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Sex - it's all in
your head, really.
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Nerve Flossing |
Statins - effects
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sciatica problems
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Sacroilliac Joint
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What is the Chain of Survival?
The Chain of Survival comprises four vital links that can save a life in cardiac emergencies: early recognition and access, early CPR, early defibrillation and advance cardiac life support. Our knowledge of cardiopulmonary resuscitation (CPR) and the use of Automated External Defibrillator (AED) is hence extremely important in reducing the number of sudden cardiac deaths. CPR and AED, if duly administered in the few critical minutes just after collapse, will skew the Chain of Survival equation towards higher chances of survival. What is CPR? CPR is an emergency procedure for restoring the breathing and heartbeat of an unconscious victim of heart attack, drowning, strangulation, suffocation, electrocution, drug over dose, carbon monoxide poisoning or accident. It is a combination of mouth-to-mouth breathing and chest compressions. The primary objective is to deliver continuous flow of oxygen to the lungs and brain. CPR essentially buys time for the victim until AED and emergency care arrive. Early CPR is the second critical link in the Chain of Survival. What is an AED? An Automated External Defibrillator (AED) is a small portable electrical device that automatically analyses potentially life threatening cardiac rhythms in a patient and treats it by defibrillation, the application of an electrical shock, to allow the heart to re-establish normal rhythms. It is designed to be used primarily by first responders in cardiac emergencies who may not be fully trained in Advanced Cardiac Life Support (ACLS). Early defibrillation, the third critical link in the Chain of Survival, can greatly improve survival rates for out-of-hospital cardiac arrests caused by irregular heart rhythms (ventricular fibrillation). Defibrillation works best in the first few minutes after the onset of cardiac arrest. If it is initiated too late, the heart may not respond to the electric therapy. For every minute of delay in giving CPR and defibrillation following collapse, the survival rate decreases by 7-10%. |
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| Hypovolemic shock | The Heimlich maneuver |
Advanced Cardiac life support
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infant CPR | CPR Quiz |
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| Reset for the Sacroiliac (SI) Joint -- SI Joint Pain Relief | How to SAFELY Pop Your Sacroiliac Joint | Understanding Sacroiliac Joint Pain | SI Joint Pain? Piriformis Syndrome? 5 Exercises to Treat & Prevent | Sacroiliac Joint Pain: Diagnosis and Treatments | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| SI Joint Stability- Dr Kristie Ennis Best Exercises To Protect Your Joint | How I Healed My Back Pain and Sciatic Nerve Pain (Sciatica) | How To Know If You Have A Herniated Disc, Piriformis, Hip, or Sciatica Problem Without An MRI! | Sacroiliac Joint Pain: Diagnosis and Treatments | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sex - it's all in your head, really.
Contrary to popular belief, sexual arousal starts in your brain, not in the nether regions. Of course, hardwired into the human being's DNA is the instinct to have sex, which is Nature's canny way of propagating the species. The brain and private parts must then work in sync. 'There's a mind component however,' said Dr Peter Lim, the president of the Society Of Men's Health and a private andrologist. 'If a medicine is given to knock off the paraventricular nucleus - the brain's sex centre - you'll have no sex drive,' he said. To put it simply, the act of romantically sniffing each other - or even looking at an erotic image - sends sensory impulses to the paraventricular nucleus, stimulating your sexual urges. The brain's reward system, the ventral tegmental area, also encourages having sex by inducing feelings of pleasure. It is especially true for men. 'A man's most important sexual organ is his brain, not his pen-is,' said Dr Ng Kok Kit, a consultant in the department of urology, andropause and men's health clinic at Changi General Hospital. It is a little different for women. Beyond sexual impulses and hormonal influences, women require love, friendship and emotional intimacy from men before they get aroused sexually, said Professor Ganesan Adaikan, a clinical sexologist with the department of obstetrics and gynaecology at National University Hospital. What drives men and women to have sex Libido, or the sex drive, is primarily driven by hormones. Testosterone - present in both sexes - is the hormone that causes most of the changes in a boy's body during puberty. It is also what drives both men and women to have sex. Oestrogen, together with luteinizing hormone (LH) and follicle-stimulating hormone (FSH) - both stimulate the development of sexual organs in both sexes - is what causes a girl's body to mature and is necessary for maintaining a woman's libido. This is why kids turn into sex-starved teenagers when puberty hits and hormonal levels are ramped up. Men peak sexually between their teens and 20s, urologists and andrologists told Mind Your Body. Women usually enter their sexual prime when they are in their early 30s. Dr Michael Wong, the president of the Singapore Urology Association and medical director of Singapore Urology & Fertility Centre, pointed out that testosterone in a man usually stays high until he hits 40. Dr Brian Yeo, a consultant psychiatrist in private practice, explained the consequences of men starting out early in life with high testosterone levels: 'There's this thing with young men about how many women they've bedded. It's easier for men to have sex without emotional bonds. 'There are a lot more men searching for commercial (paid) or consensual sex than women. It's due to testosterone and the man's cultural background and upbringing.' After 40, a man's testosterone level drops between 1.2 per cent and 5 per cent every year. 'Testosterone production declines with age and, with that, a man's libido will drop. Frequency of intercourse and *censored* will decline too,' said Dr Gan Tek Kah, a general practitioner from Singapore Men's Health Clinic. Some 50 per cent of men aged 50 and above will have some degree of erectile dysfunction while 20 per cent of men older than 60 years have low testosterone levels, which may lead to loss of sex drive, erectile dysfunction and lethargy, among other symptoms. However, sperm is produced and replenished constantly so men can be fertile into their 60s or 70s. That is how it is with men - they generally peak early and fizzle out gradually. Women, on the other hand, hit their sexual stride in their late 20s or early 30s before their libidos crash after the age of 40 or menopause. Dr Peter Chew, a senior consultant obstetrician and gynaecologist at Peter Chew Clinic For Women, said: 'Sex can still be there after menopause but it declines with age. Women can still desire sex but they won't have sex so often.' Asked whether older folk can still have sex, Dr Yeo said: 'It's a slow burndown. It's possible to have sex but its frequency will not be as high as when you were a teenager. And your positions may have to be more conservative.' Cocktail of chemicals When a couple have sex, their bodies go through four phases: excitement, plateau, orgasm and resolution. Excitement, the first stage, is when desire and arousal occur. This is what happens in a man: He receives stimulation, which can range from the visual (in the form of an attractive partner) to the tactile (in the form of touch and stroking), and his brain sends out signals to his pen-is via the spinal cord. Neurochemicals like endorphins are produced and circulated in the whole body. Nitric oxide is produced by nerves in the pen-is and expands blood vessels there, enabling the spongy tissue of the pen-is to be filled with blood and thus becoming erect. In the woman, signs of sexual arousal include secretion of va-ginal fluid and erect nipples. A cocktail of chemicals, including oxytocin and dopamine, are released in a woman's body throughout sexual intercourse. The couple enters the plateau phase when sexual stimulation is more intense and orgasm is imminent. Breathing gets heavy and heart rates shoot up, and the lovers may experience sex flush, or red spots on the skin. Dr Christopher Chong, an obstetrician, gynaecologist and urogynaecologist from Chris Chong Women And Urogynae Clinic at Gleneagles Hospital, said: 'Sex hormones like testosterone, oestrogen and oxytocin are increased. This can cause a woman's breasts to swell and her womb to contract.' The womb contracts so as to *censored* in sperm for fertilisation. As orgasm approaches and with increased blood flow to the vag-inal area, a woman's clitoris swells and the inner lips of her vag-ina thicken while the outer lips flatten. Orgasm marks the sexual climax, comprising a series of involuntary muscle contractions accompanied by a sudden release of endorphins and a feeling of euphoria. In the man, orgasm involves rapid rhythmic contractions of the prostate, urethra and the muscles at the base of the pen-is, followed by the ejaculation of semen through the tip of the pen-is. Dr Ng said: 'Men usually have a single orgasm. Some men may report multiple orgasms but it's probably because they did not ejaculate completely the first time round.' In the woman, rhythmic muscular contractions in the uterus, outer vag-ina and an-al sphincter occur and may spread through her body. Initial contractions may occur at intervals of one second or less and subsequent ones may be spaced further apart. A mild orgasm can have three to five contractions while an intense one usually counts 10 to 15 contractions. After the orgasm, the body returns to its normal, unaroused state. Some women may experience several more orgasms before calming down. After ejaculation, the man enters a refractory phase, where the pen-is becomes flaccid and he cannot be sexually stimulated any further. Depending on the man's age, physical fitness and libido, the refractory period can range from 15minutes to one day. A study last year found that satisfactory sexual intercourse - from penetration until ejaculation - for couples lasts from three to 13minutes. The survey, which looked at the ideal length of time to have penetrative sex, was conducted by 34 American and Canadian sex therapists. The time does not count foreplay and the therapists rated sexual intercourse that lasts from one to two minutes as 'too short'. Professor Adaikan said a couple is at the peak of their love and intimacy, and hence sexual desire, between three months and two years into their relationship. Asked how he would define 'good sex', Dr Adrian Wang, a consultant psychiatrist at Gleneagles Medical Centre, said: 'Sex is not just for reproduction, it's an expression of love and commitment. 'However, men tend to see sex on a more basic, primal level and find the physical aspects of sex more gratifying. Women tend to emphasise more on the emotional and psychological components.' |
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How to Interpret a Calcium Score by MAURA SHENKER Last Updated: Feb 16, 2011
A coronary calcium scan, also known as a heart scan, measures the amount of calcium deposited in the arteries of your heart. The more coronary calcium you have, the higher your levels of plaque, which may lead to atherosclerosis, or the hardening and narrowing of your arteries. As less blood flows to your heart, you increase the risk of a cardiac event or heart attack. The use of calcium scores is controversial because they may not be useful to you if you fall into either a low- or high-risk category. Step 1 Determine if a coronary calcium scan would be useful for you. If you are under 55 years old, don't smoke, don't have high blood pressure or high cholesterol and have no family history of heart disease, you are considered a low-risk patient, and a heart scan probably won't tell you anything new. If you are over 65 and have a history of high blood pressure and high cholesterol levels, you are a high-risk patient, and the scan won't tell you anything you don't already know. Step 2 Understand the meaning of your Agatston score. The lower the score, the lower your risk of coronary heart disease. There are four categories of scores; less than 10, meaning minimal to no calcium was found, and those with scores of 11 to 99 who have a moderate amount of calcification. A score between 100 and 399 is classified as increased calcification and any score over 400 signifies extensive calcium deposits. According to the American Heart Association, if your Agatston score is over 1,000, you have a 20 percent chance of having a serious or fatal cardiac episode within one year of testing. Step 3 Make healthy lifestyle changes or discuss the possibility of a bypass, angioplasty or stent if your Agatston score is high. Stop smoking, follow a diet designed to lower high blood pressure and high cholesterol, and start an exercise program to reduce your risk of coronary heart disease. Your Calcium Scoring Test Results You will receive a preliminary report with your Calcium Scoring results before you leave your appointment. The CT Scan technologist and the radiologist will collaborate to assess your scan. A final report will be provided later after the radiologist completes a comprehensive analysis of the study. Description of Calcium Scoring Results Score 0: No evidence of plaque, which means there is a less than 5 percent chance you have coronary artery disease (CAD). Your risk of a heart attack is very low. Score 1-10: A small amount of plaque is noted, which means there is less than a 10 percent chance you have CAD. Your risk of a heart attack is low. You may want to improve your diet, get regular exercise and/or quit smoking. Score 11-100: Plaque is present, which means you have CAD, but you have only mild hardening in the coronary arteries. Your risk for heart attack is moderate. Talk with your physician about this result. Score 101-400: Plaque is present in a moderate amount, which means you have CAD and plaque may be blocking an artery. Your risk for heart attack is moderate to high. Your physician may recommend additional testing. Score over 400: Plaque is extensive, which means there is more than a 90 percent chance plaque is blocking one of your coronary arteries. Your risk for heart attack is high. Your physician will recommend additional testing. If you have a positive test result and do not have a regular physician, we will help you get an appointment with a physician who can evaluate your result and plan next steps\
Interpreting the Coronary-Artery Calcium Score To the Editor: The Perspective article on the coronary-artery calcium (CAC) score by Grayburn (Jan. 26 issue)1 warrants clarification. It states that “Guidelines vary on the question of whether [CAC is] indicated for screening asymptomatic patients at intermediate risk,” yet current guidelines2 give class IIa recommendations (i.e., the weight of evidence is in favor of usefulness or efficacy) for CAC scanning for intermediate-risk persons. Grayburn describes a study involving symptomatic patients to suggest that the CAC score does not sufficiently rule out obstructive coronary artery disease (CAD) or improve risk prediction in asymptomatic persons. In that study, reported by Villines et al.,3 a CAC score of zero had a negative predictive value of 99% for greater than 70% stenosis in 10,300 persons. In addition, the CAC score, as compared with the Framingham risk score, resulted in consistently better event prediction.2,3 Grayburn also states that “there have been no prospective randomized, controlled trials,” but the results of two studies have been reported. The St. Francis Heart Study Randomized Clinical Trial (involving 1005 patients) showed that statin therapy (atorvastatin at a dose of 20 mg per day) in patients with a CAC score above 400 resulted in a 42% reduction in the relative risk and a 6.3% reduction in the absolute risk of coronary events (P<0.05).4 The Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research study (EISNER; ClinicalTrials.gov number, NCT00927693)5 randomly assigned 2137 patients to undergo or not undergo CAC scanning. Patients assigned to CAC had improvements in blood pressure (P=0.02), cholesterol levels (P=0.04), waist circumference (P=0.01), and Framingham risk score (P=0.003) as compared with those assigned to no scanning. The patient described by Grayburn was reclassified with the use of the CAC score, and the treatment (adding aspirin and increasing the dose of rosuvastatin) was prudent and appropriate.
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HEPATIC CYST A hepatic cyst, also known as a liver cyst, is a fluid-filled sac that develops within the liver. These cysts are typically benign (non-cancerous) and are quite common, often occurring incidentally during medical imaging exams such as ultrasounds, CT scans, or MRI scans. Hepatic cysts can vary in size, ranging from very small to quite large. There are two main types of hepatic cysts: 1. Simple Hepatic Cysts: These are the most common type of liver cysts. They are typically filled with clear fluid and have thin walls. Simple hepatic cysts usually do not cause symptoms and are discovered by chance during medical imaging. In most cases, they do not require treatment and are considered harmless. However, if they become very large and cause discomfort, or if there's a concern about potential complications, medical intervention might be considered. 2. Polycystic Liver Disease: This is a genetic condition in which numerous cysts form in the liver. These cysts can grow over time and may lead to enlargement of the liver. Polycystic liver disease is associated with polycystic kidney disease, which involves the formation of cysts in the kidneys. This condition can sometimes cause symptoms like abdominal pain, fullness, or discomfort due to the size of the liver. Management may involve medical monitoring and, in some cases, medical intervention or surgery to address symptoms. Most hepatic cysts do not cause noticeable symptoms and do not require treatment unless they are causing discomfort, pain, or other complications. However, if you suspect you have a hepatic cyst or if you have concerns about your liver health, it's important to consult a healthcare professional for proper evaluation and guidance. They can perform the necessary tests and imaging to determine the nature of the cyst and recommend appropriate management options.
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Sacroiliac joint (SI joint) pain Sacroiliac joint (SI joint) pain typically occurs in the lower back and buttocks and can sometimes radiate to the hips and thighs. It is often described as a dull, aching pain, and it can range from mild to severe. The SI joint is located in the pelvis, connecting the sacrum (the triangular bone at the base of the spine) to the ilium (the large pelvic bone). SI joint pain can result from various causes, and the symptoms can vary from person to person. Here are some common symptoms and causes:
Diagnosing SI joint pain can be challenging because it often mimics other conditions like herniated discs or hip problems. A healthcare provider will typically perform a physical examination, review your medical history, and may use imaging studies like X-rays, CT scans, or MRI to confirm the diagnosis.
Here are some steps you can take to recover from SI
joint pain:
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EXPLANATION OF PATHLAB BLOOD SCREEN REPORT
This booklet on Pathlab Blood Screen is not meant to be comprehensive.
It provides some relevant information on the tests done and should make
interesting reading. FOR FURTHER INFORMATION, PLEASE CONSULT YOUR
DOCTOR. LIPID PROFILE TOTAL CHOLESTEROL High blood cholesterol is due either to excessive intake of cholesterol rich food or increased production by the liver. High blood cholesterol leads to increased deposition in the wall of blood vessel (atherosclerosis) resulting in narrowing and subsequently blockage. When that happens in the heart, a heart attack results and when it happens in the brain, the result is a stroke. Cholesterol levels above 200 mg/dl is associated with increased risk of atherosclerosis and this risk rises with increasing levels. Low cholesterol level is seen in thyrotoxicosis and liver disease. HDL-CHOLESTEROL This type of cholesterol is the “good cholesterol” as it helps to remove cholesterol from the tissue and transport it to the liver for excretion. Therefore for HDL cholesterol,the higher the level the better it is for the body. High level of HDL cholesterol is associated with women before menopause because of the female hormone. All can increase their levels by doing regular exercise (30 minutes 3 times a week). Smoking of cigarettes will lower the level of HDL cholesterol. HDL cholesterol is produced by the liver. TOTAL CHOLESTEROL/HDL-CHOLESTEROL RATIO This ratio evaluates the effect of cholesterol on atherosclerosis and coronary risk.The lower the ratio, the lower will be the risk. When the ratio is high, examine the total cholesterol and HDL-cholesterol values to see if one or both are at fault. LDL-CHOLESTEROL This is the “bad cholesterol” as it helps in the deposition of cholesterol in the wall of blood vessels. High levels of LDL-cholesterol is a major risk factor for atherosclerosis.LDL-cholesterol levels can be lowered by reducing the intake of cholesterol rich food and regular exercise. TRIGLYCERIDES This type of fat is also found in the fat tissue of the body and is a major source of energy. Excess calories from consuming too much sugar, starchy and oily food and lack of exercise are converted to triglycerides resulting in high blood levels and obesity.Triglycerides are also deposited in the wall of blood vessels and high blood levels are associated with increased atherosclerosis and coronary risk. LIVER PROFILE TOTAL BILIRUBIN This is a yellow pigment produced by the breakdown of red blood cells and excreted by the liver. Blood levels above 2 mg/dl will lead to jaundice (yellowness of the eyes and skin). High blood levels are associated with liver diseases and blood disorders. ALKALINE PHOSPHATASE This is an enzyme produced by bone and liver cells. High levels are seen in some bone disorders and liver disorders like obstructive jaundice, gall stones and cancer. In these conditions other abnormal blood tests are also present as well. Levels up to 3times the adult level are seen in children when they are rapidly gaining height and is normal. SGPT This enzyme is present in high concentration in liver cells. When liver cells die, SGPT is released into the blood resulting in high blood levels. The level is related to the amount of liver cells involved. In acute hepatitis, SGPT is usually more than 10times the normal range. SGOT This enzyme is present in cells of many organs like liver, heart, skeletal muscle and blood cells. High blood levels are associated with cell destruction in the organs like acute myocardial infarction (heart attack) and hepatitis. GGT This liver enzyme is particularly useful in detecting damage to the liver due to alcohol and drugs. Heavy drinkers who have liver damage will have high blood levels. TOTAL PROTEIN This is the sum total of albumin and globulin. Abnormal blood levels may be due to increase in albumin, globulin or both. ALBUMIN This protein is produced by the liver. Low levels are seen in severe liver disease due to reduced production or kidney disease due to loss of albumin in the urine. GLOBULIN This complex group of proteins have many diverse functions. One important component is immunoglobulins which are antibodies used to fight infections. High levels indicate the presence of chronic illnesses or infections and very high levels are seen in multiple myeloma. HBs Ag (HEPATITIS B SURFACE ANTIGEN) HBs Ag is a part of the capsule of the hepatitis B virus and if positive represent hepatitis B infection. If the liver enzymes are normal, the person is a carrier of hepatitis B. If the enzymes are high for months, that person is suffering from chronic hepatitis B. Both groups have a higher risk of liver cancer than the normal population. HBs Antibody (HEPATITIS B SURFACE ANTIBODY) A person who recovers completely from a hepatitis B infection or had a successful hepatitis B immunization will have HBs antibody. The level of HBs antibody will decrease with time. Those who acquire the HBs antibody through immunization will require a booster dose if the level falls below 10 mIU/ml. HAV Antibody (HEPATITIS A IgG ANTIBODY) Hepatitis A is acquired by taking food or drinks which are contaminated with faecal matter from an infected person. The majority of patients will recover and the disease does not become chronic as in hepatitis B. Those who had recovered will be positive for HAV antibody and be protected from future infection with hepatitis A. KIDNEY PROFILE UREA Blood urea is the major “end-product” of protein metabolism and is excreted from the body by the kidneys. Levels slightly above normal are seen in persons on a high protein diet or after prolong fasting. High levels are seen in kidney diseases. CREATININE Blood creatinine is produced by the normal turnover of muscles and excreted by the kidneys. It is influenced by the muscle mass of a person but not by dietary factors.High levels are seen in kidney diseases. ELECTROLYTES (Bicarbonate, Potassium, Sodium & Chloride) Blood levels of the electrolytes depends on the balance between intake and production on the one hand and excretion by the kidney on the other. Abnormal values are usually seen in patients with kidney disorders. Medication for hypertension and heart diseases can effect the electrolyte levels. ENDOCRINE PROFILE GLUCOSE Blood glucose level is controlled by the hormone Insulin and levels above the normal range indicate the presence of diabetes mellitus. An additional test called the Glucose Tolerance Test (GTT) is indicated to confirm the diagnosis and assess the severity. FREE T4 This hormone is produced by the thyroid gland and regulates the metabolic processes of the body. High levels are seen in the disease Hyperthyroidism. Patients with this condition will experience weight loss, tremor of hands, anxiety and increased sweating. Hypothyroidism (low levels) is due to reduced production by the gland and results in slowing down of metabolism with mental dullness, physical slowness and weight gain. The gland can be enlarged due to cysts or cancer and the level of Free T4 may or may not be affected. BONE & JOINT PROFILE CALCIUM Calcium is necessary for strong bones and teeth, normal clotting of blood and muscle contraction. Low levels are due poor dietary intake and a number of medical conditions. Milk and calcium tablets are good sources of calcium. PHOSPHATE Phosphate is primarily involved in bone metabolism. High levels are seen in normal children with active bone growth. Patients with kidney failure or bone disease also have high phosphate level. URIC ACID Uric acid is formed from the metabolism of nucleic acid. Blood levels depend on the balance between dietary intake and synthesis by the cells and excretion by the kidney. High uric acid levels will lead to gout, urinary stones and kidney disease. Treatment of high uric acid should include reducing intake of high protein diet (eg. internal organs and fish roe), soya bean products and alcohol. R. A. FACTOR (RHEUMATOID ARTHRITIS FACTOR) Rheumatoid arthritis is a severe form of joint disease affecting mainly the joints of the hands and feet. The diagnosis of rheumatoid arthritis depends on the presence of symptoms and signs of joint disease and a positive R. A. Factor test. A small percentage of patients may be negative for the test and the test may be positive in some diseases other than rheumatoid arthritis. CANCER & CANCER MARKERS
Cancer occurs when cells in the body escape the control of the body and
begin to multiple and grow. They grow very quickly and to very large
size. In the process,they destroy normal cells, block the function of
normal organs, cause pain and bleeding and finally kills the person. Any
cell in the body can become cancerous and some things can increase the
chance of the cell becoming cancerous. Examples are smoking in causing
lung cancer and hepatitis B in causing liver cancer. Although cancer
cells grow quickly, it still takes many months for the original cancer
cell to grow to a large size and finally kill the person. Early
detection of cancer means the cancer is detected when it is still small
or it has not spread to the rest of the body. Surgery can remove a small
cancer completely and produce a cure. In all cases, early detection
means early treatment and better chance of survival.
CANCER MARKERS Every year, more and more cancer markers are discovered. In order to use and benefit from cancer markers, we must bear in mind the following.
Some common cancer markers
VENEREAL DISEASE PROFILE VDRL & TPHA TEST VDRL test is a very sensitive test for detecting syphilis infection (one of the many venereal disease). However, positive tests are also encountered in some patients with common viral infections and autoimmune diseases. If the VDRL test is positive, the confirmatory test, TPHA must be performed. Only when both the tests are positive isthe diagnosis of syphilis confirmed. HAEMATOLOGY HAEMOGLOBIN, RBC & PCV Haemoglobin, the red pigment in the red blood cells is essential for the transport of oxygen to the tissue. If the level is below the normal range, the person is anaemic,looks pale and tires easily. Severe anaemia can lead to heart failure. Anaemia can be due to (a) decreased production of normal red blood cells (b) lack of essential nutrients like iron and (c) hereditary disorders like thalassemia. Each of these will have features which can help the doctor make the diagnosis. Additional tests are needed to confirm the diagnosis. WHITE BLOOD CELLS & DIFFERENTIAL COUNT White blood cells acts as soldiers and scavengers in the body and are mobilised to fight against infection or remove waste debris. Different white blood cells play different roles; neutrophils against bacterial infection, lymphocytes against viral infection, monocytes act as scavengers and eosinophils against parasitic infections and allergic conditions. White blood cells will change in numbers and types of cells in response to the infective agent. Sometimes abnormal cells called atypical mononuclear cells(AMC) are also present. When leukemia (cancer of blood cells) occur, the number of white blood cells will be markedly increased and immature cells called blasts will replace the normal cells. When no mention is made of these cells in the report, theyare not detected. PLATELETS Platelets are small cytoplasmic fragments of the megakaryocytes which are found in the bone marrow. They play a major role in normal blood clotting and bleeding prevention. Platelet count below 50,000/cmm is associated with prolonged clotting and bleeding times, bleeding into the skin and tissue and is seen in patients with leukemia, ITP and dengue hemorrhagic fever. ESR (ERYTHROCYTE SEDIMENTATION RATE) Blood is made up of the cellular component and the liquid component called plasma.If blood is left to stand, the cellular component will sediment and the amount it settles in 1 hour is the ESR. Many factors can influence the ESR. In general, the higher the ESR, the higher the chance of a chronic disease. Investigations are then needed to find the disease. PBF (PERIPHERAL BLOOD FILM) A thin smear is made of the blood, stained with special dye and examined under the microscope. The normal red blood cells are described as normochromic (normal colour) and normocytic (normal size). Any variations from the normal will be duly described.The significance of abnormal cells has to be interpreted in conjunction with the rest of the blood tests. No early cells seen means that there is no leukemia. BLOOD GROUPING ABO and Rhesus are the two commonly used method of typing the blood. Under the ABO system, the blood can be A, B, AB or O. The percentage of the different ABO groups in the population is approximately A(23%), B(23%), AB(5%) and O(49%).Rhesus grouping is reported as Positive or Negative. Rhesus grouping becomes important when a Rhesus Negative woman becomes pregnant with a Rhesus Positive baby. But with modern medical treatment, this is not a problem provided the diagnosis is made early. Blood grouping is important when a person requires a blood transfusion. There is no such thing as a “bad” blood group. URINE FEME Urine is produced by the kidneys from blood flowing through them. It therefore reflects conditions in the blood, kidneys and urinary tract. The findings in the urine is also influenced by the things we eat and drink. REACTION (pH) The urine can be acidic or alkaline depending on the food we take and the time of the day the sample is taken. The types of crystals detected in the urine will vary with the reaction of the urine. GLUCOSE Glucose in the urine is commonly seen in patients with diabetes mellitus and the harmless condition called renal glycosuria. Blood glucose test is necessary to confirm diabetes mellitus. PROTEIN Protein in the urine usually indicates the presence of kidney disorder and should be present in every urine sample. Small amount of protein may be present in concentrated urine of normal person and also after strenuous exercise. KETONES Ketones are present in urine of persons after acute starvation or patients with severediabetes mellitus. BLOOD Blood in the urine usually comes from the kidney and urinary tract. When associated with pain, stones is the likely cause. Painless blood in the urine could be due to cancerous growths. In female, blood from menstruation can sometimes contaminate the urine sample. URINE MICROSCOPY RBC (RED BLOOD CELLS) This is equivalent to blood in the urine. Counts of less than 10 per HPF is usually of little significance. WBC (WHITE BLOOD CELLS) Counts of less than 10 per HPF can be found in normal urine. Infections in the kidney and urinary tract are associated with markedly increased counts. A culture test will be required to detect the nature of the infection. EPITHELIAL CELLS They are cells lining the urinary tract. Occasionally cancers of the kidney or urinary tract is associated with abnormal epithelial cells in the urine. High counts in female urine suggest contamination from vaginal discharge. CASTS Casts are formed in the kidney tubules from protein filtered from the blood. They are present in the larger numbers in kidney disorders associated with protein the urine. A few casts may be seen in urine of normal people especially after exercise. CRYSTALS The urine contains many substances in solution and depending on the reaction of the urine, they can become insoluble and form crystals. If crystals are present in large amounts and for prolonged periods, stone formation may occur. ADDITIONAL TESTS HIV ANTIBODY TEST Persons infected by the HIV viruses will produce the antibody after 3 to 4 weeks time. However, this antibody cannot affect the virus and therefore cannot protect the patient. It only serves as a marker of infection. HIV antibody positive persons can remain well for years before the onset of symptoms and signs of the disease AIDS.
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