tag:blogger.com,1999:blog-68528054094669414232024-03-28T13:14:41.276+05:45Biochemistry Class notesThis blog is useful for all who is concerned with Biochemistry.A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.comBlogger398125tag:blogger.com,1999:blog-6852805409466941423.post-25291580616942328752016-05-24T09:13:00.002+05:452016-05-24T09:13:42.716+05:45Cardiac Troponin I (cTnI) assay by immunochromatography method: Principle, Procedure, Interpretation and results<div dir="ltr" style="text-align: left;" trbidi="on">
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<b><u><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">Rapid Assay for detection of Human Cardiac Troponin I (<span style="letter-spacing: -.15pt;">cTnl)</span> in Serum/Plasma & Whole Blood by
ImmunoChromatography<o:p></o:p></span></u></b></div>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhK1ZCTDoMD86b1yo3lBRk-uuSJuZWxaBvVuZ5mMdmV8rBNCNW7_uqBvLJu5GFKX2JTz-THojD4NlUSCMv6jyvZBPa-fELWCY9MKpAEuo5SF4POjY581F_X4NAX1eEsGJ_ENvOusleJxRHt/s1600/troponin+kit.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="275" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhK1ZCTDoMD86b1yo3lBRk-uuSJuZWxaBvVuZ5mMdmV8rBNCNW7_uqBvLJu5GFKX2JTz-THojD4NlUSCMv6jyvZBPa-fELWCY9MKpAEuo5SF4POjY581F_X4NAX1eEsGJ_ENvOusleJxRHt/s320/troponin+kit.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. Troponin I kit showing Positive result</td></tr>
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<b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">Principle:<u><o:p></o:p></u></span></b></div>
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<span style="font-size: 12.0pt; letter-spacing: -.05pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">This test utilizes the principle of
immunochromatography, with a unique two-site sandwich </span><span style="font-size: 12.0pt; letter-spacing: -.1pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">immunoassay on a nitrocellulose membrane. The conjugate
pad contains two components </span><span style="font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">- <span style="letter-spacing: -.05pt;">monoclonal
anti-cTnl </span><span style="letter-spacing: .1pt;">conjugated to colloidal gold
and rabbit IgG conjugated to colloidal gold. As the test sample flows through
the </span><span style="letter-spacing: -.1pt;">membrane assembly of the device,
the highly specific anti-cTnl antibody </span>- <span style="letter-spacing: -.1pt;">colloidal gold conjugate complexes with </span><span style="letter-spacing: .15pt;">cTnl in the sample and travels on the membrane due to capillary action
along with rabbit IgG-colloidal gold </span><span style="letter-spacing: -.05pt;">conjugate.
This sample moves further on the membrane to the test region (T) where it is
immobilized by another </span><span style="letter-spacing: -.1pt;">specific
anti-cTnl antibody coated on the membrane leading to the formation of a
pink-purple band. A detectable </span><span style="letter-spacing: -.15pt;">colored
band is formed if cTnl level is equal to or greater than 0.1 ng/ml. The absence of this colored
band in the test region indicates cTnl concentration < 0.1 ng/ml.<o:p></o:p></span></span></div>
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<span style="font-size: 12.0pt; letter-spacing: -.1pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;"></span></div>
<a name='more'></a>The rabbit IgG-colloidal gold conjugate and unbound
complex, if any, moves further to the reference region (R) that contains
pre-calibrated anti rabbit IgG antibodies, corresponding to 1 ng/ml cTnl, immobilized
on the membrane. <span style="font-size: 12.0pt; letter-spacing: -.05pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">The intensity of the
pink purple colored band at the reference region (R) corresponds to a cTnI
concentration of </span><span style="font-size: 12.0pt; letter-spacing: .05pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">1 ng/ml. The reference
band would form even in a negative specimen. Semi-quantitative information
about the </span><span style="font-size: 12.0pt; letter-spacing: -.15pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">concentration of cTnl can be deduced by
comparing the intensity of the test band against the reference band. If the </span><span style="font-size: 12.0pt; letter-spacing: -.05pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">intensity of test band is less than the reference band,
cardiac Troponin I (cTnI) concentration is equal to or above </span><span style="font-size: 12.0pt; letter-spacing: -.1pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">0.1 ng/ml and less than 1 ng/ml. If the intensity of the
test band is equal to or greater than reference band, cardiac </span><span style="font-size: 12.0pt; letter-spacing: -.15pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">Troponin I (cTnl) concentration is equal to or greater than
1 ng/ml. The unreacted conjugate along with unbound complex if any, move
further on the membrane and are subsequently </span><span style="font-size: 12.0pt; letter-spacing: -.05pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">immobilized by the anti-rabbit antibodies coated on the membrane at the
control region </span><span style="font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">(C), <span style="letter-spacing: -.05pt;">forming a pink-purple
</span><span style="letter-spacing: -.15pt;">colored band. This control band acts
as a procedural control and serves to validate test results.<o:p></o:p></span></span><br />
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<b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"><br /></span></b></div>
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<b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">Specimens: </span></b><span style="font-family: "times new roman" , serif; font-size: 12pt;">Serum</span></div>
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<b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">Materials (All available in kit)<o:p></o:p></span></b></div>
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<br /></div>
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<span style="font-size: 12.0pt; letter-spacing: -.1pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">A. Individual pouches each containing</span><span style="font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;"><o:p></o:p></span></div>
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</div>
<ol>
<li><span style="font-size: 12pt; letter-spacing: -0.1pt; text-indent: -7.2pt;">Test device: Membrane assembly predispensed with
monoclonal anti-cTnI colloidal gold conjugate, rabbit IgG </span><span style="font-size: 12pt; letter-spacing: 0.1pt; text-indent: -7.2pt;">colloidal gold conjugate, monoclonal anti- cTnI antibody
and anti-rabbit antiserum coated at the respective </span><span style="font-size: 12pt; text-indent: -7.2pt;">regions.</span></li>
<li><span style="font-size: 12pt; letter-spacing: -0.05pt;">Desiccant pouch.</span></li>
<li><span style="font-size: 12pt; letter-spacing: -0.15pt;">Sample dropper.</span></li>
</ol>
<span style="font-size: 12pt; letter-spacing: -0.15pt; text-indent: -7.2pt;">B. Sample Running buffer in a dropper bottle.</span><br />
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<span style="font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">C. Package insert. <o:p></o:p></span></div>
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<b><span style="font-size: 12.0pt; letter-spacing: -.1pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">PROCEDURE & INTERPRETATION OF RESULTS:</span></b></div>
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<b><span style="font-size: 12.0pt; letter-spacing: -.1pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;"><br /></span></b></div>
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<span style="font-family: "times new roman" , serif; font-size: 12pt; letter-spacing: 0.1pt;">1. </span><span style="font-family: "times new roman" , serif; font-size: 12pt; letter-spacing: -0.2pt;">Bring the Core Troponin I-
kit components to room temperature before testing.</span></div>
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<span style="font-family: "times new roman" , serif; font-size: 12pt; letter-spacing: 0.05pt;">2. </span><span style="font-family: "times new roman" , serif; font-size: 12pt; letter-spacing: -0.15pt;">Open the pouch by tearing
along the notch.</span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">3. Retrieve the device,
sample dropper and desiccant. Check the </span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">color</span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"> of the desiccant. It
should be blue. If it has turned </span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">colorless</span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"> or pink, discard
the device and use another device.</span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt; letter-spacing: -0.2pt;"><o:p></o:p></span></div>
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<span style="font-size: 12.0pt; letter-spacing: -.05pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">4. </span><span style="font-size: 12.0pt; letter-spacing: -.15pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">Once
opened the device must be used immediately.<o:p></o:p></span></div>
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<span style="font-size: 12.0pt; letter-spacing: -.15pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">5. Tighten the vial cap of the sample
running buffer provided with the kit in clockwise direction to pierce the </span><span style="font-size: 12.0pt; letter-spacing: .1pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">pierce the </span><span style="font-size: 12.0pt; letter-spacing: -.1pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">dropper
bottle nozzle.</span><span style="font-size: 12.0pt; letter-spacing: -.15pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;"><o:p></o:p></span></div>
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<span style="font-size: 12.0pt; letter-spacing: .05pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">6. </span><span style="font-size: 12.0pt; letter-spacing: -.15pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">Label
the device with specimen identity.<o:p></o:p></span></div>
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<span style="font-size: 12.0pt; letter-spacing: -.05pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">7. </span><span style="font-size: 12.0pt; letter-spacing: -.15pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">Place
the testing device on a flat horizontal surface.<o:p></o:p></span></div>
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<span style="font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">8.<span style="letter-spacing: -.15pt;"> Holding the sample dropper
vertically, carefully dispense four </span><b><span style="letter-spacing: -.05pt;">(4) drops </span></b><span style="letter-spacing: -.1pt;">of serum/plasma/whole blood into the </span><span style="letter-spacing: .05pt;">sample port 'A'<o:p></o:p></span></span></div>
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<span style="font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">9. <span style="letter-spacing: .2pt;">Add four (4) </span><b>drops </b><span style="letter-spacing: -.15pt;">of
sample running buffer in buffer port 'B'. 10. At the end of 15 minutes read
result as the diagram given in the kit protocol.<o:p></o:p></span></span></div>
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<br /></div>
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<b><span style="font-size: 12.0pt; letter-spacing: -.1pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">Discussion:<o:p></o:p></span></b></div>
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<b><span style="font-size: 12.0pt; letter-spacing: -.1pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;"><br /></span></b></div>
<div class="Style1" style="text-align: justify;">
<span style="font-size: 12.0pt; letter-spacing: -.05pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">Discovered by <i>Ebashi,</i> Troponins are regulatory proteins in cardiac muscle that
modulate the interaction between actin and myosin, during the calcium-mediated
contraction of cardiac muscle. Three distinct tissue specific </span><span style="font-size: 12.0pt; letter-spacing: -.1pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">isoforms of Troponin I have been identified, two in
skeletal muscle and one in cardiac muscle. The cardiac isoform </span><span style="font-size: 12.0pt; letter-spacing: -.05pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">of Troponin I (cTnl) has an additional sequence of 31
amino acids at the N terminal end that accounts for cardiac </span><span style="font-size: 12.0pt; letter-spacing: -.15pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">specificity, with a molecular weight of 22.5 kDa. This
absolute specificity of Troponin I for cardiac tissue makes it an </span><span style="font-size: 12.0pt; letter-spacing: -.1pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">ideal biomarker for myocardial injury.<o:p></o:p></span></div>
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<span style="font-size: 12.0pt; letter-spacing: -.1pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;"><br /></span></div>
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<span style="font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">Clinical study results have demonstrated that elevated serum
levels of cardiac Troponin I (cTnl) are detectable <span style="letter-spacing: -.05pt;">within 4 to 6 hours after the onset of chest pain, reach peak
concentration in approximately 12 hours and remain elevated for 3-10 days
following acute myocardial infarction. Thus cardiac Troponin I (cTnI) meets the
entire criterion </span><span style="letter-spacing: -.15pt;">laid down by
National Academy of Clinical Biochemistry (NACB) for an ideal cardiac biomarker
in early identification </span><span style="letter-spacing: -.1pt;">and risk
stratification of patients with chest pain suggestive of ischemia and
identification of patients that present </span><span style="letter-spacing: -.05pt;">after infarction.<o:p></o:p></span></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt; letter-spacing: 0.15pt;">Immediately after a cardiac event, the damaged
myocardial cells start releasing cardiac Troponin I (cTnl) in </span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt; letter-spacing: -0.3pt;">circulation and their level
rises in a time specific manner. Since patients present at varying </span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">times-for <span style="letter-spacing: -.1pt;">testing
following </span><span style="letter-spacing: -.05pt;">the onset of chest pain in
a cardiac event, it is necessary to perform sequential testing for optimal
diagnostic accuracy.<o:p></o:p></span></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"><span style="letter-spacing: -.05pt;"><br /></span></span></div>
<br />
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<span style="font-size: 12.0pt; letter-spacing: -.1pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;">A protocol for measuring cardiac Troponin
I (cTnl)</span><span style="font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-no-proof: no;"> <span style="letter-spacing: -.2pt;">levels requires testing at
admission or 3 hours after onset of chest </span><span style="letter-spacing: -.05pt;">pain and at 6 and 9 hours. Modification may be necessary depending upon
specific clinical situation. Hence </span>sequential testing of cardiac
Troponin I (cTnl), together with ECG results and patient history and symptoms
are <span style="letter-spacing: -.15pt;">necessary for differential diagnosis
between acute myocardial infarction and unstable angina pectoris. </span><span style="letter-spacing: -.2pt;">The positive and negative likelihood ratios
correspond to the clinical concepts of ruling in and ruling out disease. Thus,
a higher positive likelihood ratio means that a test result is better for
ruling in disease when positive, and a </span><span style="letter-spacing: -.15pt;">lower
negative likelihood ratio means that a test result is better for ruling out
disease when negative. Examination of </span><span style="letter-spacing: -.1pt;">likelihood
ratios reveals that levels of cardiac Troponin I (cTnl) are very useful at
ruling out AMI when the value is </span>negative at 10 or more hours from the
onset of chest pain. However, a negative test value early in the course of <span style="letter-spacing: -.15pt;">episode of chest pain does very little to reduce
the likelihood of AMI. A positive cardiac Troponin I (cTnl) value after 6 </span><span style="letter-spacing: .05pt;">or more hours after the onset of chest pain
appears to be very useful at ruling in AMI. Thus a negative cardiac </span><span style="letter-spacing: -.2pt;">Troponin I (cTnl) level identifies patient at low
risk for adverse cardiac events.</span></span></div>
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<br /></div>
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(Source: Information from Kit and clinical chemistry textbook)</div>
</div>A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-14750210945772311832016-02-28T13:12:00.000+05:452016-02-28T13:22:45.388+05:45BCR/ABL1 Testing: Introduction, indications, methods and interpretation<div dir="ltr" style="text-align: left;" trbidi="on">
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<blockquote class="tr_bq">
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJrBXrBLsMALlwGze6Jh8zOV031CjXfMaNOVhwYJGHhiP9IFjnVxnMBcaRqRmVV59SmlqGGtESNXBXjmcBE9CE59oIZ8-PFW_oVrZ9Si0eEX-kflpxwY8wRK1ACWlB7HIqoqr0UgXZHcXu/s1600/bcr+abl+fusion+gene.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="278" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJrBXrBLsMALlwGze6Jh8zOV031CjXfMaNOVhwYJGHhiP9IFjnVxnMBcaRqRmVV59SmlqGGtESNXBXjmcBE9CE59oIZ8-PFW_oVrZ9Si0eEX-kflpxwY8wRK1ACWlB7HIqoqr0UgXZHcXu/s400/bcr+abl+fusion+gene.jpg" title="" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. BCR-ABL1 fusion gene (Philadelphia chromosome)</td></tr>
</tbody></table>
</blockquote>
<div class="MsoNormal" style="background: white; line-height: 16.5pt; text-align: justify;">
<em style="line-height: 16.5pt;"><b>BCR-ABL1</b></em><span class="apple-converted-space" style="line-height: 16.5pt;"> </span><span style="line-height: 16.5pt;">refers to a</span><span class="apple-converted-space" style="line-height: 16.5pt;"> </span><span class="popup-note" style="line-height: 16.5pt;">gene</span><span class="apple-converted-space" style="line-height: 16.5pt;"> </span><span style="line-height: 16.5pt;">sequence</span><span class="apple-converted-space" style="line-height: 16.5pt;"> </span><span style="line-height: 16.5pt;">found in an abnormal</span><span class="apple-converted-space" style="line-height: 16.5pt;"> </span><span style="line-height: 16.5pt;">chromosome</span><span class="apple-converted-space" style="line-height: 16.5pt;"> </span><span style="line-height: 16.5pt;">22 of some people with certain forms
of leukemia. Unlike most cancers, the cause of</span><span class="apple-converted-space" style="line-height: 16.5pt;"> </span><span style="line-height: 16.5pt;">chronic myelogenous leukemia (CML)</span><span class="apple-converted-space" style="line-height: 16.5pt;"> </span><span style="line-height: 16.5pt;">and some other leukemias can be traced
to a single, specific genetic abnormality in one chromosome. The presence of
the gene sequence known as</span><span class="apple-converted-space" style="line-height: 16.5pt;"> </span><em style="line-height: 16.5pt;"><b>BCR-ABL1</b></em><span class="apple-converted-space" style="line-height: 16.5pt;"> </span><span style="line-height: 16.5pt;">confirms the diagnosis of CML and a
form of</span><span class="apple-converted-space" style="line-height: 16.5pt;"> </span><span style="line-height: 16.5pt;">acute lymphoblastic
lymphoma (ALL). </span><b style="line-height: 16.5pt;">Chronic myelogenous leukemia (CML)</b><span style="line-height: 16.5pt;"> is part of a group of
diseases called the myeloproliferative disorders, with an estimated 4600 newly
diagnosed cases and 850 deaths in 2005. More than 95% of patients with CML have
the distinctive <b>Philadelphia chromosome (Ph1)</b> that results from a reciprocal
translocation between the long arms of </span></div>
<a name='more'></a>chromosomes 9 and 22. The translocation
involves the transfer of the Abelson (ABL) gene on chromosome 9 to the
breakpoint cluster region (BCR) of chromosome 22, resulting in a fused BCR-ABL
gene. The fusion gene produces a protein, p210 (b2a2 and b3a2), a tyrosine
kinase with deregulated activity that plays a key role in the development of
CML.<br />
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<span style="line-height: 16.5pt;"><br /></span></div>
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<o:p></o:p></div>
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Humans have 23 pairs of chromosomes
containing inherited genetic information. Those<span class="apple-converted-space"> </span>genes<span class="apple-converted-space"> </span>contain the blueprints, in the form of<span class="apple-converted-space"> </span>DNA, for producing the<span class="apple-converted-space"> </span>proteins<span class="apple-converted-space"> </span>that our bodies rely on to function
properly. While some genetic abnormalities are inherited, they can also come
from changes that occur to genes or chromosomes after a person is born. This
can happen through exposure to various environmental factors (e.g., radiation,
certain chemicals) but more often for unknown reasons.<o:p></o:p></div>
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<br /></div>
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The<span class="apple-converted-space"><i> </i></span><em>BCR-ABL1</em><span class="apple-converted-space"> </span>gene sequence is one such acquired
change that is formed when pieces of chromosome 9 and chromosome 22 break off
and switch places. When this occurs, the ABL1 region in chromosome 9 fuses with
the BCR gene region in chromosome 22. This type of change is called a
reciprocal<span class="apple-converted-space"> </span>translocation<span class="apple-converted-space"> </span>and is often abbreviated as <b>t(9;22).</b>
The resulting chromosome 22 that has the<span class="apple-converted-space"> </span><em>BCR-ABL1</em><span class="apple-converted-space"> </span>gene sequence is known as the <b>Philadelphia
(Ph) chromosome</b> because that is where it was first discovered.<o:p></o:p></div>
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<br /></div>
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The resulting Philadelphia
chromosome or<span class="apple-converted-space"> </span><em>BCR-ABL1</em><span class="apple-converted-space"> </span>gene encode an abnormal protein that
is responsible for the development of CML and a type of ALL. At diagnosis,
90-95% of cases of CML show a characteristic t(9;22)<span class="apple-converted-space"> </span><em>BCR-ABL1 </em>reciprocal
chromosomal translocation. About one in four adults with ALL have the translocation.<o:p></o:p></div>
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<br /></div>
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The protein formed by<span class="apple-converted-space"> </span><em>BCR-ABL1</em><span class="apple-converted-space"> </span>is a type of<span class="apple-converted-space"> </span>enzyme<span class="apple-converted-space"> </span>called a<span class="apple-converted-space"> </span><b>tyrosine kinase</b>. That enzyme is
<b>responsible for the uncontrolled growth of leukemic cells</b>. When large
numbers of abnormal leukemic cells start to crowd out the normal blood cell<span class="apple-converted-space"> </span>precursors<span class="apple-converted-space"> </span>in the<span class="apple-converted-space"> </span>bone marrow, signs and symptoms of
leukemia start to emerge. Treatment of these leukemias typically involves a<span class="apple-converted-space"> </span><b>tyrosine kinase inhibitor (TKI).<o:p></o:p></b></div>
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<br /></div>
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<span style="font-family: "times new roman" , serif; font-size: 12pt;">Testing for <i>BCR-ABL1</i> detects the Philadelphia
chromosome and <i>BCR-ABL1</i> fusion gene or its transcripts, which
are the </span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">RNA copies
made by the cell from the abnormal stretches of DNA. The presence of the <i>BCR-ABL1</i> abnormality
confirms the clinical diagnosis of CML, a type of ALL, and rarely AML<o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "times new roman" , serif; font-size: 12pt;">Indication:<o:p></o:p></span></b></div>
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<span style="font-family: "times new roman" , serif; font-size: 12pt;">This test is done for diagnostic
workup and monitor the treatment for patients with high probability bcr/abl1- positive
hematopoietic neoplasms, predominantly </span><b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">chronic
myelogenous leukemia (CML) </span></b><span style="font-family: "times new roman" , serif; font-size: 12pt;">and </span><b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">acute lymphoblastic leukemia (ALL).</span></b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"> When you have results of a <b>complete
blood count (CBC)</b> and/or signs and symptoms
that suggest that you may have <b>leukemia</b><span style="color: #cf0f0f;">.</span><o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "times new roman" , serif; font-size: 12pt;">Sample:<o:p></o:p></span></b></div>
<div class="MsoNormal" style="background: white; line-height: 16.5pt; text-align: justify;">
<span style="font-family: "times new roman" , serif; font-size: 12pt;">A blood sample drawn
from a vein in your arm or a bone marrow sample collected using a </span><b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">bone marrow aspiration and/or biopsy</span></b><span style="font-family: "times new roman" , serif; font-size: 12pt;"> procedure.<o:p></o:p></span></div>
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<span style="font-family: "times new roman" , serif; font-size: 12pt;"><br /></span></div>
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<span style="font-family: "times new roman" , serif; font-size: 12pt;">There are several different types of <i>BCR-ABL1</i> tests
available, including:<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">Cytogenetics (chromosome
analysis or karyotyping)<br />
</span></b><span style="font-family: "times new roman" , serif; font-size: 12pt;">This test looks at
chromosomes under a microscope to detect structural and/or numerical
abnormalities. For example, the Philadelphia chromosome looks shorter than
normal. Cells in a sample of blood or bone marrow are grown in the laboratory
and then examined to determine if the Philadelphia chromosome is present. Other
chromosomal abnormalities can also be detected.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">Fluorescence
in situ hybridization (FISH)<br />
</span></b><span style="font-family: "times new roman" , serif; font-size: 12pt;">This test method uses
fluorescent dye-labeled probes to "light up" the <i>BCR-ABL1</i> gene
sequence when it is present. It can also determine the percentage of blood or
bone marrow cells that contain the abnormal, fused <i>BCR-ABL1</i> gene.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">Genetic
molecular testing (qualitative or quantitative)<br />
Polymerase chain reaction (PCR)</span></b><span style="font-family: "times new roman" , serif; font-size: 12pt;">-based qualitative and quantitative tests detect and measure the <i>BCR-ABL1</i> gene
in leukemia cells taken from blood or bone marrow samples.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "times new roman" , serif; font-size: 12pt;">Secondary </span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">mutations within the <i>BCR-ABL1</i> are
known to cause resistance to therapy. These can be detected by DNA sequencing
methods.<o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "times new roman" , serif; font-size: 12pt;">When to order:<o:p></o:p></span></b></div>
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<i><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">BCR-ABL1</span></i><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"> testing is ordered when a health practitioner suspects
that a person has <a href="https://labtestsonline.org/understanding/conditions/leukemia/start/1"><span style="color: windowtext; text-decoration: none; text-underline: none;">CML</span></a> or
Philadelphia chromosome (Ph)-positive ALL. Initial testing may be
indicated when a person has nonspecific signs or symptoms such
as:<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10.0pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">Fatigue<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10.0pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">Weight loss<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10.0pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">Joint or bone pain<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10.0pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">Enlarged spleen<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10.0pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">As follow-up to abnormal findings on
a complete blood count (CBC)<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="background: white; line-height: 16.5pt; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">Early
in the disease, a person may have few or no symptoms. As time passes and normal
blood cells are crowded out of the <a href="https://labtestsonline.org/glossary/bone-marrow"><span style="color: windowtext; text-decoration: none; text-underline: none;">bone marrow</span></a> and the
number of abnormal leukemic cells increases, a person may experience anemia,
prolonged bleeding, and recurrent infections.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 16.5pt; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">Once
CML or Ph chromosome-positive ALL has been diagnosed, <i>BCR-ABL1</i> quantitative genetic
testing is ordered periodically (typically every 3 months) to monitor the
response to treatment and monitor for recurrence.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 16.5pt; margin-top: 9.0pt; text-align: justify;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">When a person is not responding and
treatment resistance is suspected or disease recurrence occurs after remission,
the BCR-ABL1 kinase domain mutation analysis may be performed.<o:p></o:p></span></div>
<h3 style="background: white; margin-bottom: 2.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-size: 12.0pt;"> </span></h3>
<h3 style="background: white; margin-bottom: 2.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-size: 12.0pt;">Interpretation
of BCR-ABL1 test:<o:p></o:p></span></h3>
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<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span>If a person has abnormal<span class="apple-converted-space"> </span>white blood cells<span class="apple-converted-space"> </span>in the<span class="apple-converted-space"> </span>bone marrow<span class="apple-converted-space"> </span>and has the <b>Philadelphia (Ph)
chromosome and<span class="apple-converted-space"> </span><em>BCR-ABL1</em><span class="apple-converted-space"><i> </i></span>gene</b> sequence, then the
individual is diagnosed with<span class="apple-converted-space"> </span>CML<span class="apple-converted-space"> </span>or<span class="apple-converted-space"> </span>Ph-positive
ALL.<o:p></o:p></div>
<div style="background: white; line-height: 16.5pt; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo4; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span>Of those who have CML, 90-95% have the Ph
chromosome if tested by<span class="apple-converted-space"> </span>cytogenetics<span class="apple-converted-space"> </span>and 100% have the <em>BCR-ABL1</em><span class="apple-converted-space"> </span>gene sequence by<span class="apple-converted-space"> </span>FISH<span class="apple-converted-space"> </span>and/or<span class="apple-converted-space"> </span>qualitative<span class="apple-converted-space"> </span><em>BCR-ABL1</em><span class="apple-converted-space"> </span>molecular testing. About 25% of adults
with ALL and 2-4% of children with ALL are positive for the Ph chromosome
and/or the <em>BCR-ABL1</em><span class="apple-converted-space"> </span>gene
sequence.<o:p></o:p></div>
<div style="background: white; line-height: 16.5pt; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo4; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span>A small percentage of people with CML will have
the<span class="apple-converted-space"> </span><em>BCR-ABL1</em><span class="apple-converted-space"> </span>gene sequence but not the Ph
chromosome. These cases either have variant<span class="apple-converted-space"> </span>translocations<span class="apple-converted-space"> </span>that involve a third or even a fourth
chromosome in addition to 9 and 22 or have a hidden translocation involving 9
and 22 that can not be identified by routine chromosomal analysis. Since the
treatment for<span class="apple-converted-space"> </span><em>BCR-ABL1</em>-related<span class="apple-converted-space"> </span>leukemias<span class="apple-converted-space"> </span>specifically targets the<span class="apple-converted-space"> </span>tyrosine kinase<span class="apple-converted-space"> </span>protein produced, these people can
still be monitored with quantitative<span class="apple-converted-space"> </span><em>BCR-ABL1</em><span class="apple-converted-space"> </span>molecular testing.<o:p></o:p></div>
<div style="background: white; line-height: 16.5pt; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo4; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span>In general, if the amount of<span class="apple-converted-space"> </span><em>BCR-ABL1</em><span class="apple-converted-space"> </span>in the blood or bone marrow decreases
over time, then the person is responding to treatment. If the quantity of<span class="apple-converted-space"> </span><em>BCR-ABL1</em><span class="apple-converted-space"> </span>drops below the test's detection level
and the person's blood cell counts are normal, then the person is considered to
be in remission.<o:p></o:p></div>
<div style="background: white; line-height: 16.5pt; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo4; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span>If the <em>BCR-ABL1</em><span class="apple-converted-space"> </span>level rises, then it indicates disease
progression or recurrence. It may also indicate that the person has become
resistant to <b>imatinib</b>, the first-generation<span class="apple-converted-space"> </span>tyrosine kinase inhibitor. Additional
genetic testing is often performed to detect the development of BCR-ABL1 kinase
domain<span class="apple-converted-space"> </span>mutations<span class="apple-converted-space"> </span>associated with imatinib resistance.<o:p></o:p></div>
<div style="background: white; line-height: 16.5pt; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo4; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span>If an individual's leukemia is resistant to
imatinib, a second generation tyrosine kinase inhibitor may be given. Those
tyrosine kinase inhibitors, developed after imatinib, are also given in case
the side effects from imatinib are too severe or in case of a rare<span class="apple-converted-space"> </span><em>BCR-ABL</em><span class="apple-converted-space"><i> </i></span>mutation. They include <b>ponatib,
bosutinib, nilotinib, and dasatinib</b>.<o:p></o:p></div>
<div style="background: white; line-height: 16.5pt; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo4; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span>If a person with ALL is not positive for the Ph
chromosome and the<span class="apple-converted-space"> </span><em>BCR-ABL1</em><span class="apple-converted-space"> </span>gene sequence, then that person will
not be given a tyrosine kinase inhibitor drug and<span class="apple-converted-space"> </span><em>BCR-ABL1</em><span class="apple-converted-space"> </span>molecular testing cannot be used to
monitor the person.<o:p></o:p></div>
<div class="MsoNormal" style="background: white; line-height: 16.5pt; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin-bottom: 2.25pt; text-align: justify;">
<b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">Different
phases of CML:<o:p></o:p></span></b></div>
<div class="MsoNormal" style="background: white; line-height: 16.5pt; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">Recognition
of disease progression and transformation is important for prognosis and
treatment. CML goes through three phases:<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 16.5pt; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.6pt; margin-right: 0cm; margin-top: 0cm; mso-list: l1 level1 lfo3; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10.0pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span><b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">Chronic
phase</span></b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">—most people with CML are diagnosed
in the <a href="https://labtestsonline.org/glossary/chronic"><span style="color: windowtext; text-decoration: none; text-underline: none;">chronic</span></a> phase,
which usually has an insidious onset, meaning that leukemia symptoms may be
absent or subtle. The chronic phase may last for a month to several years. This
is the phase when there are few or no symptoms and also the time period when
treatment is most successful.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10.0pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span><b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">Accelerated
phase</span></b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">—changes include but are not limited
to increasing white blood cell (WBC) counts and additional
changes to cells like an increase in blasts in blood and/or bone
marrow (but less than 20%) and lack of therapeutic response to standard
treatment<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 16.5pt; margin-bottom: 9.0pt; margin-left: 21.6pt; margin-right: 0cm; margin-top: 0cm; mso-list: l1 level1 lfo3; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10.0pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span><b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">Blast
phase</span></b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">—when blasts are 20% or more of the
cells in the blood or bone marrow or when there is blast proliferation outside
the bone marrow<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 16.5pt; text-align: justify;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">Both blood and bone marrow are often
evaluated as part of the initial diagnosis, but the majority of follow-up monitoring
is performed on blood samples. There is significant test variability among
laboratories using different test platforms. Therefore, for a given patient,
the <b>quantitative <i>BCR-ABL</i></b><i>1</i> molecular testing
should be performed by the same laboratory or referred to a laboratory that
follows universal reporting criteria. <b>Rising and falling levels of <i>BCR-ABL1</i> are
usually more important than a single test result.<o:p></o:p></b></span></div>
<br />
<div class="MsoNormal" style="background: white; line-height: 16.5pt; text-align: justify;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal" style="background: white; line-height: 16.5pt; text-align: justify;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">(References: See more at: <a href="https://labtestsonline.org/">https://labtestsonline.org</a> and <a href="http://www.cancer.org/">www.cancer.org</a> )<o:p></o:p></span></div>
</div>
</div>
A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-71466686275802105882016-01-26T13:00:00.001+05:452016-01-26T13:09:39.257+05:45Zika virus : epidemiology, symptoms, diagnosis, treatment and prevention<div dir="ltr" style="text-align: left;" trbidi="on">
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<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-family: "times new roman" , serif; font-size: 12pt; line-height: 107%;">What is
Zika Virus ?<o:p></o:p></span></b></div>
<div style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin: 0cm; text-align: justify; vertical-align: baseline;">
<b><span style="color: #333333;"><br /></span></b></div>
<div style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin: 0cm; text-align: justify; vertical-align: baseline;">
<b><span style="color: #333333;">Zika
virus</span></b><span style="color: #333333;"> falls under member of</span><span class="apple-converted-space"><span style="color: #333333; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;"> </span></span><strong style="font-style: inherit; outline: 0px; zoom: 1;"><span style="border: none 1.0pt; color: #333333; padding: 0cm;">Flavivirus.
</span></strong><span class="apple-converted-space"><span style="color: #333333; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;"> The
vector for Zika vius is A</span></span><strong><span style="border: none 1.0pt; color: #333333; padding: 0cm;">edes
mosquito</span></strong><span style="color: #333333;">. Zika virus is an</span><span class="apple-converted-space"><span style="color: #333333; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;"> </span></span><strong style="font-style: inherit; outline: 0px; zoom: 1;"><span style="border: none 1.0pt; color: #333333; font-weight: normal; padding: 0cm;">emerging mosquito-borne virus</span></strong><span class="apple-converted-space"><span style="color: #333333; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;"> </span></span><span style="color: #333333;">that was first isolated in Zika forest of
Uganda in 1947. Since then, it has been observed mainly in Africa, with
small and sporadic outbreaks in Asia. <o:p></o:p></span></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhI-7enDoTG_jMZ-O9mzvMil8nLe3JYYB-GRZdC9D_5Li-mqIZfLnYzhAHutEF5PVDOzV6trCYtT1Q5jcacIa2HsfxMI5HT5HqCwVZAqdzroa6V6-5nLTHGftgOYDDXRI0XNIJ7L2HXGZxA/s1600/aedes_aegypti_cdc-gathany.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhI-7enDoTG_jMZ-O9mzvMil8nLe3JYYB-GRZdC9D_5Li-mqIZfLnYzhAHutEF5PVDOzV6trCYtT1Q5jcacIa2HsfxMI5HT5HqCwVZAqdzroa6V6-5nLTHGftgOYDDXRI0XNIJ7L2HXGZxA/s320/aedes_aegypti_cdc-gathany.jpg" title="" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. <span style="font-family: "times new roman" , serif; font-size: 12pt;">Zika virus is transmitted by daytime
mosquitoes <br />under the genus Aedes. <br />Credit: Photo from Wikipedia</span><br />
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
</td></tr>
</tbody></table>
<h3 style="background: white; line-height: 22.5pt; margin-bottom: 7.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 7.5pt; text-align: justify;">
<b><span style="font-family: "times new roman" , serif;">Where has Zika virus been found?</span></b><span style="font-family: "times new roman" , serif;"><o:p></o:p></span></h3>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 18.75pt; mso-list: l3 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span><span style="font-family: "times new roman" , serif; font-size: 12pt;">Prior to 2015, Zika virus outbreaks have occurred in areas of
Africa, Southeast Asia, and the Pacific Islands.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 18.75pt; mso-list: l3 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span><span style="font-family: "times new roman" , serif; font-size: 12pt;">In May 2015, the <b>Pan American Health Organization (PAHO)</b>
issued an alert regarding the first confirmed Zika virus infections in Brazil.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 18.75pt; mso-list: l3 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span><span style="font-family: "times new roman" , serif; font-size: 12pt;">Currently, outbreaks are occurring in many countries.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 18.75pt; mso-list: l3 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "times new roman" , serif; font-size: 12pt;">Zika virus will continue to spread and it will be difficult to determine
how the virus will spread over time.<o:p></o:p></span></div>
<div style="background: white; line-height: 18.75pt; margin-bottom: 7.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<strong></strong></div>
<a name='more'></a><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjXxDgJqMqUjdk_LUE-KRzg1tTL1fw7JugMtkv0YjES2yT59k2bVtydVP88fi4BfKGwZF_uaQuPL-ASKOiz7nPHk-R9AUbUZ3rwueyZW5b5ZQZFStttEMAhShW5Md5xaM8-3C1t3DzWfOF7/s1600/countries+affected+with+zika+virus.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="238" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjXxDgJqMqUjdk_LUE-KRzg1tTL1fw7JugMtkv0YjES2yT59k2bVtydVP88fi4BfKGwZF_uaQuPL-ASKOiz7nPHk-R9AUbUZ3rwueyZW5b5ZQZFStttEMAhShW5Md5xaM8-3C1t3DzWfOF7/s400/countries+affected+with+zika+virus.jpg" title="" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. Zika virus affected countries</td></tr>
</tbody></table>
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<div style="background: white; line-height: 18.75pt; margin-bottom: 7.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<strong>Zika in the United States and its territories:</strong><o:p></o:p></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 18.75pt; mso-list: l0 level1 lfo5; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span><span style="font-family: "times new roman" , serif; font-size: 12pt;">No locally transmitted Zika cases have been reported in the
continental United States, but cases have been reported in returning travelers.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 18.75pt; mso-list: l0 level1 lfo5; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span><span style="font-family: "times new roman" , serif; font-size: 12pt;">Locally transmitted Zika virus has been reported in the
Commonwealth of Puerto Rico.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 18.75pt; mso-list: l0 level1 lfo5; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span><span style="font-family: "times new roman" , serif; font-size: 12pt;">With the recent outbreaks, the number of Zika cases among
travelers visiting or returning to the United States will likely increase.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 18.75pt; mso-list: l0 level1 lfo5; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "times new roman" , serif; font-size: 12pt;">These imported cases could result in local spread of the virus in
some areas of the United States.<o:p></o:p></span></div>
<h2 style="background: white; line-height: 24.0pt; margin-bottom: 7.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 7.5pt; text-align: justify;">
<b><span style="font-family: "times new roman" , serif; font-size: 12pt;">Symptoms:</span></b><span style="font-family: "times new roman" , serif; font-size: 12pt;"><o:p></o:p></span></h2>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 18.75pt; mso-list: l5 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "times new roman" , serif; font-size: 12pt;">About 1 in 5 people infected with Zika virus become ill (i.e.,
develop Zika).<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 18.75pt; mso-list: l5 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span><span style="font-family: "times new roman" , serif; font-size: 12pt;">The <b>most common symptoms of Zika are fever, rash, joint pain, or
conjunctivitis (red eyes)</b>. Other common symptoms include muscle pain and
headache. The incubation period (the time from exposure to symptoms) for Zika
virus disease is not known, but is likely to be a few days to a week.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 18.75pt; mso-list: l5 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "times new roman" , serif; font-size: 12pt;">The illness is usually mild with symptoms lasting for several days
to a week.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 18.75pt; mso-list: l5 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "times new roman" , serif; font-size: 12pt;">Zika virus usually remains in the blood of an infected person for
a few days but it can be found longer in some people.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 18.75pt; mso-list: l5 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "times new roman" , serif; font-size: 12pt;">Severe disease requiring hospitalization is uncommon.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 18.75pt; mso-list: l5 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "times new roman" , serif; font-size: 12pt;">Deaths are rare.<o:p></o:p></span></div>
<h2 style="background: white; line-height: 24.0pt; margin-bottom: 7.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 7.5pt; text-align: justify; text-rendering: optimizeLegibility;">
<b><span style="font-family: "times new roman" , serif; font-size: 12pt;">Diagnosis:</span></b><span style="font-family: "times new roman" , serif; font-size: 12pt;"><o:p></o:p></span></h2>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 18.75pt; mso-list: l2 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "times new roman" , serif; font-size: 12pt;">The <b>symptoms of Zika are similar to those of<span class="apple-converted-space"> </span>dengue<span class="apple-converted-space"> </span>and<span class="apple-converted-space"> </span>chikungunya,</b>
diseases spread through the same mosquitoes that transmit Zika.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 18.75pt; mso-list: l2 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span><span style="font-family: "times new roman" , serif; font-size: 12pt;">See your healthcare provider if you develop the symptoms described
above and have visited an area where Zika is found.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 18.75pt; mso-list: l2 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "times new roman" , serif; font-size: 12pt;">If you have recently traveled, tell your healthcare provider when
and where you traveled.<o:p></o:p></span></div>
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<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 18.75pt; mso-list: l2 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "times new roman" , serif; font-size: 12pt;">Your healthcare provider may order blood tests to look for Zika or
other similar viruses like dengue or chikungunya.<o:p></o:p></span></div>
<h2 style="background: white; line-height: 24.0pt; margin-bottom: 7.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 7.5pt; text-align: justify; text-rendering: optimizeLegibility;">
<b><span style="font-family: "times new roman" , serif; font-size: 12pt;">Treatment:</span></b><span style="font-family: "times new roman" , serif; font-size: 12pt;"><o:p></o:p></span></h2>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 18.75pt; mso-list: l1 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "times new roman" , serif; font-size: 12pt;">No vaccine or medications are available to prevent or treat Zika
infections.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 18.75pt; mso-list: l1 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "times new roman" , serif; font-size: 12pt;">Treat the symptoms:<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 37.5pt; mso-list: l1 level2 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "courier new"; font-size: 10pt;">o<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , serif; font-size: 12pt;">Get
plenty of rest<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 37.5pt; mso-list: l1 level2 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "courier new"; font-size: 10pt;">o<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , serif; font-size: 12pt;">Drink
fluids to prevent dehydration<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 37.5pt; mso-list: l1 level2 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "courier new"; font-size: 10pt;">o<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , serif; font-size: 12pt;">Take
medicines, such as acetaminophen or paracetamol, to relieve fever and pain<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 37.5pt; mso-list: l1 level2 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "courier new"; font-size: 10pt;">o<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , serif; font-size: 12pt;">Do
not take aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), like
ibuprofen and naproxen. Aspirin and NSAIDs should be avoided until dengue can
be ruled out to reduce the risk of hemorrhage (bleeding). If you are taking
medicine for another medical condition, talk to your healthcare provider before
taking additional medication.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 18.75pt; mso-list: l1 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "times new roman" , serif; font-size: 12pt;">If you have Zika, avoid mosquito bites for the first week of your
illness.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 37.5pt; mso-list: l1 level2 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "courier new"; font-size: 10pt;">o<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , serif; font-size: 12pt;">During
the first week of infection, Zika virus can be found in the blood and passed
from an infected person to another mosquito through mosquito bites.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 37.5pt; mso-list: l1 level2 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "courier new"; font-size: 10pt;">o<span style="font-family: "times new roman"; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , serif; font-size: 12pt;">An
infected mosquito can then spread the virus to other people.<o:p></o:p></span></div>
<blockquote class="tr_bq" style="text-align: justify;">
<b><span style="font-family: "times new roman" , serif; font-size: 12pt;">Frequently
Asked Questions (FAQs) for Zika Virus:</span></b></blockquote>
<blockquote class="tr_bq">
<div style="text-align: justify;">
<b><span style="font-family: "times new roman" , serif; font-size: 12pt;">How
is Zika virus (Zika) transmitted?</span></b></div>
<div style="text-align: justify;">
Zika is primarily transmitted through the bite of infected<span class="apple-converted-space"> </span><em>Aedes</em><span class="apple-converted-space"> </span>mosquitoes. It can also be transmitted
from a pregnant mother to her baby during pregnancy or around the time of
birth. We do not know how often Zika is transmitted from mother to baby during
pregnancy or around the time of birth. </div>
</blockquote>
<blockquote class="tr_bq">
<div style="text-align: justify;">
<b><span style="font-family: "times new roman" , serif; font-size: 12pt;">Who
is at risk of being infected?</span></b></div>
<div style="text-align: justify;">
Anyone who is living in or traveling to an area where Zika
virus is found who has not already been infected with Zika virus is at risk for
infection, including pregnant women. </div>
</blockquote>
<blockquote class="tr_bq">
<div style="text-align: justify;">
<b><span style="font-family: "times new roman" , serif; font-size: 12pt;">What
are the symptoms of Zika virus infection (Zika)?</span></b></div>
<div style="text-align: justify;">
About one in five people infected with Zika will get sick.
For people who get sick, the illness is usually mild. For this reason, many
people might not realize they have been infected.</div>
<div style="text-align: justify;">
The most common symptoms of Zika virus disease are fever,
rash, joint pain, or conjunctivitis (red eyes). Symptoms typically begin 2 to 7
days after being bitten by an infected mosquito. </div>
</blockquote>
<blockquote class="tr_bq">
<div style="text-align: justify;">
<b><span style="font-family: "times new roman" , serif; font-size: 12pt;">I am
pregnant. How will Zika virus affect me or my unborn baby?</span></b></div>
<div style="text-align: justify;">
CDC has issued a<span class="apple-converted-space"> </span><a href="http://wwwnc.cdc.gov/travel/notices"><span style="color: #075290; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">travel
alert (Level 2-Practice Enhanced Precautions)</span></a><span class="apple-converted-space"> </span>for people traveling to regions and
certain countries where Zika virus transmission is ongoing: Brazil, Colombia,
El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico,
Panama, Paraguay, Puerto Rico, Suriname, and Venezuela.</div>
<div style="text-align: justify;">
This alert follows reports in Brazil of<span class="apple-converted-space"> </span>microcephaly<span class="apple-converted-space"> </span>and other poor pregnancy outcomes in babies of mothers who
were infected with Zika virus while pregnant. However, additional studies are
needed to further characterize this relationship. More studies are planned to
learn more about the risks of Zika virus infection during pregnancy.</div>
<div style="text-align: justify;">
Until more is known, and out of an abundance of caution,
CDC recommends special precautions for pregnant women and women trying to
become pregnant:</div>
<span style="font-family: "symbol"; font-size: 10pt;"></span><br />
<div style="text-align: justify;">
<span style="font-family: "symbol"; font-size: 10pt;"><span style="font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt;"> </span></span><span style="font-family: "times new roman" , serif; font-size: 12pt;">Pregnant women in any trimester should consider postponing travel
to the areas where Zika virus transmission is ongoing. Pregnant women who do
travel to one of these areas should talk to their doctor or other healthcare
provider first and strictly follow<span class="apple-converted-space"> </span>steps
to avoid mosquito bites<span class="apple-converted-space"> </span>during
the trip.</span></span></div>
<span style="font-family: "symbol"; font-size: 10pt;">
</span><span style="font-family: "times new roman" , serif; font-size: 12pt;"></span>
<div style="text-align: justify;">
<span style="font-family: "times new roman" , serif; font-size: 12pt;"><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt;">
</span></span><span style="font-size: 12pt;">Women trying to become pregnant should consult with their
healthcare provider before traveling to these areas and strictly follow<span class="apple-converted-space"> </span>steps to prevent mosquito bites during
the trip.</span> </span></div>
<span style="font-family: "times new roman" , serif; font-size: 12pt;">
<o:p></o:p></span></blockquote>
<blockquote class="tr_bq">
<div style="text-align: justify;">
<b><span style="font-family: "times new roman" , serif; font-size: 12pt;">Is
there a vaccine to prevent or medicine to treat Zika?</span></b></div>
<div style="text-align: justify;">
No. There is no vaccine to prevent infection or medicine to
treat Zika. </div>
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</div>
</blockquote>
<blockquote class="tr_bq">
<div style="text-align: justify;">
<b style="line-height: 24pt;"><span style="font-family: "times new roman" , serif; font-size: 12pt;">Is
it safe to use an insect repellent if I am pregnant or nursing?</span></b></div>
<div style="text-align: justify;">
Yes! Using an insect repellent is safe and effective.
Pregnant women and women who are breastfeeding can and should choose an
EPA-registered insect repellents and use it according to the product label. </div>
</blockquote>
<blockquote class="tr_bq">
<div style="text-align: justify;">
<b><span style="font-family: "times new roman" , serif; font-size: 12pt;">If a
woman who is not pregnant is bitten by a mosquito and infected with Zika virus,
will her future pregnancies be at risk?</span></b></div>
<div style="text-align: justify;">
We do not know the risk to the baby if a woman is infected
with Zika virus while she is pregnant. However, Zika virus infection<span class="apple-converted-space"> </span><strong>does not</strong><span class="apple-converted-space"> </span>pose a risk of birth defects for
future pregnancies. Zika virus usually remains in the blood of an
infected person for only a few days to a week. The virus will not cause
infections in a baby that is conceived after the virus is cleared from the
blood. </div>
</blockquote>
<blockquote class="tr_bq">
<div style="text-align: justify;">
<b><span style="font-family: "times new roman" , serif; font-size: 12pt;">What
should I do if I have Zika?</span></b></div>
<div style="text-align: justify;">
Treat the symptoms:</div>
<span style="font-family: "symbol"; font-size: 10pt;"></span><br />
<div style="text-align: justify;">
<span style="font-family: "symbol"; font-size: 10pt;"><span style="font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt;">
</span></span><span style="font-family: "times new roman" , serif; font-size: 12pt;">Get plenty of rest</span></span></div>
<span style="font-family: "symbol"; font-size: 10pt;">
</span><span style="font-family: "times new roman" , serif; font-size: 12pt;"></span>
<div style="text-align: justify;">
<span style="font-family: "times new roman" , serif; font-size: 12pt;"><span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt;">
</span></span><span style="font-size: 12pt;">Drink fluids to prevent dehydration</span></span></div>
<span style="font-family: "times new roman" , serif; font-size: 12pt;">
<o:p><div style="text-align: justify;">
<span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt;">
</span></span><span style="font-size: 12pt;">Take medicines such as acetaminophen or paracetamol to reduce
fever and pain</span></div>
</o:p></span><span style="font-family: "times new roman" , serif; font-size: 12pt;"><div style="text-align: justify;">
<span style="font-family: "symbol"; font-size: 10pt;">·<span style="font-family: "times new roman"; font-size: 7pt;">
</span></span><span style="font-size: 12pt;">Do not take aspirin or other non-steroidal anti-inflammatory drugs</span></div>
<o:p></o:p></span></blockquote>
<div style="background: white; line-height: 18.75pt; margin-bottom: 7.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<o:p></o:p></div>
<div style="background: white; line-height: 18.75pt; margin-bottom: 7.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<o:p></o:p></div>
<div style="background: white; line-height: 18.75pt; margin-bottom: 7.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<o:p></o:p></div>
<div style="background: white; line-height: 18.75pt; margin-bottom: 7.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<o:p></o:p></div>
<div style="background: white; line-height: 18.75pt; margin-bottom: 7.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<o:p></o:p></div>
<div style="background: white; line-height: 18.75pt; margin-bottom: 7.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<o:p></o:p></div>
<div style="background: white; line-height: 18.75pt; margin-bottom: 7.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<o:p></o:p></div>
<div style="background: white; line-height: 18.75pt; margin-bottom: 7.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<o:p></o:p></div>
<div style="background: white; line-height: 18.75pt; margin-bottom: 7.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<o:p></o:p></div>
<div style="background: white; line-height: 18.75pt; margin-bottom: 7.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<o:p></o:p></div>
<div style="background: white; line-height: 18.75pt; margin-bottom: 7.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<o:p></o:p></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;">
<span style="font-family: "times new roman" , serif; font-size: 12pt;">(For
more information: Please visit <a href="http://www.cdc.gov/zika/index.html">http://www.cdc.gov/zika/index.html</a>
)<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;">
<b><span style="font-family: "times new roman" , serif; font-size: 12pt;"><br /></span></b></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;">
<b><span style="font-family: "times new roman" , serif; font-size: 12pt;">References:</span></b><span style="font-family: "times new roman" , serif; font-size: 12pt;"> 1. <a href="http://www.cdc.gov/">http://www.cdc.gov</a><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-left: 36.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "times new roman" , serif; font-size: 12pt;"> 2. </span><span style="color: #006621; font-family: "times new roman" , serif; font-size: 10.5pt;"><a href="http://www.paho.org/">www.paho.org</a></span></div>
<div style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin: 0cm; text-align: justify; vertical-align: baseline;">
<br /></div>
<br />
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; line-height: 15.75pt; margin: 0cm 0cm 0.0001pt; outline: 0px; vertical-align: baseline; zoom: 1;">
<br /></div>
</div>
</div>
</div>
</div>
A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-89250139382782310682015-12-21T09:19:00.003+05:452015-12-21T09:24:26.866+05:45Photometry: Principle, applications and types<div dir="ltr" style="text-align: left;" trbidi="on">
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<div style="background: #DBE5F1; border: solid #DBE5F1 3.0pt; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-themecolor: accent1; mso-border-themetint: 51; mso-element: para-border-div; padding: 0in 0in 0in 0in;">
<h2 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">Photometry<o:p></o:p></span></h2>
</div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5qLEp6Olfqk1COjntMW5kCNJuAIITsxCHkaXrGV8UKvwI9GNKVfbITk6RFlgc555FhwP33xJbvMS-ARWH5CNv9rnYxE_d5JRCwhjJQEVC1y5Zj6UlU07hG9KggWuxgVtiKe49aEXJ77kv/s1600/principle+of+colorimetry.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5qLEp6Olfqk1COjntMW5kCNJuAIITsxCHkaXrGV8UKvwI9GNKVfbITk6RFlgc555FhwP33xJbvMS-ARWH5CNv9rnYxE_d5JRCwhjJQEVC1y5Zj6UlU07hG9KggWuxgVtiKe49aEXJ77kv/s320/principle+of+colorimetry.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. Principle of colorimetry</td></tr>
</tbody></table>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">When light is passed through a coloured
solution, certain wavelengths are selectively absorbed giving a plot of the
absorption spectrum of the compound in solution. The wavelength at which
maximum absorption is called the absorption maximum (λ<sub>max</sub>) of that
compound. The light that is not absorbed is transmitted through the solution
and gives the solution its colour. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Photometric instruments measure
transmittance, which is defined as follows:<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span>
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span>
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"> Intensity of the emergent (or transmitted) light Ie</span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><b>Transmittance (T)</b>= ------------------------------------------------------------- = ------</span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"> Intensity of the incident light Io</span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Transmittance is usually expressed on a
range of 0 to 100%.<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">If the concentration of the substance in
solution is increased linearly, or if the path length that the light beam has
to traverse is increased, transmittance falls exponentially. So a term <b>absorbance</b> is defined so that it is
directly proportional to the concentration of the substance.<i><o:p></o:p></i></span></span><br />
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"> Ie</span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><b>Absorbance (A)</b>= log1/T = log ----</span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"> Io</span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<!--[if gte msEquation 12]><m:oMathPara><m:oMathParaPr><m:jc
m:val="left"/></m:oMathParaPr><m:oMath><b style='mso-bidi-font-weight:normal'><span
lang=IT style='font-family:"Cambria Math","serif"'><m:r><m:rPr><m:scr m:val="roman"/><m:sty
m:val="b"/></m:rPr>Absorbance</m:r></span></b><span lang=IT
style='font-family:"Cambria Math","serif"'><m:r><m:rPr><m:scr m:val="roman"/><m:sty
m:val="p"/></m:rPr>, </m:r><m:r><m:rPr><m:scr m:val="roman"/><m:sty m:val="b"/></m:rPr><b
style='mso-bidi-font-weight:normal'>A</b></m:r><m:r><m:rPr><m:scr m:val="roman"/><m:sty
m:val="p"/></m:rPr><span style='mso-spacerun:yes'> </span>=log 1/T=</m:r></span><m:func><m:funcPr><span
style='font-family:"Cambria Math","serif";mso-ascii-font-family:"Cambria Math";
mso-hansi-font-family:"Cambria Math"'><m:ctrlPr></m:ctrlPr></span></m:funcPr><m:fName><span
lang=IT style='font-family:"Cambria Math","serif"'><m:r><m:rPr><m:scr m:val="roman"/><m:sty
m:val="p"/></m:rPr>log</m:r></span></m:fName><m:e><m:f><m:fPr><span
style='font-family:"Cambria Math","serif";mso-ascii-font-family:"Cambria Math";
mso-hansi-font-family:"Cambria Math"'><m:ctrlPr></m:ctrlPr></span></m:fPr><m:num><span
lang=IT style='font-family:"Cambria Math","serif"'><m:r><m:rPr><m:scr
m:val="roman"/><m:sty m:val="p"/></m:rPr>Ie</m:r></span></m:num><m:den><span
lang=IT style='font-family:"Cambria Math","serif"'><m:r><m:rPr><m:scr
m:val="roman"/><m:sty m:val="p"/></m:rPr>Io</m:r></span></m:den></m:f></m:e></m:func></m:oMath></m:oMathPara><![endif]--><!--[if !msEquation]--><span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-size: 11pt; line-height: 115%;"><!--[if gte vml 1]><v:shape
id="_x0000_i1025" type="#_x0000_t75" style='width:167.25pt;height:27.75pt'>
<v:imagedata src="file:///C:\Users\Prem\AppData\Local\Temp\msohtmlclip1\01\clip_image005.png"
o:title="" chromakey="white"/>
</v:shape><![endif]--><!--[if !vml]--><!--[endif]--></span><!--[endif]--><i><span lang="IT"><o:p></o:p></span></i></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Absorbance has no units. Photometric
instruments electronically convert the measured transmittance to absorbance values.<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"></span></span></div>
<a name='more'></a><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<br />
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Much of photometry is therefore based on
two laws: <i><o:p></o:p></i></span></span></div>
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<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">When a parallel beam of monochromatic light
passes through a solution, the absorbance (A) of the solution is directly
proportional to concentration(c)of the compound in the solution. This is <b>Beer's law</b>. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Each successive layer of the solution
absorbs a constant proportion of the light entering the solution, although the
absolute amount entering each layer diminishes progressively. Therefore,
absorbance is directly proportional to the thickness or length of the light
path (l) through the solution. This is <b>Lambert's law. <o:p></o:p></b></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<br /></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><span lang="IT">A </span></span><span style="font-family: "symbol"; font-size: 11pt; line-height: 115%; text-align: left;">a</span><span style="font-family: "trebuchet ms" , sans-serif;"> c (Beer's
law) ------------- 1)</span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><span lang="IT">A </span></span><span style="font-family: "symbol"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Mangal; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-char-type: symbol; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-symbol-font-family: Symbol;">a</span><span style="font-family: "trebuchet ms" , sans-serif;"><span lang="IT"> l (Lambert's law)
-----------2)<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">By combining 1) and 2) , we get<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><span lang="IT"> A = </span><span lang="IT">ε</span><sub><span lang="IT">l</span></sub><span lang="IT"> c l<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><span lang="IT">ε</span><sub><span lang="IT">l</span></sub><span lang="IT">, the
proportionality constant is termed the <b>molar
absorption coefficient</b>. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">It is specific for a given substance at a
given wavelength. It is the absorbance of a one molar solution of a substance
with a light path of one centimetre (if c is expressed in mol/L). But Beer's
law applies to only dilute solutions and in practice the concentrations of the
solutions that are used in photometry are usually in the mmol/L range. In
colorimetry, the absorption coefficient is not usually used. Concentration of
an unknown solution can be determined by using equation 1, which is derived as
follows:<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><span lang="IT"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><span lang="IT">Absorbance of test sample (A<sub>t</sub>) =
</span><span lang="IT">ε</span><span lang="IT">
x concentration of test (C<sub>t</sub>) x l<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Absorbance of standard sample (A<sub>s</sub>)
= ε x concentration of standard (C<sub>s</sub>) x l<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Hence, <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><span lang="IT"> Absorbance of Test sample (At) </span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><!--[if gte msEquation 12]><m:oMath><span
lang=IT style='font-family:"Cambria Math","serif"'><m:r><m:rPr><m:scr m:val="roman"/><m:sty
m:val="p"/></m:rPr> Conc. of test (C</m:r><m:r><m:rPr><m:scr m:val="roman"/><m:sty
m:val="p"/></m:rPr><sub>t</sub></m:r><m:r><m:rPr><m:scr m:val="roman"/><m:sty
m:val="p"/></m:rPr>) = </m:r></span><m:f><m:fPr><span style='font-family:
"Cambria Math","serif";mso-ascii-font-family:"Cambria Math";mso-hansi-font-family:
"Cambria Math"'><m:ctrlPr></m:ctrlPr></span></m:fPr><m:num><span lang=IT
style='font-family:"Cambria Math","serif"'><m:r><m:rPr><m:scr m:val="roman"/><m:sty
m:val="p"/></m:rPr>Absorbance of test sample (A</m:r><m:r><m:rPr><m:scr
m:val="roman"/><m:sty m:val="p"/></m:rPr><sub>t</sub></m:r><m:r><m:rPr><m:scr
m:val="roman"/><m:sty m:val="p"/></m:rPr>) </m:r></span></m:num><m:den><span
lang=IT style='font-family:"Cambria Math","serif"'><m:r><m:rPr><m:scr m:val="roman"/><m:sty
m:val="p"/></m:rPr>Absorbance of standard sample (A</m:r><m:r><m:rPr><m:scr
m:val="roman"/><m:sty m:val="p"/></m:rPr><sub>s</sub></m:r><m:r><m:rPr><m:scr
m:val="roman"/><m:sty m:val="p"/></m:rPr>)</m:r></span></m:den></m:f><span
lang=IT style='font-family:"Cambria Math","serif"'><m:r><m:rPr><m:scr m:val="roman"/><m:sty
m:val="p"/></m:rPr>×</m:r></span></m:oMath><![endif]--><!--[if !msEquation]--><span style="font-size: 11pt; line-height: 115%; position: relative; top: 7.5pt;"><!--[if gte vml 1]><v:shape
id="_x0000_i1025" type="#_x0000_t75" style='width:248.25pt;height:24pt'>
<v:imagedata src="file:///C:\Users\Prem\AppData\Local\Temp\msohtmlclip1\01\clip_image007.png"
o:title="" chromakey="white"/>
</v:shape><![endif]--><!--[if !vml]--><!--[endif]--></span><!--[endif]--><span lang="IT">Conc. of Test (Ct) = -------------------------------------------- X Conc. of
standard (C<sub>s</sub>)<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"> </span></span><span style="font-family: "trebuchet ms" , sans-serif;"> Absorbance of Standard sample (As) </span><span style="font-family: "trebuchet ms" , sans-serif;"> </span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">The light path, l, is usually kept constant
in photometric measurements at 1 cm. This is the diameter of the tube (called
the cuvette) containing the solution.<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<br /></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">A standard (or calibrator) is
representative of the substance whose concentration is sought to be determined.
The concentration of the compound in the test sample is obtained by comparing
its absorbance with that of a known concentration of a standard solution.
Ideally, a series of standards of known concentration are prepared to obtain a
standard (calibration) curve. This helps to determine the range of
concentrations over which Beer's law is obeyed. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Appropriate blanks to exclude the
absorbance contributed by the solvents and reagents used- i.e. by anything
other than the compound of interest- are also essential for any photometric
measurement. <o:p></o:p></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<br /></div>
<div style="background: #DBE5F1; border: solid #DBE5F1 3.0pt; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-themecolor: accent1; mso-border-themetint: 51; mso-element: para-border-div; padding: 0in 0in 0in 0in;">
<h2 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">Colorimetry<o:p></o:p></span></h2>
</div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Colorimetry uses the basic principles of
photometry but the solutions have to be coloured, i.e. they must absorb light
in the visible range. Colourless compounds are converted into coloured
compounds using chemical reactions. Under defined reaction conditions, the
quantity of colour formed is proportional to the quantity of the original
colourless compound.<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div style="background: #DBE5F1; border: solid #DBE5F1 3.0pt; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-themecolor: accent1; mso-border-themetint: 51; mso-element: para-border-div; padding: 0in 0in 0in 0in;">
<h2 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">Photometric instruments<o:p></o:p></span></h2>
</div>
<div style="border-bottom: none; border-left: solid #4F81BD 1.0pt; border-right: none; border-top: solid #4F81BD 1.0pt; mso-border-left-alt: solid #4F81BD .75pt; mso-border-left-themecolor: accent1; mso-border-left-themecolor: accent1; mso-border-top-alt: solid #4F81BD .75pt; mso-border-top-themecolor: accent1; mso-border-top-themecolor: accent1; mso-element: para-border-div; padding: 7.0pt 0in 0in 2.0pt;">
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<h3 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">Colorimeter <o:p></o:p></span></h3>
</div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">It is used to measure the intensity of light transmitted
through a coloured solution. It uses light only in the visible range. Ordinary
light from a tungsten lamp is passed through a suitable filter to obtain light
of a desired wavelength, which is then passed through the solution.<i><o:p></o:p></i></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">Transmitted light falls on the sensitive surface of
selenium photocell which generates a current proportional to the light
intensity. The cell is connected to a galvanometer, which is used to read out
percentage transmission or absorbance. <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<br /></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3uwR2AzSC75u5HiJTNKJhyphenhyphenen-_KdlMXmHcTaiCcWF0zyDwEO3Gr7FbzGhq3wEu62S00MBPntU1fLO_A35USMvrudYUJCkv37HJvK74NIWwuIaOtgrUkWMK1iKODO6pH60PMf7mlb38CnP/s1600/spectrophotometer.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="232" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3uwR2AzSC75u5HiJTNKJhyphenhyphenen-_KdlMXmHcTaiCcWF0zyDwEO3Gr7FbzGhq3wEu62S00MBPntU1fLO_A35USMvrudYUJCkv37HJvK74NIWwuIaOtgrUkWMK1iKODO6pH60PMf7mlb38CnP/s640/spectrophotometer.png" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. Components of spectrophotometer</td></tr>
</tbody></table>
</span></span></div>
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<h3>
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<div style="text-align: justify;">
Spectrophotometer</div>
</span></h3>
</div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">A spectrophotometer works on the same principle as a
colorimeter but it is more <b>sensitive</b>
and <b>sophisticated.</b> There are light
sources that emit light in the <b>ultraviolet,</b>
<b>visible</b> and <b>infrared regions</b> of the spectrum. The wavelength is selected using
a prism or diffraction grating and narrower bandwidths can be selected. Since
light in the ultraviolet and infrared ranges is also emitted, the compound to
be estimated does not necessarily has to be coloured and can be measured
directly if they significantly absorb even at these wavelengths. This offers a
significant advantage over the colorimeter, which is restricted only in the
visible range.<i><o:p></o:p></i></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
<div style="border-bottom: none; border-left: solid #4F81BD 1.0pt; border-right: none; border-top: solid #4F81BD 1.0pt; mso-border-left-alt: solid #4F81BD .75pt; mso-border-left-themecolor: accent1; mso-border-left-themecolor: accent1; mso-border-top-alt: solid #4F81BD .75pt; mso-border-top-themecolor: accent1; mso-border-top-themecolor: accent1; mso-element: para-border-div; padding: 7.0pt 0in 0in 2.0pt;">
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<br />
<h3 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">Types of spectrophotometers:<o:p></o:p></span></h3>
</div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">Grating spectrophotometers: In these spectrophotometers,
the monochromator is a diffraction grating, which disperses the white light
into a continuous spectrum. By turning the wavelength adjustment knob, the
grating is rotated and different parts of the spectrum are allowed to fall on
the photocell. In this manner, the desired wavelength can be selected.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b>Prism
spectrophotometers:</b> The prisms may be made of glass or quartz. Light from a
tungsten filament is focussed on the entrance slit and it passes through a
glass prism that forms an extended spectrum. Only the light that falls on the
exit slit can pass through the cuvet and illuminate the photocell. The
monochromatic light obtained here is much more pure than that produced by light
filters, i.e. a much narrower band of wavelength is present in the incident
beam of light. Different photocells are used, one sensitive to the short
wavelength range of the instrument (360-525nm), while the other is used for the
longer wavelengths (600 to 1000nm). The total wavelength range at which
measurements can be made includes the visible spectrum (400 to 750nm) and
extends on each side into the near ultraviolet (360 to 450 nm) and the near
infrared (750 to 1000nm). It is therefore possible to estimate substances that
are more or less colourless in the visible region, but which absorb light in
the ultraviolet or infrared regions.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">Quartz prisms help in extending the wavelength range
below 350nm down to about 190nm. A deuterium lamp with a quartz envelope is
provided as an additional light source. This is a rich source of UV radiation.
Quartz cuvets will also be needed if one has to work in the UV range.<i><o:p></o:p></i></span></div>
<div style="border-bottom: none; border-left: solid #4F81BD 1.0pt; border-right: none; border-top: solid #4F81BD 1.0pt; mso-border-left-alt: solid #4F81BD .75pt; mso-border-left-themecolor: accent1; mso-border-left-themecolor: accent1; mso-border-top-alt: solid #4F81BD .75pt; mso-border-top-themecolor: accent1; mso-border-top-themecolor: accent1; mso-element: para-border-div; padding: 7.0pt 0in 0in 2.0pt;">
<h3 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">Uses <o:p></o:p></span></h3>
</div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">A spectrophotometer can be used for routine
analysis in clinical chemistry. By using
a narrower bandwidth than is available with ordinary filters, the absorbance is
often higher and the relation between absorbance and concentration remains
linear over a wide range. If very dilute colour is to be measured (e.g. in
serum iron determinations), then a spectrophotometer is usually required. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Analytical methods depending on ultraviolet
absorption are commonly used in clinical chemistry and research. Examples
include serum enzyme assays, assays of glucose, urea, uric acid, etc, which
take advantage of the UV absorption of the coenzymes NADH and NADPH at 340nm.
For, such methods a quartz spectrophotometer is essential.<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div style="border-bottom: none; border-left: solid #4F81BD 1.0pt; border-right: none; border-top: solid #4F81BD 1.0pt; mso-border-left-alt: solid #4F81BD .75pt; mso-border-left-themecolor: accent1; mso-border-left-themecolor: accent1; mso-border-top-alt: solid #4F81BD .75pt; mso-border-top-themecolor: accent1; mso-border-top-themecolor: accent1; mso-element: para-border-div; padding: 7.0pt 0in 0in 2.0pt;">
<h3 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">ELISA Reader<o:p></o:p></span></h3>
</div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">ELISA stands for "enzyme linked
immuno-sorbent assay." The ELISA reader or microplate reader is
modification of the spectrophotometer, which enables quantitation of upto 96
samples per ELISA microplate. Microplates have a 12 x 8 well format. A set of 8
lamps, 8 filters and 8 detectors enable the sequential determination of 96
samples.<i><o:p></o:p></i></span></span></div>
<div style="border-bottom: none; border-left: solid #4F81BD 1.0pt; border-right: none; border-top: solid #4F81BD 1.0pt; mso-border-left-alt: solid #4F81BD .75pt; mso-border-left-themecolor: accent1; mso-border-left-themecolor: accent1; mso-border-top-alt: solid #4F81BD .75pt; mso-border-top-themecolor: accent1; mso-border-top-themecolor: accent1; mso-element: para-border-div; padding: 7.0pt 0in 0in 2.0pt;">
<h3 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">Automated clinical chemistry analyzers:<o:p></o:p></span></h3>
</div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">These usually incorporate mechanized versions of basic
manual laboratory techniques and procedures. They help in the processing,
transport and testing of a large number of clinical specimens in an efficient
manner. Work is simplified by using robotic and computer technology to
undertake repetitive tasks like pipetting, dispensing and mixing. Advanced
versions of the spectrophotometer help in increasing specimen throughput.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
</div>
</div>
A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-586132321408601452015-12-20T14:35:00.001+05:452015-12-20T14:35:36.146+05:45Cerebrospinal fluid (CSF) : Formation, composition, function, pathological state and biochemical analysis<div dir="ltr" style="text-align: left;" trbidi="on">
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<div style="background: #DBE5F1; border: solid #DBE5F1 3.0pt; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-themecolor: accent1; mso-border-themetint: 51; mso-element: para-border-div; padding: 0in 0in 0in 0in;">
<h2 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif; font-size: small;">A. Formation<i><o:p></o:p></i></span></h2>
</div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Cerebrospinal fluid (CSF) is a clear,
colourless fluid filling the ventricles and subarachnoid space. CSF production
is a result of the combined processes of diffusion, pinocytosis and active
transfer. The majority is produced by selective dialysis of blood plasma by a
specialized sponge-like structure called the "choroid plexus" of
third, lateral and fourth ventricles.<o:p></o:p></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHNs6I2sD1Arduwr18u8ClPbj9jOykNsiWmgKd8SRLFou7qpbqLiq7qcFlZLAY26uaRUixoI6hZmfseqcfrDn39kNfxDyTVug3dPOuhiGFaZPDuyztwzsG7KBzDtzZ_SZTIXaSv9jBieDG/s1600/CSF+collection.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHNs6I2sD1Arduwr18u8ClPbj9jOykNsiWmgKd8SRLFou7qpbqLiq7qcFlZLAY26uaRUixoI6hZmfseqcfrDn39kNfxDyTVug3dPOuhiGFaZPDuyztwzsG7KBzDtzZ_SZTIXaSv9jBieDG/s320/CSF+collection.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. CSF collection</td></tr>
</tbody></table>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">The anatomy of the ventricular system
allows for movement of CSF in and around all the major structures of the brain.
From the lateral ventricles located within the cerebral hemisphere, it
circulates through the foramina of Monro into the third ventricle. At its
caudal end, the third ventricle is connected by aqueduct of Sylvius to the
fourth ventricle. CSF then flows into the basal cisterns and subarachnoid space
by two lateral foramina of Lusckha and median foramina of Magendie. From the
cisterns the CSF flows / throughout the subarachnoid space and over the
hemispheric convexities and around the spinal cord. <o:p></o:p></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"></span></span><br />
<a name='more'></a><span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">The total volume of CSF is about 150 ml and
the rate of CSF production is about 550 ml per day thus, turnover rate is about
3.7 times a day. CSF is reabsorbed into the venous system by numerous
microscopic arachnoid villi and larger but less common arachnoid granulations
(pacchinian bodies). Villi and granulations act as valves, which permit single
directional flow of CSF into the venous blood. The reabsorption of CSF occurs
along the entire neuraxis. In the SA space CSF comes in contact with
perivascular spaces around the blood vessels entering and leaving the brain
where cells and protein leak during inflammation. It must be remembered that
there is no lymphatic drainage system in the central nervous system CNS), hence
only 2 pathways are available for the elimination of wastes - capillary
drainage and excretion via CSF. CSF secretion is an active process overall but
production is independent of intraventricular pressure and resorption is
proportional to it. A blood CSF barrier exists for many substances like
bilirubin and certain drugs, so that their concentration in CSF is lower than
in plasma. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div style="background: #DBE5F1; border: solid #DBE5F1 3.0pt; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-themecolor: accent1; mso-border-themetint: 51; mso-element: para-border-div; padding: 0in 0in 0in 0in;">
<h2 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif; font-size: small;">B. Composition <i><o:p></o:p></i></span></h2>
</div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">The composition of CSF is essentially same
as that of brain ECF and is largely determined at the cell surfaces on which it
is produced (choroid plexus), where it is absorbed (arachnoid villi). Its ionic
composition is the same as that of plasma for some components and different for
others. In general CSF glucose concentration is 60% of serum, sodium chloride
and magnesium are same or greater than serum but potassium, calcium and glucose
are lower than serum. Active transport in and out of the CSF space is probably
responsible for maintaining this difference. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Total volume = 150 ml <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Specific gravity = 1.006-1.008 <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">pH =
7.31
-7.40 (7.33) <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Normal pressure = 110-130
mm Ringer's solution, or 7-10mm Hg <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Color = colorless <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Transparency = clear, free of clots ; Osmolarity = 292-297mOsm/l <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Cellularity = nil
or less than 5 lymphocyte or monocyte / mm3 <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Glucose =
40-70 mg/dl <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Protein =
15-50 mg/dl <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Bilirubin =
nil <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Na<sup>+</sup> = 138-150 mEq/L <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">CI <sup>-</sup> = 116-122 mEq/L ; HCO<sub>3</sub> = 20-24 mmol/L <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<br /></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">The normal A:G ratio in CSF proteins is 3:
1. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Ratio of serum: CSF protein is 200: 1. <i><o:p></o:p></i></span></span></div>
<div style="background: #DBE5F1; border: solid #DBE5F1 3.0pt; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-themecolor: accent1; mso-border-themetint: 51; mso-element: para-border-div; padding: 0in 0in 0in 0in;">
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<h2 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif; font-size: small;">C. Functions<i><o:p></o:p></i></span></h2>
</div>
<div class="MsoPlainText" style="margin-left: 1in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">1.<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">mechanical support (cushion
effect) <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">2.<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">removal of metabolic waste products
<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">3.<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">transport of biologically
active compounds <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">4.<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">maintenance of the chemical
environment of the brain <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1in; text-align: justify; text-indent: -0.25in;">
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
<div style="background: #DBE5F1; border: solid #DBE5F1 3.0pt; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-themecolor: accent1; mso-border-themetint: 51; mso-element: para-border-div; padding: 0in 0in 0in 0in;">
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<h2 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif; font-size: small;">D. Pathological states in which examination of CSF may be required: <i><o:p></o:p></i></span></h2>
</div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">A wide range of disorders can produce
change in CSF composition and the commonest indication for a lumbar puncture to
remove CSF is meningitis or infection of the coverings of the brain. <o:p></o:p></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<br /></div>
<div class="MsoPlainText" style="margin-left: 1in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(1)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Infections:<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(a)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Meningitis (Bacterial
commonest) <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(b)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Encephalitis <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(c)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Neurosyphylis (acute) <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(d)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">TB meningitis <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(2)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Cerebrovascular<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(a)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Sub-arachnoid haemorrhage<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(3)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Dementia and degenerative<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(a)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Alzheimer’s disease<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(4)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Neoplastic<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(a)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Meningial carcinomatosis<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(b)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Secondary deposits<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(5)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Demyelinating <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(a)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Multiple sclerosis<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(6)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Autoimmune <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(a)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Sarcoidosis<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify;">
<br /></div>
<div style="background: #DBE5F1; border: solid #DBE5F1 3.0pt; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-themecolor: accent1; mso-border-themetint: 51; mso-element: para-border-div; padding: 0in 0in 0in 0in;">
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<h2 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif; font-size: small;">E. Acquisition<i><o:p></o:p></i></span></h2>
</div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Quinke first developed the technique of LP
or spinal tap in 1891. CSF is collected by lumbar puncture in which a fine bore
needle (22 or 24 L.P needle) is passed between the 3rd and 4th lumbar vertebrae
into the subarachnoid space with the patient lying in the lateral position and
the fluid allowed to flow automatically. The bevel of the needle should be
parallel to the long axis of the spine. The whole procedure is done under
strict asepsis. The first few drops of the fluid are discarded and the rest of
the fluid is collected in sterile containers. There are specific indications
and contraindications for lumbar puncture. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<br /></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">The specimen is divided into 3 aliquots
for: <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">a)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Chemistry and Serology <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">b)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Bacteriology <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">c)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Microscopy <o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: 0.5in;">
<b><span style="font-family: "trebuchet ms" , sans-serif;">Protocol for investigation: <i><o:p></o:p></i></span></b></div>
<div class="MsoPlainText" style="margin-left: 1in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(1)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Pressure (Opening and closing
pressure) <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(2)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Appearance <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(a)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">color <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(b)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">turbidity <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(c)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">coagulum <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(3)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Cytological examination: : <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(a)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">direct examination<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(b)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">staining of the centrifuged
deposit (e.g.Leishman's stain). . <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(4)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Microbiological
investigations: <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(a)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">staining of centrifuged
deposit (gram stain, AFB) <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(b)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">culture and sensitivity. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(5)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Biochemical investigations.- <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(a)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Total proteins (Lowry method
or turbidimetry) <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(b)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Qualitative test for gamma
globulin <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(c)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Quantitation of glucose <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(d)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Quantitation of chloride <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(e)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Enzymes like LDH<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.25in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">(f)<span style="font-stretch: normal; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Bicarbonate, folate levels<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">It must be borne in mind that CSF samples
must always be centrifuged prior to analysis in order to precipitate any cells
otherwise falsely high values for CSF protein will be obtained. <o:p></o:p></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<br /></div>
<div style="background: #DBE5F1; border: solid #DBE5F1 3.0pt; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-themecolor: accent1; mso-border-themetint: 51; mso-element: para-border-div; padding: 0in 0in 0in 0in;">
<h2 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif; font-size: small;">F. Changes in CSF in diseased states</span></h2>
<h2 style="text-align: justify;">
<span style="background-color: transparent; font-family: "trebuchet ms" , sans-serif; font-size: small;">Physical Analysis</span></h2>
</div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b><u><span lang="IT"><br /></span></u></b></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b><u><span lang="IT">Pressure:</span></u></b><span lang="IT"> Normally 60-150 mm of water in recumbent position. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Low opening pressure: 10- 20 cm H<sub>2</sub>O
normal- CSF leak or spinal SA obstruction. Elevated opening pressure: More than
20 cm H<sub>2</sub>O - space occupying lesion, diffuse cerebral inflammation. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<br /></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b><u><span lang="IT">Appearance:</span></u></b><span lang="IT"> Normal CSF is clear and colorless and gives no coagulum or sediment on
standing. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<br /></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b><u><span lang="IT">Color:</span></u></b><span lang="IT"> Changes only in pathological conditions, whereas the term
xanthochromia means yellow colour. It has been used for the presence of other
colours as well<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Yellowish tinge --markedly increased
protein >200%. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Yellowish --bilirubin <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Blood may be present due to bleeding from
L.P. site, pathological subarachnoid hemorrhage, ventricular hemorrhage, or
neurosurgical operations. When hemolysis occurs in CSF the hemoglobin liberated
is converted to bilirubin and that gives a yellow coloration to the CSF (more
visible after centrifugation) called xanthochromia. Bilirubin is detected after
10 hours of subarachnoid bleeding. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<br /></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b><u><span lang="IT">Turbidity:</span></u></b><span lang="IT"> CSF may occasionally clot if the ratio of blood to CSF is high.
Usually due to fibrin clot (e.g., tubercular meningitis a cobweb coagulum
appears by keeping CSF for 12-15 hours). Turbidity can also be due to
microscopic fat globules (fat embolism). <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<br /></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b><u><span lang="IT">Cell
count :</span></u></b><span lang="IT"> Normal CSF should contain no more than 5
lymphocytes or monocytes / mm3. Nature and number of cells are noted. Presence
of RBCs indicate hemorrhage. Presence of WBCs predominantly polymorphs indicate
bacterial meningitis. In viral infection and chronic infections a lymphocytic
response is obtained. <i><o:p></o:p></i></span></span></div>
<div style="background: #DBE5F1; border: solid #DBE5F1 3.0pt; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-themecolor: accent1; mso-border-themetint: 51; mso-element: para-border-div; padding: 0in 0in 0in 0in;">
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<h2 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif; font-size: small;">Biochemical analysis <i><o:p></o:p></i></span></h2>
</div>
<div style="border-bottom: none; border-left: solid #4F81BD 1.0pt; border-right: none; border-top: solid #4F81BD 1.0pt; mso-border-left-alt: solid #4F81BD .75pt; mso-border-left-themecolor: accent1; mso-border-left-themecolor: accent1; mso-border-top-alt: solid #4F81BD .75pt; mso-border-top-themecolor: accent1; mso-border-top-themecolor: accent1; mso-element: para-border-div; padding: 7.0pt 0in 0in 2.0pt;">
<h3 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif; font-size: small;">Proteins:<o:p></o:p></span></h3>
</div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">CSF proteins ordinarily originate from
serum and reach the cerebral space by endocytosis across the capillary
endothelium. An increase in total proteins is the commonest chemical
abnormality in CSF and results from a breakdown of the blood CSF and brain-CSF
barriers usually as a consequences of an inflammatory reaction but on occasion,
if the flow of CSF is obstructed. Albumin is the predominant protein to be
increased, globulins appear in varying amount. If the permeability of the
barriers is markedly increased, fibrinogen is present which in the test tube
forms a clot or coagulum. <o:p></o:p></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Examination of CSF protein is done mainly
to detect : <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
</div>
<ul>
<li><span style="font-family: "trebuchet ms" , sans-serif;">Increased blood-brain barrier permeability
to plasma protein (80%)</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;">Increased intrathecal IgG secretion (20% ).</span></li>
</ul>
<br />
<div style="border-bottom: none; border-left: solid #4F81BD 1.0pt; border-right: none; border-top: solid #4F81BD 1.0pt; mso-border-left-alt: solid #4F81BD .75pt; mso-border-left-themecolor: accent1; mso-border-left-themecolor: accent1; mso-border-top-alt: solid #4F81BD .75pt; mso-border-top-themecolor: accent1; mso-border-top-themecolor: accent1; mso-element: para-border-div; padding: 7.0pt 0in 0in 2.0pt;">
<h3 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif; font-size: small;">Increase in CSF protein occurs in <i><o:p></o:p></i></span></h3>
</div>
<div class="MsoPlainText" style="text-align: left;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Hemorrhage
(trauma, neoplasm, ruptured aneurysm). Note: A false result may occur from a
"bloody tap" -rupture of a blood vessel during LP (presence of
1000RBCs -increase protein I mg / ml). <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Inflammation, meningitis especially
bacterial (meningococcal), may be as high as 2000mg/dl. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Other causes: encephalitis, polio. <o:p></o:p></span></span></div>
<div style="border-bottom: none; border-left: solid #4F81BD 1.0pt; border-right: none; border-top: solid #4F81BD 1.0pt; mso-border-left-alt: solid #4F81BD .75pt; mso-border-left-themecolor: accent1; mso-border-left-themecolor: accent1; mso-border-top-alt: solid #4F81BD .75pt; mso-border-top-themecolor: accent1; mso-border-top-themecolor: accent1; mso-element: para-border-div; padding: 7.0pt 0in 0in 2.0pt;">
<h3 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif; font-size: small;">Glucose <o:p></o:p></span></h3>
</div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">CSF glucose concentration is ~ 60% of the
normal plasma glucose. Blood and CSF glucose equilibrate only after a lag
period of 4hours so that CSF glucose at a given time reflects blood glucose
level during the past 5 hrs. When glucose determination is critical, CSF and
blood glucose should be obtained only after the patient has been fasted for the
last 4 hrs. Equilibrated CSF glucose is definitely abnormal when it is less
than 40% of simultaneously determined blood glucose-values of 40 mg/dl are
almost always abnormal. <o:p></o:p></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div style="border-bottom: none; border-left: solid #4F81BD 1.0pt; border-right: none; border-top: solid #4F81BD 1.0pt; mso-border-left-alt: solid #4F81BD .75pt; mso-border-left-themecolor: accent1; mso-border-left-themecolor: accent1; mso-border-top-alt: solid #4F81BD .75pt; mso-border-top-themecolor: accent1; mso-border-top-themecolor: accent1; mso-element: para-border-div; padding: 7.0pt 0in 0in 2.0pt;">
<h3 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif; font-size: small;">Decreased CSF glucose (Hypoglycorrachia): <o:p></o:p></span></h3>
</div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Markedly decreased in pyogenic meningitis (
e.g., 10-20 mg/dl); in tuberculous meningitis it is 30-50mg/dl; in viral
meningitis it is normal. <o:p></o:p></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Specialised Tests: <o:p></o:p></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Increased lactate Bacterial meningitis <o:p></o:p></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Increased glutamine Hepatic encephalopathy <o:p></o:p></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Increased LDH </span></span><span style="font-family: "trebuchet ms" , sans-serif;">Bacterial meningitis, metastatic carcinoma </span><span style="font-family: "trebuchet ms" , sans-serif;">Increased CK-BB Parenchymal damage</span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Increased adenosine Tuberculous meningitis deaminase </span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"> <o:p></o:p></span></span></div>
<div style="border-bottom: none; border-left: solid #4F81BD 1.0pt; border-right: none; border-top: solid #4F81BD 1.0pt; mso-border-left-alt: solid #4F81BD .75pt; mso-border-left-themecolor: accent1; mso-border-left-themecolor: accent1; mso-border-top-alt: solid #4F81BD .75pt; mso-border-top-themecolor: accent1; mso-border-top-themecolor: accent1; mso-element: para-border-div; padding: 7.0pt 0in 0in 2.0pt;">
<h3 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif; font-size: small;">Protocol for Protein Estimation in CSF <o:p></o:p></span></h3>
</div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Add I ml each of test CSF, standard and
distilled water in respective tubes. Then add 4ml of 3% TCA in all tubes. Mix.
keep for 10 mins. Read at 450nm Standard protein concentration - 50mg/dl <o:p></o:p></span></span></div>
<div style="border-bottom: none; border-left: solid #4F81BD 1.0pt; border-right: none; border-top: solid #4F81BD 1.0pt; mso-border-left-alt: solid #4F81BD .75pt; mso-border-left-themecolor: accent1; mso-border-left-themecolor: accent1; mso-border-top-alt: solid #4F81BD .75pt; mso-border-top-themecolor: accent1; mso-border-top-themecolor: accent1; mso-element: para-border-div; padding: 7.0pt 0in 0in 2.0pt;">
<h3 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif; font-size: small;">Protocol for estimation of CSF glucose <o:p></o:p></span></h3>
</div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigSdgmnb1g3RxZ9R2s1ArT_cfhAN4DtK-zUqD6U_8Em88l6sUqB6u9DE6zOWBG8RwOSERLrheiWIAegJUYzQktSjYCD4ryL4beUzcZ2wuoUtVHd9nivym6B-1lcllJGycGBt-Q4PrO91zj/s1600/normal+CSF+characteristics+and+main+pathological+findings.gif" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="211" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigSdgmnb1g3RxZ9R2s1ArT_cfhAN4DtK-zUqD6U_8Em88l6sUqB6u9DE6zOWBG8RwOSERLrheiWIAegJUYzQktSjYCD4ryL4beUzcZ2wuoUtVHd9nivym6B-1lcllJGycGBt-Q4PrO91zj/s400/normal+CSF+characteristics+and+main+pathological+findings.gif" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. Normal CSF interperetation and pathological states</td></tr>
</tbody></table>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Place 0.1ml of CSF into 7.8ml of isotonic
solution in a centrifuge tube. Mix well. Add 0.1ml of sodium tungstate
solution. Mix and centrifuge at 2000 rpm for 10 min. Take 2ml each of the
supernatant, standard and isotonic solution in the respective tubes. Then add
2ml of alkaline reagent in all tubes. Mix well and heat in boiling water for 10
min, cool and add 2ml of color reagent in all tubes. Mix and wait for 5 min.
Read at 540 nm.Concentration of standard: 1.25 mg/dl. <o:p></o:p></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; margin-left: 5.4pt; text-align: justify; width: 624px;">
<tbody>
<tr style="height: 31.9pt; mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid windowtext 1.0pt; height: 31.9pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 85.5pt;" width="114"><div class="MsoNormal">
<br /></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; height: 31.9pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 81.0pt;" width="108"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">NORMAL CSF<o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; height: 31.9pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 67.5pt;" width="90"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">VIRAL MENINGITIS<o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; height: 31.9pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 121.5pt;" width="162"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">BACTERIAL MENINGITIS<o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; height: 31.9pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 112.5pt;" width="150"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">T.B.MENINGITIS<o:p></o:p></span></div>
</td>
</tr>
<tr style="height: 16.05pt; mso-yfti-irow: 1;">
<td style="border-top: none; border: solid windowtext 1.0pt; height: 16.05pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 85.5pt;" width="114"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">APPEARANCE<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 16.05pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 81.0pt;" width="108"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">CLEAR<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 16.05pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 67.5pt;" width="90"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">CLEAR<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 16.05pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 121.5pt;" width="162"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">TURBID<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 16.05pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 112.5pt;" valign="top" width="150"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">CLEAR/TURBID<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">(cobweb coagulum)<o:p></o:p></span></div>
</td>
</tr>
<tr style="height: 34.15pt; mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; height: 34.15pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 85.5pt;" width="114"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">LYMPHOCYTES<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 34.15pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 81.0pt;" width="108"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">< 5/ mm3<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 34.15pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 67.5pt;" width="90"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">10-100/mm3<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 34.15pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 121.5pt;" width="162"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">5-50/mm3<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 34.15pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 112.5pt;" width="150"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">100-300/mm3<o:p></o:p></span></div>
</td>
</tr>
<tr style="height: 28.75pt; mso-yfti-irow: 3;">
<td style="border-top: none; border: solid windowtext 1.0pt; height: 28.75pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 85.5pt;" width="114"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">POLYMORPHS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 28.75pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 81.0pt;" width="108"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">< 5/mm3<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 28.75pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 67.5pt;" width="90"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">NIL<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 28.75pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 121.5pt;" width="162"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">200-2000/mm3<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 28.75pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 112.5pt;" width="150"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">0-100/mm3<o:p></o:p></span></div>
</td>
</tr>
<tr style="height: 30.1pt; mso-yfti-irow: 4;">
<td style="border-top: none; border: solid windowtext 1.0pt; height: 30.1pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 85.5pt;" width="114"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">GLUCOSE<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 30.1pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 81.0pt;" width="108"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">40-70 mg/dl<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 30.1pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 67.5pt;" width="90"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">30-60 mg/dl<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 30.1pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 121.5pt;" width="162"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">20-30 mg/dl<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 30.1pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 112.5pt;" width="150"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">20-40 mg/dl<o:p></o:p></span></div>
</td>
</tr>
<tr style="height: 35.5pt; mso-yfti-irow: 5; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; height: 35.5pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 85.5pt;" width="114"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">PROTEINS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 35.5pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 81.0pt;" width="108"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">15-50 mg/dl<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 35.5pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 67.5pt;" width="90"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">20-80 mg/dl<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 35.5pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 121.5pt;" width="162"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">50-200 mg/dl or
more<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 35.5pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 112.5pt;" width="150"><div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">20-100 mg/dl<o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<br />
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
</div>
</div>
A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-43475934449152630332015-12-17T12:25:00.001+05:452015-12-20T14:37:23.805+05:45Protein separation techniques: Protein fractionation<div dir="ltr" style="text-align: left;" trbidi="on">
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrNxu29G6LM9OM1Bu0alssAf4MpBBkG3ouZfcr8ihjKyxIf7Z3fcgzveorXKDG5N66MzSWqqMtR-Aw4RqHBLqUe8L9J3gfoZ9PXBa01RTCY7gYEiJh4RG1FKi-FcmYeEKMcW7IScn-INcM/s1600/purity-chart2.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="246" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrNxu29G6LM9OM1Bu0alssAf4MpBBkG3ouZfcr8ihjKyxIf7Z3fcgzveorXKDG5N66MzSWqqMtR-Aw4RqHBLqUe8L9J3gfoZ9PXBa01RTCY7gYEiJh4RG1FKi-FcmYeEKMcW7IScn-INcM/s400/purity-chart2.jpg" style="outline: red dashed 1px;" title="" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. Protein purification steps</td></tr>
</tbody></table>
<div style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">Proteins differ in their molecular size and
charge. They can be separated on the basis of their following properties:</span></div>
<div class="WordSection1">
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">1.<span style="font-size: 7pt; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">molecular size <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">2.<span style="font-size: 7pt; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">solubility <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">3.<span style="font-size: 7pt; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">electrical charge <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">4.<span style="font-size: 7pt; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">adsorption properties <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">5.<span style="font-size: 7pt; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">specific bioaffinity.<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Many techniques for protein purification
exist, but the emphasis here is on some of the most popular procedures and the
principles involved in their use.
Protein fractionation is required to separate and characterize a protein
in detail.<i><o:p></o:p></i></span></span><br />
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"></span></span><br />
<a name='more'></a></div>
<div style="background: #DBE5F1; border: solid #DBE5F1 3.0pt; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-themecolor: accent1; mso-border-themetint: 51; mso-element: para-border-div; padding: 0in 0in 0in 0in;">
<h2 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">Differential Centrifugation<o:p></o:p></span></h2>
</div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">A typical crude broken cell preparation
contains disrupted cell membranes, cellular organelles and a large number of
soluble proteins all dispersed in an aqueous buffered solution. The membranes
and the organelles can be separated from the soluble proteins by differential
centrifugation.<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">This type of centrifugation involves the
use of different speeds and different durations. For eg. If the protein of
interest is in the mitochondrial fraction, the crude cell lysate is first
centrifuged at 1000g for removing nuclei, debris etc. The supernatant contains
among other elements the mitochondria, which can be pelleted at 3300g for 10
minutes. <i><o:p></o:p></i></span></span></div>
<div style="background: #DBE5F1; border: solid #DBE5F1 3.0pt; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-themecolor: accent1; mso-border-themetint: 51; mso-element: para-border-div; padding: 0in 0in 0in 0in;">
<br />
<h2 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">Salt Fractionation<o:p></o:p></span></h2>
</div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Proteins show a variation in solubility
that depends on the concentration of salts in the solution. This method is
frequently used to separate serum proteins into albumins and globulins. Albumin is soluble in water whereas globulins
are not. Globulins are soluble in weak
salt solutions, going into solution at salt concentrations of 0.1 mol/L. This
phenomenon called <b>"salting
in".</b> This is thought to be due to electrostatic attraction between
salt ions and the charged groups on the protein, which decreases the
intermolecular electrostatic attraction of proteins & increases the
interactions of protein molecules with water, a polar solvent, thus making them
soluble. Salts with divalent ions are
more effective than those with monovalent ions.<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">As the salt concentration is increased,
however, salt ions compete for the water molecules of hydration of the hydrated
groups of proteins, resulting in the decreased solubility and precipitation of
protein out of the solution. The larger
proteins are usually precipitated first. This phenomenon is referred to as “<b>salting out”</b> of protein. Ammonium sulphate is commonly used for
salting out proteins. Globulins are the proteins precipitated by half
saturation of a solution with ammonium sulphate, while Albumin is precipitated
on fully saturating the solution.<o:p></o:p></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<br /></div>
<div style="background: #DBE5F1; border: solid #DBE5F1 3.0pt; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-themecolor: accent1; mso-border-themetint: 51; mso-element: para-border-div; padding: 0in 0in 0in 0in;">
<h2 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">Electrophoresis<o:p></o:p></span></h2>
</div>
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuZ87fWRTZImR26T740JgDqQj17KQlSyer4ZcO_nktghLqMB97MB6BlpnCsPlJ5DLgmR99EjaGbm4UgGE_ef58849nrR9VEqFYGM8I0KZ7MXocld0-qY1PX0-GOcO2kdztQDIO8mm2kP3x/s1600/electrophoresis.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="228" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuZ87fWRTZImR26T740JgDqQj17KQlSyer4ZcO_nktghLqMB97MB6BlpnCsPlJ5DLgmR99EjaGbm4UgGE_ef58849nrR9VEqFYGM8I0KZ7MXocld0-qY1PX0-GOcO2kdztQDIO8mm2kP3x/s320/electrophoresis.jpg" style="outline: red dashed 1px;" title="" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. Electrophoresis apparatus</td></tr>
</tbody></table>
<br />
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b><span lang="IT">Electrophoresis
is the movement of charged particles through an electrolyte in an electric
field.</span></b><span lang="IT"> The positively charged particles move towards
the cathode and the negative ions to the anode. The rate of migration of
particles of like charge will depend among other things on the number of
charges it carries. Different rates of migration separate a complex mixture
such as plasma proteins into a number of fractions according to mobility.
Electrophoresis is not used to purify proteins because some alteration in
protein structure and ultimately function. This is used as a analytical method.
It permits to estimate number of proteins in a mixture. This is also useful to
determine isoelectric point and approximate molecular weight. <o:p></o:p></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<br /></div>
<div style="background: #DBE5F1; border: solid #DBE5F1 3.0pt; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-themecolor: accent1; mso-border-themetint: 51; mso-element: para-border-div; padding: 0in 0in 0in 0in;">
<h2 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">Chromatography <o:p></o:p></span></h2>
</div>
<div class="MsoPlainText" style="text-align: justify;">
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<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">This technique was originally used to
separate chlorophyll from plant extracts on silica, hence the name
chromatography, which means separation of colored compounds. It is the name
given to any <b>technique in which the
members of a group of similar substances are separated by a continuous
redistribution between two phases.</b> One is the stationary phase, which may
be solid, liquid, gel or solid/liquid mixture which is immobilised. The second
mobile phase may be liquid or gaseous and flows over or through the stationary
phase. The choice of stationary or mobile phases is made so that the compounds
to be separated have different distribution coefficients. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">The movement of any substance being
chromatographed is the outcome of <i><o:p></o:p></i></span></span></div>
<br />
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">a.<span style="font-size: 7pt; font-style: normal;"> </span></span></i><span lang="IT">Forces resulting from its
interaction with the mobile phase which tend to pull it along with the mobile
phase <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">b.<span style="font-size: 7pt; font-style: normal;"> </span></span></i><span lang="IT">Forces resulting from its
attraction to the stationary phase, which tend to retard its movement. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Since the forces are different for
different substances chromatography will be able to separate out the components
of a mixture of substances. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Based on the properties of the stationary
phase and the acting forces, several different types of chromatographic
procedures have been described. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">1.<span style="font-size: 7pt; font-style: normal;"> </span></span></i><b><span lang="IT">Adsorption chromatography</span></b><span lang="IT">: Adsorption
equilibrium between a stationary solid and a mobile liquid phase. This is used
to separate the non ionic, water insoluble compounds such as vitamins,
triglycerides drugs etc. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">2.<span style="font-size: 7pt; font-style: normal;"> </span></span></i><b><span lang="IT">Partition chromatography</span></b><span lang="IT">: Partition
equilibrium between a stationary liquid and a mobile liquid phase. This is used
to analyze drugs, insecticides, pestisides,amino acids .<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">3.<span style="font-size: 7pt; font-style: normal;"> </span></span></i><b><span lang="IT">Gas-Liquid chromatography</span></b><span lang="IT">: Partition
equilibrium between a stationary liquid and a mobile gaseous phase. The mobile
phase is generally an inert gas - steroid separation.<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">4.<span style="font-size: 7pt; font-style: normal;"> </span></span></i><b><span lang="IT">Ion-exchange chromatography</span></b><span lang="IT">: Ion exchange
equilibrium between an ion-exchange stationary resin phase and a mobile
electrolyte phase. So amino acids proteins which have ionized groups can be
separated on the basis of this. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">5.<span style="font-size: 7pt; font-style: normal;"> </span></span></i><b><span lang="IT">Gel permeation chromatography:</span></b><span lang="IT"> Equilibrium
between a liquid phase inside and outside a porous molecular sieve depending on
molecular size - preparative procedure. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">6.<span style="font-size: 7pt; font-style: normal;"> </span></span></i><b><span lang="IT">Affinity chromatography:</span></b><span lang="IT"> Equilibrium between a
macromolecule and a small molecule (Ligand) for which it has high affinity -
monoclonal antibody purification. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<br /></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b>Types of solid support media</b></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">a.<span style="font-size: 7pt; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Dextran (Sephadex), <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">b.<span style="font-size: 7pt; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Agarose (Sepharose), <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">c.<span style="font-size: 7pt; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Silica Gel,<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">d.<span style="font-size: 7pt; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Cellulose (Sephacel)</span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<span style="font-family: "trebuchet ms" , sans-serif;"><span lang="IT"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b><span lang="IT">Dextran</span></b><span lang="IT"> is a polysaccharide built from glucose residues. When the dextran is
cross-linked by epichlorhydrin to form a gel, the polysaccharide chains of the
gel from a 3-dimensional network. The product is insoluble unless it is broken
down chemically. Dextran gels are commercially known under the name of
Sephadex. The different types of sephadex beads differ in their degree of
cross-linking. The various types are characterized by the letter G, followed by
a number. Based on their extent of cross-linkage, proteins of different MW are
separated from each other.</span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b><br /></b></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b>Principle of the method:</b></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b><br /></b></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">In the column, proteins of different
molecular size penetrate into the internal pores of the beads to different
degrees and thus travel down the column at different rates. In other words,
very large protein molecules cannot enter the pores of the beads and they are
excluded, while small proteins can enter the pores of the beads freely and are
retarded. This is called molecular sieving or gel permeation. The different
peaks of separation can be monitored by UV detectors and recorded. The peak
containing required material can be identified depending upon the properties of
the substance for e.g. measurement of enzyme activity, Ag-Ab binding, etc.</span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b>Bed volume</b></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Volume of the gel which is available to
those molecules which are smaller than the fractionation range for the gel.</span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b>Void volume</b></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Volume of the liquid in the interstitial
spaces between beads of the gel. It is available to those molecules whose size
is bigger than the fractionation range of the gel eg. Blue Dextran (2 million
MW).</span></span><span lang="IT" style="font-family: "trebuchet ms" , sans-serif; font-size: 14pt;"> </span><span lang="IT" style="font-family: "trebuchet ms" , sans-serif;"> </span></div>
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<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><i>Applications of protein purification:</i> <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">1.<span style="font-size: 7pt; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Protein concentration<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">2.<span style="font-size: 7pt; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Monoclonal antibody
purification<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">3.<span style="font-size: 7pt; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Removal of endotoxins from a
protein solution<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><span lang="IT">4.<span style="font-size: 7pt;"> </span></span><!--[endif]--><span lang="IT">Removal of proteins from a sugar solution.<o:p></o:p></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify;">
<br /></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7B0j_by1o9-b0wUbOHbknacPPZolBaULtnaKeuIz4k3vl3vlxUv7Q3xKW9O2RHxH1s5MAJl_UhTdnpjJd-OMT6y_2InEf0UVCT2XNr9PXQGfLYV_XBn3mUuhikrPMYmt1uAoIUvks1-zP/s1600/paper+chromatography.gif" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7B0j_by1o9-b0wUbOHbknacPPZolBaULtnaKeuIz4k3vl3vlxUv7Q3xKW9O2RHxH1s5MAJl_UhTdnpjJd-OMT6y_2InEf0UVCT2XNr9PXQGfLYV_XBn3mUuhikrPMYmt1uAoIUvks1-zP/s400/paper+chromatography.gif" style="outline: red dashed 1px;" title="" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. Paper chromatography</td></tr>
</tbody></table>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b>Amino acid separation by paper chromatography:</b></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">In this, the amino acids partition themselves
on the paper between an organic solvent of choice and water.<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b><span lang="IT"><br /></span></b></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b><span lang="IT">Procedure:</span></b><span lang="IT" style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"> </span><span lang="IT">There are two techniques, which may be employed for the development of
paper chromatograms: ascending or descending methods. In ascending technique, the paper is kept in
a glass jar containing the solvent such that the lower edge of the paper is in
contact with the solvent. The sample is applied to the position just above the
surface of the solvent. As the solvent moves vertically up the paper by
capillary action, separation of the amino acids is achieved. In the descending
techniques, the solvent moves downwards under gravity.<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b><span lang="IT"><br /></span></b></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b><span lang="IT">Component
Detection:</span></b><span lang="IT" style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"> </span><span lang="IT">Spraying of the paper with ninhydrin will stain
amino acids. The identification of a
given amino acid may be on the basis of its relative fraction (R<span style="mso-text-raise: -3.5pt; position: relative; top: 3.5pt;">f</span>) value,
which is defined as:<o:p></o:p></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<br /></div>
<div class="MsoPlainText">
<!--[if gte msEquation 12]><m:oMathPara><m:oMath><m:sSub><m:sSubPr><span
style='font-family:"Cambria Math","serif";mso-ascii-font-family:"Cambria Math";
mso-hansi-font-family:"Cambria Math"'><m:ctrlPr></m:ctrlPr></span></m:sSubPr><m:e><i
style='mso-bidi-font-style:normal'><span lang=IT style='font-family:"Cambria Math","serif"'><m:r>R</m:r></span></i></m:e><m:sub><i
style='mso-bidi-font-style:normal'><span lang=IT style='font-family:"Cambria Math","serif"'><m:r>f</m:r></span></i><span
lang=IT style='font-family:"Cambria Math","serif"'><m:r><m:rPr><m:scr m:val="roman"/><m:sty
m:val="p"/></m:rPr> =</m:r></span></m:sub></m:sSub><m:f><m:fPr><span
style='font-family:"Cambria Math","serif";mso-ascii-font-family:"Cambria Math";
mso-hansi-font-family:"Cambria Math"'><m:ctrlPr></m:ctrlPr></span></m:fPr><m:num><i
style='mso-bidi-font-style:normal'><span lang=IT style='font-family:"Cambria Math","serif"'><m:r>T</m:r><m:r>h</m:r><m:r>e</m:r></span></i><span
lang=IT style='font-family:"Cambria Math","serif"'><m:r><m:rPr><m:scr m:val="roman"/><m:sty
m:val="p"/></m:rPr> </m:r><m:r><i style='mso-bidi-font-style:normal'>distance</i></m:r><m:r><m:rPr><m:scr
m:val="roman"/><m:sty m:val="p"/></m:rPr> </m:r><m:r><i
style='mso-bidi-font-style:normal'>moved</i></m:r><m:r><m:rPr><m:scr m:val="roman"/><m:sty
m:val="p"/></m:rPr> </m:r><m:r><i style='mso-bidi-font-style:normal'>by</i></m:r><m:r><m:rPr><m:scr
m:val="roman"/><m:sty m:val="p"/></m:rPr> </m:r><m:r><i
style='mso-bidi-font-style:normal'>solute</i></m:r><m:r><m:rPr><m:scr
m:val="roman"/><m:sty m:val="p"/></m:rPr> </m:r><m:r><i
style='mso-bidi-font-style:normal'>front</i></m:r></span></m:num><m:den><i
style='mso-bidi-font-style:normal'><span lang=IT style='font-family:"Cambria Math","serif"'><m:r>T</m:r><m:r>h</m:r><m:r>e</m:r></span></i><span
lang=IT style='font-family:"Cambria Math","serif"'><m:r><m:rPr><m:scr m:val="roman"/><m:sty
m:val="p"/></m:rPr> </m:r><m:r><i style='mso-bidi-font-style:normal'>distance</i></m:r><m:r><m:rPr><m:scr
m:val="roman"/><m:sty m:val="p"/></m:rPr> </m:r><m:r><i
style='mso-bidi-font-style:normal'>moved</i></m:r><m:r><m:rPr><m:scr m:val="roman"/><m:sty
m:val="p"/></m:rPr> </m:r><m:r><i style='mso-bidi-font-style:normal'>by</i></m:r><m:r><m:rPr><m:scr
m:val="roman"/><m:sty m:val="p"/></m:rPr> </m:r><m:r><i
style='mso-bidi-font-style:normal'>solvent</i></m:r><m:r><m:rPr><m:scr
m:val="roman"/><m:sty m:val="p"/></m:rPr> </m:r><m:r><i
style='mso-bidi-font-style:normal'>front</i></m:r></span></m:den></m:f></m:oMath></m:oMathPara><![endif]--><!--[if !msEquation]--><span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-size: 11pt; line-height: 115%;"><v:shape id="_x0000_i1025" style="height: 30.75pt; width: 204pt;" type="#_x0000_t75">
<v:imagedata chromakey="white" o:title="" src="file:///C:\Users\Prem\AppData\Local\Temp\msohtmlclip1\01\clip_image002.png">
</v:imagedata></v:shape></span><!--[endif]--><span lang="IT"><o:p></o:p></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">This value is constant for a particular
compound under standard conditions.</span><span style="font-family: "trebuchet ms" , sans-serif;">
Quantification of the amino acid may be carried out after eluting it
with a suitable solvent.</span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b>Clinical applications:</b></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">1.<span style="font-size: 7pt; font-style: normal;"> </span></span></i><span lang="IT">Screening and diagnosis of
inherited disorders of amino acid metabolism e.g. Phenylketonuria and
Tyrosinaemia.<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">2.<span style="font-size: 7pt; font-style: normal;"> </span></span></i><span lang="IT">Peptide fingerprinting for the
diagnosis of diseases like sickle cell anemia.<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: left; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">3.<span style="font-size: 7pt; font-style: normal;"> </span></span></i><span lang="IT">One dimensional thin layer chromatography (TLC) can detect
aminoacidopathies and is the most adequate for screening. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: left; text-indent: -0.25in;">
<span style="font-family: "trebuchet ms" , sans-serif;"><span lang="IT"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: left;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Specimens
reference solution (mixture of known amino acids at known concentration) and
controls are applied to thin layer plates, run in an appropriate solvent-vapor
system and then dried and stained with ninhydrin<o:p></o:p></span></span></div>
</div>
<span lang="IT"></span><br />
<div style="text-align: justify;">
<span lang="IT"><span style="font-family: "calibri" , sans-serif; font-size: 14.666666984558105px;"><br /></span></span></div>
<span lang="IT">
</span></div>
</div>
A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-27167313223510002622015-12-17T12:03:00.002+05:452015-12-20T14:39:58.560+05:45Qualitative and qualitative estimation of Proteins<div dir="ltr" style="text-align: left;" trbidi="on">
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<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">Proteins are the most abundant
biomolecules, constituting more than 50% of the dry weight of the cell. They
are known to perform many different biological functions. Qualitative and quantitative estimation of
proteins in biological fluids is based on the physico-chemical properties of
proteins.</span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div style="background: #DBE5F1; border: solid #DBE5F1 3.0pt; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-themecolor: accent1; mso-border-themetint: 51; mso-element: para-border-div; padding: 0in 0in 0in 0in;">
<h2 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">Denaturation of proteins<o:p></o:p></span></h2>
</div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">In each type of protein, the three
dimensional structure is essential for its biological function. A protein in the biologically active form is
termed as the native protein and the native state is called “optimum” state.
The disruption of the three dimensional structure is called denaturation. On denaturation, the primary structure
remains intact. It is an all or none
phenomenon and does not cause any alteration in the quantity of protein
present.<i><o:p></o:p></i></span></span><br />
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"></span></span><br />
<a name='more'></a></div>
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<h2 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">Characteristics of denaturation<o:p></o:p></span></h2>
</div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Following are the major changes involved in
denaturation:<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">1.<span style="font-size: 7pt; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Increase in the viscosity due
to uncoiling<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">2.<span style="font-size: 7pt; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Change in the isoelectric pH<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">3.<span style="font-size: 7pt; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Changes in the properties of
solubilization and crystallization<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">4.<span style="font-size: 7pt; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Loss of biological activity.</span></span></div>
<div style="background: #DBE5F1; border: solid #DBE5F1 3.0pt; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-themecolor: accent1; mso-border-themetint: 51; mso-element: para-border-div; padding: 0in 0in 0in 0in;">
<h2 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">Denaturing agents<o:p></o:p></span></h2>
</div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">1.<span style="font-size: 7pt; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Heat<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">2.<span style="font-size: 7pt; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Mineral acids or alkalis alter
the ionisation of COOH</span><span lang="IT" style="font-size: 6.5pt; mso-bidi-font-size: 10.0pt; mso-text-raise: 3.5pt; position: relative; top: -3.5pt;">-</span><span lang="IT"> and NH</span><span lang="IT" style="font-size: 6.5pt; mso-bidi-font-size: 10.0pt; mso-text-raise: -3.5pt; position: relative; top: 3.5pt;">2</span><span lang="IT"> groups,
destroying the salt bridges<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">3.<span style="font-size: 7pt; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Vigorous shaking or grinding
causes mechanical disruption of various bonds <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">4.<span style="font-size: 7pt; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Ultraviolet radiation and Ultrasonic
waves<i>.<o:p></o:p></i></span></span></div>
<div class="MsoPlainText">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">
</span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "trebuchet ms" , sans-serif;"><i><span lang="IT">5.<span style="font-size: 7pt; font-style: normal;">
</span></span></i><!--[endif]--><span lang="IT">Chemical agents like urea and
certain acid and guanidine derivatives that
cleave H-bonds </span></span></div>
<div class="MsoPlainText" style="margin-left: 1.4in; text-align: justify; text-indent: -0.25in;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"></span></span><br />
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"></span></span></div>
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<h2 style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">Heat Test<o:p></o:p></span></h2>
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Based on principle of heat coagulation and
precipitation of proteins</span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="text-indent: -0.25in;"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="text-indent: -0.25in;">Procedure: Fill half the test tube with
urine and heat the top 1/2 of the sample. Look for any turbidity at the upper
part of the tube by comparing with the lower part of the tube. If any turbidity
appears, add 2 drops of 33% acetic acid. (Acidification is necessary because in
alkaline medium heating may precipitate phosphates). </span><span style="text-indent: -0.25in;">If the precipitate is due to proteins, it
will increase on acidification and if it is due to phosphates, it will dissolve
again.</span><span style="text-indent: -0.25in;"> </span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
<div class="MsoPlainText" style="text-align: justify;">
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<span style="font-family: "trebuchet ms" , sans-serif;"><b>Color reaction of proteins and amino acids</b></span></div>
<div class="WordSection1">
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;">Proteins react with a variety of reagents
to form coloured products, which can be measured colorimetrically. They are
important for qualitative and quantitative estimation of protein and their constituent
amino acids.<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><span class="Heading3Char"><span lang="IT" style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><b>Ninhydrin reaction</b>:</span></span><span lang="IT"> It is one of the most important
reactions used for the qualitative detection of hydrolytic products of protein
i.e. amino acids. All amino acids give
the ninhydrin reaction. <o:p></o:p></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><span class="Heading3Char"><span lang="IT" style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><b></b></span></span></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><span class="Heading3Char"><span lang="IT" style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><b></b></span></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><span class="Heading3Char"><span lang="IT" style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><b>Principle:</b></span></span><span lang="IT"><b> </b>The
amino acids are deaminated to CO</span><span lang="IT" style="font-size: 6.5pt; mso-bidi-font-size: 10.0pt; mso-text-raise: -3.5pt; position: relative; top: 3.5pt;">2</span><span lang="IT"> , NH</span><span lang="IT" style="font-size: 6.5pt; mso-bidi-font-size: 10.0pt; mso-text-raise: -3.5pt; position: relative; top: 3.5pt;">3</span><span lang="IT"> and an aldehyde under heat. Ninhydrin reacts with NH</span><span lang="IT" style="font-size: 6.5pt; mso-bidi-font-size: 10.0pt; mso-text-raise: -3.5pt; position: relative; top: 3.5pt;">3</span><span lang="IT"> and forms a purple coloured complex, which can
be measured at 570 nm. All amino acids,
except proline, react with ninhydrin at ambient temperature to form a blue
colored complex, which intensifies to purple on heating. Proline forms a yellow coloured complex.<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"> </span></span></div>
<div class="MsoPlainText">
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</span></v:stroke></v:line></v:group><span style="font-family: "trebuchet ms" , sans-serif;"></span></div>
<div style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><span lang="IT">Ninhydrin + Amino acid ------------------------------> Hydrindantin +
Aldehyde + <i><o:p></o:p></i></span>CO<sub>2</sub> + NH<sub>3</sub></span></div>
<br />
<div class="MsoPlainText" style="text-align: justify;">
<br /></div>
<div class="MsoPlainText" style="text-align: left;">
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<v:stroke endarrow="block"><span style="font-family: "trebuchet ms" , sans-serif;">
</span></v:stroke></v:line><span lang="IT"></span></div>
<div style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">Ninhydrin + Hydrindantin
+ </span><span style="font-family: "trebuchet ms" , sans-serif;"> </span><span style="font-family: "trebuchet ms" , sans-serif;">NH</span><sub style="font-family: 'Trebuchet MS', sans-serif;">3</sub><span style="font-family: "trebuchet ms" , sans-serif;"> ----------------------></span><sub style="font-family: 'Trebuchet MS', sans-serif;"> </sub><span style="font-family: "trebuchet ms" , sans-serif;">Purple colored complex</span></div>
<span style="font-family: "trebuchet ms" , sans-serif; text-align: justify;"> (Ruhemann’s purple) </span><br />
<span style="font-family: "trebuchet ms" , sans-serif; text-align: justify;"><br /></span>
<br />
<div class="MsoPlainText" style="text-align: justify;">
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwx0Jo39FXRU5bpvBM42JS_AP5riJXOzP6z_3E6xAO9EXrHOms802DEAHYEmgVlPvT-SZ86QmrfHwSI2r80a6hTyfWaccbYEJqCTAnL_CbcwSi_eaaubGwyHoaRHSxrg884i6nqGfmCFq-/s1600/Biuret_Test.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwx0Jo39FXRU5bpvBM42JS_AP5riJXOzP6z_3E6xAO9EXrHOms802DEAHYEmgVlPvT-SZ86QmrfHwSI2r80a6hTyfWaccbYEJqCTAnL_CbcwSi_eaaubGwyHoaRHSxrg884i6nqGfmCFq-/s200/Biuret_Test.jpg" style="outline: red dashed 1px;" title="" width="128" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. Biruret test postive</td></tr>
</tbody></table>
<span style="font-family: "trebuchet ms" , sans-serif;"><span class="Heading3Char"><span lang="IT" style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><b>Biuret reaction:</b></span></span><span lang="IT">
When urea is heated to 180</span><span lang="IT" style="font-size: 6.5pt; mso-bidi-font-size: 10.0pt; mso-text-raise: 3.5pt; position: relative; top: -3.5pt;">o</span><span lang="IT">C, it forms biuret which in the presence of strong alkali reacts with
dilute solutions of copper sulphate to form a violet coloured complex. Proteins and peptides give this
reaction. Presence of at least two
peptide bonds is essential for the reaction.
Proteins give violet or purple colour while proteoses and peptones give
light pink colour. Histidine gives a
positive Biuret reaction. Two or more - CONH</span><span lang="IT" style="font-size: 6.5pt; mso-bidi-font-size: 10.0pt; mso-text-raise: -3.5pt; position: relative; top: 3.5pt;">2</span><span lang="IT"> groups joined directly or though a carbon or
nitrogen atom gives this reaction. <i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;">Absorption maximum of the colored complex
is 540 nm. Since the method is based on reaction with peptide bonds, it is an
absolute one. The main disadvantage is
its lack of sensitivity. It cannot be
used to estimate protein less than </span><b style="font-family: 'trebuchet ms', sans-serif;">1
mg/ml</b><span style="font-family: "trebuchet ms" , sans-serif;">. Amino acids and dipeptides do
not give this reaction.</span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><span class="Heading3Char"><span lang="IT" style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><b>Bradford Method:</b></span></span><span lang="IT">
Coomassie Brilliant Blue complexes with protein (Absorption maxima - 595 nm).
This method is simple and very sensitive.
Colour development is rapid but not very stable. Sensitivity is <b>20 µg/ ml.<i><o:p></o:p></i></b></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span lang="IT"><b><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></b></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><span class="Heading3Char"><span lang="IT" style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><b>Lowry’s Method:</b></span></span><span lang="IT"><b>
</b>This is also a sensitive method. It
involves the formation of a copper-protein complex in alkaline solution and the
reduction of phosphotungstic and phosphomolybdic acids by the copper-protein
complex into tungsten blue and molybdenum blue respectively. </span><span lang="IT">λ<sub>max </sub></span><span lang="IT">660 nm. Sensitivity is <b>10 µg/ ml</b>.<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span class="Heading3Char"><span lang="IT" style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><b><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></b></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><span class="Heading3Char"><span lang="IT" style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><b>Separation of amino acids:</b></span></span><span lang="IT"><b> </b> The two most commonly used
methods are:<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: justify;">
<b><span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></b></div>
<div class="MsoPlainText" style="text-align: justify;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b><span lang="IT"><i>Electrophoresis:</i></span></b><span lang="IT"> Amino acids can be separated in an electric field, on the basis of the
charge they carry.<i><o:p></o:p></i></span></span></div>
<div class="MsoPlainText" style="text-align: left;">
<b><span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></b></div>
<div class="MsoPlainText" style="text-align: left;">
<span style="font-family: "trebuchet ms" , sans-serif;"><b><span lang="IT"><i>Chromatography:</i></span></b><span lang="IT"> This is a
technique by which molecules are separated on the basis of their charge,
molecular weight or specific ligand affinity.<o:p></o:p></span></span></div>
</div>
<span lang="IT"></span><br />
<div style="text-align: justify;">
<span lang="IT"><span style="font-family: "trebuchet ms" , sans-serif; font-size: 14.666666984558105px;"><br /></span></span></div>
<span lang="IT">
</span>
<br />
<div class="MsoPlainText" style="text-align: justify;">
<span style="text-indent: -0.25in;"><span style="font-family: "trebuchet ms" , sans-serif;"> </span></span></div>
</div>
</div>
A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-9693755888003643742015-03-31T14:53:00.001+05:452015-03-31T14:53:28.375+05:45Transforming Blood Testing : ELizabeth Holmes invention<script async src="//pagead2.googlesyndication.com/pagead/js/adsbygoogle.js"></script>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; text-align: right;"><tbody>
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<tr><td class="tr-caption" style="text-align: center;">Fig. Elizabeth Holmes featuring in Fortune magazine</td></tr>
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<span style="font-family: Trebuchet MS, sans-serif;">Revolutionizing the blood test is a golden idea. Because of new testing methods developed by Holmes' startup Theranos, that lone drop can now yield a ton of information. The company can run hundreds of tests on a drop of blood far more quickly than could be done with whole vials in the past—and it costs a lot less.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b>A Billion-Dollar Idea</b></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Holmes dropped out of Stanford at 19 to found what would become Theranos after deciding that her tuition money could be better put to use by transforming healthcare.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Traditional blood testing is shockingly difficult and expensive for a tool that's used so frequently. It also hasn't changed since the 1960s. It's </span></div>
<a name='more'></a><span style="font-family: Trebuchet MS, sans-serif;">done in hospitals and doctors' offices. Vials of blood have to be sent out and tested, which can take weeks using traditional methods and is prone to human error. And, of course, sticking a needle in someone's arm scares some people enough that they avoid getting blood drawn, even when it could reveal lifesaving information.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Holmes recognized that process was ripe for disruption. It took a decade for her idea to be ready for primetime, but now it seems that her decision to drop out was undoubtedly a good call. Last year, Walgreen Co. announced that it would be installing Theranos Wellness Centers in pharmacies across the country, with locations already up and running in Phoenix and Palo Alto, California. And Holmes has raised $400 million in venture capital for Theranos, which is now valued at $9 billion (Holmes owns 50 percent).</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">The other two 30-year-olds on Forbes' List, Facebook founder Mark Zuckerberg and his former roommate and Facebook CEO Dustin Moskovitz, also have access to a wealth of information about people—but their data is less likely to directly save a life.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b>How It Works</b></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">One closely guarded secret is what MedCityNews calls "the most interesting part of [the Theranos] story": how exactly the technology behind its blood test works. The company's methods are protected by more than a dozen patents filed as far back as 2004 and as recently as last week.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">In an interview with Wired, Holmes hinted at some of the key ideas behind Theranos. "We had to develop ... methodologies that would make it possible to accelerate results," she said. "In the case of a virus or bacteria, traditionally tested using a culture, we measure the DNA of the pathogen instead so we can report results much faster."</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">While we can't yet assess independently how well that method works when compared with traditional blood tests, it already seems to be upending the old way of doing things.</span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBIC2wRNRmExsISst6syh3hqSlcIWrkae7OVj44TOKnRq32uEC-r7sFfq8dlDv-9Q4FGzuDIwFlP24eCbs44Nseqv3b5LLJWuzskz5UGRfihsSmDsEFMHqqhfEOcAzaIvNGzpYwaRrJqx5/s1600/blood+drawing.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;" title=""><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBIC2wRNRmExsISst6syh3hqSlcIWrkae7OVj44TOKnRq32uEC-r7sFfq8dlDv-9Q4FGzuDIwFlP24eCbs44Nseqv3b5LLJWuzskz5UGRfihsSmDsEFMHqqhfEOcAzaIvNGzpYwaRrJqx5/s1600/blood+drawing.jpg" height="228" title="" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. Capillary blood drawing</td></tr>
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<span style="font-family: Trebuchet MS, sans-serif;"><b>Why Blood Tests?</b></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Holmes told Medscape that she targeted lab medicine because it drives about 80 percent of clinical decisions made by doctors. By zeroing in on the inefficiencies of that system, the Theranos approach completely revolutionizes it.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">The new tests can be done without going to the doctor, which saves both money and time. Most results are available in about four hours, which means that you could swing by a pharmacy and have a test done the day before a doctor's visit, and then the results would be available for the physician. Quick tests that can be done at any time are already a total change, but the amount of data the company can get from a single drop of blood is amazing.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Blood samples have traditionally been used for one test, but if a follow-up was needed, another sample had to be drawn and sent out—making it less likely that someone would get care. The Theranos approach means the same drop can be used for dozens of different tests.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">It's cheap, too. One common criticism of the healthcare system is that the pricing structure is a confusing labyrinth that makes it impossible to know how much anything costs. Theranos lists its prices online, and they're impressive. Each test costs less than 50 percent of standard Medicare and Medicaid reimbursement rates. If those two programs were to perform all tests at those prices, they'd save $202 billion over the next decade, Holmes said in an interview on Wired</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Plus, people get access to their own results. As an example of how helpful that can be, Holmes told Wired that Theranos charges $35 for a fertility test, which is usually paid for out-of-pocket and costs up to $2,000. But she also said that this data could be useful for anyone looking to gain a better understanding of his or her health. "By testing, you can start to understand your body, understand yourself, change your diet, change your lifestyle, and begin to change your life," she said.</span></div>
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<i style="font-family: 'Trebuchet MS', sans-serif;">This article originally appeared in Business Insider.</i></div>
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<span style="font-family: Trebuchet MS, sans-serif;">(Source: http://www.slate.com By Kevin Loria)</span></div>
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</div>A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-54439065445358126672015-03-01T14:02:00.000+05:452015-03-09T14:22:39.590+05:45Swine flu: Panic in India<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-family: Trebuchet MS, sans-serif;">Indian Health Minister JP Nadda has urged the public not to panic, as the number of deaths so far this year from swine flu passed 900 from 16,000 cases.</span>
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<span style="font-family: Trebuchet MS, sans-serif;">Rajasthan and Gujarat are among the worst affected states.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Officials in Ahmedabad, Gujarat's largest city, have announced restrictions on public gatherings as a precautionary measure.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">The current outbreak, which began in December last year, is India's deadliest since 2010.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Nearly 4,000 people have been killed in separate outbreaks of the H1N1 virus since 2009.</span></div>
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<a name='more'></a><span style="font-family: Trebuchet MS, sans-serif;">In Ahmedabad, officials have said weddings and funerals may take place but participants must wear protective masks.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">The Gujarat state assembly's speaker and health minister both have swine flu. Some opposition politicians have criticised the government's response, describing it as a public health crisis.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Workplaces and schools have been open as normal but a charity walk and concert are among several public events in Ahmedabad which have been put on hold.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Organiser Kaushal Mehta said the walk was to have taken place on 1 March: "Around 5,000 [were to] walk for charity.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">"However, due to swine flu and the prohibitionary order we have postponed the event. The experts have told us to wait."</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Doctors believe that as temperatures rise during the summer the effect of the virus will subside, BBC Hindi's Ankur Jain in Ahmedabad reports.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b>What is swine flu?</b></span></div>
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<ul>
<li><span style="font-family: 'Trebuchet MS', sans-serif;">A respiratory disease caused by a strain of the influenza type A virus known as H1N1, which first appeared in Mexico in 2009</span></li>
<li><span style="font-family: 'Trebuchet MS', sans-serif;">Originated in pigs, but is now a human disease spread by coughing and sneezing</span></li>
<li><span style="font-family: 'Trebuchet MS', sans-serif;">Symptoms similar to those produced by standard, seasonal flu - fever, cough, sore throat, body aches and chills</span></li>
<li><span style="font-family: 'Trebuchet MS', sans-serif;">Vulnerable groups include pregnant women, children under five, the over-65s and those with serious medical conditions</span></li>
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<span style="font-family: Trebuchet MS, sans-serif; font-size: small;">Sonam Kapoor tests positive for swine flu</span></h1>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEic_LjZKWuSooNLc6NKFzA_KcXQl0sLWVvJSaXkWiP0PofoDuhZqYU1G5LScq7nhyfT__BriQa6nOAPUxiKmJVc0vZpk8ch7TLLhZ5rXOKnhQMIBbAZoRdHjjNsDcqybxed8bI1m4pR69q9/s1600/sonam-kapoor-swine+flue.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;" title=""><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEic_LjZKWuSooNLc6NKFzA_KcXQl0sLWVvJSaXkWiP0PofoDuhZqYU1G5LScq7nhyfT__BriQa6nOAPUxiKmJVc0vZpk8ch7TLLhZ5rXOKnhQMIBbAZoRdHjjNsDcqybxed8bI1m4pR69q9/s1600/sonam-kapoor-swine+flue.jpg" height="221" title="" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: #747474; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: 18px; text-align: start;">Sources said that the shooting of 'Prem Ratan Dhan Payo' had resumed <br />even as Sonam Kapoor had been admitted in the hospital on Saturday.</span></td></tr>
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<span style="font-family: 'Trebuchet MS', sans-serif;">Bollywood actress Sonam Kapoor, 28, who was shooting for ‘Prem Ratan Dhan Payo’ in Gondal, Rajkot district, was admitted in an ICU after she tested positive for swine flu.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Sonam Kapoor had reportedly arrived at Rajkot airport and left for Gondal on February 25 and then proceeded to Gondal’s royal Orchard Palace to join Salman Khan and Anupam Kher for shooting of the film. “She had been having a fever since after the day she came in and is admitted to a city-based hospital today. Meanwhile there is no ruckus on the film set and no-one else has shown any symptoms so far and shooting has resumed in the palace premises,” said a source close to the development.</span></div>
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<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">She was taken to Sterling Hospital in Rajkot on Saturday (February 28) and was tested positive for swine flu. Spokesperson for Sterling Hospital confirmed the actress had tested positive for H1N1 virus. “She had been admitted to the hospital at around 10 am on Saturday. Dr Chirag Matravadiya, examined her. As the patient had symptoms of cold, fever etc, the doctor recommended her swine flu test. The lab tests came positive for H1N1virus in the evening,” said the spokesperson.</span></div>
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<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">“Right now, she is being treated in an intensive care unit in isolation ward of our hospital. Doctors treating her are saying that her condition is stable,” added the spokesperson.</span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">The hospital further added that arrangements were being made to shift Sonam Kapoor to Mumbai through an air ambulance and that she was likely to leave the Rajkot hospital by 8:30 pm on February 28.</span></div>
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<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Arrangements were made to fly the actress to Kokilaben Dhirubhai Ambani hospital in Mumbai. </span><span style="font-family: 'Trebuchet MS', sans-serif;">Sources at the palace in Gondal where the film ‘Prem Ratan Dhan Payo’ is being shot said that the shooting of the film had resumed even as Sonam Kapoor had been admitted in the hospital on Saturday.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Sonam would often doze off in between the shots during the shoot, indicating that she was indeed unwell as soon as she started with the shoot in Rajkot.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">(Source: BBC Health and </span><span style="text-align: left;"><span style="font-family: Trebuchet MS, sans-serif;">http://indianexpress.com)</span></span></div>
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</div>A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-18446018324449853892015-01-31T18:22:00.000+05:452015-03-09T14:15:38.313+05:45Megaloblastic Anemia: Folate and Vitamin B12 Metabolism, Causes, diagnosis and therapy<div dir="ltr" style="text-align: left;" trbidi="on">
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtd0N6PkoFiY6fTdsIgA37QrTIW-DOCq4ZMs4qeH_ompDIyR6iwt7seTNM4MssBuizGXau1OpwTBnhzQ0vdK47Ed-haGGW5vVIyrdYl4dHJxwRaomY4sWR0Zv-oj-idMgzbXFqiVJXVIL_/s1600/Megaloblastic+anemia.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtd0N6PkoFiY6fTdsIgA37QrTIW-DOCq4ZMs4qeH_ompDIyR6iwt7seTNM4MssBuizGXau1OpwTBnhzQ0vdK47Ed-haGGW5vVIyrdYl4dHJxwRaomY4sWR0Zv-oj-idMgzbXFqiVJXVIL_/s1600/Megaloblastic+anemia.jpg" height="185" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. Megaloblastic anemia showing megaloblastics cells</td></tr>
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<b style="line-height: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;"><u>MACROCYTOSIS</u></span></b><br />
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<span style="line-height: 12pt; text-align: left;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></span></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;">An increased MCV can be due to a number of reasons but
careful review of the patient's history and blood smear can narrow the
diagnostic possibilities. The
differential can be divided into two broad categories based on RBC morphology.<o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><u><span style="letter-spacing: -0.15pt;">Round</span></u><span style="letter-spacing: -0.15pt;">
macrocytosis-due to abnormal lipid composition of the erythrocyte
membrane. Common etiologies include:<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 12.0pt; margin-left: .5in; mso-hyphenate: none; tab-stops: -.5in 0in; text-align: justify; text-indent: -.5in;">
<span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;"> 1. Alcoholism.<o:p></o:p></span></span></div>
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<span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;"> 2. Liver Disease.<o:p></o:p></span></span></div>
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<span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;"> 3. Renal Disease.<o:p></o:p></span></span></div>
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<span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;"> 4. Hypothyroidism ("myxedema of
the red cell").<o:p></o:p></span></span></div>
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</div>
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<span style="font-family: Trebuchet MS, sans-serif;"><u><span style="letter-spacing: -0.15pt;"><br /></span></u></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><u><span style="letter-spacing: -0.15pt;"></span></u></span></div>
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<a name='more'></a><span style="font-family: Trebuchet MS, sans-serif;"><u>Oval</u><span style="letter-spacing: -0.15pt;">
macrocytosis (macroovalocytes) is a sign of problem with cell DNA replication. The developing red cell has difficulty in
undergoing cell division but RNA continues to be translated and transcribed
into protein leading to growth of the cytoplasm while the nucleus lags
behind. Often one or more cell division
are skipped leading to a larger than normal cell. Common causes are:<o:p></o:p></span></span><br />
<br />
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<!--[if !supportLists]--><span style="font-family: Trebuchet MS, sans-serif;"><span style="letter-spacing: -0.15pt;">1.<span style="line-height: normal;"> </span></span><u><span style="letter-spacing: -0.15pt;">Drug effect</span></u><span style="letter-spacing: -0.15pt;"> including cytotoxic chemotherapy.</span></span></div>
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<span style="font-family: 'Trebuchet MS', sans-serif; letter-spacing: -0.15pt; line-height: 12pt; text-indent: -0.25in;">2.<span style="line-height: normal;"> </span></span><u style="font-family: 'Trebuchet MS', sans-serif; line-height: 12pt; text-indent: -0.25in;"><span style="letter-spacing: -0.15pt;">Megaloblastic Anemias</span></u><span style="font-family: 'Trebuchet MS', sans-serif; letter-spacing: -0.15pt; line-height: 12pt; text-indent: -0.25in;">-Folate Deficiency or Vitamin
B<sub>12</sub> deficiency - Patients will have hypersegmented neutrophils on
review of the peripheral smear.</span></div>
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<span style="font-family: 'Trebuchet MS', sans-serif; letter-spacing: -0.15pt; line-height: 12pt; text-indent: -0.25in;">3. </span><u style="font-family: 'Trebuchet MS', sans-serif; letter-spacing: -0.15pt; line-height: 12pt; text-indent: -0.5in;">Myelodysplasia</u><span style="font-family: 'Trebuchet MS', sans-serif; letter-spacing: -0.15pt; line-height: 12pt; text-indent: -0.5in;">
- Patients often have </span><b style="font-family: 'Trebuchet MS', sans-serif; letter-spacing: -0.15pt; line-height: 12pt; text-indent: -0.5in;">hypo</b><span style="font-family: 'Trebuchet MS', sans-serif; letter-spacing: -0.15pt; line-height: 12pt; text-indent: -0.5in;">segmented neutrophils and abnormal platelet
morphology.</span></div>
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<br /></div>
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<span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;">Patients with increased reticulocyte counts can also
have an increase MCV due to the large size of the reticulocyte (MCV = 160).<o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b><u><span style="letter-spacing: -0.15pt;">ABSORPTION AND METABOLISM OF VITAMIN B<sub>12</sub> AND
FOLATE</span></u></b><b><span style="letter-spacing: -0.15pt;"> <o:p></o:p></span></b></span></div>
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<br /></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b><u><span style="letter-spacing: -0.15pt;">Folate</span></u></b><b><span style="letter-spacing: -0.15pt;">:</span></b><span style="letter-spacing: -0.15pt;"> The body
stores very little folate (several weeks) and maintenance of folate stores is
dependent on adequate dietary intake.
Folate is found in green leafy vegetables, and liver. Folate is absorbed in the small bowel and
circulates in a free form or loosely bond to albumin.<o:p></o:p></span></span></div>
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<span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;"> <o:p></o:p></span></span></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixUY2BVcMYsNz1ub5IbbDKwWxKUtbgTGJVzyKLfPmhBp5KXxZJZWvhW4BYT65jZz8oezuFSk1TCvbrOR45jNLcvELdtPErMwFRkYWAsltRt2Dq2AmwJzMa5CmMy40Twn8ViTM8RyktFJwf/s1600/cobalamin_absorption1316395327159.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixUY2BVcMYsNz1ub5IbbDKwWxKUtbgTGJVzyKLfPmhBp5KXxZJZWvhW4BYT65jZz8oezuFSk1TCvbrOR45jNLcvELdtPErMwFRkYWAsltRt2Dq2AmwJzMa5CmMy40Twn8ViTM8RyktFJwf/s1600/cobalamin_absorption1316395327159.jpg" height="306" width="400" /></a></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b><u><span style="letter-spacing: -0.15pt;">Vitamin B<sub>12</sub></span></u></b><span style="letter-spacing: -0.15pt;">: In
contrast to folate the body stores copious amounts of vitamin B<sub>12</sub>
(2-6 years). This is fortunate as the
absorption of vitamin B<sub>12</sub> is complex and can be interrupted by a
variety of mechanisms. Vitamin B<sub>12</sub>
is synthesized by microbes and the major dietary source is animal protein. When animal protein is ingested, vitamin B<sub>12</sub>
is freed from the protein and binds to "R proteins". The R protein-vitamin B<sub>12</sub> complex
travels to the duodenum where pancreatic enzymes destroy the R protein. This allows intrinsic factor (IF) to bind to
vitamin B<sub>12</sub>. This IF-vitamin
B<sub>12</sub> complex is absorbed only in the last 1-2 feet of terminal
ileum. Vitamin B<sub>12</sub> binds to
transcobalamin II and is delivered to tissues.<o:p></o:p></span></span></div>
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<span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;"> <o:p></o:p></span></span></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWhLPbHaO6LKNZfcAznWhGGf-u7Kdt-4p76VnI2csCaVZsNt80Fr_yrBjlqnxtvtPD3MJTET3mZ_Bp5HC29dPwdyuO-uozB3TvlSUgywb4jqzgseLxkZTGMgoW_Uv6qRqohuav34kXlDEb/s1600/folate.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;" title=""><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWhLPbHaO6LKNZfcAznWhGGf-u7Kdt-4p76VnI2csCaVZsNt80Fr_yrBjlqnxtvtPD3MJTET3mZ_Bp5HC29dPwdyuO-uozB3TvlSUgywb4jqzgseLxkZTGMgoW_Uv6qRqohuav34kXlDEb/s1600/folate.jpg" height="291" title="" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. Vitamin B12 and folate metabolic pathway</td></tr>
</tbody></table>
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<span style="font-family: Trebuchet MS, sans-serif;"><b><u><span style="letter-spacing: -0.15pt;">VITAMIN B<sub>12</sub> AND FOLATE- METABOLIC </span></u></b><b><u><span style="letter-spacing: -0.15pt;">PATHWAYS</span></u></b><b><span style="letter-spacing: -0.15pt;"><o:p></o:p></span></b></span></div>
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<br /></div>
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<span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;">Both vitamin B<sub>12</sub> and folate are key
components in the synthesis of DNA due to their role in conversion of uridine
to thymidine. When
methyltetrahydrofolate loses a methyl group to form tetrahyrodrofolate, vitamin
B<sub>12</sub> "shuttles" the methyl group to homocysteine converting
it to methionine. Tetrahydrofolate is
eventually converted to methylenetetrahydrofolate which is required for
thymidine synthase. Vitamin B<sub>12</sub> other role is a co-factor in the
conversion of methymalonyl-CoA to succinyl-CoA.<o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b><u><span style="letter-spacing: -0.15pt;">CONSEQUENCES OF VITAMIN B<sub>12</sub> OR FOLATE
DEFICIENCY</span></u></b><b><span style="letter-spacing: -0.15pt;"><o:p></o:p></span></b></span></div>
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<br /></div>
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<span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;">When vitamin B<sub>12</sub> or folate is deficient,
thymidine synthase function is impaired and DNA synthesis is interrupted. As described above this leads to
megaloblastic changes in all rapidly dividing cells. The inability to synthesized DNA leads to
ineffectual erythropoiesis. There is
often erythroid hyperplasia in the marrow but most of these immature cells die
before reaching maturity. This process, <b>intramedullary
hemolysis</b>, leads to the classic biochemical picture of hemolysis-elevated
LDH and indirect bilirubinemia. The LDH
level is often in the 1,000's in patients with megaloblastic anemia. The lack of DNA synthesis affects the
neutrophils leading to nuclear hypersegmentation. The anemia is of gradual onset and is often
very well tolerated despite low hematocrits.
Often a mild pancytopenia is seen but thrombocytopenia can be severe.<o:p></o:p></span></span></div>
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<span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;"> <o:p></o:p></span></span></div>
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<span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;">Other rapidly dividing tissue are influenced by the
megaloblastic process. In the GI tract
this can lead to atrophy of the luminal lining and further malabsorption. This also leads to the classic sign of tongue
smoothing.<o:p></o:p></span></span></div>
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<span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;"> <o:p></o:p></span></span></div>
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<span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;">As discussed further below, only vitamin B<sub>12</sub>
deficiency leads to neurological damage.
The mechanism is unknown.<o:p></o:p></span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b><u><span style="letter-spacing: -0.15pt;">ETIOLOGIES OF FOLATE DEFICIENCY</span></u></b><b><span style="letter-spacing: -0.15pt;"><o:p></o:p></span></b></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><u><span style="letter-spacing: -0.15pt;">Decreased intake</span></u><span style="letter-spacing: -0.15pt;">- The
average intake of folate in the diet is only 2-300 ug/day which is less than
the estimated daily requirement. Thus,
for most people a poor diet or decrease eating will lead to folate deficiency.<o:p></o:p></span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><u><span style="letter-spacing: -0.15pt;">Increased requirements</span></u><span style="letter-spacing: -0.15pt;">-Patients
who are pregnant, have hemolytic anemia, or psoriasis have increased needs for
folate which can cause them to rapidly develop folate deficiency if intake is
not kept up.<o:p></o:p></span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><u><span style="letter-spacing: -0.15pt;">Malabsorption</span></u><span style="letter-spacing: -0.15pt;"><o:p></o:p></span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><u><span style="letter-spacing: -0.15pt;">Drugs</span></u><span style="letter-spacing: -0.15pt;"> - Patient
with underlying mild folate deficiency are more susceptible to
trimethoprim/sulfa, <o:p></o:p></span></span></div>
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<span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;">pyrimethamine and methotrexate toxicity. Oral contraceptive and anticonvulsants lead
to increase consumption of folate.<o:p></o:p></span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><u><span style="letter-spacing: -0.15pt;">Alcohol</span></u><span style="letter-spacing: -0.15pt;">- Alcohol
affects several aspects of folate metabolism.
Alcoholics have poor intake of folate.
In addition, folate metabolism is interfered with leading to a
functional folate deficiency. Alcoholics
have an inability to mobilize folate stores and can have depleted tissue stores
with normal serum levels of folate.<o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b><u><span style="letter-spacing: -0.15pt;">ETIOLOGIES OF VITAMIN B<sub>12</sub> DEFICIENCY</span></u></b><b><span style="letter-spacing: -0.15pt;"><o:p></o:p></span></b></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><u><span style="letter-spacing: -0.15pt;">Inadequate intake</span></u><span style="letter-spacing: -0.15pt;"> is rare
but seen in very strict vegins.<o:p></o:p></span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><u><span style="letter-spacing: -0.15pt;">Abnormal gastric events</span></u><span style="letter-spacing: -0.15pt;"> include
being unable to dissociated vitamin B<sub>12</sub> from food due to lack of
stomach acid or enzymes. This is a
recently recognized group of patients which may compose a very large subset of
patients with vitamin B<sub>12</sub> deficiency. 10-30% percent of patients with partial
gastrectomy will develop vitamin B<sub>12</sub> deficiency.<o:p></o:p></span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><u><span style="letter-spacing: -0.15pt;">Deficient intrinsic factor</span></u><span style="letter-spacing: -0.15pt;"> most
commonly occurs due to destruction of parietal cells by autoantibodies
(pernicious anemia).<o:p></o:p></span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><u><span style="letter-spacing: -0.15pt;">Abnormal small bowel events</span></u><span style="letter-spacing: -0.15pt;"> include
pancreatic insufficiency, blind loops syndromes (bacterial absorbing vitamin B<sub>12</sub>-IF
complexes) and patients infested with <i>Diphyllobothrium latum</i>.<o:p></o:p></span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><u><span style="letter-spacing: -0.15pt;">Abnormal mucosal events</span></u><span style="letter-spacing: -0.15pt;"> including
malabsorption syndromes and surgical removal of the terminal ileum.<o:p></o:p></span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><u><span style="letter-spacing: -0.15pt;">Drugs</span></u><span style="letter-spacing: -0.15pt;"> - Metformin, PPIs<o:p></o:p></span></span></div>
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<br /></div>
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<b><u><span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;">APPROACH TO THE PATIENT WITH A MEGALOBLASTIC ANEMIA<o:p></o:p></span></span></u></b></div>
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<br /></div>
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<span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;"> 1. Recognizing that a megaloblastic
anemia is present.<o:p></o:p></span></span></div>
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<span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;"> 2. Diagnosing vitamin B<sub>12</sub>
and or folate deficiency<o:p></o:p></span></span></div>
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<span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;"> 3. Determining the underlying cause.<o:p></o:p></span></span></div>
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<span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;"> 4. Therapy<o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b><u><span style="letter-spacing: -0.15pt;">DIAGNOSING VITAMIN B<sub>12</sub> AND OR FOLATE
DEFICIENCY</span></u></b><b><span style="letter-spacing: -0.15pt;"><o:p></o:p></span></b></span></div>
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<br /></div>
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<span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;">It turns out that simply measuring serum levels of B<sub>12</sub>
or folate is very inadequate to diagnosis deficiency. Up to 30% of people with low normal B<sub>12</sub>
levels will be deficient and many people with low B<sub>12</sub> stores have
normal tissue stores. A more reliable
method is to assay for the metabolic products that accumulate in B<sub>12</sub>
deficiency. Since B<sub>12</sub> is
involved in conversion of homocysteine to methionine, lack of B<sub>12</sub>
will lead to elevated homocysteine level.
Also B<sub>12</sub> is involved in conversion of methylmalonic acid to
succinyl so in B<sub>12</sub> deficiency, methylmalonic acid accumulates. Both homocysteine and methylmalonic acid
assays are widely available and should be the first line tests for B<sub>12</sub>
deficiency.<o:p></o:p></span></span></div>
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<br /></div>
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<span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;">Serum folate levels are also very unreliable. Since folate is needed for conversion of
homocysteine to methionine, serum homocysteine will also accumulate in folate
deficiency and is a more sensitive marker of tissue folate stores.<o:p></o:p></span></span></div>
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<!--[if supportFields]><span
style='font-family:"Times New Roman","serif";letter-spacing:-.15pt'><span
style='mso-element:field-begin'></span>PRIVATE </span><![endif]--><!--[if supportFields]><span
style='font-family:"Times New Roman","serif";letter-spacing:-.15pt'><span
style='mso-element:field-end'></span></span><![endif]--><span style="letter-spacing: -0.15pt;"><span style="font-family: Trebuchet MS, sans-serif;"><o:p></o:p></span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b>DEFICIENCY</b><o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b>HOMOCYSTEINE</b><o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b>METHYLMALONIC
ACID</b><o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b>FOLATE</b><o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b>ELEVATED</b><o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b>NORMAL</b><o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b>B<sub>12</sub></b><o:p></o:p></span></div>
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<h4 style="text-align: justify;">
<span style="vertical-align: baseline;"><span style="font-family: Trebuchet MS, sans-serif;">ELEVATED<o:p></o:p></span></span></h4>
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<b><span style="font-family: Trebuchet MS, sans-serif;">ELEVATED<o:p></o:p></span></b></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b>Increased
Homocysteine level</b>: <o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><span style="letter-spacing: -0.15pt;">B<sub>12</sub></span>
or folate deficiency, renal failure (kidney significant organ for homocysteine
metabolism).<o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b><u>Implications:</u></b> <o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">1)
Marker for possible nutritional
deficiency<o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">2)
Elevated levels of homocysteine are associated with an increased risk of
atherosclerosis or venous thrombosis.<o:p></o:p></span></div>
</div>
<span style="line-height: 12pt; text-align: justify;"><span style="font-family: Trebuchet MS, sans-serif;">3)
Increased levels of homocysteine (reflecting lack of folic acid) in pregnant
women is a risk factor for neural tubes defects.</span></span><br />
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<br /></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b>Increased
Methylmalonic Acid</b><o:p></o:p></span></div>
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<b><u><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></u></b></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b><u>Causes:</u></b><b> </b><o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">B<sub>12</sub>
deficiency, renal failure (MMA renal excreted), methylmalonic aciduria (rare)<u><o:p></o:p></u></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b><u>Implications:</u></b><o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">B<sub>12</sub>
deficiency.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b><u>DETERMINING
THE UNDERLYING CAUSE</u></b><b><o:p></o:p></b></span></div>
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<br /></div>
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<span style="font-family: Trebuchet MS, sans-serif;">In
the majority of patients with folate deficiency, one can determine the
underlying cause by history. The key
concern in vitamin B<sub>12</sub> deficiency is determining a which point in
the complex pathway of vitamin B<sub>12</sub> absorption the "lesion"
is. The Schilling test is a test of
vitamin B<sub>12</sub> absorption.
Patients are given radiolabeled vitamin B<sub>12</sub> orally and a
large dose of vitamin B<sub>12</sub> is given intravenously. The IV dose of vitamin B<sub>12</sub>
prevents binding any absorbed labeled vitamin B<sub>12</sub> and this is
excreted. The amount of excreted vitamin
B<sub>12</sub> is reflective of vitamin B<sub>12</sub> absorption. The Schilling test is <b><u>NOT</u></b> a test of vitamin B<sub>12</sub> deficiency but a tool to
determine the etiology of the deficiency.
The tradition Schilling test is call "stage I". If less than 8% of the labeled vitamin B<sub>12</sub>
is excreted then one can perform the Schilling test with a variety of
diagnostic maneuvers to pinpoint the lesion.
This includes giving intrinsic factor, pancreatic enzymes, or
antibiotics.<o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"> <o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">The
Schilling test has several shortcomings.
One is it require patient cooperation in collecting the 24 hour urine
sample. As noted above patients can have
secondary malabsorption due to vitamin B<sub>12</sub> deficiency. The classic Schilling test will not detect
abnormalities in patients with difficulties in disassociating vitamin B<sub>12</sub>
from food. <o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"> <o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Patients
with pernicious anemia can be detected by assaying for autoantibodies but these
tests can lack diagnostic specificity.
Antibodies to IF are specific but not sensitive and antibodies to
parietal cells are sensitive but not specific for pernicious anemia.<o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b><u>THERAPY</u></b><b><o:p></o:p></b></span></div>
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<br /></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Patients
with severe megaloblastic anemia need immediate therapy. One should quickly obtain serum vitamin B<sub>12</sub>
and red cell folate levels and then give 1-5 mg of folate and 1000 ug IM of
vitamin B<sub>12</sub>. Patients should
be treated daily with folate. Schedules
for vitamin B<sub>12</sub> replacement vary but a common approach to all is
daily therapy for one week to rapidly build up stores and supply vitamin B<sub>12</sub>
to tissues, then weekly for a month, then monthly life-long. Patients with severe anemia should have
increased reticulocyte by day three and increased hematocrit by day 5. Patients with alcoholism and folate
deficiency can take up to three weeks to respond to folate therapy. It used routine to use IM injection to
replace vitamin B<sub>12</sub>. Oral
therapy with 1-2000 ug/day has been tested and has been found to be just as
reliable as IM therapy and is becoming more widely used.<o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"> <o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Although
patients will megaloblastic anemia often present with severe anemia,
transfusion therapy is rarely indicated.
Since the anemia is rapidly reversible with therapy there is little
justification for exposing the patient to the risk of transfusion except if the
patient is having life-threatening symptoms such as severe ischemia. A further hazard of transfusion is since some
of these patients have high-output heart failure, overzealous transfusion may
lead to pulmonary edema.<o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><u><b>VITAMIN B<sub>12</sub>-
NEUROLOGICAL CONSEQUENCES</b></u><o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"> <o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Recently
it has become clear the patients can have neurological damage due to vitamin B<sub>12</sub>
deficiency without anemia. In fact as
many as 30% of patients with neurological disease due to vitamin B<sub>12</sub>
deficiency will have no or only subtle hematological symptoms. Patients with the most severe neurological
manifestation often have mild hematological disease. Thus it is appearing that vitamin B<sub>12</sub>
deficiency may exhibit two different types of disease states in humans -
hematological or neurological.
Neurological symptoms are reversible if found early but those present
for over a year slowly, if ever, improve. <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Trebuchet MS, sans-serif;">The
neurological symptoms include:<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 12.0pt; margin-bottom: 3.15pt; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-hyphenate: none; mso-list: l1 level1 lfo2; tab-stops: -.5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Trebuchet MS, sans-serif;">o<span style="line-height: normal;">
</span><!--[endif]-->Paresthesias-most
often in fingers and toes. The most
common symptom of vitamin B<sub>12 </sub><span style="line-height: 12pt;">deficiency.</span></span></div>
<div class="MsoNormal" style="line-height: 12.0pt; margin-bottom: 3.15pt; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-hyphenate: none; mso-list: l1 level1 lfo2; tab-stops: -.5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Trebuchet MS, sans-serif;">o<span style="line-height: normal;">
</span><!--[endif]-->Diminished
vibratory sense<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 12.0pt; margin-bottom: 3.15pt; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-hyphenate: none; mso-list: l1 level1 lfo2; tab-stops: -.5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Trebuchet MS, sans-serif;">o<span style="line-height: normal;">
</span><!--[endif]-->Gait
ataxia<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 12.0pt; margin-bottom: 3.15pt; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-hyphenate: none; mso-list: l1 level1 lfo2; tab-stops: -.5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Trebuchet MS, sans-serif;">o<span style="line-height: normal;">
</span><!--[endif]-->Increases
deep tendon reflexes<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 12.0pt; margin-bottom: 3.15pt; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-hyphenate: none; mso-list: l1 level1 lfo2; tab-stops: -.5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Trebuchet MS, sans-serif;">o<span style="line-height: normal;">
</span><!--[endif]-->Memory
loss<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 12.0pt; margin-bottom: 3.15pt; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-hyphenate: none; mso-list: l1 level1 lfo2; tab-stops: -.5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Trebuchet MS, sans-serif;">o<span style="line-height: normal;">
</span><!--[endif]-->Personality
change<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 12.0pt; margin-bottom: 3.15pt; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-hyphenate: none; mso-list: l1 level1 lfo2; tab-stops: -.5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Trebuchet MS, sans-serif;">o<span style="line-height: normal;">
</span><!--[endif]-->Orthostatic
hypotension<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 12.0pt; margin-bottom: 3.15pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 12.0pt; margin-bottom: 3.15pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><u><b>VITAMIN B<sub>12</sub> AND THE ELDERLY</b></u><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 12.0pt; margin-bottom: 3.15pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"> <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 12.0pt; margin-bottom: 3.15pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">On
routine screening as many as 10-23% of elderly patients will have low vitamin B<sub>12</sub>
levels. One study found that 14.5% had
levels below 300 pg/ml with 56% of these patients having increased levels of
homocysteine and methylmalonic acid indicative of tissue vitamin B<sub>12</sub>
deficiency. The most common mechanism is
inability to absorb vitamin B<sub>12</sub> from food. It is speculated the rapid rise in the use of
H<sub>2</sub> blockers will increase this problem in this patient population.
Patients with dementia have lower levels of vitamin B<sub>12</sub> then those
without but treatment with vitamin B<sub>12</sub> is often not effective,
perhaps due to the long duration of the neurological damage. Studies are underway to examine the
relationship of vitamin B<sub>12</sub> deficiency to neurological disease in
the elderly and the effects of early intervention.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 12.0pt; margin-bottom: 3.15pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 12.0pt; margin-bottom: 3.15pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<b><span style="font-family: Trebuchet MS, sans-serif;">CLINICAL
DIFFERENCES BETWEEN VITAMIN B<sub>12</sub> AND FOLATE DEFICIENCIES<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 12.0pt; margin-bottom: 3.15pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<br /></div>
<table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; margin-left: 38.7pt; mso-padding-alt: 0in .1in 0in .1in; mso-table-layout-alt: fixed;">
<tbody>
<tr style="height: 26.65pt; mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border-bottom: none; border-left: double windowtext 2.25pt; border-right: none; border-top: double windowtext 2.25pt; height: 26.65pt; padding: 0in .1in 0in .1in; width: 2.0in;" valign="top" width="192"><div class="MsoNormal" style="line-height: 2.8pt; margin-bottom: 3.15pt; mso-hyphenate: none; mso-line-height-rule: exactly; tab-stops: -.5in; text-align: justify;">
<!--[if supportFields]><span
style='font-family:"Times New Roman","serif"'><span style='mso-element:field-begin'></span>PRIVATE
</span><![endif]--><!--[if supportFields]><span style='font-family:"Times New Roman","serif"'><span
style='mso-element:field-end'></span></span><![endif]--><span style="font-family: Trebuchet MS, sans-serif;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<br /></div>
</td>
<td style="border-bottom: none; border-left: solid windowtext 1.0pt; border-right: none; border-top: double windowtext 2.25pt; height: 26.65pt; padding: 0in .1in 0in .1in; width: 136.5pt;" valign="top" width="182"><div class="MsoNormal" style="line-height: 2.8pt; margin-bottom: 3.15pt; mso-hyphenate: none; mso-line-height-rule: exactly; tab-stops: -.5in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><b>Folate
Deficiency</b><o:p></o:p></span></div>
</td>
<td style="border-bottom: none; border-left: solid windowtext 1.0pt; border-right: double windowtext 2.25pt; border-top: double windowtext 2.25pt; height: 26.65pt; padding: 0in .1in 0in .1in; width: 120.0pt;" valign="top" width="160"><div class="MsoNormal" style="line-height: 2.8pt; margin-bottom: 3.15pt; mso-hyphenate: none; mso-line-height-rule: exactly; tab-stops: -.5in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><b>Vitamin
B<sub>12</sub></b>
<b>Deficiency</b><o:p></o:p></span></div>
</td>
</tr>
<tr style="height: 29.55pt; mso-height-rule: exactly; mso-yfti-irow: 1;">
<td style="border-bottom: none; border-left: double windowtext 2.25pt; border-right: none; border-top: double windowtext 2.25pt; height: 29.55pt; mso-height-rule: exactly; padding: 0in .1in 0in .1in; width: 2.0in;" valign="top" width="192"><div class="MsoNormal" style="line-height: 2.8pt; margin-bottom: 3.15pt; mso-hyphenate: none; mso-line-height-rule: exactly; tab-stops: -.5in; text-align: justify;">
<br /></div>
<div class="MsoEndnoteText" style="tab-stops: -.5in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Most
common cause</span></div>
</td>
<td style="border-bottom: none; border-left: solid windowtext 1.0pt; border-right: none; border-top: double windowtext 2.25pt; height: 29.55pt; mso-height-rule: exactly; padding: 0in .1in 0in .1in; width: 136.5pt;" valign="top" width="182"><div class="MsoNormal" style="line-height: 2.8pt; margin-bottom: 3.15pt; mso-hyphenate: none; mso-line-height-rule: exactly; tab-stops: -.5in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Dietary
deficiency<o:p></o:p></span></div>
</td>
<td style="border-bottom: none; border-left: solid windowtext 1.0pt; border-right: double windowtext 2.25pt; border-top: double windowtext 2.25pt; height: 29.55pt; mso-height-rule: exactly; padding: 0in .1in 0in .1in; width: 120.0pt;" valign="top" width="160"><div class="MsoNormal" style="line-height: 2.8pt; margin-bottom: 3.15pt; mso-hyphenate: none; mso-line-height-rule: exactly; tab-stops: -.5in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Malabsorption</span></div>
</td>
</tr>
<tr style="height: 21.9pt; mso-height-rule: exactly; mso-yfti-irow: 2;">
<td style="border-bottom: none; border-left: double windowtext 2.25pt; border-right: none; border-top: solid windowtext 1.0pt; height: 21.9pt; mso-height-rule: exactly; padding: 0in .1in 0in .1in; width: 2.0in;" valign="top" width="192"><div class="MsoNormal" style="line-height: .9pt; margin-bottom: 3.15pt; mso-hyphenate: none; mso-line-height-rule: exactly; tab-stops: -.5in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Time
to development<o:p></o:p></span></div>
</td>
<td style="border-bottom: none; border-left: solid windowtext 1.0pt; border-right: none; border-top: solid windowtext 1.0pt; height: 21.9pt; mso-height-rule: exactly; padding: 0in .1in 0in .1in; width: 136.5pt;" valign="top" width="182"><div class="MsoNormal" style="line-height: .9pt; margin-bottom: 3.15pt; mso-hyphenate: none; mso-line-height-rule: exactly; tab-stops: -.5in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-hyphenate: none; mso-pagination: lines-together; page-break-after: avoid; tab-stops: -.5in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Months<o:p></o:p></span></div>
</td>
<td style="border-bottom: none; border-left: solid windowtext 1.0pt; border-right: double windowtext 2.25pt; border-top: solid windowtext 1.0pt; height: 21.9pt; mso-height-rule: exactly; padding: 0in .1in 0in .1in; width: 120.0pt;" valign="top" width="160"><div class="MsoNormal" style="line-height: .9pt; margin-bottom: 3.15pt; mso-hyphenate: none; mso-line-height-rule: exactly; tab-stops: -.5in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-hyphenate: none; mso-pagination: lines-together; page-break-after: avoid; tab-stops: -.5in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Years<o:p></o:p></span></div>
</td>
</tr>
<tr style="height: .3in; mso-yfti-irow: 3;">
<td style="border-bottom: none; border-left: double windowtext 2.25pt; border-right: none; border-top: solid windowtext 1.0pt; height: .3in; padding: 0in .1in 0in .1in; width: 2.0in;" valign="top" width="192"><div class="MsoNormal" style="line-height: .9pt; margin-bottom: 3.15pt; mso-hyphenate: none; mso-line-height-rule: exactly; tab-stops: -.5in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-hyphenate: none; mso-pagination: lines-together; page-break-after: avoid; tab-stops: -.5in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Neurologic abnormalities<o:p></o:p></span></div>
</td>
<td style="border-bottom: none; border-left: solid windowtext 1.0pt; border-right: none; border-top: solid windowtext 1.0pt; height: .3in; padding: 0in .1in 0in .1in; width: 136.5pt;" valign="top" width="182"><div class="MsoNormal" style="line-height: .9pt; margin-bottom: 3.15pt; mso-hyphenate: none; mso-line-height-rule: exactly; tab-stops: -.5in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-hyphenate: none; mso-pagination: lines-together; page-break-after: avoid; tab-stops: -.5in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">No<o:p></o:p></span></div>
</td>
<td style="border-bottom: none; border-left: solid windowtext 1.0pt; border-right: double windowtext 2.25pt; border-top: solid windowtext 1.0pt; height: .3in; padding: 0in .1in 0in .1in; width: 120.0pt;" valign="top" width="160"><div class="MsoNormal" style="line-height: .9pt; margin-bottom: 3.15pt; mso-hyphenate: none; mso-line-height-rule: exactly; tab-stops: -.5in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-hyphenate: none; mso-pagination: lines-together; page-break-after: avoid; tab-stops: -.5in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Yes<o:p></o:p></span></div>
</td>
</tr>
<tr style="height: .5in; mso-height-rule: exactly; mso-yfti-irow: 4;">
<td style="border-bottom: none; border-left: double windowtext 2.25pt; border-right: none; border-top: solid windowtext 1.0pt; height: .5in; mso-height-rule: exactly; padding: 0in .1in 0in .1in; width: 2.0in;" valign="top" width="192"><div class="MsoNormal" style="line-height: .9pt; margin-bottom: 3.15pt; mso-hyphenate: none; mso-line-height-rule: exactly; tab-stops: -.5in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-hyphenate: none; mso-pagination: lines-together; page-break-after: avoid; tab-stops: -.5in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Response to treatment with
vitamin B<sub>12</sub><o:p></o:p></span></div>
</td>
<td style="border-bottom: none; border-left: solid windowtext 1.0pt; border-right: none; border-top: solid windowtext 1.0pt; height: .5in; mso-height-rule: exactly; padding: 0in .1in 0in .1in; width: 136.5pt;" valign="top" width="182"><div class="MsoNormal" style="line-height: .9pt; margin-bottom: 3.15pt; mso-hyphenate: none; mso-line-height-rule: exactly; tab-stops: -.5in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 12.0pt; margin-bottom: 3.15pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">No<o:p></o:p></span></div>
</td>
<td style="border-bottom: none; border-left: solid windowtext 1.0pt; border-right: double windowtext 2.25pt; border-top: solid windowtext 1.0pt; height: .5in; mso-height-rule: exactly; padding: 0in .1in 0in .1in; width: 120.0pt;" valign="top" width="160"><div class="MsoNormal" style="line-height: .9pt; margin-bottom: 3.15pt; mso-hyphenate: none; mso-line-height-rule: exactly; tab-stops: -.5in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 12.0pt; margin-bottom: 3.15pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Yes<o:p></o:p></span></div>
</td>
</tr>
<tr style="height: 36.3pt; mso-height-rule: exactly; mso-yfti-irow: 5; mso-yfti-lastrow: yes;">
<td style="border-bottom: double windowtext 2.25pt; border-left: double windowtext 2.25pt; border-right: none; border-top: solid windowtext 1.0pt; height: 36.3pt; mso-height-rule: exactly; padding: 0in .1in 0in .1in; width: 2.0in;" valign="top" width="192"><div class="MsoNormal" style="line-height: .9pt; margin-bottom: 3.15pt; mso-hyphenate: none; mso-line-height-rule: exactly; tab-stops: -.5in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Response
to treatment with folate<o:p></o:p></span></div>
</td>
<td style="border-bottom: double windowtext 2.25pt; border-left: solid windowtext 1.0pt; border-right: none; border-top: solid windowtext 1.0pt; height: 36.3pt; mso-height-rule: exactly; padding: 0in .1in 0in .1in; width: 136.5pt;" valign="top" width="182"><div class="MsoNormal" style="line-height: .9pt; mso-hyphenate: none; mso-line-height-rule: exactly; tab-stops: -.5in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Yes<o:p></o:p></span></div>
</td>
<td style="border-bottom: double 2.25pt; border-color: windowtext; border-left: solid 1.0pt; border-right: double 2.25pt; border-top: solid 1.0pt; height: 36.3pt; mso-height-rule: exactly; padding: 0in .1in 0in .1in; width: 120.0pt;" valign="top" width="160"><div class="MsoNormal" style="line-height: .9pt; mso-hyphenate: none; mso-line-height-rule: exactly; tab-stops: -.5in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Hematologic
- Yes<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-hyphenate: none; tab-stops: -.5in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Neurologic
- No<o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span>
<br />
<div>
<b><span style="font-family: Trebuchet MS, sans-serif;">Source:</span></b></div>
<div>
<span style="text-align: justify;"><span style="font-family: Trebuchet MS, sans-serif;">Thomas G. DeLoughery, MD FACP</span></span></div>
<div>
<div class="MsoNormal" style="mso-hyphenate: none; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Professor of Medicine, Pathology,
and Pediatrics<o:p></o:p></span></div>
<div class="MsoNormal" style="mso-hyphenate: none; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Oregon Health Sciences University<o:p></o:p></span></div>
<div class="MsoNormal" style="mso-hyphenate: none; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Portland, Oregon<o:p></o:p></span></div>
<div class="MsoNormal" style="mso-hyphenate: none; text-align: justify;">
<span style="letter-spacing: -0.15pt;"><a href="mailto:delought@ohsu.edu"><span style="font-family: Trebuchet MS, sans-serif;">delought@ohsu.edu</span></a><span style="font-family: Times New Roman, serif;"><o:p></o:p></span></span></div>
</div>
</div>A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-3485511555143280532015-01-21T21:37:00.001+05:452015-01-25T14:23:38.877+05:45Chronic Cough: most common 8 reasons<script async src="//pagead2.googlesyndication.com/pagead/js/adsbygoogle.js"></script>
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<span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12pt; line-height: 18pt;">Are you fed up with your stubborn cough? There
are many reasons why a cough may not improve, and that can be frustrating for
people and their doctors alike.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 16.5pt; mso-fareast-font-family: "Times New Roman";"><br /></span></span>
<span style="font-family: Trebuchet MS, sans-serif;"><b><a href="https://www.blogger.com/blogger.g?blogID=6852805409466941423" name="1"></a></b><span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 16.5pt; mso-fareast-font-family: "Times New Roman";"><b>Reason
1: Irritated Airways After a Cold or Flu</b><o:p></o:p></span></span></div>
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<span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">The most common cause of chronic cough is
predictable. It's the aftermath of a cold or other viral infection, says Norman
H. Edelman, MD, chief medical officer of the American Lung Association. Most
cold symptoms may go away after a few days. Your cough, though, can </span></div>
<a name='more'></a><span style="font-family: Trebuchet MS, sans-serif;">hang around
for weeks, sometimes for months, because viruses can cause your airways to
become swollen and oversensitive. This can last long after the virus is gone.<o:p></o:p></span><br />
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<span style="font-family: Trebuchet MS, sans-serif;"><span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 16.5pt; mso-fareast-font-family: "Times New Roman";"><br /></span></span>
<span style="font-family: Trebuchet MS, sans-serif;"><b><a href="https://www.blogger.com/blogger.g?blogID=6852805409466941423" name="2"></a></b><span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 16.5pt; mso-fareast-font-family: "Times New Roman";"><b>Reason
2: Underlying Health Problems</b><o:p></o:p></span></span></div>
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<span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Allergies and asthma are common causes of a
cough. A cold can even cause an asthma attack. Some people learn they have
asthma during a cold.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Acid reflux and obstructive sleep apnea can
also cause a chronic cough. Fortunately, these conditions are treatable. See
your doctor for diagnosis and treatment if you have symptoms of acid reflux,
including:</span></div>
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</div>
<ul>
<li><span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12pt; line-height: 18pt;">Burping</span></li>
<li><span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12pt; line-height: 18pt;">Heartburn</span></li>
<li><span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12pt; line-height: 18pt;">Ongoing cough</span></li>
<li><span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12pt; line-height: 18pt;">Regurgitation</span></li>
</ul>
<span style="background-color: white; font-family: 'Trebuchet MS', sans-serif; line-height: 18pt; text-align: justify;">Also see your doctor if you have symptoms of
obstructive sleep apnea, such as:</span><br />
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</div>
<ul>
<li><span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12pt; line-height: 18pt;">Insomnia</span></li>
<li><span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12pt; line-height: 18pt;">Loud snoring</span></li>
<li><span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12pt; line-height: 18pt;">Nighttime choking or
gasping</span></li>
<li><span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12pt; line-height: 18pt;">Repeated awakenings</span></li>
<li><span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12pt; line-height: 18pt;">Sleepiness during the
day</span></li>
</ul>
<b style="font-family: 'Trebuchet MS', sans-serif;">Reason
3: Stress</b><br />
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<span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Stress, especially when it's chronic, can make
colds last longer. To beat back a lingering cough, slow down and ease stress
while you're sick. Pushing yourself too hard might just make you sicker. One
way to relax is to rest more: Aim for 7 to 8 hours of sleep a night.<o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b><a href="https://www.blogger.com/blogger.g?blogID=6852805409466941423" name="4"></a></b><span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 16.5pt; mso-fareast-font-family: "Times New Roman";"><b>Reason
4: Not Drinking Enough Fluids</b><o:p></o:p></span></span></div>
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<span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">When you have a cold or the flu, you need to
drink a lot of fluids. Water, juice, and soup can help loosen mucus in your
airways so you can cough it up and out. Alcohol and drinks with caffeine in
them are not helpful choices because they can dehydrate you -- the opposite of
what you need when you're sick. Another way to add moisture to your airways is
by using a saline nasal spray.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 16.5pt; mso-fareast-font-family: "Times New Roman";"><b>Reason 5: Overusing
OTC Nasal Decongestant Spray</b><o:p></o:p></span></div>
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<span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Over-the-counter (OTC) nasal decongestant
sprays may help with a stuffy or runny nose. Don't use them for more than 3
days, though. If you do, when you finally stop taking them, your symptoms may
be worse -- a rebound effect. Those excess sprays make your nasal membranes
swell, which triggers more congestion, postnasal drip, and coughing.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 16.5pt; mso-fareast-font-family: "Times New Roman";"><b>Reason 6: Air That's
Too Dry or Too Moist</b><o:p></o:p></span></div>
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<span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">"Dry air -- especially common in the
winter -- can irritate a cough," Edelman says. On the other hand, cranking
up the humidifier too high isn't helpful, either. Moist air can be a trigger
for asthma and encourage the growth of dust mites and mold, allergens that may
start you hacking.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">"People should aim for humidity levels of
40% to 50% in their homes, winter and summer," Edelman says.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 16.5pt; mso-fareast-font-family: "Times New Roman";"><b>Reason 7: Bacterial
Infection</b><o:p></o:p></span></div>
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<span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Sometimes, a cold can leave behind an
unwelcome parting gift. When your airways are raw and irritated after a cold,
it's easier for bacteria to invade. Bacteria can cause sinus infections,
bronchitis, and pneumonia. If you have a fever or pain along with your
lingering cough, a bacterial infection could be the reason. See your doctor, as
you may need to take an antibiotic.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 16.5pt; mso-fareast-font-family: "Times New Roman";"><b>Reason 8: Your Blood
Pressure Medicine</b><o:p></o:p></span></div>
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<span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Do you take medicine for high blood pressure?
If so, that may be why your cough won't quit. About 1 out of 5 people who take
ACE inhibitors develop a chronic, dry cough as a side effect. If you have this
side effect, talk to your doctor. Another drug may work better for you. There
are many available ACE inhibitors, including:<o:p></o:p></span></div>
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<ul>
<li><span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12pt; line-height: 18pt;">Altace (ramipril)</span></li>
<li><span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12pt; line-height: 18pt;">Capoten (captopril)</span></li>
<li><span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12pt; line-height: 18pt;">Lotensin (benazepril)</span></li>
<li><span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12pt; line-height: 18pt;">Prinivil, Zestril
(lisinopril)</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;"><span style="color: #222222; font-size: 12pt; line-height: 18pt;">Vasotec </span><span style="color: #222222; font-size: 12pt; line-height: 18pt;">(enalapril)</span></span></li>
</ul>
<span style="background-color: white; font-family: 'Trebuchet MS', sans-serif; line-height: 18pt; text-align: justify;">If the generic name of your medicine ends with
"pril," there's a good chance it's an ACE inhibitor. </span><br />
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<span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><br /></span>
<span style="color: #222222; font-family: Trebuchet MS, sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">If your cough isn’t getting better after a
week, call your doctor. Together, you can find out what’s causing your cough
and make sure you get the right treatment.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Trebuchet MS, sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">(Source: <a href="http://www.webmd.com/">www.webmd.com</a>, Author: R. Morgan Griffin, Reviewed
by Michael W. Smith, MD)<o:p></o:p></span></div>
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span>
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</div>A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-23511965412170222132014-12-25T10:59:00.000+05:452015-01-25T14:12:44.754+05:45Subacute Thyroiditis: Introduction, Pathogenesis, symptoms and treatment<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgM5kkMqOScRF7LZI9UCrn4yEsr7Dt3qen-UNMQrykyK7TqmCdUnMZ-t0JSAkhzvHKEBlepGbWd3FAPlmRFiHMcXdWXaPCuVV2F8gjpbOu9SbhrYWjxXlgb5z57LA8lgAioFnFs7xyMtH1Z/s1600/Thyroiditis.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;" title=""><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgM5kkMqOScRF7LZI9UCrn4yEsr7Dt3qen-UNMQrykyK7TqmCdUnMZ-t0JSAkhzvHKEBlepGbWd3FAPlmRFiHMcXdWXaPCuVV2F8gjpbOu9SbhrYWjxXlgb5z57LA8lgAioFnFs7xyMtH1Z/s1600/Thyroiditis.jpg" height="213" title="" width="320" /></a></div>
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<b><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">What Is
Subacute Thyroiditis?<o:p></o:p></span></span></b></div>
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<br /></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b><span style="border: 1pt none windowtext; font-size: 12pt; padding: 0in;">Thyroiditis </span></b><span style="font-size: 12pt;">refers to an inflamed thyroid. Your <b><span style="border: none windowtext 1.0pt; mso-border-alt: none windowtext 0in; padding: 0in;">thyroid</span></b> is a gland in the front of your neck that
controls your metabolism by releasing a variety of hormones.<o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Most
types of thyroiditis do not cause pain in the thyroid gland. However, they
typically lead to either<b><span style="border: none windowtext 1.0pt; mso-border-alt: none windowtext 0in; padding: 0in;"> hyperthyroidism</span></b> (overactive
thyroid) or <b><span style="border: none windowtext 1.0pt; mso-border-alt: none windowtext 0in; padding: 0in;">hypothyroidism</span></b> (underactive
thyroid). Both of these conditions cause </span></span></div>
<a name='more'></a><span style="font-family: Trebuchet MS, sans-serif;">symptoms such as weight changes,
anxiety, and fatigue.<o:p></o:p></span><br />
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<br /></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b><span style="border: 1pt none windowtext; font-size: 12pt; padding: 0in;">Subacute
thyroiditis</span></b><span style="font-size: 12pt;"> leads to pain and discomfort
in the thyroid gland. Individuals with this condition will also have symptoms
of overactive thyroid and later develop symptoms of underactive thyroid.<o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Subacute
thyroiditis generally occurs after an upper respiratory viral infection such as
the flu or the mumps. The <b><span style="border: none windowtext 1.0pt; mso-border-alt: none windowtext 0in; padding: 0in;">mumps</span></b> is a
highly contagious viral infection that causes inflamed salivary glands.
Subacute thyroiditis is very rare. However, it is slightly more common in
middle-aged women.<o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b><span style="font-size: 12pt;">Pathogenesis</span></b><span style="font-size: 12pt;">:<o:p></o:p></span></span></div>
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<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Subacute thyroiditis is presumed to
be caused by a viral infection or a post-viral inflammatory process. The
majority of patients have a history of an upper respiratory infection prior to
the onset of thyroiditis (typically two to eight weeks beforehand). The disease
was thought to have a seasonal incidence (higher in summer), and clusters of
cases have been reported in association with Coxsackie virus, mumps, measles,
adenovirus, and other viral infections. However, in other series, there was a
relatively comparable distribution of presentation throughout the year. Serial
studies of viral antibody titers have implicated many of the same viruses, but
the changes could equally be attributed to nonspecific anamnestic responses.
Viral inclusion bodies are not seen in thyroid tissue.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Thyroid autoimmunity does not appear to play a primary role
in the disorder, but it is strongly associated with HLA-B35 in many ethnic
groups. A unifying hypothesis might be that the disorder results from a common
subclinical viral infection that provides an antigen, either of viral origin or
resulting from virus-induced host tissue damage, that uniquely binds to HLA-B35
molecules on macrophages. The resulting antigen-HLA-B35 complex activates
cytotoxic T lymphocytes that then damage thyroid follicular cells, because the
cells have partial structural similarity with the infection-related antigen.
Unlike autoimmune thyroid disease, however, the immune reaction is not
self-perpetuating, so the process is limited.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Whatever factors initiate subacute thyroiditis, the
resulting thyroid inflammation damages thyroid follicles and activates
proteolysis of the thyroglobulin stored within the follicles. The result is
unregulated release of large amounts of thyroxine (T4) and triiodothyronine
(T3) into the circulation resulting in clinical and biochemical
hyperthyroidism. This state lasts only until the stores of thyroglobulin are
exhausted because new hormone synthesis ceases, not only because of damage to
the thyroid follicular cells but also because of inhibition of thyrotropin
(TSH) secretion by the increased serum T4 and T3 concentrations.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">As the inflammation subsides, the thyroid follicles
regenerate and thyroid hormone synthesis and secretion resume. There is usually
a period of rapid evolution through euthyroidism and then into hypothyroidism.
The hypothyroidism lasts until the thyroid gland can generate sufficient
thyroid hormone synthesis and secretion so that the patient regains normal
homeostasis. Each phase typically lasts two to eight weeks with the possible
exception of the initial transition through euthyroidism, which may be shorter<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;">
<b><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Symptoms
of Subacute Thyroiditis:<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Unlike
other forms of thyroid inflammation, this condition causes pain in your thyroid
gland. In some cases, this pain might also occur in other parts of your neck,
your ears, or your jaw. Your thyroid may be tender and swollen to the touch.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Other
symptoms of this condition include:</span></span><br />
<br />
<ul>
<li><span style="font-family: 'Trebuchet MS', sans-serif; font-size: 12pt; text-indent: -0.25in;">fatigue</span></li>
<li><span style="font-family: 'Trebuchet MS', sans-serif; font-size: 12pt; text-indent: -0.25in;">metabolism issues (such as weight
changes and difficulty regulating body temperature</span></li>
<li><span style="font-family: 'Trebuchet MS', sans-serif; font-size: 12pt; text-indent: -0.25in;">weakness</span></li>
</ul>
</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;">
<span style="font-family: 'Trebuchet MS', sans-serif; font-size: 12pt;">You
will typically develop hyperthyroidism in the initial stages of this condition.
Your symptoms during this stage of the disease may include:</span></div>
<ul style="margin-top: 0in; text-align: left;" type="disc">
<li><span style="font-family: 'Trebuchet MS', sans-serif; font-size: 12pt; text-align: justify; text-indent: -0.25in;">mental or emotional difficulties
(such as nervousness, irritability, restlessness, trouble concentrating)</span></li>
<li class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">fatigue<o:p></o:p></span></span></li>
<li class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">increased body temperature
(leading to excessive sweating)<o:p></o:p></span></span></li>
<li class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">weight loss<o:p></o:p></span></span></li>
<li class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">fast or irregular heartbeat<o:p></o:p></span></span></li>
</ul>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; vertical-align: baseline;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">As
the disease progresses, hypothyroidism generally replaces hyperthyroidism. You
will typically develop a new set of symptoms, including:</span></span></div>
<ul style="margin-top: 0in; text-align: left;" type="disc">
<li><span style="font-family: 'Trebuchet MS', sans-serif; font-size: 12pt; text-align: justify; text-indent: -0.25in;">fatigue, lethargy, weakness, and
sluggishness</span></li>
<li class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">constipation<o:p></o:p></span></span></li>
<li class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">weight gain<o:p></o:p></span></span></li>
<li class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">heavy menstrual periods</span></span></li>
</ul>
<span style="font-family: 'Trebuchet MS', sans-serif; font-size: 12pt; text-align: justify;">According to the American Thyroid
Association, the first stage of the condition usually lasts for less than three
months. The second stage may last for an additional nine to 15 months (</span><a href="http://www.thyroid.org/what-is-thyroiditis" style="font-family: 'Trebuchet MS', sans-serif; font-size: 12pt; text-align: justify;"><span style="border: none windowtext 1.0pt; color: windowtext; mso-border-alt: none windowtext 0in; padding: 0in;">ATA</span></a><span style="font-family: 'Trebuchet MS', sans-serif; font-size: 12pt; text-align: justify;">,
2012).</span><br /><div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;">
<b><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">How Is
Subacute Thyroiditis Diagnosed?<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Your
doctor will diagnose this condition using blood tests. The results of these
tests will vary depending on the disease’s stage. For example, in the initial
stages, your thyroid hormone (free T4) levels will be elevated, while your TSH
(thyroid stimulating hormone) levels will be low.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">The
free T4 and TSH levels are part of an internal feedback loop. When one is high,
the other is low and vice versa. In the later stages of the disease, your TSH
levels will be elevated while your T4 levels will be low.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Your
doctor will also diagnose this condition based on your recent medical history.
Your doctor will be more likely to check for this condition if you have
recently had an infection. This is because subacute thyroiditis usually
develops after a viral infection.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Pain
in your thyroid gland is another clue that you have this condition.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;">
<b><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">How Is
Subacute Thyroiditis Treated?<o:p></o:p></span></span></b></div>
<div style="font-style: inherit; font-variant: inherit; margin: 0in 0in 0.0001pt; overflow: hidden; text-align: justify; vertical-align: baseline;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in; text-align: justify; vertical-align: baseline;">
<span style="font-family: Trebuchet MS, sans-serif;">Your doctor will give you medications to help reduce the pain and
control inflammation. This is the only treatment necessary in some cases.
Possible medications include steroids, aspirin, and ibuprofen.<o:p></o:p></span></div>
<div style="font-style: inherit; font-variant: inherit; margin: 0in 0in 0.0001pt; overflow: hidden; text-align: justify; vertical-align: baseline;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in; text-align: justify; vertical-align: baseline;">
<span style="font-family: Trebuchet MS, sans-serif;">Your doctor may also want to treat this condition using beta-blocker
medications if hyperthyroidism is present in the early stages. These
medications lower blood pressure and reduce symptoms such as irregular
heartbeat and nervousness.<o:p></o:p></span></div>
<div style="font-style: inherit; font-variant: inherit; margin: 0in 0in 0.0001pt; overflow: hidden; text-align: justify; vertical-align: baseline;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in; text-align: justify; vertical-align: baseline;">
<span style="font-family: Trebuchet MS, sans-serif;">However, the treatments for overactive thyroid will be temporary.
Your doctor will eventually wean you off any medications that had been
prescribed to treat the condition.<o:p></o:p></span></div>
<div style="font-style: inherit; font-variant: inherit; margin: 0in 0in 0.0001pt; overflow: hidden; text-align: justify; vertical-align: baseline;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in; text-align: justify; vertical-align: baseline;">
<span style="font-family: Trebuchet MS, sans-serif;">Keep in mind that the disease usually occurs in two stages. Treatment
for overactive thyroid is important at the beginning of the disease. However,
it will not be helpful once your condition progresses into the second phase.<o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in; text-align: justify; vertical-align: baseline;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in; text-align: justify; vertical-align: baseline;">
<span style="font-family: Trebuchet MS, sans-serif;">During the later stages of the disease, you will have underactive
thyroid. You will generally need to take hormones to replace those that your
body is not producing.<o:p></o:p></span></div>
<div class="MsoNormal" id="section-disclaimer-5" style="margin-bottom: 0.0001pt; overflow: hidden; vertical-align: baseline;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;">
<b><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">What Is
the Outlook for Subacute Thyroiditis?<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;">
<br /></div>
<div style="font-style: inherit; font-variant: inherit; margin: 0in 0in 0.0001pt; overflow: hidden; text-align: justify; vertical-align: baseline;">
<span style="font-family: Trebuchet MS, sans-serif;">Symptoms will resolve within a year and a half on their own in
the majority of cases. However, hypothyroidism may end up being permanent. The
ATA estimates that this occurs in approximately five percent of cases (<a href="http://www.thyroid.org/what-is-thyroiditis" style="font-size: inherit; font-style: inherit; font-variant: inherit; line-height: inherit;"><span style="border: none windowtext 1.0pt; color: windowtext; mso-border-alt: none windowtext 0in; padding: 0in; text-decoration: none; text-underline: none;">ATA</span></a>, 2012).<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Ref:
<a href="http://www.healthline.com/">www.healthline.com</a><o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;"><a href="http://www.uptodate.com/">www.uptodate.com</a></span></span></div>
</div>
</div>A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-55443301101541292332014-12-16T08:51:00.003+05:452015-01-25T14:13:15.960+05:45Low blood sugar: What are the effects in our body<div dir="ltr" style="text-align: left;" trbidi="on">
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: justify;"><tbody title="">
<tr title=""><td style="text-align: center;" title=""><div title="">
<div title="">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEje3kj1wxucNa6FVK8N1uU92pea-GQg_mz1oeHa1uA8x6ex367OnkaRFC1T1gI1R6ZYV-fiwWBXuw-C5MHdZAc45G8YsdV_qWNn9vx-2b2MAc1-hYqcYU51P_rqYjdGcIbXLVotSXUh6NI9/s1600/Hypoglycemia+effects.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;" title=""><span style="font-family: Trebuchet MS, sans-serif;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEje3kj1wxucNa6FVK8N1uU92pea-GQg_mz1oeHa1uA8x6ex367OnkaRFC1T1gI1R6ZYV-fiwWBXuw-C5MHdZAc45G8YsdV_qWNn9vx-2b2MAc1-hYqcYU51P_rqYjdGcIbXLVotSXUh6NI9/s1600/Hypoglycemia+effects.JPG" height="400" title="" width="305" /></span></a></div>
</div>
</td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif; font-size: small;">Fig. Effects of low blood sugar</span></td></tr>
</tbody></table>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Every cell in your body
needs sugar (glucose) to function. When your blood sugar levels drop too low,
your cells become starved for energy. Initially, that can cause minor symptoms,
but if you don’t get your blood sugar levels up soon, you’re at risk of serious
complications.</span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<h4 style="margin-top: 0in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif; line-height: 115%;">Effects of Low Blood Sugar on the Body<o:p></o:p></span><script async src="//pagead2.googlesyndication.com/pagead/js/adsbygoogle.js"></script>
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<div style="margin: 0in 0in 0.0001pt;">
<span style="font-family: Trebuchet MS, sans-serif; text-align: justify;">When your blood sugar (glucose) levels
fall below the normal range, it’s called hypoglycemia, or insulin shock.</span></div>
<div style="margin: 0in 0in 0.0001pt; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;">
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Low blood sugar can happen when you skip a
meal. It can also happen if your pancreas releases more insulin than it should
after you’ve eaten. The most common reason for low blood sugar is diabetes. In
type 1 diabetes, the pancreas can no longer produce insulin. In type 2
diabetes, the pancreas doesn’t make enough, or your body can’t use it properly.
To keep blood sugar levels from rising too much (hyperglycemia), you need the
right amount of insulin. With </span></div>
</div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">insufficient insulin, your blood sugar levels
rise. Too much, and your blood sugar levels can plummet.<o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;">
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
</div>
<div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;">
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"></span></div>
<a name='more'></a><span style="font-family: Trebuchet MS, sans-serif;">Another possible cause of low blood sugar
is drinking too much alcohol, especially on an empty stomach. This can
interfere with the liver’s ability to release stored glucose into your bloodstream.
Hepatitis and other problems with your liver can also lead to low blood sugar.
Other causes include kidney disorders, anorexia nervosa, a pancreatic tumor, or
adrenal gland disorders.<o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;">
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
</div>
<div style="margin: 0in 0in 0.0001pt; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">There are a variety of symptoms of low
blood sugar, but the only way to be sure what your blood glucose levels are is
by taking a blood glucose test.<o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;">
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
</div>
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<br />
<div style="margin: 0in 0in 0.0001pt; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Generally, blood sugar levels below 70 mg/dL
are considered too low, according to the<span class="apple-converted-space"> </span><a href="http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html" target="_blank"><span style="text-decoration: none; text-underline: none;">American
Diabetes Association</span></a>. If you have diabetes, it’s important to
monitor your blood sugar levels often. Low blood sugar can come on quickly, but
it can usually be treated easily. However, if you don’t take care of it, it can
lead to severe complications and even death.<o:p></o:p></span></div>
<h4 id="id1" style="margin-top: 0in;">
<span style="font-family: Trebuchet MS, sans-serif; line-height: 115%; text-align: justify;"><br /></span></h4>
<h4 id="id1" style="margin-top: 0in;">
<span style="font-family: Trebuchet MS, sans-serif; line-height: 115%; text-align: justify;">Digestive, Endocrine, and Circulatory Systems</span></h4>
<div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;">
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">After you eat, your digestive system
breaks down carbohydrates and turns them into glucose to fuel your body. As
your sugar levels rise, your pancreas releases a hormone called insulin. The
insulin helps glucose travel within your bloodstream to cells throughout your
body. If you have insulin-dependent diabetes, you must take the right about of
insulin to get the job done. Any excess glucose goes to your liver for storage.<o:p></o:p></span></div>
</div>
<div style="margin: 0in 0in 0.0001pt; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;">
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">When you go a few hours without eating,
blood sugar levels go down. If you have a healthy pancreas, it releases a
hormone called glucagon. That tells your liver to process the stored sugars and
release them into your bloodstream. If everything works as it should, your
blood sugar levels should remain in the normal range until your next meal.<o:p></o:p></span></div>
</div>
<div style="margin: 0in 0in 0.0001pt; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;">
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Insufficient blood sugar levels can cause
a rapid heartbeat and heart palpitations. However, even if you have diabetes,
you may not always have obvious symptoms of low blood sugar. It’s a condition
called <b>“hypoglycemia unawareness.”</b>
This happens when you experience low blood sugar so often that it changes your
body’s response to it. Normally, low blood sugar causes your body to release
stress hormones, such as epinephrine. Epinephrine is responsible for those early
warning signs, like hunger and shakiness. When low blood sugar happens too
frequently, your body may stop releasing stress hormones
(hypoglycemia-associated autonomic failure, or HAAF). That’s why it’s so
important to check your blood sugar levels often.<o:p></o:p></span></div>
</div>
<h4 id="id2" style="margin-top: 0in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif; line-height: 115%;"><br /></span></h4>
<h4 id="id2" style="margin-top: 0in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif; line-height: 115%;">Central Nervous System</span></h4>
<div style="margin: 0in 0in 0.0001pt;">
<span style="font-family: Trebuchet MS, sans-serif; text-align: justify;">Every cell in your body needs sugar to
work properly. It’s your body’s main source of energy. Low blood sugar levels
can cause a variety of problems within your CNS. Early
symptoms include weakness, lightheadedness, and dizziness. You may feel
nervous, anxious, or irritable, and you’ll probably be hungry. Lack of
coordination, chills, clammy skin, and sweating are common. Tingling or
numbness of the mouth may be a sign of low blood sugar. Other symptoms include
blurred vision, headache, and confusion. You may have difficulty performing
simple tasks. When blood sugar levels drop during the night, you may have
nightmares, cry out during sleep, or other unusual behaviors.</span></div>
<div style="margin-bottom: .0001pt; margin: 0in; text-align: justify;">
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
</div>
<div style="margin: 0in 0in 0.0001pt; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Severe low blood sugar is sometimes called
insulin shock. Untreated, it can be very dangerous, resulting in seizures, loss
of consciousness, or death.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Credit: http://www.healthline.com<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<div style="text-align: justify;">
<br /></div>
</div>
</div>
</div>A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-26159245402344247932014-11-21T11:14:00.000+05:452014-11-23T10:14:19.493+05:45Bone Metabolism : Regulation (Part 2)<script type="text/javascript"><!--
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<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<b><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Calcium
and phosphate balance</span></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<b><span style="font-family: Tahoma, sans-serif; font-size: 12pt;">Soluble Ca<sup>2+</sup>,
hydroxyapatite and calcitonin </span></b><span style="font-family: Tahoma, sans-serif; font-size: 12pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;" title="">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirVTR4fFiWMAB3AC32DykRQK9C0nZLv0ozM7BndknWalyY9Q3c4ZvZhyEsqheW9X6vjBj0nHOtj7pgpjlJN8vdU8bJKEOI45KK7ecSheFUabmnB3Vxa0ZBxjo_V67vY-Rn0-lMtC-wejaV/s1600/Calcium_Homeostasis.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;" title=""><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirVTR4fFiWMAB3AC32DykRQK9C0nZLv0ozM7BndknWalyY9Q3c4ZvZhyEsqheW9X6vjBj0nHOtj7pgpjlJN8vdU8bJKEOI45KK7ecSheFUabmnB3Vxa0ZBxjo_V67vY-Rn0-lMtC-wejaV/s1600/Calcium_Homeostasis.png" height="316" title="" width="640" /></a></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">As
calcium (Ca<sup>2+</sup>) is one of the main components of our bones, large
amounts are present </span></span></div>
<a name='more'></a><span style="font-family: Trebuchet MS, sans-serif;">in our body. At the same time, comparatively low
extracellular concentrations of Ca<sup>2+</sup> are fine-tuned to regulate important
functions, not to speak of even far lower intracellular concentrations. This
dichotomy is possible due to the low solubility product of Ca<sup>2+</sup> and
phosphate (PO<sub>4</sub><sup>3<b>-</b></sup>): if one ion is added to a
solution of the other, most of it precipitates as calcium phosphate. <o:p></o:p></span><br />
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">In the
bone, the two ions combine with hydroxide (OH<b>-</b>) to form hydroxyapatite </span></span><span style="font-family: Tahoma, sans-serif; font-size: 12pt; line-height: 115%;">Ca<sub>10</sub>(PO4)<sub>6</sub>(OH)<sub>2</sub></span><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;"> a hard mineral forming hexagonal crystals. Up to 70% of the
weight of bone is due to hydroxyapatite. Dental enamel consists almost
exclusively of the mineral, accounting for its mechanical resistance. The
disadvantage to this solution is that hydroxyapatite is sensitive to acidity.
Low pH attacks enamel via the same mechanism that osteoclasts use to resorb
bone. Citric acid from an orange, or lactic acid produced by bacteria
metabolizing sugar in dental plaque make protons come into contact with the enamel
surface. A proton H+ pulls out the hydroxide ion OH<b>- </b>from Ca<sub>5</sub>(PO4)<sub>3</sub>(OH)
to form a H2O water molecule, with the rest disintegrating into 5 Ca<sup>2+</sup>
und 3 PO43<b>- </b>ions. The hydroxyapatite complex dissolves, ultimately
leading to caries. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Plasma Ca<sup>2+</sup>
concentration is physiologically maintained in a small window between 2.2 and
2.7 mM. This measured Ca<sup>2+</sup> is the sum of three forms: Ca<sup>2+</sup>
bound to plasma proteins (about 45%), Ca<sup>2+ </sup>complexed with small
organic anions (10%) and free ionized Ca2+ (about 45%). Hence, total Ca<sup>2+</sup>
depends on plasma protein concentration. The biologically relevant, regulated
parameter is free Ca<sup>2+</sup>. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Ca<sup>2+</sup>
balance is basically maintained by two hormones: parathyroid hormone (PTH) and
calcitriol (1,25-dihydroxyvitamin D). PTH regulates short-term plasma Ca<sup>2+</sup>
concentrations by dipping into bone reserves. Vitamin D strategically maintains
the total Ca<sup>2+</sup> pool of the body. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">A third Ca<sup>2+</sup>
regulating hormone, <b>calcitonin</b>, is of minor importance in humans. It is
secreted by parafollicular C cells in the thyroid gland and lowers plasma Ca<sup>2+</sup>
levels for a short time by directly inhibiting osteoclast activity, with the
system quickly swinging back to a neutral position. Neither a total loss of
calcitonin-producing cells (e. g., by thyroidectomy), nor massive
overproduction by rare tumors lastingly interfere with Ca<sup>2+</sup> balance.
Probably, calcitonin is a remnant from evolution. Animals such as salmon, which
switch from fresh water to calcium-rich sea water, seem to rely on calcitonin
to cope with massive differences in Ca<sup>2+</sup> intake. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<b><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Parathyroid
hormone <o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Parathyroid
hormone (PTH) is named for the four parathyroid glands producing it, tiny
epitheloid bodies located right behind the thyroid. An increase in the
concentration of free Ca2+ activates the <i>calcium-sensing receptor </i>(CaSR)
located at the membrane of their chief cells. The cells react by decreasing PTH
production. A second means to lower PTH secretion is a high concentration of
1,25 dihydroxyvitamin D. The message of Vitamin D seems to be: "Stop
cannibalizing our bones, I'll organize more Ca<sup>2+</sup> from outside in a
minute!" PTH is a small protein of 84 amino acids and has an extremely
short half-life of about four minutes. PTH increases Ca<sup>2+</sup> concentration
via two main mechanisms: by liberating it from bone and by influencing the
kidneys. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">PTH's
net effect in bone is an increase in resorption by activation of osteoclasts.
This is achieved via a detour, as osteoclasts do not express PTH receptors. PTH
is sensed by osteoblasts, which react by producing IL-1, IL-6 and other
cytokines to activate osteoclasts. In addition, PTH increases osteoblast
production of the two molecules that induce differentiation and proliferation
of more osteoclasts: M-CSF (macrophage colony-stimulating factor) and RANKL. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><b><span style="font-size: 12pt;">RANK-ligand
(RANKL) </span></b><span style="font-size: 12pt;">is a molecule from the TNF-superfamily. It acts as a trimer,
either on the surface of osteoblasts, or, "cut off", as a soluble
signaling molecule. In the bone marrow, M-CSF and RANKL encounter precursor
cells of the hematopoietic lineage leading to macrophages and neutrophil granulocytes.
These precursor cells express RANK (receptor-activator of NFκB), a
transmembrane protein of the TNF receptor superfamily. RANK functions as
receptor for RANKL. As precursor cell RANK is trimerized by osteoblast-emitted
RANKL, the precursor cells are activated to differentiate first to
mononucleated osteoclast precursors that subsequently fuse to mature
polynucleated osteoclasts. Osteoblasts secrete a further protein,
osteoprotegerin (OPG), that looks like a soluble receptor for RANKL. This is called
a decoy receptor; by neutralizing RANKL, it acts as its inhibitor. Thus, the
formation rate of osteoclasts depends on the relative amounts of RANKL and OPG
produced by osteoblasts. While PTH induces expression of M-CSF and RANKL, it
inhibits production of OPG, cranking up the generation of osteoclasts. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">If PTH
just mobilized Ca<sup>2+</sup>, not much would be gained: due to the low
solubility product with phosphate, it would soon reprecipitate. Therefore, PTH
simultaneously lowers phosphate levels by inhibiting renal reabsorption in both
the proximal and distal tubule. This is achieved by removing the Na/phosphate
cotransporter from the luminal membrane and parking it in vesicles below. Apart
from inducing phosphaturia, PTH increases reabsorption of Ca<sup>2+</sup> in
the distal tubule, further reducing the already minimal loss of Ca<sup>2+ </sup>in
the urine. The third renal function of PTH is to stimulate hydroxylation of
carbon atom 1 of vitamin D: this is the last and rate-limiting step in its
activation. From there, 1,25 dihydroxyvitamin D sets out to refill the Ca<sup>2+</sup>
pool. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<b><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Vitamin
D <o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Lipid-soluble
vitamin D3 can be taken up with animal foods, especially fatty fish species
(cod liver oil, mackerel, salmon), or can be produced in our own skin from
7-dehydrocholesterol. This requires sunlight to open the second ring of the
cholesterol backbone. This UV B-dependent synthesis is probably the cause of
Caucasians' pale complexion. Until the first wave of <i>homo sapiens </i>left
Africa about 60,000 years ago, all modern humans probably had dark skin. The
further north the people migrated, the less ultraviolet light they absorbed.
Those with lighter complexions obtained a selective advantage, as they were
better able to synthesize vitamin D. Ethnic groups using the sea as their primary
food source, like the Inuit, took up enough vitamin D3 with their food and were
thus able to retain a higher level of pigmentation than people living off the
land. The causal relationship between a lack of sunlight and rickets was only
recognized in the late 19th century. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Two
successive hydroxylation steps are required to metabolize D3 and D2, which
already contain one hydroxyl group, to their active form, calcitriol. The first
hydroxyl group is added at position 25, the end of the side chain, in the
liver. The second hydroxylation occurs in the kidney, at position 1 of the
first ring of the erstwhile cholesterol structure. This decisive, last
activation step is performed in the proximal tubule under tightly regulated conditions.
PTH stimulates hydroxylation, while the end product calcitriol as well as
increased levels of phosphate act inhibitory. 1,25-dihydroxyvitamin D
(calcitriol) equilibrates over the entire body and binds to the vitamin D
receptor (VDR), a member of the nuclear receptor superfamily. As a
ligand-dependent transcription factor, one of its functions is the induction of
genes that are necessary to maintain Ca<sup>2+</sup> reserves. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">The
central target organ in this respect is the duodenum. Here, calcitriol induces
several proteins that in concert enhance absorption of Ca<sup>2+</sup> from
food. While Ca<sup>2+</sup> concentrations in the lumen of the gut and in blood
are in the nanomolar range, they are much lower inside the cell; too much free Ca<sup>2+</sup>
in the cytosol would be dangerous. At the luminal side of the duodenal
epithelial cell, vitamin D induces a channel, allowing Ca<sup>2+</sup> to
trickle in passively. In the cytosol, the Ca<sup>2+</sup>-affine protein
calbindin is increased to neutralize passaging Ca<sup>2+</sup>. At the
basolateral membrane, an ATP-driven Ca<sup>2+</sup>-H<sup>+</sup>-antiporter as
well as a Na+-driven Ca<sup>2+</sup>-Na<sup>+</sup>-antiporter are induced to
pump Ca2+ into the blood against a steep concentration gradient. Calcitriol
also enhances phosphate absorption in the small intestine. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">In the
kidney, the action of vitamin D parallels that of PTH by increasing
reabsorption of Ca<sup>2+</sup> in the distal tubule, although its effect is
much weaker. Contrary to PTH, vitamin D also enhances reabsorption of
phosphate: both ions are required to promote bone mineralization. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: Trebuchet MS, sans-serif;">Together, these
effects of vitamin D raise Ca<sup>2+</sup> and phosphate concentrations above
their solubility product, inducing their precipitation in osteoid, an effect
that is enhanced by vitamin D-stimulated transcription of the osteocalcin gene
in osteoblasts. This predominant, indirect effect outweighs an opposite direct,
receptor-mediated activation of osteoblast and osteoclast precursors that
enhances bone turnover and Ca<sup>2+</sup> mobilization.<o:p></o:p></span></span></div>
<br />
<div class="Default">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div class="Default">
<span style="font-family: Trebuchet MS, sans-serif;">(Credit:
Arno Helmberg)</span><o:p></o:p></div>
</div>A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-25156798711299122062014-11-21T10:37:00.000+05:452014-11-23T10:14:03.761+05:45Bone Metabolism: Bone formation and bone resorption (Part 1)<div dir="ltr" style="text-align: left;" trbidi="on">
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<div class="Default" style="text-align: justify;">
<span style="font-family: 'Trebuchet MS', sans-serif;"><b>BONE
FORMATION AND BONE RESORPTION</b></span></div>
<div class="Default" style="text-align: justify;">
<br /></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgw1nllGvj_c5c0788u97ysbdUtJ03T3Wu6fXEgWBxDiVlvE-rPhfbLlY2lsRZTDgX284m_e_lwmU0fVieFvu8tscdfirT3T7ky1kygl-0VMJnHVenExt1n28cMia-nQc9Sy7pbz6iy6JO4/s1600/bone+cells.png" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgw1nllGvj_c5c0788u97ysbdUtJ03T3Wu6fXEgWBxDiVlvE-rPhfbLlY2lsRZTDgX284m_e_lwmU0fVieFvu8tscdfirT3T7ky1kygl-0VMJnHVenExt1n28cMia-nQc9Sy7pbz6iy6JO4/s1600/bone+cells.png" height="150" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. Bone Cells</td></tr>
</tbody></table>
<div class="Default" style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Living
bone is constantly being remodeled. The state of our bones is always close to
an equilibrium between bone formation and bone resorption. In childhood and
during the teens, bone formation is slightly ahead. We reach peak bone mass in
the twenties, and from then onwards, resorption has the upper hand. There are
two reasons for the </span><br />
<a name='more'></a><span style="font-family: Trebuchet MS, sans-serif;">constant remodeling process. Firstly, it allows our bones
to adapt to changes in load. For example, consider how easily skilled
orthodontists maneuver teeth in the jaw bone by applying modest targeted
strain. Secondly, continuous remodeling is necessary to repair the damage
caused by recurrent microtraumas. At a typical remodeling site, termed basic
multicellular unit, specialized osteoclasts first remove bone over a period of
approximately three weeks. The resulting resorption lacuna is subsequently
filled by osteoblasts, a process lasting about three months. Bone tissue is
found in two forms: <i>substantia compacta </i>and <i>substantia spongiosa. </i>As
much weight is saved as possible: only the outer contour, the cortical compact
bone, is massive. The inner part is made up of trabecular, or cancellous bone,
a three-dimensional scaffold of pillars and beams that is constantly modified
to accommodate load. Prominent examples of cancellous bone are found in
vertebral bodies or at the ends of long bones. <o:p></o:p></span></div>
<div class="Default" style="text-align: justify;">
<br /></div>
<div class="Default" style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">The
fundamental unit of compact bone is the osteon or Havers system. A central
vascular canal is surrounded by massive concentric lamellae of mineralized
fibers. In consecutive lamellae, matrix fibers are arranged in spirals with
alternating sense of rotation, contributing to mechanical strength. Encased
bone cells, osteocytes, are interspersed between lamellae. <o:p></o:p></span></div>
<div class="Default" style="text-align: justify;">
<br /></div>
<div class="Default" style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">In
essence, bone metabolism is due to only two types of cells: osteoblasts and osteoclasts.
Osteocytes are simply osteoblasts that have encased themselves in bone.
Individual osteocytes remain connected by long cellular processes, forming a
network connected by gap junctions. Osteocytes are able to sense mechanical
strain, which they report to the bone construction units via this network. <o:p></o:p></span></div>
<div class="Default" style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div class="Default" style="page-break-before: always; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><b>Osteoblasts </b>differentiate from stromal marrow
cells. They produce the organic part of the bone matrix, an array of proteins
collectively termed osteoid. In the following, a look at three out of a much larger
number of these proteins:<o:p></o:p></span></div>
<div class="Default" style="margin-left: .25in; text-align: justify;">
<br /></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtXZiOX7ZFt8qyNBOrqEd2m6qTc-DUHRQvTCYEM9ddbgoVEL_qgHJoIYRJbwqnDuC4sezMF8wOJIPtswaiQQW6xBBe5z8ZfEfKh5NoIK0Vj5G_liEKencj7dDPns-oojNk2PYWHm_MvJ5w/s1600/cartilage.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;" title=""><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtXZiOX7ZFt8qyNBOrqEd2m6qTc-DUHRQvTCYEM9ddbgoVEL_qgHJoIYRJbwqnDuC4sezMF8wOJIPtswaiQQW6xBBe5z8ZfEfKh5NoIK0Vj5G_liEKencj7dDPns-oojNk2PYWHm_MvJ5w/s1600/cartilage.jpg" height="400" title="" width="345" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fig. Composition of Aricular cartilage </td></tr>
</tbody></table>
<div class="Default" style="margin-left: .25in; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Trebuchet MS, sans-serif;">1.<span style="font-size: 7pt;"> </span><b>Collagen type I </b>represents the bulk
of osteoid. It consists of triple helix units containing two α1-chains and one
α2 chain, which already form in the endoplasmic reticulum of the osteoblast
after the individual chains have been posttranslationally hydroxylated on
lysines and prolines. This procollagen unit is secreted, followed by
proteolytic removal of C- and N-terminal peptides. The resulting collagen
monomers spontaneously aggregate in a staggered fashion, forming long fibrils
that are subsequently covalently cross linked via their hydroxylated lysines. A
cofactor required for lysine and proline hydroxylation is vitamin C. Lack of
vitamin C results in scurvy, characterized by collagen that is instable due to
insufficient cross linking. <o:p></o:p></span></div>
<div class="Default" style="margin-left: .25in; text-align: justify;">
<br /></div>
<div class="Default" style="margin-left: .25in; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Trebuchet MS, sans-serif;">2.<span style="font-size: 7pt;"> </span><!--[endif]--><b>Osteocalcin</b> is a small protein that
is carboxylated on glutamic acid residues with the help of vitamin K. As
glutamate already contains one COO <b>-</b>-group, carboxylation of the
γ-C-Atom creates a second one right next to the first. The two adjacent
negative charges are ideal docking sites for double positive </span><span style="font-family: 'Trebuchet MS', sans-serif; text-indent: 0px;">Ca</span><sup style="font-family: 'Trebuchet MS', sans-serif; text-indent: 0px;">2+</sup><span style="font-family: Trebuchet MS, sans-serif;"> ions. </span><span style="font-family: 'Trebuchet MS', sans-serif; text-indent: 0px;">Ca</span><sup style="font-family: 'Trebuchet MS', sans-serif; text-indent: 0px;">2+</sup><span style="font-family: Trebuchet MS, sans-serif;"> is
thus locally concentrated in the bone and, with the help of integrin-binding
sialoprotein, nucleates crystals with phosphate ions to form hydroxyapatite Ca5(PO4)3(OH).
The process makes sure that Ca2+ and phosphate precipitate in the bone and not
in other tissues of the body. Vitamin K is also necessary to carboxylate
clotting factors II, VII, IX, X, providing them with functionally essential </span><span style="font-family: 'Trebuchet MS', sans-serif; text-indent: 0px;">Ca</span><sup style="font-family: 'Trebuchet MS', sans-serif; text-indent: 0px;">2+</sup><span style="font-family: Trebuchet MS, sans-serif;"> binding sites. Therefore, deficiency of vitamin K results in bleeding disorder
long before effects on bone might cause problems. A second vitamin is important
for osteocalcin: the transcription of its gene is induced by activated vitamin
D receptor. Osteocalcin itself has a second function, too. A proportion of
non-carboxylated osteocalcin enters the blood stream and functions as a
metabolic hormone enhancing insulin activity. It stimulates proliferation of
pancreatic β-cells, and sensitizes fat cells to insulin by stimulating them to
secrete adiponectin. Via this mechanism, bone metabolism influences energy
metabolism. <o:p></o:p></span></div>
<div class="Default" style="margin-left: .25in; text-align: justify;">
<br /></div>
<div class="Default" style="margin-left: .25in; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Trebuchet MS, sans-serif;">3.<span style="font-size: 7pt;"> </span><b>Osteonectin</b> is an osteoid component
that makes contact to collagen type I as well as to hydroxyapatite, forming a
link between organic and inorganic bone matrix. <o:p></o:p></span></div>
<div class="Default" style="text-align: justify;">
<br /></div>
<div class="Default" style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">In
addition, osteoblasts engage in targeted export of Ca<sup>2+</sup> and
phosphate, inducing local super saturation conditions to mineralize the freshly
produced osteoid. For this process, alkaline phosphatase tethered to the
outside of the osteoblast plasma membrane seems to be important, though the
enzyme's role remains insufficiently understood. It may increase extracellular
phosphate concentration by dephosphorylating organic molecules or cleaving
pyrophosphate.<o:p></o:p></span></div>
<div class="Default" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><b><span style="font-size: 12pt;">Osteoclasts </span></b><span style="font-size: 12pt;">are
giant, multinucleated cells that derive from hematopoietic stem cells in the
bone marrow, branching from the lineage leading to macrophages and neutrophils.
A series of cytokines induces precursor cells to differentiate to osteoclasts.
The basic mix combines M-CSF (macrophage colony stimulating factor) with RANKL
(explained in the following section on parathyroid hormone), two cytokines
produced by osteoblasts. In addition, mediators produced by macrophages and
other cells during inflammatory responses enhance osteoclast differentiation:
IL-1, IL-6 , TNFα and prostaglandin E. Osteoclasts break down bone tissue much
like macrophages break down phagocytosed material; only the process is shifted
to the extracellular space. Employing normal lysosomal chemistry, it involves
acidification and activation of acid hydrolases. Osteoclasts seal off a certain
matrix area, which they acidify with the help of a proton pump. To maintain
intracellular pH, they release HCO3- at their back side. Hydroxyapatite
dissolves in the acidic environment, setting free </span></span><span style="font-family: 'Trebuchet MS', sans-serif;">Ca</span><sup style="font-family: 'Trebuchet MS', sans-serif;">2+</sup><span style="font-family: Trebuchet MS, sans-serif;"><span style="font-size: 12pt;"> Thus, on the scale of
the entire body, an orchestrated activation of osteoclasts is a means to
increase extracellular </span></span><span style="font-family: 'Trebuchet MS', sans-serif;">Ca</span><sup style="font-family: 'Trebuchet MS', sans-serif;">2+</sup><span style="font-family: Trebuchet MS, sans-serif;"><span style="font-size: 12pt;"> concentration. After the mineral has melted away,
acid proteases like Cathepsin K hydrolyze the remaining matrix proteins. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<br />
<div class="Default" style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Growth
of long bones is not possible in bone tissue itself, but happens in epiphyseal
cartilage. Driven by growth hormone and other hormones (see below),
chondrocytes proliferate and increase their production of cartilage. At the
border zone, the cartilaginous tissue is first simply mineralized (enchondral
ossification), but soon remodeled to osteon structure by immigrating
osteoclasts and osteoblasts. A second ossification mechanism, intramembranous
ossification, is the direct transformation of fibrous mesenchymal tissue to
bone. This type of ossification is found in the development of large parts of
the skull, as well as in healing of bone fractures.</span><span style="font-family: Tahoma, sans-serif;"><o:p></o:p></span></div>
<div class="Default" style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div class="Default" style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">(Credit: Arno Helmberg)</span></div>
</div>
</div>
A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-59891320442331078802014-10-17T15:11:00.000+05:452015-01-25T14:13:36.967+05:45Chemotherapy and it's side effects<script type="text/javascript"><!--
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<b style="background-color: white; font-family: 'Trebuchet MS', sans-serif; line-height: 18.75pt; text-align: justify;"><span style="font-size: 12pt;">Chemotherapy side effects</span></b><br />
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAc4zYhVZrorPj30Peyhyphenhyphenb3mg9QkvT6XyFwRAjEzQ65-PiBTII2ZhV2o_b6iORqDsgEaIHgdv0UZX2duN5SHo5dM8c5-Zpp6yYZ9xmytd-Awlppymzwu1MmEIsPMiThDfZ-PtFxc7YGi1N/s1600/chemotherapy+treatment.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;" title=""><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAc4zYhVZrorPj30Peyhyphenhyphenb3mg9QkvT6XyFwRAjEzQ65-PiBTII2ZhV2o_b6iORqDsgEaIHgdv0UZX2duN5SHo5dM8c5-Zpp6yYZ9xmytd-Awlppymzwu1MmEIsPMiThDfZ-PtFxc7YGi1N/s1600/chemotherapy+treatment.jpg" height="213" title="" width="320" /></a><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Chemotherapy drugs kill cancer cells, but they can also damage healthy
cells. This damage to healthy cells causes side effects. Different cells and
tissues in the body tolerate chemotherapy differently. Chemotherapy drugs have
the greatest effect on rapidly dividing cells, such as blood cells in the bone
marrow, cells lining the mouth and gastrointestinal (GI) tract and hair
follicle cells.<o:p></o:p></span></span></div>
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<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 19.5pt; margin-bottom: 7.5pt; text-align: justify; vertical-align: baseline;">
<span style="font-family: Trebuchet MS, sans-serif;"><b><span style="font-size: 12pt;">What causes side effects?</span></b><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-bottom: 11.25pt; text-align: justify; vertical-align: baseline;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Cancer cells tend to grow fast, and chemo drugs kill fast-growing
cells. But because these </span></span></div>
<a name='more'></a><span style="font-family: Trebuchet MS, sans-serif;">drugs travel throughout the body, they can affect
normal, healthy cells that are fast-growing, too. Damage to healthy cells
causes side effects. Side effects are not always as bad as you might expect,
but many people worry about this part of cancer treatment.<o:p></o:p></span><br />
<div class="MsoNormal" style="line-height: 15.0pt; margin-bottom: 11.25pt; text-align: justify; vertical-align: baseline;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">The normal cells most likely to be damaged by chemo are blood-forming
cells in the bone marrow; hair follicles; and cells in the mouth, digestive
tract, and reproductive system. Some chemo drugs can damage cells in the heart,
kidneys, bladder, lungs, and nervous system. In some cases, medicines can be
given with the chemo to help protect the body’s normal cells.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 19.5pt; margin-bottom: 7.5pt; text-align: justify; vertical-align: baseline;">
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<span style="font-family: Trebuchet MS, sans-serif;"><b><span style="font-size: 12pt;">What should I know about side effects?</span></b><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<br />
<ul type="disc">
<li class="MsoNormal" style="text-align: justify;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Every person
doesn’t get every side effect, and some people get few, if any.</span></span></li>
</ul>
<ul type="disc">
<li class="MsoNormal" style="text-align: justify;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">The severity of
side effects (how “bad” they are) varies greatly from person to person. Be
sure to talk to your doctor and nurse about which side effects are most
common with your chemo, how long they might last, how bad they might be,
and when you should call the doctor’s office about them.</span></span></li>
</ul>
<ul type="disc">
<li class="MsoNormal" style="text-align: justify;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Your doctor may
give you medicines to help prevent some side effects before they happen.</span></span></li>
</ul>
<ul type="disc">
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: Trebuchet MS, sans-serif;"><span style="font-size: 12pt;">Some types of
chemo cause long-term side effects, like heart or </span><span style="border: 1pt none windowtext; color: windowtext; font-size: 12pt; padding: 0in;">nerve damage</span><span style="font-size: 12pt;"> or fertility problems.
Still, many people have no long-term problems from chemo. Ask your doctor
about the long-term risks of the chemo drugs you’re getting.<o:p></o:p></span></span></li>
</ul>
<span style="font-size: 12pt;"></span><br />
<div style="text-align: justify;">
<span style="font-size: 12pt;"><span style="font-family: 'Trebuchet MS', sans-serif; font-size: 12pt;">While side effects can be unpleasant, they must
be weighed against the need to kill the cancer cells.</span></span></div>
<span style="font-size: 12pt;">
</span>
<br />
<div class="MsoNormal" style="margin-bottom: 13.5pt; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><b><span style="font-size: 12pt;"><br /></span></b></span></div>
<div class="MsoNormal" style="margin-bottom: 13.5pt; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><b><span style="font-size: 12pt;">How long
do side effects last?</span></b><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-bottom: 11.25pt; text-align: justify; vertical-align: baseline;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Most side effects slowly go away after treatment ends because the
healthy cells recover over time. The time it takes to get over some side
effects and regain energy varies from person to person. It depends on many
factors, including your overall health and the drugs you were given.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7Ajnqg5wnngT-cE8IhoW53z87jLo04arVvm8YZ-6svdqHvy2bnri3ReVLxH8hypySwqB3R6IpsbXn1pqiqD8FMoXEQfpNNMVLgTeDrRA-YhyWLLU_tI1sutuCP8N6jf5N-XLxKPtgCK_Y/s1600/chemotheray+drugs.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7Ajnqg5wnngT-cE8IhoW53z87jLo04arVvm8YZ-6svdqHvy2bnri3ReVLxH8hypySwqB3R6IpsbXn1pqiqD8FMoXEQfpNNMVLgTeDrRA-YhyWLLU_tI1sutuCP8N6jf5N-XLxKPtgCK_Y/s1600/chemotheray+drugs.jpg" /></a><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Many side effects go away
fairly quickly, but some may take months or even years to completely go away.
Sometimes the side effects can last a lifetime, such as when chemo causes
long-term damage to the heart, lungs, kidneys, or reproductive organs. Certain
types of chemo sometimes cause delayed effects, such as a <span style="border: none windowtext 1.0pt; mso-border-alt: none windowtext 0in; padding: 0in;">second cancer</span> that may show up many years later.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<br /></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-bottom: 11.25pt; text-align: justify; vertical-align: baseline;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">People often become discouraged about how long their treatment
lasts or the side effects they have. If you feel this way, talk to your doctor.
You may be able to change your medicine or treatment schedule. Your doctor or
nurse also may be able to suggest ways to reduce any pain and discomfort you
have.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 19.5pt; margin-bottom: 7.5pt; text-align: justify; vertical-align: baseline;">
<span style="font-family: Trebuchet MS, sans-serif;"><b><span style="font-size: 12pt;">What are common side effects?</span></b><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-bottom: 11.25pt; text-align: justify; vertical-align: baseline;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Most people worry about whether they will have side effects from
chemo, and, if so, what they’ll be like. Here’s a review of some of the more
common side effects caused by chemotherapy. We also share some tips on how you
can manage them.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Side effects can happen any time during, immediately after, or a
few days or weeks after chemotherapy. Most side effects go away when
chemotherapy is over. However, some side effects may continue after treatment
is over because it takes time for healthy cells to recover from the effects of
chemotherapy drugs. Late side effects can occur months or years after
treatment. Some side effects may last a long time or be permanent. It is
important to report side effects to the healthcare team. Doctors may also grade
(measure) how severe certain side effects are. Sometimes chemotherapy
treatments need to be adjusted if side effects are severe.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 13.5pt; text-align: justify;">
<span style="font-family: 'Trebuchet MS', sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: 13.5pt; text-align: justify;">
<span style="font-family: 'Trebuchet MS', sans-serif; font-size: 12pt;">The
following are the most common side effects that people tend to experience with
chemotherapy. Some people may experience all, some or none of these side
effects. Others may experience different side effects.</span></div>
<div class="MsoNormal" style="margin-bottom: 13.5pt; text-align: justify;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">
<!--[if !supportLineBreakNewLine]-->
<!--[endif]--><o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">1. Bone marrow
suppression<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">2. Sore mouth<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">3. Inflamed mucous
membranes<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">4. Nausea and vomiting<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">5. Loss of appetite<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">6. Changes in taste and
smell<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">7. Diarrhea<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">8. Dehydration<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">9. Constipation<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">10. Fatigue<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">11. Flu-like symptoms<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">12. Hair loss<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">13. Skin changes<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">14. Eye changes<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">15. Pain<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">16. Cystitis<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">17. Bedwetting<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">18. Weight gain<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">19. Pain at the injection site<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">20. Inflamed vein<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">21. Allergic reactions<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">22. Fluid retention<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">23. Organ damage<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">24. Second cancers<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Side effects can occur with any type of treatment, but not
everyone has them or experiences them in the same way. Side effects of
chemotherapy will depend mainly on:<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.75in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Trebuchet MS, sans-serif;"><span style="font-size: 10pt;">·<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 12pt;">the type of drug<o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span style="font-family: Trebuchet MS, sans-serif;"><span style="font-size: 10pt;">·<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 12pt;">the dose<o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span style="font-family: Trebuchet MS, sans-serif;"><span style="font-size: 10pt;">·<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 12pt;">how the drug is given<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.75in; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Trebuchet MS, sans-serif;"><span style="font-size: 10pt;">·<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 12pt;">the person’s overall health<o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">
Reference:<o:p></o:p></span></span></div>
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<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">1. <a href="http://www.cancer.org/"><span style="color: blue;">http://www.cancer.org</span></a><o:p></o:p></span></span></div>
<div class="MsoNormal" style="background: white; line-height: 18.75pt; margin-bottom: 7.5pt; margin-left: 0in; margin-right: 0in; margin-top: 7.5pt; mso-outline-level: 1; text-align: justify; vertical-align: baseline;">
</div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: -0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">2. <a href="http://www.cancer.ca/"><span style="color: blue;">http://www.cancer.ca</span></a></span><span style="font-family: Verdana, sans-serif;"><o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in;">
<o:p></o:p></div>
</div>A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-30572215592125627312014-10-17T08:56:00.001+05:452014-10-17T08:56:16.749+05:45Experiences from Ebola Outbreak zone<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLU1W-eSIZ6UuybTSsNVee2hFxpXxwG_h6Stm58CTXqLR3Z0naLd2Lvv92Zap9GsH-LuzH96T99T8_rFgE7aqEWpHMT5-aDlqmhfNybPhH_5-xp3678bTgyVgpjrqr-mSBT8IXdcexK8Fp/s1600/Ebola.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;" title=""><br /><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLU1W-eSIZ6UuybTSsNVee2hFxpXxwG_h6Stm58CTXqLR3Z0naLd2Lvv92Zap9GsH-LuzH96T99T8_rFgE7aqEWpHMT5-aDlqmhfNybPhH_5-xp3678bTgyVgpjrqr-mSBT8IXdcexK8Fp/s1600/Ebola.JPG" height="167" title="" width="320" /></a></div>
<div class="MsoNormal" style="margin: 0.75pt 0in 3.75pt; text-align: justify;">
<b><span style="color: #333333; font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Interview with
Photojournalist Neil Brandvold<o:p></o:p></span></span></b></div>
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<br /></div>
<div class="MsoNormal" style="margin: 0.75pt 0in 3.75pt; text-align: justify;">
<b><span style="color: #333333; font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Q&A: What It’s
Like to Cover Ebola<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="margin-bottom: 6pt; text-align: justify;">
<i><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">After returning from West Africa, photojournalist Neil Brandvold
is isolating himself as a precaution.<o:p></o:p></span></span></i></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.25in; text-align: justify;">
<b><span style="color: #333333; font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Photojournalist Neil
Brandvold recently shot video of patients and caregivers in Liberia and Sierra
Leone, at the epicenter of the <span style="color: #044e8e; text-decoration: none; text-underline: none;">Ebola outbreak</span> that
has killed more than 4,400 people in recent months.<o:p></o:p></span></span></b></div>
<div style="background: white; margin-bottom: .25in; margin-left: 0in; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="color: #333333;"><span style="font-family: Trebuchet MS, sans-serif;"></span></span></div>
<a name='more'></a><span style="font-family: Trebuchet MS, sans-serif;">Now home in Washington, D.C., Brandvold is spending 21 days in
self-imposed isolation—the maximum incubation period for Ebola—and seeing as
few people as possible, on the off chance that he might be incubating the virus
himself. Mostly, he said, he's doing it because other people are afraid to be
around him. <o:p></o:p></span><br />
<div style="background: white; margin-bottom: .25in; margin-left: 0in; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="color: #333333;"><span style="font-family: Trebuchet MS, sans-serif;">While in West Africa, he ate his own packaged granola bars, beef
jerky, and ramen so he wouldn't have to eat locally prepared foods. When it was
time to head home, he left behind the clothes he had worn to the Ebola clinics.
Now—and until his quarantine period ends around October 26—he is checking his
temperature at least twice a day, because the first sign of Ebola is usually a
fever. <o:p></o:p></span></span></div>
<div style="background: white; margin-bottom: .25in; margin-left: 0in; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333;">Q: How have you adjusted to your return?</span></strong><span style="color: #333333;"><o:p></o:p></span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333;">A:</span></strong><span class="apple-converted-space"><b><span style="color: #333333;"> </span></b></span><span style="color: #333333;">It's been a strange culture shock. I still feel the compulsive
need to wash my hands over and over all day long. For the whole time I was over
there, you don't touch anyone or anything, and that was very strange to go
weeks without any physical interaction with anyone. I still feel conscious of
anything I touch or do.<o:p></o:p></span></span></div>
<div style="background-color: white; margin: 0in 0in 0.25in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333;">Q: Do you have any
reason to think you might have caught the virus?</span></strong><span style="color: #333333;"><o:p></o:p></span></span></div>
<div style="background-color: white; margin: 0in 0in 0.25in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333;">A:</span></strong><span class="apple-converted-space"><span style="color: #333333;"> </span></span><span style="color: #333333;">I took all the necessary precautions: wore gloves, rubber boots.
Sprayed everything with chlorine about a million times a day.<o:p></o:p></span></span></div>
<div style="background-color: white; margin: 0in 0in 0.25in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333;">Q: But you're still a
little nervous, particularly after another videographer, Ashoka Mukpo,
contracted the virus?</span></strong><span style="color: #333333;"><o:p></o:p></span></span></div>
<div style="background-color: white; margin: 0in 0in 0.25in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333;">A:</span></strong><span class="apple-converted-space"><b><span style="color: #333333;"> </span></b></span><span style="color: #333333;">There are always flukes. If you got close when they disinfected
a car or body and they sprayed up, you could get some Ebola from the spray. You
can never be 100 percent safe, especially in situations like that. <o:p></o:p></span></span></div>
<div style="background: white; margin-bottom: .25in; margin-left: 0in; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333;">Q: And you won't know for certain that you're safe until the
21-day incubation period ends?</span></strong><span style="color: #333333;"><o:p></o:p></span></span></div>
<div style="background-color: white; margin: 0in 0in 0.25in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333;">A:</span></strong><span class="apple-converted-space"><b><span style="color: #333333;"> </span></b></span><span style="color: #333333;">I'm here counting my days. It's been [11] days.<o:p></o:p></span></span></div>
<div style="background-color: white; margin: 0in 0in 0.25in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333;">Q: Are other people
scared of you, even though you're unlikely to have Ebola and people with Ebola
aren't contagious unless they have symptoms?</span></strong><span style="color: #333333;"><o:p></o:p></span></span></div>
<div style="background-color: white; margin: 0in 0in 0.25in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333;">A:</span></strong><span class="apple-converted-space"><span style="color: #333333;"> </span></span><span style="color: #333333;">People are overly scared. I think it's lack of education of how
it's spread. It's happening in Africa, too. The medical workers—their families
have disowned them, kicked them out of the house. They've been evicted from
multiple landlords. I met this group of nurses and they were all living on two
beds in an Ebola clinic because no one would let them rent a place.<o:p></o:p></span></span></div>
<div style="background-color: white; margin: 0in 0in 0.25in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333;">Q: They lived in the
clinic?</span></strong><span style="color: #333333;"><o:p></o:p></span></span></div>
<div style="background-color: white; margin: 0in 0in 0.25in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333;">A:</span></strong><span class="apple-converted-space"><span style="color: #333333;"> </span></span><span style="color: #333333;">It was really sad to see these<span class="apple-converted-space"> </span>people
who are on the front line risking their lives, and they've been shunned by
everyone. The ones I met, they haven't been paid in two weeks. They didn't have
food. When we came in, they were basically begging for food. It's super
dangerous for them. It's really hard and hot work for them in these suits that
are heavy, suffocating. To be doing that kind of work without any food, without
any pay, and without a place to stay at the end of the day, it's just
incredible that people would sacrifice like that.<o:p></o:p></span></span></div>
<div style="background-color: white; margin: 0in 0in 0.25in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333;">Q: Why do they stay on
the job?</span></strong><span style="color: #333333;"><o:p></o:p></span></span></div>
<div style="background-color: white; margin: 0in 0in 0.25in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333;">A:</span></strong><span class="apple-converted-space"><b><span style="color: #333333;"> </span></b></span><span style="color: #333333;">[In] the most poignant interview I might have shot the whole
trip, a nurse said that it was a war and she feels like she's on the front line
of this war. She's lost so many people [in her family to Ebola], she wants to
do whatever she can do to win the battle.<o:p></o:p></span></span></div>
<div style="background-color: white; margin: 0in 0in 0.25in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333;">Q: You also followed
people who help to safely remove the bodies of those who have died—from Ebola
or other causes.</span></strong><span style="color: #333333;"><o:p></o:p></span></span></div>
<div style="background-color: white; margin: 0in 0in 0.25in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333;">A:</span></strong><span class="apple-converted-space"><span style="color: #333333;"> </span></span><span style="color: #333333;">In three hours, they collected 20 bodies. They said they
collected over 100 in the previous two days. These aren't trained
professionals. These are people who've volunteered and said they want to help
out.<o:p></o:p></span></span></div>
<div style="background-color: white; margin: 0in 0in 0.25in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333;">Q: Did you see any
hopeful signs? Any sense that things might be getting better?</span></strong><span style="color: #333333;"><o:p></o:p></span></span></div>
<div style="background-color: white; margin: 0in 0in 0.25in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333;">A:</span></strong><span class="apple-converted-space"><span style="color: #333333;"> </span></span><span style="color: #333333;">Toward the end, it seems like they had gotten a better handle on
things. There weren't the huge lines of people trying to get into clinics.
Either people were afraid and dying at home, or the clinics had enough beds
that they were able to let people in.<o:p></o:p></span></span></div>
<div style="background-color: white; margin: 0in 0in 0.25in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333;">Q: Did the conditions at
the hospitals surprise you?</span></strong><span style="color: #333333;"><o:p></o:p></span></span></div>
<div style="background-color: white; margin: 0in 0in 0.25in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333;">A:</span></strong><span class="apple-converted-space"><span style="color: #333333;"> </span></span><span style="color: #333333;">They're glorified tents or abandoned wards from old hospitals.
You wouldn't want to get treated for a cold in there. [At a center in Monrovia,
Liberia] they had 35 beds and 75 patients. Most were on mattresses on the
ground in incredible humidity and heat. The sanitation levels are rough. One of
the last days we were there, the clinic completely ran out of chlorine, which
is the front-line defense for everyone. There's no way to interact [safely]
with patients if you can't wash all your gear multiple times with chlorine.<o:p></o:p></span></span></div>
<div style="background-color: white; margin: 0in 0in 0.25in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333;">Q: Most people would do
whatever they could to avoid West Africa, but you willingly headed there. Why?</span></strong><span style="color: #333333;"><o:p></o:p></span></span></div>
<div style="background-color: white; margin: 0in 0in 0.25in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333;">A:</span></strong><span class="apple-converted-space"><span style="color: #333333;"> </span></span><span style="color: #333333;">For me, it's just always been an interest in what's happening
and storytelling. I covered the Arab Spring and the coup in Honduras. I think
it's important to tell people's stories and let [other] people be aware of
what's happening. To be able to go over and tell that, it seems like the most
important thing I could be doing with my life right now.<o:p></o:p></span></span></div>
<div style="background-color: white; margin: 0in 0in 0.25in; text-align: justify;">
<em><span style="color: #333333;"><span style="font-family: Trebuchet MS, sans-serif;">This interview has been
edited and condensed.<o:p></o:p></span></span></em></div>
<div style="background: white; margin-bottom: .25in; margin-left: 0in; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><em><span style="color: #333333;">(Source: </span></em><span style="color: #333333;">Author: Karen Weintraub ;<em>
http://news.nationalgeographic.com)</em></span></span></div>
</div>
</div>
A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-80521289493278121212014-10-12T15:48:00.002+05:452014-10-12T15:48:22.397+05:45Twitter, Facebook and Zinch may help you to find out Scholarships<div dir="ltr" style="text-align: left;" trbidi="on">
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<div class="MsoNormal" style="line-height: 15pt; margin-bottom: 7.5pt; text-align: justify; vertical-align: baseline;">
<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Going to college can be expensive,
especially after the four or five years it takes you to finish your
undergraduate degree. The average American student graduates from college owing
$20,000 in debt. However, there are ways to make your college experience less
of a financial burden, and applying for scholarships is a fantastic way to do
so. Not only will you receive financial rewards, but winning a scholarship can
also help you gain stable employment after graduation or help you out if you're
looking to apply for grad school. One great way to find scholarships is over
various social media sites, including Twitter and </span></span></div>
<a name='more'></a><span style="font-family: Trebuchet MS, sans-serif;">Facebook. Many students
disregard this method, but if you consider these five pointers you may land
yourself a great scholarship!<o:p></o:p></span><br />
<h3 style="text-align: left;">
<span style="font-size: 12pt; line-height: 15pt;"><span style="font-family: Trebuchet MS, sans-serif;">Search Key Phrases and Hashtags on
Twitter</span></span></h3>
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<span style="font-size: 12pt; line-height: 15pt;"><span style="font-family: Trebuchet MS, sans-serif;">First off, create a Twitter account.
Being technically savvy and being active in a range of social media sites will
only benefit you. Once you've joined Twitter and you're familiar with how the
site works, search key phrases and hashtags that will help you pin down a
scholarship. For example, follow the #scholarship hashtag. Doing this will
connect you with people you want to know and with people who will help you.
People on Twitter using this #scholarship hashtag may be teachers, colleges,
professors or even scholarship providers. Searching key terms, such as
"financial aid," "merit based scholarships" or
"federal aid" will also provide you make connections.</span></span></div>
<h3 style="text-align: left;">
<span style="font-size: 12pt; text-align: left;"><span style="font-family: Trebuchet MS, sans-serif;">Follow Like Minded People On Twitter</span></span></h3>
<div class="MsoNormal" style="line-height: 15pt; margin-bottom: 7.5pt; text-align: justify; vertical-align: baseline;">
<span style="font-size: 12pt; line-height: 15pt;"><span style="font-family: Trebuchet MS, sans-serif;">Becoming a follower of people on
Twitter who have similar goals as you can also be beneficial. If you know of a
student who is following a particular college or scholarship provider, you
should then follow this student. Also, you can see who this student is
following on Twitter and see if any of those Tweets would help you further. Widening
your social circle on Twitter will provide you with valuable information and
fantastic contacts.</span></span></div>
<h3 style="text-align: left;">
<span style="font-size: 12pt; line-height: 15pt;"><span style="font-family: Trebuchet MS, sans-serif;">Create a Zinch Profile</span></span></h3>
<div class="MsoNormal" style="line-height: 15pt; margin-bottom: 7.5pt; text-align: justify; vertical-align: baseline;">
<span style="font-size: 12pt; line-height: 15pt;"><span style="font-family: Trebuchet MS, sans-serif;">Zinch is a college-based admissions
portal that helps students with their applications. However, Zinch is also
known for helping students find scholarship opportunities. It is a great idea
to create a Zinch profile. Not only will this refine your college application,
but it will also be another outlet for scholarship information. Zinch is also
on Facebook and Twitter!</span></span></div>
<h3 style="text-align: left;">
<span style="font-size: 12pt; line-height: 15pt;"><span style="font-family: Trebuchet MS, sans-serif;">Make "Friends" With Different
Scholarship Providers on Facebook</span></span></h3>
<div class="MsoNormal" style="line-height: 15pt; margin-bottom: 7.5pt; text-align: justify; vertical-align: baseline;">
<span style="font-size: 12pt; line-height: 15pt;"><span style="font-family: Trebuchet MS, sans-serif;">Nowadays, colleges, scholarship
providers and professors are all on Facebook. Become their "friend"
on Facebook or "like" their page if they're an organization or
institution. For example, Find Scholarships, ScholarshipsCanada and
Scholarships.com all have a Facebook page. Use this social media site to your
advantage!</span></span></div>
<h3 style="text-align: left;">
<span style="font-size: 12pt; line-height: 15pt;"><span style="font-family: Trebuchet MS, sans-serif;">Connect with People You Know Who Could
Help You</span></span></h3>
<div class="MsoNormal" style="line-height: 15pt; margin-bottom: 7.5pt; text-align: justify; vertical-align: baseline;">
<span style="font-size: 12pt; line-height: 15pt;"><span style="font-family: Trebuchet MS, sans-serif;">While Twitter helps you connect with
people you want to know, Facebook is a great social media site to connect you
with people who you already know. Take advantage of that! Get in contact via
Facebook with your friend who has applied for scholarships before. Ask a family
member or relative about any connections they might have. Ask your teacher
questions. Facebook draws you closer to people you know who can help you out!
Many students think to turn to college websites and scholarship provider
websites to find out about different scholarships and to apply for them. In
reality, only looking here will really limit what you find and reduce your
chance of achieving a scholarship! Get actively involved with Twitter and
Facebook, and use them to your advantage. Connect with people you already know,
strengthen connections you may have lost and connect with people you want to
know. If you're a strong scholarship candidate, be sure that you don't give up
until you've looked at all the sources, or until you've achieved what you are
looking for!</span></span></div>
<div class="MsoNormal" style="margin-bottom: 7.5pt; text-align: justify; vertical-align: baseline;">
<span style="font-family: Trebuchet MS, sans-serif;"><span style="font-size: 12pt; line-height: 15pt;">(Source: </span><span style="line-height: 20px; text-align: left;">www.course-notes.org)</span></span></div>
</div>
</div>A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-3779794652944287972014-10-07T10:00:00.000+05:452014-10-07T10:03:01.182+05:45The Nobel Prize winners in Physiology or Medicine 2014<div dir="ltr" style="text-align: left;" trbidi="on">
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<div class="MsoNormal" style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 3.95pt 0in 4.8pt; text-align: justify;">
<b><span style="font-family: Trebuchet MS, sans-serif;">The
Nobel Prize in Physiology or Medicine 2014</span><span style="font-family: Times New Roman, serif; font-size: 24pt;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="background-color: white; text-align: justify;">
<b><span style="font-family: Arial, sans-serif;"><span style="color: blue;"></span></span></b><br />
<b><span style="font-family: Arial, sans-serif;"><span style="color: blue;"></span></span></b></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwHaBq8R2JTF9DUqK1I-3ry1y-uXF3yIM_AnWwK_ypVki9gZLi9-NDrKIb6KBUSIUhX_q4hxCdvQmYX2JyRU4H5u-xWxKavX3mfxNcyGDxJ4KRLMppp7hdxhwEHurg8vElSRUWFTqIKgkX/s1600/John+O'Keefe.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwHaBq8R2JTF9DUqK1I-3ry1y-uXF3yIM_AnWwK_ypVki9gZLi9-NDrKIb6KBUSIUhX_q4hxCdvQmYX2JyRU4H5u-xWxKavX3mfxNcyGDxJ4KRLMppp7hdxhwEHurg8vElSRUWFTqIKgkX/s1600/John+O'Keefe.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><div class="MsoNormal" style="background: white; line-height: 12.0pt; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: #666666; font-family: "Arial","sans-serif"; font-size: 8.5pt; mso-fareast-font-family: "Times New Roman";">Photo: David Bishop,
UCL<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.4pt; margin-bottom: .05in; mso-outline-level: 3;">
<b><span style="font-family: Arial, sans-serif; font-size: 9.5pt;">John O'Keefe<o:p></o:p></span></b></div>
<div class="MsoNormal" style="background-color: white; background-position: initial initial; background-repeat: initial initial;">
<b><span style="font-family: inherit, serif; font-size: 9.5pt;">Prize share:</span></b><span style="font-family: inherit, serif; font-size: 9.5pt;"> 1/2<o:p></o:p></span></div>
</td></tr>
</tbody></table>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirvMZKEaFkvw5p3QnIIYGnckGJISrOf5Blm3Xu54J9_I3PPSjDyWbnv2zUN-oAGps2gq3k_l0lKKkyrrqqqRmuC9EmImjqqCxaEbYZwulvHG3LbmKX-yRzzG2-t_YVHbu7xvKKrEFAaoVs/s1600/May-Britt+Moser.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirvMZKEaFkvw5p3QnIIYGnckGJISrOf5Blm3Xu54J9_I3PPSjDyWbnv2zUN-oAGps2gq3k_l0lKKkyrrqqqRmuC9EmImjqqCxaEbYZwulvHG3LbmKX-yRzzG2-t_YVHbu7xvKKrEFAaoVs/s1600/May-Britt+Moser.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><div class="MsoNormal" style="background: white; line-height: 12.0pt; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: #666666; font-family: "Arial","sans-serif"; font-size: 8.5pt; mso-fareast-font-family: "Times New Roman";">Photo: Kavli
Institute, NTNU, </span></div>
<div class="MsoNormal" style="background: white; line-height: 12.0pt; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: #666666; font-family: "Arial","sans-serif"; font-size: 8.5pt; mso-fareast-font-family: "Times New Roman";">CC-BY-SA-3.0 via Wikimedia Commons<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.4pt; margin-bottom: .05in; mso-outline-level: 3;">
<b><span style="font-family: Arial, sans-serif; font-size: 9.5pt;">May-Britt Moser<o:p></o:p></span></b></div>
<div class="MsoNormal" style="background-color: white; background-position: initial initial; background-repeat: initial initial;">
<b><span style="font-family: inherit, serif; font-size: 9.5pt;">Prize share:</span></b><span style="font-family: inherit, serif; font-size: 9.5pt;"> 1/4<o:p></o:p></span></div>
</td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7YK5-HuIUg_cg2eK8t4facWla6jbnZgBMlT7wCq5snX54MxWALVrfFzTT_8RnW9K-UUkomBspg5Kc86kFGUvHxNe5mPP9FbbC89MdKI8aOlZKFhFIbwRUkgycs9DpEnK8_aJAWOvExyRP/s1600/Edvard+I+Moser.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7YK5-HuIUg_cg2eK8t4facWla6jbnZgBMlT7wCq5snX54MxWALVrfFzTT_8RnW9K-UUkomBspg5Kc86kFGUvHxNe5mPP9FbbC89MdKI8aOlZKFhFIbwRUkgycs9DpEnK8_aJAWOvExyRP/s1600/Edvard+I+Moser.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><div class="MsoNormal" style="background: white; line-height: 12.0pt; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: #666666; font-family: "Arial","sans-serif"; font-size: 8.5pt; mso-fareast-font-family: "Times New Roman";">Photo: Kavli
Institute, NTNU, CC-BY-SA-3.0 via Wikimedia Commons<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.4pt; margin-bottom: .05in; mso-outline-level: 3;">
<b><span style="font-family: Arial, sans-serif; font-size: 9.5pt;">Edvard I. Moser<o:p></o:p></span></b></div>
<div class="MsoNormal" style="background-color: white; background-position: initial initial; background-repeat: initial initial;">
<b><span style="font-family: inherit, serif; font-size: 9.5pt;">Prize share:</span></b><span style="font-family: inherit, serif; font-size: 9.5pt;"> 1/4<o:p></o:p></span></div>
</td></tr>
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<br />
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<b><span style="font-family: Arial, sans-serif;"><span style="color: blue;">The Nobel Prize in
Physiology or Medicine 2014 was divided, one half awarded to John O'Keefe, the
other half jointly to May-Britt Moser and Edvard I. Moser <i>"for
their discoveries of cells that constitute a positioning system in the
brain"</i>.</span><span style="color: #555555;"><o:p></o:p></span></span></b></div>
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</div>
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<span class="row1"><b><span style="background: white; color: #666666; font-family: "Arial","sans-serif"; font-size: 8.5pt; line-height: 115%;">Reference:
</span></b></span><span class="row2"><span style="background: white; color: #666666; font-family: "Arial","sans-serif"; font-size: 8.5pt; line-height: 115%;"> "The Nobel Prize in Physiology or
Medicine 2014".</span></span><span class="apple-converted-space"><span style="background: white; color: #666666; font-family: "Arial","sans-serif"; font-size: 8.5pt; line-height: 115%;"> </span></span><span class="row2"><i style="box-sizing: border-box; line-height: inherit;"><span style="background: white; color: #666666; font-family: "Arial","sans-serif"; font-size: 8.5pt; line-height: 115%;">Nobelprize.org.</span></i></span><span class="apple-converted-space"><span style="background: white; color: #666666; font-family: "Arial","sans-serif"; font-size: 8.5pt; line-height: 115%;"> </span></span><span class="row2"><span style="background: white; color: #666666; font-family: "Arial","sans-serif"; font-size: 8.5pt; line-height: 115%;">Nobel Media AB 2014. Web. 6 Oct 2014. <a href="http://www.nobelprize.org/nobel_prizes/medicine/laureates/2014/">http://www.nobelprize.org/nobel_prizes/medicine/laureates/2014/</a><o:p></o:p></span></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span class="row2"><br /></span></div>
<h2 style="background-color: white; margin: 3.95pt 0in 1.2pt; text-align: center;">
<span style="color: #20124d;"><span style="font-family: Trebuchet MS, sans-serif;"><a name='more'></a><span style="font-size: small;">Here is the </span></span><span style="font-family: Trebuchet MS, sans-serif; font-size: small;">Press Release by <b>The Nobel Assembly at Karolinska Institutet on </b></span></span><span style="font-family: 'Trebuchet MS', sans-serif; font-size: small; text-align: center;">2014-10-06</span></h2>
<div align="center" style="background-color: white; background-position: initial initial; background-repeat: initial initial; box-sizing: border-box; margin: 1.25rem; text-align: center; text-rendering: optimizelegibility;">
<span style="font-family: Trebuchet MS, sans-serif;"><b>The Nobel Assembly at
Karolinska Institutet</b><span class="apple-converted-space"> </span>has today
decided to award</span></div>
<div align="center" style="background-color: white; background-position: initial initial; background-repeat: initial initial; box-sizing: border-box; margin: 1.25rem; text-align: center; text-rendering: optimizelegibility;">
<span style="font-family: Trebuchet MS, sans-serif;"><b style="box-sizing: border-box; line-height: inherit;">The 2014 Nobel Prize in
Physiology or Medicine</b><o:p></o:p></span></div>
<div align="center" style="background-color: white; background-position: initial initial; background-repeat: initial initial; box-sizing: border-box; margin: 1.25rem; text-align: center; text-rendering: optimizelegibility;">
<span style="font-family: Trebuchet MS, sans-serif;">with one half to<o:p></o:p></span></div>
<div align="center" style="background-color: white; background-position: initial initial; background-repeat: initial initial; box-sizing: border-box; margin: 1.25rem; text-align: center; text-rendering: optimizelegibility;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong style="box-sizing: border-box; line-height: inherit;">John O´Keefe</strong><o:p></o:p></span></div>
<div align="center" style="background-color: white; background-position: initial initial; background-repeat: initial initial; box-sizing: border-box; margin: 1.25rem; text-align: center; text-rendering: optimizelegibility;">
<span style="font-family: Trebuchet MS, sans-serif;">and the other half jointly to<o:p></o:p></span></div>
<div align="center" style="background-color: white; background-position: initial initial; background-repeat: initial initial; box-sizing: border-box; margin: 1.25rem; text-align: center; text-rendering: optimizelegibility;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong style="box-sizing: border-box; line-height: inherit;">May-Britt Moser and Edvard I. Moser</strong><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span class="row2"><span style="font-family: Trebuchet MS, sans-serif;">
</span></span></div>
<div align="center" style="background-color: white; background-position: initial initial; background-repeat: initial initial; box-sizing: border-box; margin: 1.25rem; text-align: center; text-rendering: optimizelegibility;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong style="box-sizing: border-box; line-height: inherit;">for their discoveries of cells that constitute a positioning</strong><span class="apple-converted-space"><b> </b></span><br style="box-sizing: border-box;" />
<strong style="box-sizing: border-box; line-height: inherit;">system in the brain</strong></span><span style="font-family: Arial, sans-serif; font-size: 9.5pt;"><o:p></o:p></span></div>
<div style="background-color: white; box-sizing: border-box; margin: 1.25rem; text-align: justify; text-rendering: optimizelegibility;">
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<span style="font-size: 9.5pt; text-align: left;"><span style="font-family: Trebuchet MS, sans-serif;">How do we know where we are? How can we find the way from one
place to another? And how can we store this information in such a way that we
can immediately find the way the next time we trace the same path? This year´s
Nobel Laureates have discovered a positioning system, an “inner GPS” in the
brain that makes it possible to orient ourselves in space, demonstrating a
cellular basis for higher cognitive function.</span></span></div>
<div style="background-color: white; box-sizing: border-box; margin: 1.25rem; text-align: justify; text-rendering: optimizelegibility;">
<span style="font-size: 9.5pt;"><span style="font-family: Trebuchet MS, sans-serif;">In 1971, John O´Keefe discovered the first component of this
positioning system. He found that a type of nerve cell in an area of the brain
called the hippocampus that was always activated when a rat was at a certain
place in a room. Other nerve cells were activated when the rat was at other
places. O´Keefe concluded that these “place cells” formed a map of the room.<o:p></o:p></span></span></div>
<div style="background-color: white; box-sizing: border-box; margin: 1.25rem; text-align: justify; text-rendering: optimizelegibility;">
<span style="font-size: 9.5pt;"><span style="font-family: Trebuchet MS, sans-serif;">More than three decades later, in 2005, May-Britt and Edvard Moser
discovered another key component of the brain’s positioning system. They
identified another type of nerve cell, which they called “grid cells”, that
generate a coordinate system and allow for precise positioning and pathfinding.
Their subsequent research showed how place and grid cells make it possible to
determine position and to navigate.<o:p></o:p></span></span></div>
<div style="background-color: white; box-sizing: border-box; margin: 1.25rem; text-align: justify; text-rendering: optimizelegibility;">
<span style="font-size: 9.5pt;"><span style="font-family: Trebuchet MS, sans-serif;">The discoveries of John O´Keefe, May-Britt Moser and Edvard Moser
have solved a problem that has occupied philosophers and scientists for
centuries – how does the brain create a map of the space surrounding us and how
can we navigate our way through a complex environment?<o:p></o:p></span></span></div>
<h3 style="background-color: white; box-sizing: border-box; margin: 0in 0in 0.05in; text-align: justify; text-rendering: optimizelegibility;">
<span style="font-size: 14.5pt; font-weight: normal;"><span style="font-family: Trebuchet MS, sans-serif;">How do we experience our environment?<o:p></o:p></span></span></h3>
<div style="background-color: white; box-sizing: border-box; margin: 1.25rem; text-align: justify; text-rendering: optimizelegibility;">
<span style="font-size: 9.5pt;"><span style="font-family: Trebuchet MS, sans-serif;">The sense of place and the ability to navigate are fundamental to
our existence. The sense of place gives a perception of position in the
environment. During navigation, it is interlinked with a sense of distance that
is based on motion and knowledge of previous positions.<o:p></o:p></span></span></div>
<div style="background-color: white; box-sizing: border-box; margin: 1.25rem; text-align: justify; text-rendering: optimizelegibility;">
<span style="font-size: 9.5pt;"><span style="font-family: Trebuchet MS, sans-serif;">Questions about place and navigation have engaged philosophers and
scientists for a long time. More than 200 years ago, the German philosopher
Immanuel Kant argued that some mental abilities exist as a priori knowledge,
independent of experience. He considered the concept of space as an inbuilt
principle of the mind, one through which the world is and must be perceived.
With the advent of behavioural psychology in the mid-20th century, these
questions could be addressed experimentally. When Edward Tolman examined rats moving
through labyrinths, he found that they could learn how to navigate, and
proposed that a “cognitive map” formed in the brain allowed them to find their
way. But questions still lingered - how would such a map be represented in the
brain?<o:p></o:p></span></span></div>
<h3 style="background-color: white; box-sizing: border-box; margin: 0in 0in 0.05in; text-align: justify; text-rendering: optimizelegibility;">
<span style="font-size: 14.5pt; font-weight: normal;"><span style="font-family: Trebuchet MS, sans-serif;">John O´Keefe and the place in space<o:p></o:p></span></span></h3>
<div style="background-color: white; box-sizing: border-box; margin: 1.25rem; text-align: justify; text-rendering: optimizelegibility;">
<span style="font-size: 9.5pt;"><span style="font-family: Trebuchet MS, sans-serif;">John O´Keefe was fascinated by the problem of how the brain
controls behaviour and decided, in the late 1960s, to attack this question with
neurophysiological methods. When recording signals from individual nerve cells
in a part of the brain called the hippocampus, in rats moving freely in a room,
O’Keefe discovered that certain nerve cells were activated when the animal
assumed a particular place in the environment (Figure 1). He could demonstrate
that these “place cells” were not merely registering visual input, but were
building up an inner map of the environment. O’Keefe concluded that the
hippocampus generates numerous maps, represented by the collective activity of
place cells that are activated in different environments. Therefore, the memory
of an environment can be stored as a specific combination of place cell
activities in the hippocampus.<o:p></o:p></span></span></div>
<h3 style="background-color: white; box-sizing: border-box; margin: 0in 0in 0.05in; text-align: justify; text-rendering: optimizelegibility;">
<span style="font-size: 14.5pt; font-weight: normal;"><span style="font-family: Trebuchet MS, sans-serif;">May-Britt and Edvard Moser find the coordinates<o:p></o:p></span></span></h3>
<div style="background-color: white; box-sizing: border-box; margin: 1.25rem; text-align: justify; text-rendering: optimizelegibility;">
<span style="font-size: 9.5pt;"><span style="font-family: Trebuchet MS, sans-serif;">May-Britt and Edvard Moser were mapping the connections to the
hippocampus in rats moving in a room when they discovered an astonishing
pattern of activity in a nearby part of the brain called the entorhinal cortex.
Here, certain cells were activated when the rat passed multiple locations
arranged in a hexagonal grid (Figure 2). Each of these cells was activated in a
unique spatial pattern and collectively these “grid cells” constitute a
coordinate system that allows for spatial navigation. Together with other cells
of the entorhinal cortex that recognize the direction of the head and the border
of the room, they form circuits with the place cells in the hippocampus. This
circuitry constitutes a comprehensive positioning system, an inner GPS, in the
brain (Figure 3).<o:p></o:p></span></span></div>
<h3 style="background-color: white; box-sizing: border-box; margin: 0in 0in 0.05in; text-align: justify; text-rendering: optimizelegibility;">
<span style="font-size: 14.5pt; font-weight: normal;"><span style="font-family: Trebuchet MS, sans-serif;">A place for maps in the human brain<o:p></o:p></span></span></h3>
<div style="background-color: white; box-sizing: border-box; margin: 1.25rem; text-align: justify; text-rendering: optimizelegibility;">
<span style="font-size: 9.5pt;"><span style="font-family: Trebuchet MS, sans-serif;">Recent investigations with brain imaging techniques, as well as
studies of patients undergoing neurosurgery, have provided evidence that place
and grid cells exist also in humans. In patients with Alzheimer´s disease, the
hippocampus and entorhinal cortex are frequently affected at an early stage, and
these individuals often lose their way and cannot recognize the environment.
Knowledge about the brain´s positioning system may, therefore, help us
understand the mechanism underpinning the devastating spatial memory loss that
affects people with this disease.<o:p></o:p></span></span></div>
<div style="background-color: white; box-sizing: border-box; margin: 1.25rem; text-align: center; text-rendering: optimizelegibility;">
</div>
<div style="background-color: white; box-sizing: border-box; margin: 1.25rem; text-align: justify; text-rendering: optimizelegibility;">
<span style="font-size: 9.5pt;"><span style="font-family: Trebuchet MS, sans-serif;">The discovery of the brain’s positioning system represents a
paradigm shift in our understanding of how ensembles of specialized cells work
together to execute higher cognitive functions. It has opened new avenues for
understanding other cognitive processes, such as memory, thinking and planning.</span><span style="font-family: Arial, sans-serif;"><o:p></o:p></span></span></div>
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<span style="font-size: 14.5pt; font-weight: normal;">Key publications:<o:p></o:p></span></h3>
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<td style="background-color: #f9f9f9; background-position: initial initial; background-repeat: initial initial; border-left-color: rgb(221, 221, 221); border-left-width: 1pt; border-right-color: rgb(221, 221, 221); border-right-width: 1pt; border-style: none solid; box-sizing: border-box; font-size: 0.875rem; line-height: 1.125rem; padding: 0.5625rem 0.625rem;"><div style="box-sizing: border-box; font-size: inherit; margin: 1.25rem; text-rendering: optimizelegibility;">
<span style="color: #222222; font-family: "inherit","serif"; mso-bidi-font-family: Arial;">O'Keefe,
J., and Dostrovsky, J. (1971). The hippocampus as a spatial map. Preliminary
evidence from unit activity in the freely</span><span style="color: #222222; font-family: "Cambria Math","serif"; mso-bidi-font-family: "Cambria Math";">‐</span><span style="color: #222222; font-family: "inherit","serif"; mso-bidi-font-family: Arial;">moving
rat. Brain Research 34, 171-175.<o:p></o:p></span></div>
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<tr style="box-sizing: border-box; mso-yfti-irow: 2;">
<td style="border-left-color: rgb(221, 221, 221); border-left-width: 1pt; border-right-color: rgb(221, 221, 221); border-right-width: 1pt; border-style: none solid; box-sizing: border-box; font-size: 0.875rem; line-height: 1.125rem; padding: 0.5625rem 0.625rem;"><div style="box-sizing: border-box; font-size: inherit; margin: 1.25rem; text-rendering: optimizelegibility;">
<span style="color: #222222; font-family: "inherit","serif"; mso-bidi-font-family: Arial;">O´Keefe,
J. (1976). Place units in the hippocampus of the freely moving rat.
Experimental Neurology 51, 78-109.<o:p></o:p></span></div>
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<td style="background-color: #f9f9f9; background-position: initial initial; background-repeat: initial initial; border-left-color: rgb(221, 221, 221); border-left-width: 1pt; border-right-color: rgb(221, 221, 221); border-right-width: 1pt; border-style: none solid; box-sizing: border-box; font-size: 0.875rem; line-height: 1.125rem; padding: 0.5625rem 0.625rem;"><div style="box-sizing: border-box; font-size: inherit; margin: 1.25rem; text-rendering: optimizelegibility;">
<span style="color: #222222; font-family: "inherit","serif"; mso-bidi-font-family: Arial;">Fyhn,
M., Molden, S., Witter, M.P., Moser, E.I., Moser, M.B. (2004) Spatial
representation in the entorhinal cortex. Science 305, 1258-1264.<o:p></o:p></span></div>
</td>
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<td style="border-left-color: rgb(221, 221, 221); border-left-width: 1pt; border-right-color: rgb(221, 221, 221); border-right-width: 1pt; border-style: none solid; box-sizing: border-box; font-size: 0.875rem; line-height: 1.125rem; padding: 0.5625rem 0.625rem;"><div style="box-sizing: border-box; font-size: inherit; margin: 1.25rem; text-rendering: optimizelegibility;">
<span style="color: #222222; font-family: "inherit","serif"; mso-bidi-font-family: Arial;">Hafting,
T., Fyhn, M., Molden, S., Moser, M.B., and Moser, E.I. (2005). Microstructure
of spatial map in the entorhinal cortex. Nature 436, 801-806.<o:p></o:p></span></div>
</td>
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<td style="background-color: #f9f9f9; background-position: initial initial; background-repeat: initial initial; border-bottom-color: rgb(221, 221, 221); border-bottom-width: 1pt; border-left-color: rgb(221, 221, 221); border-left-width: 1pt; border-right-color: rgb(221, 221, 221); border-right-width: 1pt; border-style: none solid solid; box-sizing: border-box; font-size: 0.875rem; line-height: 1.125rem; padding: 0.5625rem 0.625rem;"><div style="box-sizing: border-box; font-size: inherit; margin: 1.25rem; text-rendering: optimizelegibility;">
<span style="color: #222222; font-family: "inherit","serif"; mso-bidi-font-family: Arial;">Sargolini,
F., Fyhn, M., Hafting, T., McNaughton, B.L., Witter, M.P., Moser, M.B., and
Moser, E.I. (2006). Conjunctive representation of position, direction, and
velocity in the entorhinal cortex. Science 312, 758-762.<o:p></o:p></span></div>
</td>
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<div style="background: white;">
<strong><span style="font-family: Arial, sans-serif; font-size: 9.5pt;"><br /></span></strong></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong>John O’Keefe</strong><span class="apple-converted-space"> </span>was born in 1939 in New York City, USA, and holds both American
and British citizenships. He received his doctoral degree in physiological
psychology from McGill University, Canada in 1967. After that, he moved to
England for postdoctoral training at University College London. He has remained
at University College and was appointed Professor of Cognitive Neuroscience in
1987. John O´Keefe is currently Director of the Sainsbury Wellcome Centre in
Neural Circuits and Behaviour at University College London.</span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; text-align: justify;">
<strong style="box-sizing: border-box; line-height: inherit;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></strong></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong style="box-sizing: border-box; line-height: inherit;">May-Britt
Moser</strong><span class="apple-converted-space"> </span>was born
in Fosnavåg, Norway in 1963 and is a Norwegian citizen. She studied psychology
at the University of Oslo together with her future husband and co-Laureate
Edvard Moser. She received her Ph.D. in neurophysiology in 1995. She was a postdoctoral
fellow at the University of Edinburgh and subsequently a visiting scientist at
University College London before moving to the Norwegian University of Science
and Technology in Trondheim in 1996. May-Britt Moser was appointed Professor of
Neuroscience in 2000 and is currently Director of the Centre for Neural
Computation in Trondheim.</span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; text-align: justify;">
<strong style="box-sizing: border-box; line-height: inherit;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></strong></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b>Edvard I. Moser </b>was born in born 1962 in Ålesund, Norway and
has Norwegian citizenship. He obtained his Ph.D. in neurophysiology from the
University of Oslo in 1995. He was a postdoctoral fellow together with his wife
and co‐Laureate May‐Britt Moser, first at the University of Edinburgh and later
a visiting scientist in John O´Keefe´s laboratory in London. In 1996 they moved
to the Norwegian University of Science and Technology in Trondheim, where
Edvard Moser became Professor in 1998. He is currently Director of the Kavli
Institute for Systems Neuroscience in Trondheim.</span><o:p></o:p></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif; font-size: xx-small;">(Reference: <span style="background-color: white; color: #666666; line-height: 16px; text-align: left;">"The 2014 Nobel Prize in Physiology or Medicine - Press Release".</span><i style="background-color: white; box-sizing: border-box; color: #666666; line-height: 16px; text-align: left;">Nobelprize.org.</i><span style="background-color: white; color: #666666; line-height: 16px; text-align: left;"> Nobel Media AB 2014. Web. 7 Oct 2014. <http://www.nobelprize.org/nobel_prizes/medicine/laureates/2014/press.html>)</span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif; font-size: xx-small;"><span style="background-color: white; color: #666666; line-height: 16px; text-align: left;"><br /></span></span></div>
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A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-38101164645416389002014-09-26T14:50:00.002+05:452015-01-25T14:11:31.658+05:45Career opportunities in Medical Biochemistry Degree<div dir="ltr" style="text-align: left;" trbidi="on">
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<div class="MsoNormal" style="background: white; line-height: 17.4pt; margin-bottom: 7.5pt; mso-outline-level: 1; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><span style="color: #333333; font-size: 12pt; line-height: 19.2pt;">Biochemistry involves studying the chemistry of living things
such as substances, compounds and processes. Biochemists combine the fields of
microbiology, cell biology, genetics, chemistry, cell biology, and physics in
their day-to-day work or experiments. They get into the most, minute
characteristics of organisms, and their biological processes. They may be
identifying the way in which DNA, which carries the genetic information, is
</span></span></div>
<a name='more'></a><div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">transferred between cells and can be manipulated. Biochemistry finds
application in clinical and forensic science and in the food and pharmacological
industries. Biochemists are contributing to advances in a wide variety of
areas, including health, agriculture and the environment. The screening of
unborn babies for disease and investigation of possible cures for illnesses
such as cancer and<span class="apple-converted-space" style="color: #333333; font-size: 12pt; line-height: 19.2pt;"> </span><span style="color: #333333; font-size: 12pt; line-height: 19.2pt;">AIDS</span><span class="apple-converted-space" style="color: #333333; font-size: 12pt; line-height: 19.2pt;"> </span><span style="color: #333333; font-size: 12pt; line-height: 19.2pt;">are possible due to progress in the
biochemical understanding of disease The work environment could be the
government, private sector, laboratories, hospitals,</span><span class="apple-converted-space" style="color: #333333; font-size: 12pt; line-height: 19.2pt;"> </span><span style="color: #333333; font-size: 12pt; line-height: 19.2pt;">universities, and other educational
and research institutions.</span><span class="apple-converted-space" style="color: #333333; font-size: 12pt; line-height: 19.2pt;"> </span></span></div>
<div class="MsoNormal" style="background: white; line-height: 19.2pt; margin-bottom: 12.0pt; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333; font-size: 12.0pt;"><br /></span></strong></span>
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333; font-size: 12.0pt;">USEFUL
ATTRIBUTES</span></strong><span class="apple-converted-space"><b><span style="color: #333333; font-size: 12pt;"> <o:p></o:p></span></b></span></span></div>
<div class="MsoNormal" style="background: white; line-height: 19.2pt; margin-bottom: 12.0pt; text-align: justify;">
<span style="color: #333333; font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Problem-solving, research and analytical skills, and curiosity
are important traits for future biochemists. Good oral and written
communication skills are critical as many scientists work as part of a team,
write research papers or proposals, and have contact with clients or customers
with non-science backgrounds. Observational, planning, team work, organizational,
and computational skills are important for all scientists, including
biochemists.<span class="apple-converted-space"> <o:p></o:p></span></span></span></div>
<div class="MsoNormal" style="background: white; line-height: 19.2pt; margin-bottom: 12.0pt; text-align: justify;">
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<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333; font-size: 12.0pt;">EDUCATION</span></strong><span class="apple-converted-space"><b><span style="color: #333333; font-size: 12pt;"> <o:p></o:p></span></b></span></span></div>
<div class="MsoNormal" style="background: white; line-height: 19.2pt; margin-bottom: 12.0pt; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><span style="color: #333333; font-size: 12pt;">It is started with science in plus two/equivalent with Physics,
Chemistry, Biology and Maths for future career in Biochemistry. </span><span style="color: #333333; font-size: 12pt;">Completing the BSc (Hons) degree in Medical
Biochemistry will give you a firm grounding in modern biochemistry, with
particular reference to the ways in which this relates to medicine and health
issues. Along the way you will gain not only subject knowledge but also
important transferable skills that should make you an attractive prospect for
future employers.<br />
<br />
The programme for the first year incorporates relevant components drawn from
both the Medicine and Biological Sciences degree streams.<br />
<br />
Key Skills modules, designed specifically for this course, will help you
develop your communication and data handling skills, serving you in good stead
both for your other studies and your career. </span></span></div>
<div class="MsoNormal" style="background: white; line-height: 19.2pt; margin-bottom: 12.0pt; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><span style="color: #333333; font-size: 12pt;">In the second and third years, you can begin to develop
Medical Biochemistry with, if you would like, a leaning towards Genetics,
Microbiology or Physiology. Modules on proteins, gene expression, molecular
cell biology, metabolism and molecular machines are taken in the second year,
along with a module on molecular medicine and biomedical ethics exclusively for
Medical Biochemists. A third of the material in the year is then chosen by
you to reflect your particular interests.<br />
<br />
In the final year, Biochemical mechanisms of Human Disease, a core
module specifically for the Medical Biochemists, is studied along with three
units of your choice. The options include Biochemistry modules Cancer Cell and
Molecular Biology, Proteins: Structure, Dynamics and Engineering and the Molecular
Biology of Gene Expression as well as one or two units coordinated by other
Departments, including the popular Understanding Disease module.<br />
<br />
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In addition to your taught courses, you will undertake a research project that
may be depending upon the resources available of your medical
school/University. You can do either hospital based or community based research
projects.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background: white; line-height: 19.2pt; margin-bottom: 12.0pt; text-align: justify;">
<span style="color: #333333; font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Although some universities do offer biochemistry during
graduation, post-graduation really establishes you as a biochemist. After your
post-graduation degree, you could lead to a lectureship and a career in
research and development, consulting or allied work. Some medical colleges may
offer MD Biochemistry open to MBBS graduates/BDS graduates.<span class="apple-converted-space"> <o:p></o:p></span></span></span></div>
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<b><span style="color: #444444; font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Career Opportunities<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="background: white; line-height: 19.2pt; margin-bottom: 12.0pt; text-align: justify;" title="">
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<div title="">
<span style="color: #333333; font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">In the recent, the
graduates from the Medical Biochemistry degree stream can go on to a wide
variety of further training and careers. These have included M.Sc. programmes
in, for example, molecular genetics, cancer biology, bioinformatics, forensics
and pathology & toxicology. Others may have gone on to do PhDs in diverse
fields, including cancer research, molecular biology and membrane physiology.
</span></span></div>
</div>
<div class="separator" style="clear: both; text-align: center;" title="">
<span style="font-family: Trebuchet MS, sans-serif;" title=""></span></div>
<div style="text-align: justify;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjg0MeNFtof8DVjpUUWoysYLn6l7cb5FymHXnMtm-Tc-B6oPUJZKId70eUUOdopFw8uvZkULwQ8RByhunhB6fMBcRwAYvmNoFuOyszi4aoYujz8DGBqvVNCMcIbAYYKSmue2QIum-P1qiBu/s1600/lab-research.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;" title=""><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjg0MeNFtof8DVjpUUWoysYLn6l7cb5FymHXnMtm-Tc-B6oPUJZKId70eUUOdopFw8uvZkULwQ8RByhunhB6fMBcRwAYvmNoFuOyszi4aoYujz8DGBqvVNCMcIbAYYKSmue2QIum-P1qiBu/s1600/lab-research.jpg" height="179" title="" width="320" /></a><span style="font-family: Trebuchet MS, sans-serif;">First career destinations have included employment as a research assistant, medical
sales representative, systems analyst and medical archivist. If anyone choses
the academic field, they could do their job as various faculty position in
Medical school. The entry level will be Assistant Professor. <o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333; font-size: 12.0pt;"><br /></span></strong></span>
<span style="font-family: Trebuchet MS, sans-serif;"><strong><span style="color: #333333; font-size: 12.0pt;"><br /></span></strong></span>
<strong style="font-family: 'Trebuchet MS', sans-serif; line-height: 19.2pt;"><span style="color: #333333; font-size: 12.0pt;">Other Employment prospects</span></strong></div>
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<div class="separator" style="clear: both; text-align: center;">
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<span style="color: #333333; font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Biochemists may work in vaccine research, hormone production,
virology or immunology; food science jobs; plant science jobs; or zoology jobs
in areas from marine biology to entomology. They could be placed in industry,
hospitals, forestry, agriculture, dietetics, research institutes, education and
associated areas. They may work in pharmaceutical, food, brewing, biotechnology
and agrochemical companies not just to develop new products but also to monitor
the production, quality control and safety of existing ones.</span></span><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
</div>
</div>A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-72332800607568297802014-09-18T16:03:00.000+05:452014-09-18T16:03:17.554+05:45Breast Cancer: Introduction, pathophysiology and diagnosis<div dir="ltr" style="text-align: left;" trbidi="on">
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<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<b><span style="font-size: 12.0pt;"><span style="font-family: Trebuchet MS, sans-serif;">Breast Cancer: Where It Starts<o:p></o:p></span></span></b></div>
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<br /></div>
<span style="font-family: 'Trebuchet MS', sans-serif; font-size: 12pt; text-align: justify;">The earlier a breast
cancer lump is found, identified, and treated, the better the outlook. That’s
why breast cancer testing plays such a key role in so many facets of the
disease.</span><br />
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1ifSJjYIKGDgaAU2kScjOFbMsEZKt9A-9NhFr8dEhq6TZFtujJFticILsxBCpFyFD_7DLycmwlgEVGdWyZAtNvvNAJWjJ473bftTCGIPP8h9oDm36tWCkSg6W8h7hZ6XvWDcTA9GThjwb/s1600/breast+cancer.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1ifSJjYIKGDgaAU2kScjOFbMsEZKt9A-9NhFr8dEhq6TZFtujJFticILsxBCpFyFD_7DLycmwlgEVGdWyZAtNvvNAJWjJ473bftTCGIPP8h9oDm36tWCkSg6W8h7hZ6XvWDcTA9GThjwb/s1600/breast+cancer.jpg" height="150" width="200" /></a><span style="font-size: 12.0pt;"><span style="font-family: Trebuchet MS, sans-serif;">Unfortunately, signs
of breast cancer are rarely visible from the surface of the skin. Breast
self-exams should be done regularly to detect physically substantial lumps
under the skin. But even self-exams may miss some cases. By moving the slide
from left to right, you will see where (in most cases) breast cancer develops:
deep down in the inner structures of the breast, within the ducts.<o:p></o:p></span></span></div>
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<br /></div>
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<b><span style="font-size: 12.0pt;"><span style="font-family: Trebuchet MS, sans-serif;">Cellular Abnormalities & Cancer<o:p></o:p></span></span></b></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12.0pt;"><span style="font-family: Trebuchet MS, sans-serif;">Cancer begins deep
down in the body, at the cellular level. Cells are the basic building </span></span></div>
<a name='more'></a><span style="font-family: Trebuchet MS, sans-serif;">blocks of
the human body, and are constantly growing and dividing in a controlled manner
to create new tissues. Normally, new cells replace older cells as they die out.
However, cells can mutate for a variety of factors—including chemicals,
heredity, and others—leading to unchecked cell growth.<o:p></o:p></span><br />
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12.0pt;"><span style="font-family: Trebuchet MS, sans-serif;">The breast ducts are
lined with epithelial cells, a cell type that, when mutated, replicates easily
and freely because they lose adhesion to other cells. Cancer that begins in the
ducts is called ductal carcinoma—this is the most common type of breast cancer.<o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<b><span style="font-size: 12.0pt;"><span style="font-family: Trebuchet MS, sans-serif;">Why a Tumor Grows<o:p></o:p></span></span></b></div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJPcT1fqUJG8p6lo-eNYdQz45lm-0kQZLzgmg-cYyYFrTkIRPyFQ69epeMHympuCpth0rMQ-_TyOYwtX84IWKjwl-VkP00v1MZXYC1JuGm80Gi-vXSk2BVQaV4l199ClhAsv059C4cJZaR/s1600/symptoms-of-Breast-Cancer.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJPcT1fqUJG8p6lo-eNYdQz45lm-0kQZLzgmg-cYyYFrTkIRPyFQ69epeMHympuCpth0rMQ-_TyOYwtX84IWKjwl-VkP00v1MZXYC1JuGm80Gi-vXSk2BVQaV4l199ClhAsv059C4cJZaR/s1600/symptoms-of-Breast-Cancer.jpg" height="152" width="320" /></a></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12.0pt;"><span style="font-family: Trebuchet MS, sans-serif;">Tumors form when the
cell regrowth process gets mixed up and cells do not die when they should.
These damaged cells continue to mutate and grow uncontrollably. The cause of
this is still largely unknown. As cancerous epithelial cells begin to reproduce
and take up space in the breast ducts, the pressure can force a liquid
discharge from the nipple. Not all nipple discharge indicates cancer, but it is
a good reason to see your doctor.<o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-size: 12.0pt;"><span style="font-family: Trebuchet MS, sans-serif;">Your doctor will use
a number of diagnostic methods, potentially including x-rays (mammography) and
breast MRIs to determine whether you do in fact have a cancerous growth.<o:p></o:p></span></span></div>
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<br /></div>
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<b><span style="font-size: 12.0pt;"><span style="font-family: Trebuchet MS, sans-serif;">Mammography<o:p></o:p></span></span></b></div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjo1DtOd3ravwoo8uUzXX0IXclSz2dbgFwmvnDTEHKDh1ziWBsDf3kyjlSbkRn9BWaqVxVdd049Fxa3YI-0MB8yVI4RO_wZMUwL8B4X1QEUiVFOQIayToGbE5A6LtpYIU0AVLD4FgbCO-yu/s1600/preparation+for+mammography.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjo1DtOd3ravwoo8uUzXX0IXclSz2dbgFwmvnDTEHKDh1ziWBsDf3kyjlSbkRn9BWaqVxVdd049Fxa3YI-0MB8yVI4RO_wZMUwL8B4X1QEUiVFOQIayToGbE5A6LtpYIU0AVLD4FgbCO-yu/s1600/preparation+for+mammography.jpg" /></a></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12.0pt;"><span style="font-family: Trebuchet MS, sans-serif;">A mammogram is a
breast X-ray, and is used to screen for breast cancer in women who have no
signs of the disease, or to further diagnose a woman who has discovered a lump.
Although there is some debate, a mammography is typically recommended every
year or two for women over 40 (or 50).<o:p></o:p></span></span></div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVelE_n0SLQd4g0XkXGtoiuJ6j4iRfYFBdNfRQZ5ibTdvHclPlhgXXw9k70tVwp2G2KCpYha08qhfbYuktXVM4a52DlBnC-d1yf8Otg554qe70fBET3LyoC1KeNbQUBPcYEeu8APv_Ea_k/s1600/mammography+1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVelE_n0SLQd4g0XkXGtoiuJ6j4iRfYFBdNfRQZ5ibTdvHclPlhgXXw9k70tVwp2G2KCpYha08qhfbYuktXVM4a52DlBnC-d1yf8Otg554qe70fBET3LyoC1KeNbQUBPcYEeu8APv_Ea_k/s1600/mammography+1.jpg" height="125" width="200" /></a></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12.0pt;"><span style="font-family: Trebuchet MS, sans-serif;">The image here is a
split screen: on the left is a mammogram showing a cancerous lump in the breast
duct; on the right is an illustration showing the same cancer-stricken breast.
If you move the slider from left to right, the illustration will help you
understand the X-ray image that your doctor sees in his or her office.<o:p></o:p></span></span></div>
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<br /></div>
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<b><span style="font-size: 12.0pt;"><span style="font-family: Trebuchet MS, sans-serif;">Breast MRI<o:p></o:p></span></span></b></div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEmxBO11VX30R7ZQQvxcaAPlubEB2M2-YjBDtTFyac-IfhS2CHWqEA7cEXJYs3v2VSFb4Tx4Lu_7MOmrYT6QLhnoIOl6GsVAsNA_rx3xMG20wIuA_1QhLhdBWiFaNK25oAPSIN5qVc3qIx/s1600/breast+MRI.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEmxBO11VX30R7ZQQvxcaAPlubEB2M2-YjBDtTFyac-IfhS2CHWqEA7cEXJYs3v2VSFb4Tx4Lu_7MOmrYT6QLhnoIOl6GsVAsNA_rx3xMG20wIuA_1QhLhdBWiFaNK25oAPSIN5qVc3qIx/s1600/breast+MRI.jpg" height="213" width="320" /></a></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12.0pt;"><span style="font-family: Trebuchet MS, sans-serif;">Magnetic resonance
imaging (MRI) uses radio waves and magnets to create images of the inside of
the breast. They are very sensitive and can detect even the smallest
abnormality. In fact, they can be too sensitive. MRIs can generate “false
positives;” incorrect positive diagnoses.<o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12.0pt;"><span style="font-family: Trebuchet MS, sans-serif;">Nevertheless, MRIs
are a powerful screening tool and can detect breast cancers that have not yet
(or will not ever) cause lumps to develop. Like the previous image, this split
screen shows an MRI on the left, and an illustration on the right.<o:p></o:p></span></span></div>
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<br /></div>
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<b><span style="font-size: 12.0pt;"><span style="font-family: Trebuchet MS, sans-serif;">Cancer & the Lymphatic System<o:p></o:p></span></span></b></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12.0pt;"><span style="font-family: Trebuchet MS, sans-serif;">As cancer cells
continue to grow into a tumor, it can spread to lymph nodes, clusters of
infection-fighting structures that release white blood cells throughout the
body to keep you healthy. These nodes filter out contaminants throughout the body,
but with enough exposure, the cancer cells can spread to the lymph nodes and
possibly to other parts of the body.<o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12.0pt;"><span style="font-family: Trebuchet MS, sans-serif;">Breast cancer that
spreads to other areas of the body is called “metastatic.” Metastatic cancer in
lymphatic system can cause severe problems, including compromising your body’s
ability to ward off disease, leaving you unable to fight off even the smallest
infections.<o:p></o:p></span></span></div>
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<span style="font-size: 12.0pt;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12.0pt;"><span style="font-family: Trebuchet MS, sans-serif;"><b>More Breast Cancer
Resources</b><o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-size: 12.0pt;"><span style="font-family: Trebuchet MS, sans-serif;">While breast cancer
can affect many women, knowing your risk factors, the signs and symptoms, and
other important details can help you with early detection—your strongest weapon
against breast cancer. Explore more of Healthline's resources to learn more
about the importance in remaining vigilant in the fight against breast cancer.<o:p></o:p></span></span></div>
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<br /></div>
<br />
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><span style="font-size: 12.0pt;">(Sources: <a href="http://www.healthline.com/">http://www.healthline.com</a> , medically
reviewed by </span><span style="border: 1pt none windowtext; font-size: 12pt; padding: 0in;">George
Krucik, MD, MBA</span><span style="font-size: 12.0pt;"> </span><span style="font-size: 12pt;">on May 15, 2013</span></span><span style="font-size: 12.0pt;"><span style="font-family: Trebuchet MS, sans-serif;">)</span><o:p></o:p></span></div>
</div>
</div>A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-48405404034220380472014-09-09T16:37:00.000+05:452014-09-09T16:37:00.161+05:45The Three Major Stress Hormones: Adrenaline, Cortisol, Norepinephrine<div dir="ltr" style="text-align: left;" trbidi="on">
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<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: 11.25pt; text-align: justify; vertical-align: baseline;">
<span style="font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Thanks to the work of our sympathetic
nervous system, the "fight or flight" system that takes over when
we're stressed, when you see your boss's name in your inbox late at night, your
body reacts like there's a lion on the loose.<o:p></o:p></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTB9B_FHPiAok-vI1_sc35nGsUKLzhG03K9juUzPZXJb3GFXBou1KBNqc5hAGwhNVjOb-66d3b3NLk4VJAbBITjzxCxDUsMbzISLiMXjMQlHnzZ1yUWpMu4L0NE1JdH_Yql1P8Ko6w37rt/s1600/stressful+condition.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTB9B_FHPiAok-vI1_sc35nGsUKLzhG03K9juUzPZXJb3GFXBou1KBNqc5hAGwhNVjOb-66d3b3NLk4VJAbBITjzxCxDUsMbzISLiMXjMQlHnzZ1yUWpMu4L0NE1JdH_Yql1P8Ko6w37rt/s1600/stressful+condition.jpg" /></a></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: 11.25pt; text-align: justify; vertical-align: baseline;">
<span style="font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Behind the wide range of both physical
and mental reactions to stress are a number of hormones that are in charge of
adding fuel to the fire.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<b><span style="border: none windowtext 1.0pt; font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-border-alt: none windowtext 0in; mso-fareast-font-family: "Times New Roman"; padding: 0in;">Adrenaline</span></b><span style="font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><b><span style="border: none windowtext 1.0pt; mso-border-alt: none windowtext 0in; padding: 0in;"><o:p></o:p></span></b></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<b><span style="border: none windowtext 1.0pt; font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-border-alt: none windowtext 0in; mso-fareast-font-family: "Times New Roman"; padding: 0in;">What It Is:</span></b><span style="font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"> Commonly known
as <span style="border: none windowtext 1.0pt; mso-border-alt: none windowtext 0in; padding: 0in;">the fight or flight hormone</span>, it is produced by the adrenal
glands after receiving a message from the brain that a stressful situation has
presented itself.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<b><span style="border: none windowtext 1.0pt; font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-border-alt: none windowtext 0in; mso-fareast-font-family: "Times New Roman"; padding: 0in;">What It Does:</span></b><span style="font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"> Adrenaline,
along with norepinephrine (more on that below), is largely </span></div>
<a name='more'></a>responsible for the <i><span style="border: none windowtext 1.0pt; mso-border-alt: none windowtext 0in; padding: 0in;">immediate</span></i> reactions we feel when stressed. Imagine
you're trying to change lanes in your car, says Amit Sood, M.D., director of
research at the Complementary and Integrative Medicine and chair of Mayo Mind
Body Initiative at Mayo Clinic. Suddenly, from your blind spot, comes a car
racing at 100 miles per hour. You return to your original lane and your heart
is pounding. Your muscles are tense, you're breathing faster, you may start
sweating. That's adrenaline.<o:p></o:p><br />
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<span style="font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Along with the
increase in heart rate, <span style="border: none windowtext 1.0pt; color: windowtext; mso-border-alt: none windowtext 0in; padding: 0in; text-decoration: none; text-underline: none;">adrenaline also gives you
a surge of energy</span> -- which you might need to run away from a
dangerous situation -- and also focuses your attention.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
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<b><span style="border: none windowtext 1.0pt; font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-border-alt: none windowtext 0in; mso-fareast-font-family: "Times New Roman"; padding: 0in;">Norepinephrine</span></b><span style="font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><br />
<b><span style="border: none windowtext 1.0pt; mso-border-alt: none windowtext 0in; padding: 0in;">What It Is:</span></b> A hormone similar to adrenaline,
released from the adrenal glands and also from the brain, says Sood.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<b><span style="border: none windowtext 1.0pt; font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-border-alt: none windowtext 0in; mso-fareast-font-family: "Times New Roman"; padding: 0in;">What It Does:</span></b><span style="font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"> The primary
role of norepinephrine, like adrenaline, is arousal, says Sood. "When you
are stressed, you become more aware, awake, focused," he says. "You
are just generally more responsive." It also helps to shift blood flow
away from areas where it might not be so crucial, like the skin, and toward
more essential areas at the time, like the muscles, so you can flee the
stressful scene.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<span style="font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Although
norepinephrine might seem redundant given adrenaline (which is also sometimes
called epinephrine), Sood imagines we have both hormones as a type of backup
system. "Say your adrenal glands are not working well," he says.
"I still want <i><span style="border: none windowtext 1.0pt; mso-border-alt: none windowtext 0in; padding: 0in;">something</span></i> to save me from
acute catastrophe."<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: 11.25pt; text-align: justify; vertical-align: baseline;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: 11.25pt; text-align: justify; vertical-align: baseline;">
<span style="font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Depending on the long-term impact of
whatever's stressing you out -- and how you personally handle stress -- it
could take anywhere from half an hour to a couple of days to return to your
normal resting state, says Sood.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<b><span style="border: none windowtext 1.0pt; font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-border-alt: none windowtext 0in; mso-fareast-font-family: "Times New Roman"; padding: 0in;">Cortisol</span></b><span style="font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><b><span style="border: none windowtext 1.0pt; mso-border-alt: none windowtext 0in; padding: 0in;"><o:p></o:p></span></b></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<b><span style="border: none windowtext 1.0pt; font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-border-alt: none windowtext 0in; mso-fareast-font-family: "Times New Roman"; padding: 0in;">What It Is:</span></b><span style="font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"> A steroid hormone,
commonly known as <span style="border: none windowtext 1.0pt; color: windowtext; mso-border-alt: none windowtext 0in; padding: 0in; text-decoration: none; text-underline: none;">the stress hormone</span>, produced by the adrenal glands.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<b><span style="border: none windowtext 1.0pt; font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-border-alt: none windowtext 0in; mso-fareast-font-family: "Times New Roman"; padding: 0in;">What It Does:</span></b><span style="font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"> It takes a
little more time -- minutes, rather than seconds -- for you to feel the effects
of cortisol in the face of stress, says Sood, because the release of this
hormone takes a multi-step process involving two additional minor hormones.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<span style="font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">First, the part of
the brain called the <span style="border: none windowtext 1.0pt; color: windowtext; mso-border-alt: none windowtext 0in; padding: 0in; text-decoration: none; text-underline: none;">amygdala</span> has to recognize a threat. It then sends a
message to the part of the brain called the <span style="border: none windowtext 1.0pt; color: windowtext; mso-border-alt: none windowtext 0in; padding: 0in; text-decoration: none; text-underline: none;">hypothalamus</span>, which releases corticotropin-releasing hormone
(CRH). CRH then tells the pituitary gland to release adrenocorticotropic
hormone (ACTH), which tells the adrenal glands to produce cortisol. Whew!<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<span style="font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">In survival mode, the <i><span style="border: none windowtext 1.0pt; mso-border-alt: none windowtext 0in; padding: 0in;">optimal</span></i> amounts of cortisol can be life saving. It
helps to maintain fluid balance and blood pressure, says Sood, while regulating
some body functions that aren't crucial in the moment, like reproductive drive,
immunity, digestion and growth.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<span style="font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">But when you stew on a
problem, the body <i><span style="border: none windowtext 1.0pt; mso-border-alt: none windowtext 0in; padding: 0in;">continuously</span></i> releases
cortisol, and <span style="border: none windowtext 1.0pt; color: windowtext; mso-border-alt: none windowtext 0in; padding: 0in; text-decoration: none; text-underline: none;">chronic elevated levels can lead to serious issues</span>. Too much
cortisol can suppress the immune system, increase blood pressure and sugar,
decrease libido, produce acne, contribute to obesity and more.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; vertical-align: baseline;">
<span style="font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><br /></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: 11.25pt; text-align: justify; vertical-align: baseline;">
<span style="font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">"Ducks walk out of a lake, flap
their wings and they fly off," says Sood. "When you face something
stressful, particularly if it's not likely to repeat or doesn't have a huge
long-term impact, you want to be able to shake it off and move on with
life."<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.75pt; margin-bottom: 11.25pt; text-align: justify; vertical-align: baseline;">
<span style="font-family: "Georgia","serif"; font-size: 11.5pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Of course, he adds, estrogen and
testosterone are also hormones that affect how we react to stress, as are the
neurotransmitters dopamine and serotonin. But the classic fight-or-flight
reaction is mostly due to the three major players mentioned above. How do you
react to stress? Let us know in the comments.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="text-align: justify;">
(<span style="text-align: left;"><span style="border: 1pt none windowtext; font-family: 'Times New Roman', serif; line-height: 115%; padding: 0in;">By <span style="color: windowtext; text-decoration: none; text-underline: none;">Sarah Klein: </span></span></span><span style="font-family: ''; text-align: left;"><span style="border: 1pt none windowtext; font-family: 'Times New Roman', serif; line-height: 13px; padding: 0in;">The Huffington Post </span><span style="border: 1pt none windowtext; font-family: 'Times New Roman', serif; line-height: 12px; padding: 0in;"> | </span></span> www.huffingtonpost.com)</div>
<div class="MsoNormal" style="text-align: justify;">
<o:p></o:p></div>
</div>
</div>
A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-17901905254001196872014-08-21T12:43:00.001+05:452015-03-09T14:08:02.836+05:45Diabetes could be cured: A study from scientists at Manchester University<div dir="ltr" style="text-align: left;" trbidi="on">
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<h3 style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Scientists at Manchester University have discovered that the hormone amylin can clump together and stop cells producing insulin</span></h3>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><img alt="Diabetes could be cured with medication after scientists discovered that clumps of amylin may be stopping cells producing insulin" src="http://i.telegraph.co.uk/multimedia/archive/02936/diabetes_2936249b.jpg" height="199" style="margin-left: auto; margin-right: auto;" width="320" /></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: 'Trebuchet MS', sans-serif; font-size: small; text-align: justify;">Fig. Diabetes could be cured with medication after scientists discovered that clumps of amylin may be stopping cells producing insulin (Photo courtesy: Alamy)</span></td></tr>
</tbody></table>
<div style="text-align: justify;">
<span style="clear: right; float: right; font-family: Trebuchet MS, sans-serif; margin-bottom: 1em; margin-left: 1em;"> </span></div>
<div style="text-align: justify;">
<span style="font-family: 'Trebuchet MS', sans-serif;">Diabetes could be cured after scientists discovered that toxic clumps of a hormone stop cells producing insulin.</span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Scientists at Manchester University have found that both Type 1 and Type 2 diabetes are driven by the same underlying mechanism. </span></div>
<div style="text-align: justify;">
</div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"></span></div>
<a name='more'></a><span style="font-family: Trebuchet MS, sans-serif;">The findings suggest that both forms occur when the hormone amylin begins to clump together, surrounding cells, and preventing them from producing insulin. </span><br />
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Insulin is essential for moving sugar from the blood stream into muscles and fatty tissue to provide energy. </span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">But too little insulin allows dangerous levels of glucose to build up in the blood, causing damage to the heart kidneys, eyes and nerves. </span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">However the new finding could pave the way for drugs which stop the amylin build-up in the first place or dissolve clumps which are already present. </span></div>
<h4 style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">More than three million people in Britain have been diagnosed with diabetes, with that figure expected to five million by 2025.</span></h4>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">The vast majority of sufferers (85 per cent) have Type 2 diabetes, which is linked to obesity, poor diet and sedentary lifestyles. </span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">More than 70,000 deaths a year occur among those suffering from the condition - one in seven of all deaths. </span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">The pancreas produces both insulin and amylin which usually work together to regulate the body’s response to food. </span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">However, some of the amylin that is produced can get deposited around cells in the pancreas as toxic clumps, which then, in turn, destroy those cells that produce insulin. The consequence of this cell death is diabetes. </span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Previous research suggested that this was the cause of Type 2 diabetes. But now scientists believe it could also explain Type 1, which occurs in childhood. </span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">The team hopes to have potential medicines ready to go into clinical trials in the next two years and it is anticipated that these will be tested in both type-1 and type-2 diabetic patients. </span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Clinical trials are being planned with research groups in England and Scotland. </span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">However diabetes charities said people should adopt healthier lifestyles to avoid Type 2 diabetes rather than wait for a pill. </span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Dr Alasdair Rankin, Director of Research at Diabetes UK, said: “Amylin has been studied in diabetes for many years. </span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">“Type 1 and Type 2 diabetes are two very different conditions. We don’t know exactly what causes Type 1 but many possibilities have been suggested and amylin is just one of these. </span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">“We know that in Type 2 diabetes there are several factors that increase a person’s risk, including ethnicity, age, family history and being overweight. </span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">“So while there is no way to reduce your risk of Type 1 diabetes, the most effective way to reduce your risk of Type 2 is to keep to a healthy weight by eating a healthy balanced diet and being physically active.” </span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">The study was published in the Journal of the Federation of American Societies for Experimental Biology. </span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">(Source: http://www.telegraph.co.uk</span></div>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Author: Sarah Knapton, Science Correspondent)</span></div>
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<br /></div>A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-74374978657540903432014-08-10T11:05:00.004+05:452015-01-25T14:12:19.793+05:45Ebola Virus Outbreak in west Africa and its Risk Assessment<script async src="//pagead2.googlesyndication.com/pagead/js/adsbygoogle.js"></script>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUpDvqlro8LJ3zN-RD0J78Eir4vStNJXsh2JWcjZBYIjgpV7RY5KyZDeMC0lz0ICv6Xbz-b2Sui0tGLyPeGDZK_KnkCIZG7gOxmhm2E5DkH24bzCuSPn9KXUJ3l0cT8g98kSDKBkc1XuS0/s1600/ebola+virus.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;" title=""><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUpDvqlro8LJ3zN-RD0J78Eir4vStNJXsh2JWcjZBYIjgpV7RY5KyZDeMC0lz0ICv6Xbz-b2Sui0tGLyPeGDZK_KnkCIZG7gOxmhm2E5DkH24bzCuSPn9KXUJ3l0cT8g98kSDKBkc1XuS0/s1600/ebola+virus.png" height="320" title="" width="235" /></a></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="background-color: white; color: #333333; font-family: 'Trebuchet MS', sans-serif; font-size: 12pt; line-height: 115%;">The current Ebola Virus outbreak began in Guinea in December
2013. This outbreak now involves transmission in Guinea, Liberia, Nigeria, and
Sierra Leone. As of 4 August 2014, countries have reported 1 711 cases (1 070
confirmed, 436 probable, 205 suspect), including 932 deaths. This is currently
the largest EVD outbreak ever recorded. And on 8 August 2014, WHO declared the
Ebola outbreak in West Africa a Public Health Emergency of International
Concern.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-size: 13.5pt;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-size: 13.5pt;"><span style="font-family: Trebuchet MS, sans-serif;">Epidemiological facts and experience<o:p></o:p></span></span></b></div>
<ul type="disc">
<li class="MsoNormal" style="text-align: justify;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">The incubation period of Ebola
virus disease (EVD) varies from 2 to 21 days. Person-to-person
transmission by means of direct contact with infected persons or their
body fluids/secretions is considered the principal mode of transmission.
In a household study, secondary transmission took <a name='more'></a>place only if direct
physical contact occurred. No transmission was reported without this
direct contact. Airborne transmission has not been documented during
previous EVD outbreaks. <o:p></o:p></span></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">There is no risk of
transmission during the incubation period and only low risk of
transmission in the early phase of symptomatic patients. The risk of
infection during transport of persons can be further reduced through use of
infection control precautions.<o:p></o:p></span></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">In the current outbreak,
infected travelers have crossed land borders with neighboring countries
and there is a possibility that other cases might occur in neighboring
countries. <o:p></o:p></span></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Historically, several cases of hemorrhagic
fever (Ebola, Marburg, Lassa, Crimean Congo hemorrhagic fever) disease
were diagnosed after long distance travel but none developed the symptoms
during the international travel. Long-distance travelers (e.g. between
continents) infected in affected areas could arrive while incubating the
disease and develop symptoms compatible with EVD, after arrival. <o:p></o:p></span></span></li>
</ul>
<div style="margin-left: .5in; mso-list: l1 level1 lfo1; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Trebuchet MS, sans-serif;"><span style="font-size: 10pt;">·<span style="font-size: 7pt;">
</span></span><!--[endif]-->Natural Host of Ebola virus: In Africa, fruit
bats, particularly species of the genera: <i>Hypsignathus monstrosus, Epomops
franqueti</i> and <i>Myonycteris torquata</i>, are considered possible natural
hosts for Ebola virus. As a result, the geographic distribution of Ebola
viruses may overlap with the range of the fruit bats.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 0.5in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-size: 14pt; line-height: 115%;"><span style="font-family: Trebuchet MS, sans-serif;">Risks
of Ebola Virus for different groups<o:p></o:p></span></span></b></div>
<h3 style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Tourists and businessmen/women returning from
affected areas in a country<o:p></o:p></span></h3>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">The risk of a tourist or businessman/woman becoming
infected with Ebola virus during a visit to the affected areas and developing
disease after returning is extremely low, even if the visit included travel to
the local areas from which primary cases have been reported. Transmission
requires direct contact with blood, secretions, organs or other body fluids of
infected living or dead persons or animal, all unlikely exposures for the
average traveler. Tourists are in any event advised to avoid all such contacts.<o:p></o:p></span></div>
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</script>
<h3 style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Visiting families and relatives <o:p></o:p></span></h3>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">The risk for travelers visiting friends and
relatives in affected countries is similarly low, unless the traveler has
direct physical contact with a sick or dead person or animal infected with
Ebola virus. In such a case, contact tracing should confirm the exposure and
prevent further spread of the disease through monitoring the exposed traveler. <o:p></o:p></span></div>
<h3 style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Patients
travelling with symptoms and fellow travelers<o:p></o:p></span></h3>
<div style="text-align: justify;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicB0kcVOAp9-o9wcnmmU-qYc4O-uiNyZz4hkATPDKEmHFe1XVGxqq0joZxXf9y7N5bGqj2Q8hHfbzqpaH9HsoR2PoZ_TVGMCjeu_ckIl2I-QXBPAT6iuEj1TM__D1yuFxv6XNgHDm5294H/s1600/ebola+outbreak+2014.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;" title=""><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicB0kcVOAp9-o9wcnmmU-qYc4O-uiNyZz4hkATPDKEmHFe1XVGxqq0joZxXf9y7N5bGqj2Q8hHfbzqpaH9HsoR2PoZ_TVGMCjeu_ckIl2I-QXBPAT6iuEj1TM__D1yuFxv6XNgHDm5294H/s1600/ebola+outbreak+2014.jpg" height="221" title="" width="400" /></a><span style="font-family: Trebuchet MS, sans-serif;">There is a possibility that a person who had been
exposed to Ebola virus and developed symptoms may board a commercial flight, or
other mode of transport, without informing the transport company of his status.
It is highly likely that such patients would seek immediate medical attention
upon arrival, especially if well informed, and then should be isolated to prevent
further transmission. Although the risk to fellow travelers in such a situation
is very low, contact tracing is recommended in such circumstances. <o:p></o:p></span></div>
<h3 style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">Risk for health care workers posted in affected
areas <o:p></o:p></span></h3>
<div style="text-align: justify;">
<span style="font-family: Trebuchet MS, sans-serif;">There is a risk for healthcare workers and
volunteers, especially if involved in caring for EVD patients. However, if the
recommended level of precaution for such settings is implemented, transmission
of the disease should be prevented. The risk level can be considered very low
to low unless these precautions are not followed, e.g. no personal protective
equipment, needle stick injury etc.<o:p></o:p></span></div>
<div style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-size: 13.5pt;"><span style="font-family: Trebuchet MS, sans-serif;">Template message for travelers and Ebola Virus Disease<o:p></o:p></span></span></b></div>
<ul type="disc">
<li class="MsoNormal" style="text-align: justify;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Ebola Virus Disease is formerly
Known as Ebola hemorrhagic Fever and highly fatal up to 90% <o:p></o:p></span></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">The virus took its name as it
is thought to be seen near by Ebola River at first on 1976.<o:p></o:p></span></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Infection is by contact with
blood or body fluids of an infected person or an animal infected or by
contact with contaminated objects.<o:p></o:p></span></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Symptoms include fever,
weakness, muscle pain, headache and sore throat. This is followed by
vomiting, diarrhoea, rash, and in some cases, bleeding. <o:p></o:p></span></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Cases of Ebola have recently
been confirmed in XXX and YYY. <o:p></o:p></span></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Persons who come into direct
contact with body fluids of an infected person or animal are at risk. <o:p></o:p></span></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">There is no licensed vaccine. <o:p></o:p></span></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Practice careful hygiene i.e.
frequent hand washing. <o:p></o:p></span></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Avoid all contact with blood
and body fluids of infected people or animals. <o:p></o:p></span></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">Do not handle items that may
have come in contact with an infected person’s blood or body fluids. <o:p></o:p></span></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">If you stayed in the areas
where Ebola cases have been recently reported seek medical attention if
you feel sick (fever, headache, achiness, sore throat, diarrhoea,
vomiting, stomach pain, rash, or red eyes). </span></span></li>
</ul>
<span style="font-family: Trebuchet MS, sans-serif;"><span style="font-size: 12pt; text-align: justify;">Ref:
</span><a href="http://www.who.int/" style="text-align: justify;"><span style="font-size: 12pt;">www.who.int</span></a><span style="font-size: 12pt; text-align: justify;">, Accessed on 9 August 2014</span></span></div>
</div>A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0tag:blogger.com,1999:blog-6852805409466941423.post-32459920688842627832014-08-05T16:07:00.002+05:452014-08-05T16:07:35.803+05:45Preanalytical Variables : Controllable or uncontrollable (Part 3)<div dir="ltr" style="text-align: left;" trbidi="on">
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<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-family: Trebuchet MS, sans-serif;">Standardization of specimen collection practices help reduce errors due to preanalytical variables.</span><br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgh3E6Aw7KdCSco4iGpQKGVpP7CL27mYNuFlPDIqnS_DbyJwwn24-z7SOy7dDR9vhhoMXm5_XCUDWhUUkOe9s1774m04kRCDYar2yIFuV5dEzniXf7S_7ajQoKDGQ_wRllVpenVZZTlP9ZG/s1600-h/clip_image006%25255B3%25255D.jpg" style="clear: right; display: inline !important; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-family: Trebuchet MS, sans-serif;"><img alt="clip_image006" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRC-mhwqRUFQXqo4mi9a-v4MJxoLl5Khh3NA-PAky6y6HisR2YkUTXKA4qPlfZQ6DZntY0uFrRkp5DuHh0KO4ZDAlfByijIN1cPhiPCcr2qs11KC5VNLs-NloWD6rEZ2_CCBtD-hegvWk7//?imgmax=800" height="196" style="background-image: none; border: 0px; display: inline; padding-left: 0px; padding-right: 0px; padding-top: 0px;" title="clip_image006" width="125" /></span></a><span style="font-family: Trebuchet MS, sans-serif;"> </span><br />
<ul style="text-align: left;">
<li><span style="font-family: Trebuchet MS, sans-serif;">Major physiological variables include posture, prolonged bed rest, exercise, physical training,</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">circadian variation and travel.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Other physiological variables include diet, lifestyle, stimulants, drugs, herbal preparations,</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">recreational drug ingestions etc.</span></li>
</ul>
<b><span style="font-family: Trebuchet MS, sans-serif;">Controllable Parameters</span></b><br />
<ul style="text-align: left;">
<li><span style="font-family: Trebuchet MS, sans-serif;">Posture – Changes water and plasma protein distribution. Many hormones’ values are</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">affected, some of them drastically. Related to that, electrolytes’ values also change.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Prolonged bed rest – Fluid retention occurs and related changes occur. Ca, Na, K, PO4 , SO4 changes. Also enzymes and hormones.</span><a name='more'></a></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Exercise – Static exercise – ATP, hormones etc. due to fluid shift.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Moderate exercise – Increases glucose levels, lactate. Decreases pH and pCO2. Increased</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">enzymes, AST, LDH, aldolase etc. Reduces cholesterol levels.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Strenuous exercise – Hypoglycemia, increased glucose tolerance. Increased lactate, plasma proteins, CK levels.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Renin and cortisol increased dramatically.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Physical training – Higher skeletal muscle enzymes. Urea, urate, creatinine, thyroxine higher. Lipids dramatically reduced.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Circadian rhythm – Serum iron (50%), cortisol, potassium, most hormones except FSH and LH. Other physiological factors can affect circadian rhythm.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Travel – Affects pituitary and adrenal function. Related hormones show variation.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Diet – Changes occur within a few days of changed diet.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">High protein diet increases urea, cholesterol, ammonia and urate.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">High fat diet – Produces negative nitrogen balance and increases cholesterol.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">High starch diet – Reduces cholesterol levels. Many small meals rather than one heavy meal has a beneficial effect on cholesterol profile.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Food ingestion – Overnight affects many variables.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Meals can increase cholesterol, urea nitrogen etc. for up to 12 hours Glucagon, insulin stimulated by protein rich meal.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Alkaline tide occurs post-prandially.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Glucose is the analyte maximally altered by food intake.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Vegetarianism – Reduced lipids, reduced B12.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Malnutrition – Proteins reduced. Lipid less than desired. Usually, glucose levels are maintained. Cortisol increased, thyroid hormones reduced.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Fasting and starvation – Used to treat obesity. Starvation ketosis may occur. Hormone profile altered. Transient increase in body water.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Lifestyle (smoking and alcohol) – Changes in many enzymes and hormones which affect laboratory result adversely.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Drugs – Can have in vivo and in vitro effects on laboratory results. All drugs can alter laboratory results substantially.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Extent varies according to specific drug.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Herbal preparations – Aloe vera, sandalwood and cascara segrada can cause hematuria and albuminuria on long-term use. Hypokalemia, hemolytic anemia, liver damage, microcytic anemia, hyperthyroidism, hypercoagulability and cholestatic jaundice are other side effects.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Amphetamines – Increase FFA.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Morphine – Increases amylase, lipase, ALT, AST, ALP and bilirubin. Decreases insulin, norepinephrine, neurotensin.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Heroin – Increases cholesterol, potassium, thyroxine. pCO2 increased, pO2 decreased. Albumin reduced.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Cannabis – Increases Na, K, urea, Cl, insulin. Reduces creatinine, glucose and urate.</span></li>
</ul>
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<b><span style="font-family: Trebuchet MS, sans-serif;">Non-controllable Variables</span></b><br />
<ul style="text-align: left;">
<li><span style="font-family: Trebuchet MS, sans-serif;">Biological influences – Heredity, age, sex and race can affect individual lab results.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Age - Affects many parameters dramatically.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Sex – After puberty, changes in ALP, AST, ALT, CK and many other hormones are seen.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Race – Some parameters are affected by ethnicity of the individual.</span></li>
</ul>
<span style="font-family: 'Trebuchet MS', sans-serif;"><b>Environmental Factors</b></span><br />
<ul style="text-align: left;">
<li><span style="font-family: Trebuchet MS, sans-serif;">Altitude – Hemoglobin, hematocrit. Plasma Na, K not affected.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Ambient temperature – Decreased plasma proteins and potassium. Extensive sweating can cause hemoconcentration.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Residence – Geographical location can change lipid profile, trace element distribution etc. Urban areas can have higher levels of pollutants in blood.</span></li>
</ul>
<span style="font-family: 'Trebuchet MS', sans-serif;"><b>Long-term Cyclical Changes</b></span><br />
<ul style="text-align: left;">
<li><span style="font-family: Trebuchet MS, sans-serif;">Seasonal influences – Relatively small compared to a tourniquet. Calcium and vitamin D levels change with extent of sunlight received.</span></li>
<li><span style="font-family: Trebuchet MS, sans-serif;">Menstrual cycle – Hormones, catecholamines, cholesterol and minerals change with menstrual cycle.</span></li>
</ul>
<span style="font-family: 'Trebuchet MS', sans-serif;"><b>Underlying Medical Conditions</b></span><br />
<span style="font-family: 'Trebuchet MS', sans-serif;"><b><br /></b></span>
<span style="font-family: Trebuchet MS, sans-serif;">1. Obesity – Lipid profile, hormones, glucose tolerance, pyruvate, lactate etc. vary. </span><br />
<span style="font-family: Trebuchet MS, sans-serif;">2. Blindness – Hypothalamic-pituitary axis stimulation is lost. Low Na, Cl, glucose seen. Impaired renal function and </span><br />
<span style="font-family: Trebuchet MS, sans-serif;">negative nitrogen balance seen. </span><br />
<span style="font-family: Trebuchet MS, sans-serif;">3. Stress – Many hormones and other analytes altered by stress. </span><br />
<span style="font-family: Trebuchet MS, sans-serif;">4. Pregnancy – Depending on duration of pregnancy concentration of many analytes can vary. </span><br />
<span style="font-family: Trebuchet MS, sans-serif;">5. Fever – Early hyperglycemia and changes in hormones. Changes in electrolyte levels. </span><br />
<span style="font-family: Trebuchet MS, sans-serif;">6. Shock and trauma – Lipids, hormones can be altered by shock. Fluid balance, muscle related parameters can vary. </span><br />
<span style="font-family: Trebuchet MS, sans-serif;">7. Transfusions and infusions – Proteins, water and electrolytes can vary. </span><br />
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span>
<span style="font-family: Trebuchet MS, sans-serif;">(Source: Supplementary information, Textbook of Biochemistry for Medical Students, 7th Edn.)</span></div>
</div>
A guide for Clinical Laboratory Scientisthttp://www.blogger.com/profile/00228470081744180737noreply@blogger.com0