 [crusher] the reaction will divert to form DHAP.
21:56:55 [sweta_med] lactate
21:57:26 [crusher] what does DHAP gives u?
21:57:55 [sweta_med] i will be back pl continue
21:57:57 [Lorena] glycerol 3P
21:58:08 [acestep1] k
21:58:25 [acestep1] agree
21:58:37 [crusher] very good lor,,and Glycerol 3 phosphate is a back bone of???
21:58:49 [Lorena] thats wht fatty liver?
21:59:11 [crusher] excellent!!!!!
21:59:16 [Lorena] thats why...right? tryglycerides accumulate
21:59:29 [crusher] thats why alcoholic have fatty liver
21:59:51 [Lorena]
22:00:22 [Lorena] thanks crush
22:00:35 [crusher] u welcome
22:01:26 [Lorena] do you guys want to move to neoplasia?
22:01:39 [crusher] sure
22:01:51 [hutals] sure
22:01:51 [hutals] sure
22:02:10 [acestep1] wait wait wht happens in floride toxicity
22:03:17 [Lorena] teeth get mottled and calcification in ligaments and tendons which is visible in xr
22:03:22 [acestep1] u guys there
22:03:24 [ninadnashua] folate vitamin b12 defieceincy
22:03:49 [acestep1] excellent lor also ligament rupture
22:04:15 [Lorena] thanks ace
22:04:57 [Lorena] folate and B12 def cause megaloblastic anemia - and vit b12 also cause neurological symptoms
22:05:17 [ninadnashua] ya
22:05:18 [acestep1] agree
22:05:34 [crusher] agree
22:05:47 [acestep1] also heyperseg pmn n dec plts
22:05:56 [Lorena] in whci one you have methilmalonic aciduria?
22:06:04 [acestep1] causes of folate def
22:06:32 [crusher] what is the co factor in glutathione peroxidase
22:06:35 [acestep1] b6 /12
22:06:41 [crusher] lack of green veg
22:06:51 [acestep1] se- crush
22:07:00 [crusher] b12 def
22:07:09 [crusher] yes ans is selinium def
22:07:41 [Lorena] pregnancy
22:08:20 [crusher] folate are present in green vegtables
22:08:28 [acestep1] yes
22:08:38 [acestep1] v good lor
22:08:42 [crusher] and also yes pregnacy require more amount of folate
22:09:01 [acestep1] also alcoholics , elderly ppl
22:09:30 [Lorena] alcoholics but not if they drink beer
22:09:47 [crusher] where does folate reabsorb
22:10:02 [acestep1] also in malabsp d/s -folate
22:10:16 [acestep1] s.intestine?
22:10:29 [Lorena] agree
22:10:37 [crusher] jejunem
22:10:55 [acestep1] k
22:11:01 [hutals] i seem to be having computer problems.....my computer froze and i won't be able to post transript. can someone else post transcript tonight?
22:11:18 [Lorena] i will
22:12:01 [hutals] if i become silent all of a sudden, its because it froze again
22:12:07 [acestep1] hey guys i gtg
22:12:11 [hutals]
22:12:15 [acestep1] k
22:12:34 [acestep1] see u guys later
22:12:39 [hutals] nite ace....c ya tomorrow
22:12:46 [Lorena] dont worry hutals , you will read the transcript later
22:12:51 [crusher] name some reactions Cu require as a co factor
22:13:01 [crusher] good night ace
22:13:02 [Lorena] see yuo tomorrow ace
22:13:24 [acestep1] yes . sure
22:13:40 [Lorena] lysil oxiodase for collagen stabilization
22:13:43 [acestep1] gn crush
22:14:34 [crusher] lysl oxidase.......SOD.....tyrosinase...cytochrome c oxidase
22:14:41 [crusher] gn ace
22:14:44 [ninadnashua] cytochrome c in ets
22:15:02 [crusher] yes ninad
22:15:22 [Lorena] i didnt remember the rest, thanks
22:16:09 [ninadnashua] cancer cause in us
22:16:14 [hutals] i just figured out the reason for the copper levels in wilsons. the bound copper is actually bound to ceruloplasmin, so a decrease in ceruloplamin would mean a decrease in bound copper. if less is bound, that would have to mean that more is free because it has less to bind to. make sense?
22:16:44 [Lorena] thank you hutals
22:16:58 [crusher] thanks hutal
22:17:04 [ninadnashua] cause is relate to smoking
22:17:12 [Lorena] lung cancer
22:17:28 [ninadnashua] ya
22:17:36 [hutals] no prob....it finally makes sense to me
22:17:55 [sweta_med] age related cancers?
22:18:09 [Lorena] kids Leukemia
22:18:20 [crusher] proste Ca.....old age
22:18:21 [hutals] prostate
22:18:29 [sweta_med] breast,prostrayte
22:18:58 [sweta_med] which leukemia inkids?
22:19:14 [crusher] ALL
22:19:20 [hutals] ALL my children
22:19:26 [sweta_med] yes
22:19:31 [Lorena] agree
22:19:41 [ninadnashua] what is seen in picture of sq ca
22:19:46 [sweta_med] CLL in adults
22:19:51 [hutals] mneumonic is the soap opera "ALL my children"
22:19:56 [sweta_med] keratin pearls
22:20:26 [Lorena] ok
22:20:32 [ninadnashua] ya
22:20:54 [Lorena] guys i have to go, i will post transcript until here , can someone post the rest?
22:21:22 [sweta_med] what ate the oncogenes for breast cancer
22:21:23 [hutals] i have to go to.
22:21:24 [Lorena] hutals? hopefully if you dont have more computer problems?
22:21:31 [crusher] i got to leave too
22:21:37 [Lorena] oh ok
22:22:01 [Lorena] see you tomorrow , take care
22:22:09 [crusher] i think most of us leaving
22:22:09 [sweta_med] ok bye lorena and crusher
22:22:17 [crusher] bye lorena
22:22:23 [crusher] see ya t,m
22:22:27 [hutals] ok lorena, you will post transcript up to now?
22:22:28 [sweta_med] and hutals
22:22:41 [crusher] bye all
22:22:51 [hutals] nite all, c ya tomorrow
22:22:52 crusher exits from this room
22:23:16 hutals exits from this room
22:23:16 [Lorena] yes, but now that i am checking i had to refresh the page so i lost the beginning
22:23:29 [Lorena] oh no
22:23:39 [Lorena] ninad?? are you there?
22:24:08 [Lorena] ninadnashua>
22:24:29 [ninadnashua] 454546
22:24:34 [ninadnashua] ya
22:24:49 [Lorena] do you have the beginning of this chat?
22:24:56 [ninadnashua] what
22:25:05 [ninadnashua] ya
22:25:22 [Lorena] do you know how to post the transcript?
22:25:46 [ninadnashua] please tell me
22:26:31 [ninadnashua] u tell me i will do it
22:40:34 [dr_yasir] tell me how to post i will do it
22:40:40 [jwls29] ok...she's gone
22:40:47 [jwls29] i don't know how
22:40:55 [jwls29] goodnite
22:41:11 [hutals] yep, i was just checking to see if she posted it.....i dont see it so i will post it.....nite
22:43:39 hutals exits from this room
22:43:45 [dr_yasir] ok i am leaving to so bye every one
23:35:38 malumed007 enters this room
23:38:57 crusher exits from this room
--------- The messages that have been sent today start below ---------
04:55:49 soni_pande enters this room
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16:17:05 [emmanueljoshua] hello
16:17:25 [emmanueljoshua] anybody here?
19:59:32 hutals enters this room
20:03:04 jwls29 enters this room
20:03:25 [hutals] hey jwls
20:03:26 ninadnashua enters this room
20:03:27 >[ninadnashua] Welcome to our chat. Please obey the net etiquette while chatting: try to be pleasant and polite.
20:03:37 [jwls29] hi hutals
20:03:48 [hutals] hey nina
20:04:01 [jwls29] hi nina
20:04:29 [ninadnashua] hi
20:05:14 Lorena enters this room
20:05:35 [Lorena] hi everyone
20:05:51 [jwls29] hi lore
20:07:28 [hutals] hey lor
20:08:07 [Lorena] hi jwls hutals ninad
20:08:37 [hutals] i guess ppl will show up late again tonight. i didnt get a chance to post an announcement on other site, so i hope that wont affect attendance tonight
20:09:24 [ninadnashua] hi lorena
20:10:12 [Lorena] we can start if you want
20:11:07 [jwls29] we should start
20:11:31 [hutals] ok, i'm sure other will join later
20:11:57 [hutals] so we're starting with nutrition and then moving to neoplasia....right?
20:12:30 [Lorena] right
20:12:30 [hutals] top 3 causes of death in u.s.?
20:12:56 [Lorena] MI, cancer, stroke
20:13:32 [jwls29] agree
20:13:35 [hutals] heart dz, cancer, stroke is right....good job lor. high fat, low fiber diets contribute to this
20:14:11 [hutals] what is main difference between anorexia nervosa and bulemia?
20:14:32 [jwls29] in anorexia they are underweight
20:14:43 [jwls29] in bulimia they are not necessarily underweight
20:14:48 [Lorena] body weight , in anorexia nervossa is less 15% and bulimia they can be normal or overweight
20:14:53 [jwls29] in anorexia they have distorted body image
20:15:08 [jwls29] not necessarily so in bulimia
20:15:09 [Lorena] agree
20:15:22 [hutals] body image is the main difference where anorexics have disrorted image of themselves regardless of how little they weight. bulemics can have normal body weight and even a little increased
20:15:28 [hutals] good job
20:16:02 [hutals] which one will have osteoporosis? what causes it?
20:16:24 [Lorena] anorexia
20:16:36 [jwls29] anorexia...lack of estrogen
20:16:42 [Lorena] they have decreased strogen
20:17:07 [hutals] anorexics have osteoporosis from the estrogen lack. they will also have secondary amenorrhea from this
20:17:22 [hutals] very good again
20:17:37 [Lorena] how does strogen regulates this? just to remember
20:17:45 [hutals] what is most common cause of death in anorexics?
20:18:02 [jwls29] arrhythmias
20:18:09 [Lorena] cardiac arrythmias
20:18:28 [hutals] yep, cardiac arrythmias
20:18:54 [jwls29] b/c of the loss of body fat there is a decrease in GnRh secretion which leads to low FSH/LH causing low estrogen levels
20:19:22 [hutals] agree with jwls
20:19:34 [Lorena] strogen regulates IL1 (inhibitory) which is the osteoclast activating factor
20:19:45 [Lorena] yes very good
20:20:12 [hutals] same reasoning behind osteoporosis in post menopausal women i think
20:20:31 [Lorena] yes
20:20:31 [jwls29] yes
20:20:43 [hutals] what type of electolyte disturbances seen in bulemics?
20:21:14 [jwls29] hypokalemic metabolic alkalosis
20:21:17 [Lorena] hypokalemia with metabolic acidosis
20:21:29 [jwls29] b/c of the vomiting
20:21:32 [ninadnashua] hypokalemic metabolic alkalosis
20:21:41 [Lorena] sorry alkalosis
20:21:50 [hutals] yep, all correct
20:22:27 [hutals] just one more tid bit on this.....don't give buproprion to bulemics because it can cause seizures
20:22:29 [Lorena] what does alkalosys causes in the Oxygen Hb curve?
20:22:54 [ninadnashua] left sift
20:22:57 [hutals] left shift
20:23:09 [Lorena] thank you huts, didnt know that
20:23:11 [jwls29] agree
20:23:33 [Lorena] yes good
20:23:47 [hutals] i didnt either until i got it wrong on q bank
20:24:39 [hutals] what is considered obese as far as BMI? what about morbidly obese?
20:24:58 [jwls29] >30 bmi
20:25:09 [jwls29] and for morbidly >40
20:25:09 [Lorena] more than 30BMI obese, morbidity is more than 40
20:25:22 [Lorena] how to calculate BMI?
20:25:29 [hutals] yep, both right
20:25:56 [hutals] kg / m squared
20:26:04 [Lorena] yes
20:26:05 [jwls29] weight in kg/height in meters squared
20:26:13 [Lorena]
20:26:50 [hutals] most common complication in obesity?
20:27:07 [jwls29] hypertension
20:27:07 [Lorena] hypertension
20:27:28 [hutals] yep, HTN
20:27:50 [hutals] first treatment of choice for obesity?
20:28:07 [hutals] think cheap as papi says....hint
20:28:15 [jwls29] behavior modification
20:28:27 [Lorena] behavior modification
20:28:33 [jwls29] low calorie diet and exercise
20:28:44 [hutals] yep, behavior modifications like diet and excercise
20:29:15 [hutals] difference between kwashiorkor and marasmus?
20:29:46 [jwls29] kwarshiorkor is decreased protein intake,diet mostly cbh
20:29:58 [Lorena] kwashiorkov decreaed proteins in diet
20:30:00 [jwls29] marasmus is decreased caloric intake
20:30:20 [hutals] kwash is dec protein and marasmus is dec total calories.....good.....which is worse? which has pitting edema?
20:30:21 [Lorena] agree
20:30:46 [Lorena] kwarshiorkov is worse, it has pitting edema for hypoalbuminemia
20:31:06 [jwls29] kwarshiorkor has pitting edema b/c of hypoalbuminemia
20:31:14 [Lorena] why do they have fatty liver?
20:31:32 crusher enters this room
20:31:34 [hutals] if you have dec albumin (protein), you will have pitting edema.....very good......kwash is worse
20:31:38 [jwls29] decreased synthesis of apolipoproteins
20:31:51 [crusher] hello everybody
20:31:55 [jwls29] hi crusher
20:31:58 [hutals] dec apolipoprotens
20:32:03 [Lorena] hi crush
20:32:03 [hutals] hey crush
20:32:15 [crusher] he lorena
20:32:21 [crusher] hey hutal
20:32:27 [Lorena] explain why they have red hair
20:32:41 [jwls29] copper deficiency
20:32:52 [hutals] copper deficiency
20:33:05 [crusher] lack of copper
20:33:21 [Lorena] yes, what does copper do?
20:33:42 [crusher] coper is a co factor
20:34:17 [crusher] for the synthesis of collagen
20:34:32 [hutals] tyrosinase relationship
20:34:49 [Lorena] yes, copper is cofactor for lysil oxidase, it stabilizes collagen
20:35:26 [hutals] i guess tyrosinase relationship would be for the skin depigmentation....oops
20:35:38 [hutals] what vits are likely to be dec in pt with cystic fibrosis? why?
20:36:00 [crusher] allfat soluble vit
20:36:01 [jwls29] a,d,e,k
20:36:08 [jwls29] fat soluble vitamins
20:36:14 [Lorena] fat soluble proteins because cystic fibrosis causes malabsorption
20:36:29 [hutals] pancreatic malabsorption of fat sol vits.....ADEK....very good
20:36:38 [jwls29] yes
20:37:33 [crusher] cos in where these vitamins absorb???
20:37:50 [Lorena] what vit defficiency may be defficient in a ptient with Chron's disease?
20:38:20 [hutals] B12 i think
20:38:42 [Lorena] yes very good hutals
20:38:43 [crusher] where does fat solu vit reabsorb
20:38:54 [hutals] reabsorp of vits are in prox small intest
20:38:57 [crusher] b12 absorb in terminal ileum
20:39:05 [hutals] b12 is in term ilieum
20:39:22 [jwls29] agree
20:39:28 [Lorena] small intestine except vit B12 in terminakl ileum-the most common affected site in Chrons
20:39:48 [hutals] what is the leading cause of blindness worldwide? 2nd? what about in u.s.?
20:39:50 [crusher] what is basic differnec of anorexia and Bulemin by definition
20:40:11 [crusher] us is Dibetes.
20:40:23 [hutals] body image
20:40:42 [jwls29] worlwide it's trachomata
20:41:10 [hutals] us is diabetes. worldwide 1. trichomonis 2. vit A def
20:41:27 [Lorena] thanks hutals
20:41:51 [hutals] isnt that crazy, we can prevent millions of blindness cases with a simple vit pill???
20:42:01 [crusher] its body weight and distorted body image ..anorexia= less than 15% ideal wt n distored image while bulemia both normal
20:43:16 [Lorena] do you remember the serotypes hutals for trachoma?
20:43:18 [hutals] which vit can cause birth defects
20:43:21 [hutals] ?
20:43:41 [Lorena] def folic acid
20:43:46 [crusher] i think vit A overdose
20:44:09 [jwls29] vit a overdose is cerebral edema and papilledema
20:44:17 [jwls29] agree with lorena
20:44:49 [hutals] the answer i was looking for, i think step 1 provided it as a real question, was vit a in the form of retinoic acid given for treatment of acne
20:45:08 [crusher] folate def gluteal with neural tube defect
20:45:10 [jwls29] ah ok
20:45:10 acestep1 enters this room
20:45:39 [jwls29] hi ace
20:45:43 [acestep1] hi guys
20:45:54 [hutals] hey ace
20:45:55 [acestep1] hi jwls
20:46:00 [crusher] hello ace
20:46:09 [Lorena] hi ace
20:46:09 [acestep1] hey hutals
20:46:21 [acestep1] hi lor
20:46:33 [acestep1] hi crush
20:46:42 [Lorena] ok, but in that case they would specify if an overdose or a defficiency in a vitamin
20:46:51 [hutals] i cant remember the serotypes of the top of my head
20:47:34 [acestep1] agree . 1 more pt it treats a wbc cancer as well
20:48:04 [acestep1] i think a-l
20:48:10 [jwls29] ace, can you change your color,please?
20:48:13 [Lorena] serotypes a to C for trachoma
20:48:14 [hutals] i cant remember the question that was given to us, but it said something like which vitamin can cause birth defects? i guess both could depending on choices given and wording
20:48:18 [crusher] follicular hyperkeratosis secondry to squamous metaplasia inhair follicles linked to which vit def
20:48:26 [Lorena] i just looked
20:48:38 [acestep1] oops im really sorry
20:48:51 [hutals] i was way off....i was thinking it was a number instead of letters
20:48:54 [jwls29] vit c
20:48:54 [Lorena] vit A
20:48:56 [acestep1] is it ok now?
20:49:04 [hutals] thanks lor
20:49:13 [acestep1] oh ok
20:49:15 [jwls29] lorena is right
20:49:21 [crusher] lorena ur rite its VIT A def
20:49:21 [Lorena] thank you for bringing that up, now we know
20:49:31 [jwls29] i was thinking of perifollicular hemorrhage which is vit c
20:49:40 [jwls29] better ace, thanks
20:49:54 [acestep1] k:0
20:50:05 [acestep1]
20:50:33 [hutals] what is the most imp source of vit D?
20:50:47 [acestep1] sunlight?
20:51:00 [jwls29] agree with ace
20:51:10 [ninadnashua] ya
20:51:10 [Lorena] sun, UBV
20:51:11 [crusher] squmous metaplasia of straitified columnar epith of of bronchiloes linked to which vit def
20:51:20 [jwls29] vit a
20:51:24 [hutals] yep, sunlight. what about colostrum.....is this a good source of vit D?
20:51:29 [crusher] agree sun light
20:51:33 [acestep1] vit a
20:51:35 [Lorena] agree with jwls
20:52:07 [crusher] i thinlk not its lack vitD.
20:52:10 [hutals] is that vit a crush?
20:52:17 [acestep1] i think yes- hutals
20:52:28 [crusher] yes u all right its vit A
20:52:33 [Lorena] no, not a good sourse of vit D
20:52:43 [jwls29] agree with crusher and lorena
20:53:13 [Lorena] thats hy they recommedn to expose the baby to the sunlight
20:53:21 [hutals] believe it or not, vit D is absent in colostrum of milk. in fact, it is not even in cows milk normally, but is added
20:53:55 [jwls29] where are vitamin d receptors located
20:53:55 [acestep1] ok 1 pt i think if vitA def then u get all kinds of resp d/s like colds ( recurrent) , pneumonitis n lung ca
20:54:46 [crusher] which two reactions in vit D synthesis require Ohlation
20:55:05 [Lorena] small intestine, kidney , osteoblasts
20:55:25 [crusher] agree with lorena
20:55:36 [jwls29] yes
20:55:49 [hutals] crush...is that hydroxylation?
20:56:03 [crusher] yes hyroxylation
20:56:19 [hutals] took me a while to get that one
20:56:36 [Lorena] hepatic and renal hydroxilations before it is 1,25 dihydrocholecalciferol
20:56:51 [hutals] 25 OD D3
20:57:02 [jwls29] 25 hydroxylation occurs in the liver and 1,25 hydroxylation occurs in the kidney
20:57:03 [crusher] one in the live by 25 oHlase and other in kidney by alpha 1 hyroxylase
20:57:06 [acestep1] chol- 25oh chol ( liver) n 1,25 chol- kiney
20:57:13 [hutals] oops thats 25-OH-D3
20:58:25 [Lorena] so in apatient with renal failure, is it effective to give over the counter vit D?
20:58:29 [hutals] what is the most common cause of vit D deficiency?
20:58:56 [acestep1] nosunlite
20:59:02 [hutals] nope lor, because they cant convert it without functioning kidney
20:59:13 [crusher] lack of sunlight
20:59:14 [acestep1] no sunlight imean
20:59:33 [Lorena] yes hutals
20:59:36 [acestep1] agree with hutals
21:00:10 [hutals] that is a cause of vit D deficiency, but MCC according to golijan is chronic renal failure
21:00:15 [Lorena] the same happens with patient with liver insufficiency or cirrhosis
21:00:43 [hutals] other causes?
21:00:44 [acestep1] colostrum is def in which other vit?
21:01:32 [crusher] lab value dec ca inc P inc,,patient patient on renal dialysis what could be the cause
21:01:45 [hutals] vit k??
21:01:50 [Lorena] vit K ace
21:02:31 [crusher] lab value dec ca inc P inc PTH ,, patient on renal dialysis what could be the cause
21:02:48 [crusher] yes dec vit k
21:03:19 [Lorena] renal insufficiency , high phosphate because parathormone is trying to compensate the hypocalcemia
21:03:24 [hutals] chronic renal failure
21:04:39 [acestep1] sorry guys my comp froze. yes v good vita k
21:05:00 [crusher] its cos of lack of alpha 1 Oh lase def cos of renal failure..sec Hpterparthyroism
21:05:00 [hutals] other causes of vit D def include poor diet, malabsorption, liver dz, drugs enhancing p450, hypoPTH, genetic dzs
21:05:10 [acestep1] vit k imean
21:05:40 [hutals] ace, i thought u were just building the suspense
21:05:46 [Lorena] thanks crush
21:06:05 [acestep1] lol . no hutals .
21:06:17 [acestep1]
21:06:19 [hutals] big game hunter presents with headaches....what might be the cause?
21:06:52 [Lorena] ate bear liver-overdose of vit A
21:07:00 [crusher] agree
21:07:33 [acestep1] agree
21:07:33 [jwls29] agree
21:07:37 [hutals] rule out papilledema from inc cranial pressure due to hypervit A tox from eating bear liver.....very good
21:07:47 [crusher] in bone on which cells does pth receptors located
21:08:15 [hutals] osteoblasts
21:08:39 [Lorena] agree
21:09:21 [hutals] what are vit K dependent factors?
21:09:27 sweta_med enters this room
21:09:30 [crusher] yes osteoblast which secrete interleukin 1 which then linked it to osteoclast ,,result in CALCIUM release by activation of PTH
21:09:46 [sweta_med] hi everyone
21:09:46 [hutals] hey sweta
21:09:47 [crusher] 2 7 9 10
21:10:01 [Lorena] hi sweta
21:10:03 [jwls29] protein c and protein s
21:10:07 [sweta_med] are u discussind nutrition
21:10:22 [crusher] yes sweta
21:10:34 [Lorena] what vitamin overdose can cause the deff of another vitamin?
21:10:34 [hutals] yep sweta
21:10:37 [hutals] 2,7,9,10, prot c/s
21:11:06 [hutals] vit E can dec vit k
21:11:22 [crusher] wht will happen to bone reabsorption with inc or dec vit D
21:11:39 [Lorena] good hutals
21:11:46 [acestep1] wow i didnt know tht
21:12:05 [sweta_med] it will increase
21:12:07 [crusher] and osteocalcien another factor form in liver
21:12:22 [sweta_med] with decrease vit d
21:12:40 [acestep1] agree with sweta
21:13:01 [crusher] there is inc bone reabsorption in both inc or dec vit D
21:13:03 [Lorena] bothj decreased or increased will result in loss of bone
21:13:41 [hutals] lor, correct me if i'm wrong, but i think that vit E tox causes bleeding which will basically use up vit k factors and that is how it will have an effect....am i understanding that correctly?
21:13:55 [sweta_med] what would be the cause
21:14:53 [acestep1] ok .yes cuz vit d also cuzes bone resorption by activating osteoclasts in addition to inc the s. intestine absp n kidney absp
21:14:59 [hutals] child presents to ER after eating rat poison. what is intial treatment? why?
21:15:05 [crusher] most common cause of vit D def?
21:15:21 [Lorena] vit E toxicity decreases synthesis of vit K factors, and will result in bleeding but after some days because you still have some coagulation factors around
21:15:22 [hutals] the cause of what sweta?
21:15:37 [hutals] crush, chronic renal failure
21:15:53 [acestep1] vit k - hutals?
21:16:02 [hutals] ok, thanks lor
21:16:03 [Lorena] vitamin K
21:16:07 [sweta_med] the bone resorption in vit d deficiency would be due to PTH
21:16:16 [crusher] yes good hutal renal failure n dc alpha i ohlase def
21:16:16 [Lorena] you are welcome
21:16:34 [jwls29] vitamin k
21:16:57 [hutals] yes, its vit k given IM
21:17:06 [crusher] other cause of vitD def are.....alcolism..liver damage...celiac dis
21:17:17 [hutals] because rat poison contains warfarin
21:17:42 [sweta_med] should heparin be given
21:18:48 [crusher] what would be valus of ca ,P and alk Phosphatse in rickets and osteomalacia????
21:18:50 [hutals] heparin would cause further bleeding, so i dont think it would be good to give it
21:19:13 [hutals] no, i am wrong...sorry
21:19:42 [crusher] rat poision conatin warfarin...anticoagulat so >>>>>>bleeding
21:20:12 [sweta_med] CA and p is lowand alkaline phos is high
21:20:18 [crusher] no donot give heparin............another anticoagiulant
21:20:40 [Lorena] when you want to anticoagulate a patient (post MI for example) you give heparin and warfarin, but not in a warfarin overdose in a normal patient
21:21:00 [hutals] sweta, i'm confused by your question....should hep be given in case of child with rat poison (warfarin).....if that is the question than no because it can cause further bleeding
21:21:33 acestep1 enters this room
21:21:37 [sweta_med] ok but its in the <a target=new HREF=http://www.amazon.com/exec/obidos/external-search?tag=valuetheplace-20&keyword=Goljan&mode=books>Goljan</A> notes that heparin and warfarin shoould be given together
21:21:39 [hutals] but if you mean why give hep with warfarin normally it is because hep will work right away whereas warfarin will take longer
21:22:07 [crusher] sweta u r right in osteomalcia n oricj=ket its deminerlization so dec ca and P. n inc alk phosphate
21:22:49 [sweta_med] i got that thanks
21:23:20 [hutals] yes sweta, they can be given together if you want to prevent clots, but not if you have warfarin toxicity like with child taking rat poinson
21:24:10 [Lorena] in what other disorders is alkaline phosphatase increased?
21:24:31 [sweta_med] tumors of the bone
21:24:45 [crusher] what are the level of Ca.P and alk P in osteoporosis
21:25:18 [ninadnashua] normal
21:25:22 [acestep1] any bone forming patho - lor
21:25:40 [Lorena] yes
21:25:52 [crusher] osteochonroma..sarcoma etc lor
21:25:53 [acestep1] agree with nina
21:26:09 [crusher] yes all normal in osteoporosis
21:26:21 [Lorena] good question crush
21:26:27 [hutals] liver dz, kid normal to be elevated
21:27:21 [hutals] what vit supplement should be given to TB pt be treated?
21:27:31 [acestep1] b6
21:27:39 [Lorena] agree
21:27:41 [sweta_med] pyridoxine
21:27:41 [crusher] b6
21:27:58 [hutals] why B6.....which drug causing deficiency?
21:28:14 [crusher] isoniazid i think lower down b6
21:28:21 [acestep1] otherwise b6 is amde by n. flora i think
21:28:36 [acestep1] made by n.flora
21:28:49 [hutals] Isonizaid (INH) used to treat TB can cause deficiency of B6.....good job
21:28:51 [acestep1] agree with crusher
21:28:52 [Lorena] yes isoniazid
21:28:53 [sweta_med] birth contol pills also
21:29:30 [hutals] yes sweta....also alcoholism and pregnancy
21:29:37 [sweta_med] what are the ymotoms
21:29:45 [sweta_med] ji mean symptoms
21:29:59 [Lorena] sideroblastic anemia, cheilosis, stomatitis
21:30:22 [sweta_med] peripheral neuropathy,
21:30:27 [hutals] sideroblastic anemia, convulsions
21:30:37 [hutals] neuropathy
21:31:19 [hutals] interesting.....convulsions seen in both B6 deficiency and toxicity
21:31:19 [ninadnashua] what is brown bowel syndrome
21:31:47 [sweta_med] the deposition of lipofuscin
21:31:52 [Lorena] what else cause sideroblastic anemia?
21:32:13 [ninadnashua] ya in cystic fibrosis
21:32:17 [jwls29] seen in CF and due an increase in liprofuscin from increased lipid peroxidation
21:32:18 [acestep1] lead
21:32:20 [Lorena] agree with sweta but dont remember secondary to what?
21:32:34 [Lorena] thanks
21:32:36 [ninadnashua] ya
21:32:40 [hutals] lead
21:32:45 [Lorena] yes ace very good
21:32:54 [ninadnashua] vit e
21:33:10 [ninadnashua] defieceincy
21:33:16 [acestep1] thanks
21:33:22 [sweta_med] yes agree
21:33:44 [hutals] eating raw eggs can cause a deficiency in what?
21:33:55 [acestep1] biotin
21:34:08 [sweta_med] biotin
21:34:14 [ninadnashua] true
21:34:16 [Lorena] yes
21:34:31 [hutals] yep biotin.....what is a sign that can be seen with this?
21:35:06 [Lorena] alopecia
21:35:07 [acestep1] dont remb
21:35:14 [ninadnashua] mcc of vitk defeieiency
21:35:15 [sweta_med] alopecia
21:35:21 [hutals] alopecia is right
21:35:40 [hutals] antibiotics
21:35:50 [acestep1] antibiotics?
21:35:57 [sweta_med] antibiotics
21:35:40 [hutals] antibiotics
21:35:50 [acestep1] antibiotics?
21:35:57 [sweta_med] antibiotics
21:36:18 [jwls29] i have to go...goodnight all....see you tomorrow
21:36:30 [ninadnashua] ya
21:36:33 [sweta_med] bye jwls
21:36:38 [Lorena] see you tomorrow jwls
21:36:46 [acestep1] bye jwls
21:36:46 [hutals] nite jwls
21:36:55 [acestep1] tc
21:36:57 [jwls29] bye
21:37:12 [sweta_med] what essential amino acid is needed for niacin formation
21:37:29 [Lorena] tryptophan
21:37:41 [acestep1] ok . 1 q y in b6 def u see neuropathy
21:37:49 [sweta_med] yes
21:37:53 [acestep1] agree with lor
21:38:03 [hutals] tryptophan
21:38:08 [hutals] patient eating lots and lots of corn can have what symprtoms?
21:38:17 [Lorena] what if the patient has phenylketonurya? what aminoacid then?
21:38:19 [sweta_med] pellagra
21:38:37 [acestep1] b6 - fits
21:38:49 [sweta_med] aspartic acid
21:38:56 [Lorena] pellagra the 5 D's
21:38:58 [acestep1] tyrosine
21:39:05 [hutals] ace, i think because B6 involved in neurotransmitter synthese
21:39:21 [crusher] tyrosine
21:39:27 [Lorena] yes ace good job
21:39:56 [Lorena] and crush
21:39:57 [hutals] hmmmm.....i only know of 4 D's.....diarrhea, dementia, dermatitis, death
21:40:00 [acestep1] no d-ALA accumulatesn it is neurotoxic i think
21:40:15 [acestep1] thanks lor
21:41:06 [Lorena] the 5 D is D-ehydrogenases for the ez that requiere niacin as cofactor
21:41:09 [crusher] in wilson disearw what level of ceruloplasin free cU and total copper,explain also plz???
21:41:21 [hutals] ok, thanks lorena
21:41:26 [acestep1] k
21:41:49 [sweta_med] i want to know the question crusher
21:42:22 [hutals] in wilsons, you will have low ceruloplasim, low total copper, and high free copper
21:42:37 [crusher] in wilson diseae wht the level of ceruloplasmin,,Free Cu+2,total cu?
21:42:48 [acestep1] dec ceruloplasm- genetic defect - inc free cu which binds 2 liver n hepatotoxic
21:43:35 [acestep1] and is hepatotoxic imean cirrhosis
21:44:14 [ninadnashua] total cu les but free more
21:44:30 [Lorena] low total copper because you only measure the bound one hutals?
21:44:59 [acestep1] dm pts lack which trace element
21:45:00 [sweta_med] whta are the symptoms of zn deficiency
21:45:07 [crusher] wilson Dz is AR diseas in which there is DEFECTIVE EXCRETION CU into BILE ..from chronic levr dz.DEc ceruloplasim(low copper level)Bcoz synthesis in liver......inc free cupper that deposit in eye give kaysers fleisher rings
21:45:35 [acestep1] agree
21:45:51 [sweta_med] yes aree
21:46:06 [Lorena] poor wpund healing, taste decreases and anosmia
21:46:10 [crusher] but i donot understand why total dec n free inc can some one explain?
21:46:31 [sweta_med] yes lor
21:46:32 [acestep1] agree - lor
21:46:53 [acestep1] dm pts lack zn
21:47:18 [sweta_med] rash around the mouth , growthn ertardation and hypogonadism
21:47:24 [acestep1] which trace element will dec hyeprglycemia
21:47:56 [Lorena] chromium
21:48:22 ggg enters this room
21:48:23 [acestep1] v good lor
21:48:42 [Lorena] chromium increases glucose uptake by insulin
21:48:55 [Lorena] thanks ace
21:48:59 [acestep1] trace element for hair colour?
21:49:12 [acestep1] yes
21:49:14 [hutals] low ceruloplasmin levels with subsequent increase in free copper in blood. But that will be less total copper (bound) which is the one that is measured. but dont be fooled because the free is the one that really matters
21:49:34 [ninadnashua] thiamine defeceiency related to what
21:49:34 [Lorena] copper?
21:50:08 [crusher] sweta zinc >>>ans
21:50:12 [acestep1] execellent lor
21:50:24 [hutals] hey ggg
21:50:29 [acestep1] excellent imean
21:50:31 [Lorena] thiamine deficiency is common in alcoholics
21:50:35 [sweta_med] copper
21:50:48 [crusher] korsakof physosis,,wernikes enceph...ninad
21:50:53 [acestep1] agree. also dry n wet berri berri
21:51:04 [crusher] cu related to hair changes
21:51:04 [ggg] hi all
21:51:06 [ninadnashua] yes also atp defeieceiency
21:51:13 [sweta_med] nystagmus, confusion, ataxia
21:51:38 [acestep1] alos memory loss
21:51:50 [ninadnashua] ya wet dry beriberi
21:51:57 [acestep1] yes - crush
21:52:11 [hutals] pt given IV glucose and develops wernicke's encephalopathy.....why?
21:52:22 [ninadnashua] ya
21:52:26 [Lorena] also seen in kwarshirokor-red hair for lack of copper
21:52:27 [acestep1] no b1
21:52:45 [acestep1] agree with lor
21:52:48 [sweta_med] glucoses uses up the thiamine
21:53:05 [Lorena] glucose precipitated thiamine deficiency because it was used in glycolysis a cofactor for pyruvate dehydrogenase
21:53:10 [sweta_med] for pyruvate formation
21:53:19 [crusher] agree
21:53:30 [acestep1] i think in alco u need b1 pyrophos
21:53:31 [hutals] always infuse IV thiamine before giving pt glucose because glucose is converted to pyr and pyr to acetyl CoA which uses up thiamine and precipitates attack.....excellent
21:53:33 [crusher] two reactions require thiamine as a co factor
21:53:58 [sweta_med] pyrvate dehydroge
21:54:19 [acestep1] 3 i think
21:54:19 [sweta_med] and alpha keto glutarate dehydro
21:54:26 [Lorena] actually 3 reactions
21:54:43 [acestep1] n transketolase?
21:54:46 [sweta_med] also alpha keto acid dehdrogenase
21:54:54 [hutals] pyr DH, alpha ketoglutarate DH, alpha keto acid DH
21:54:57 [crusher] transketolase and pyruvate to acetyl coa...(tender loving care for nancy) co factors.
21:55:00 [Lorena] also tranketolase in HMP shunt
21:55:21 [crusher] very good all
21:55:21 [hutals] RBC transketolase
21:55:32 [acestep1] agreee
21:55:34 [Lorena] excellent crush
21:55:58 [ninadnashua] ya
21:56:04 [hutals] we should probably discuss a little neoplasia....what do you think?
21:56:04 [crusher] if there is def of thiamine what will happen in reaction of pyruvate to acetyl coa..what product will form?
21:56:26 [Lorena] NADH
21:56:40 [acestep1] lactate?
21:56:43 [crusher] the reaction will divert to form DHAP.
21:56:55 [sweta_med] lactate
21:57:26 [crusher] what does DHAP gives u?
21:57:55 [sweta_med] i will be back pl continue
21:57:57 [Lorena] glycerol 3P
21:58:08 [acestep1] k
21:58:25 [acestep1] agree
21:58:37 [crusher] very good lor,,and Glycerol 3 phosphate is a back bone of???
21:58:49 [Lorena] thats wht fatty liver?
21:59:11 [crusher] excellent!!!!!
21:59:16 [Lorena] thats why...right? tryglycerides accumulate
21:59:29 [crusher] thats why alcoholic have fatty liver
21:59:51 [Lorena]
22:00:22 [Lorena] thanks crush
22:00:35 [crusher] u welcome
22:01:26 [Lorena] do you guys want to move to neoplasia?
22:01:39 [crusher] sure
22:01:51 [hutals] sure
22:01:51 [hutals] sure
22:02:10 [acestep1] wait wait wht happens in floride toxicity
22:03:17 [Lorena] teeth get mottled and calcification in ligaments and tendons which is visible in xr
22:03:22 [acestep1] u guys there
22:03:24 [ninadnashua] folate vitamin b12 defieceincy
22:03:49 [acestep1] excellent lor also ligament rupture
22:04:15 [Lorena] thanks ace
22:04:57 [Lorena] folate and B12 def cause megaloblastic anemia - and vit b12 also cause neurological symptoms
22:05:17 [ninadnashua] ya
22:05:18 [acestep1] agree
22:05:34 [crusher] agree
22:05:47 [acestep1] also heyperseg pmn n dec plts
22:05:56 [Lorena] in whci one you have methilmalonic aciduria?
22:06:04 [acestep1] causes of folate def
22:06:32 [crusher] what is the co factor in glutathione peroxidase
22:06:35 [acestep1] b6 /12
22:06:41 [crusher] lack of green veg
22:06:51 [acestep1] se- crush
22:07:00 [crusher] b12 def
22:07:09 [crusher] yes ans is selinium def
22:07:41 [Lorena] pregnancy
22:08:20 [crusher] folate are present in green vegtables
22:08:28 [acestep1] yes
22:08:38 [acestep1] v good lor
22:08:42 [crusher] and also yes pregnacy require more amount of folate
22:09:01 [acestep1] also alcoholics , elderly ppl
22:09:30 [Lorena] alcoholics but not if they drink beer
22:09:47 [crusher] where does folate reabsorb
22:10:02 [acestep1] also in malabsp d/s -folate
22:10:16 [acestep1] s.intestine?
22:10:29 [Lorena] agree
22:10:37 [crusher] jejunem
22:10:55 [acestep1] k
22:11:01 [hutals] i seem to be having computer problems.....my computer froze and i won't be able to post transript. can someone else post transcript tonight?
22:11:18 [Lorena] i will
22:12:01 [hutals] if i become silent all of a sudden, its because it froze again
22:12:07 [acestep1] hey guys i gtg
22:12:11 [hutals]
22:12:15 [acestep1] k
22:12:34 [acestep1] see u guys later
22:12:39 [hutals] nite ace....c ya tomorrow
22:12:46 [Lorena] dont worry hutals , you will read the transcript later
22:12:51 [crusher] name some reactions Cu require as a co factor
22:13:01 [crusher] good night ace
22:13:02 [Lorena] see yuo tomorrow ace
22:13:24 [acestep1] yes . sure
22:13:40 [Lorena] lysil oxiodase for collagen stabilization
22:13:43 [acestep1] gn crush
22:14:34 [crusher] lysl oxidase.......SOD.....tyrosinase...cytochrome c oxidase
22:14:41 [crusher] gn ace
22:14:44 [ninadnashua] cytochrome c in ets
22:15:02 [crusher] yes ninad
22:15:22 [Lorena] i didnt remember the rest, thanks
22:16:09 [ninadnashua] cancer cause in us
22:16:14 [hutals] i just figured out the reason for the copper levels in wilsons. the bound copper is actually bound to ceruloplasmin, so a decrease in ceruloplamin would mean a decrease in bound copper. if less is bound, that would have to mean that more is free because it has less to bind to. make sense?
22:16:44 [Lorena] thank you hutals
22:16:58 [crusher] thanks hutal
22:17:04 [ninadnashua] cause is relate to smoking
22:17:12 [Lorena] lung cancer
22:17:28 [ninadnashua] ya
22:17:36 [hutals] no prob....it finally makes sense to me
22:17:55 [sweta_med] age related cancers?
22:18:09 [Lorena] kids Leukemia
22:18:20 [crusher] proste Ca.....old age
22:18:21 [hutals] prostate
22:18:29 [sweta_med] breast,prostrayte
22:18:58 [sweta_med] which leukemia inkids?
22:19:14 [crusher] ALL
22:19:20 [hutals] ALL my children
22:19:26 [sweta_med] yes
22:19:31 [Lorena] agree
22:19:41 [ninadnashua] what is seen in picture of sq ca
22:19:46 [sweta_med] CLL in adults
22:19:51 [hutals] mneumonic is the soap opera "ALL my children"
22:19:56 [sweta_med] keratin pearls
22:20:26 [Lorena] ok
22:20:32 [ninadnashua] ya
22:20:54 [Lorena] guys i have to go, i will post transcript until here , can someone post the rest?
22:21:22 [sweta_med] what ate the oncogenes for breast cancer
22:21:23 [hutals] i have to go to.
22:21:24 [Lorena] hutals? hopefully if you dont have more computer problems?
22:21:31 [crusher] i got to leave too
22:21:37 [Lorena] oh ok
22:22:01 [Lorena] see you tomorrow , take care
22:22:09 [crusher] i think most of us leaving
22:22:09 [sweta_med] ok bye lorena and crusher
22:22:17 [crusher] bye lorena
22:22:23 [crusher] see ya t,m
22:22:27 [hutals] ok lorena, you will post transcript up to now?
22:22:28 [sweta_med] and hutals
22:22:41 [crusher] bye all
22:22:51 [hutals] nite all, c ya tomorrow
22:22:52 crusher exits from this room
22:23:16 hutals exits from this room
22:23:16 [Lorena] yes, but now that i am checking i had to refresh the page so i lost the beginning
22:23:29 [Lorena] oh no
22:23:39 [Lorena] ninad?? are you there?
22:24:08 [Lorena] ninadnashua>
22:24:29 [ninadnashua] 454546
22:24:34 [ninadnashua] ya
22:24:49 [Lorena] do you have the beginning of this chat?
22:24:56 [ninadnashua] what
22:25:05 [ninadnashua] ya
22:25:22 [Lorena] do you know how to post the transcript?
22:25:46 [ninadnashua] please tell me
22:26:31 [ninadnashua] u tell me i will do it