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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). 

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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
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Exercises For SI Joint Pain Relief

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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.'

 
 

How to Interpret a Calcium Score

by MAURA SHENKER Last Updated: Feb 16, 2011

Patient speaking to doctor in an office. Photo Credit amanaimagesRF/amana images/Getty Images

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.

 

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.

Cholesterol levels: What numbers should you aim for?Cholesterol levels: What numbers should you aim for?

 

 

 

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:


Symptoms of SI Joint Pain:
1. Lower back pain: The pain is typically felt on one side of the lower back and can sometimes extend to the other side.
2. Buttock pain: Discomfort or pain in the buttocks, usually on one side.
3. Hip pain: Pain may radiate to the hip and sometimes down the leg.
4. Pain during activity: Pain often worsens with activities like walking, climbing stairs, or standing for extended periods.
5. Pain while sitting: Discomfort can also occur when sitting for prolonged periods.
6. Stiffness and muscle tightness: The affected area may feel stiff, and the surrounding muscles might become tense.
7. Radiating pain: Pain may radiate to the groin or the upper thigh, resembling other conditions like sciatica.
Causes of SI Joint Pain:
1. Trauma: Injuries, falls, or accidents can disrupt the normal functioning of the SI joint, leading to pain.
2. Arthritis: Osteoarthritis or ankylosing spondylitis can cause inflammation and degeneration of the SI joint.
3. Pregnancy: Hormonal changes and increased joint laxity during pregnancy can lead to SI joint pain.
4. Gait abnormalities: Abnormal walking patterns can place stress on the SI joint.
5. Inflammatory conditions: Conditions like rheumatoid arthritis or psoriatic arthritis can cause SI joint inflammation.
6. Leg length discrepancy: When one leg is shorter than the other, it can affect SI joint function and cause pain.
7. Infection: Rarely, infections in or around the SI joint can lead to pain.
 

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.


Treatment for SI joint pain can vary depending on the underlying cause but may include physical therapy, anti-inflammatory medications, corticosteroid injections, and in severe cases, surgical interventions. If you suspect you have SI joint pain, it's important to consult with a healthcare professional for an accurate diagnosis and treatment plan.
Recovery from sacroiliac joint (SI joint) pain depends on the underlying cause and the severity of the condition. Treatment may involve a combination of self-care measures, physical therapy, and, in some cases, medical interventions.

 

Here are some steps you can take to recover from SI joint pain:
1. Diagnosis: Seek a proper diagnosis from a healthcare professional, such as a physician or orthopedic specialist. Accurate diagnosis is crucial to determine the cause of your SI joint pain and the appropriate treatment.
2. Rest: Resting is often the first step in managing SI joint pain. Avoid activities that exacerbate the pain, such as prolonged standing, walking, or heavy lifting. Give your body time to heal.
3. Ice and Heat: Apply ice or heat to the painful area. Ice can help reduce inflammation and numb the pain, while heat can relax tight muscles. Apply for 15-20 minutes at a time, with a cloth or towel as a barrier between the ice or heat source and your skin.
4. Medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, can help reduce pain and inflammation. Follow your healthcare provider's recommendations and use these medications as directed.
5. Physical Therapy: A physical therapist can design an exercise program to strengthen the muscles around the SI joint and improve joint stability. They may also teach you techniques to improve your posture and body mechanics.
6. Stretches: Perform gentle stretching exercises to maintain flexibility and reduce muscle tightness in the area. Common stretches include piriformis stretches, hamstring stretches, and hip flexor stretches.
7. Core Strengthening: Strengthening your core muscles can help stabilize the SI joint. Exercises like planks and bridges can be beneficial.
8. Supportive Devices: A sacroiliac belt or support brace can provide extra stability to the SI joint and help alleviate pain during daily activities.
9. Lifestyle Modifications: Avoid activities that exacerbate the pain, maintain good posture, and be mindful of your body mechanics when lifting or performing physical tasks.
10. Injections: In some cases, your healthcare provider may recommend corticosteroid injections into the SI joint to reduce inflammation and provide pain relief. These injections are typically done under image guidance for accuracy.
11. Regenerative Therapies: Some people benefit from regenerative therapies like prolotherapy or platelet-rich plasma (PRP) injections to stimulate healing in the SI joint.
12. Surgery: Surgery is typically considered a last resort and is reserved for severe cases where other treatments have failed. Surgical procedures for SI joint pain may include joint fusion or denervation.


It's important to work closely with your healthcare provider to develop a personalized treatment plan based on the specific cause and severity of your SI joint pain. Recovery can take time, so be patient and diligent in following your recommended treatment plan. Additionally, maintaining a healthy lifestyle, including regular exercise and a balanced diet, can contribute to overall joint health and pain management.
 

 
 
 
 
 

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.

For each test, you are supplied with your result and the normal range of that test. The normal range of a test will cover 95% of normal people. Thus 5% of the results can be slightly above or below the normal range and occur in normal people. The value of the test will fluctuate from time to time but always within the normal range if the person is not sick.

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.

Signs and symptoms of cancer

  1. As the cancer grow in size, it will produce a lump or cause the organ in which the cancer cells are growing to enlarge. In all cases, the lump or organ will get bigger and bigger.

  2. When the cancer cells press or invade normal tissue, there will be pain and the pain will get worse and worse.

  3. Cancer cells grow rapidly and use up nutrients meant for normal cells. This result in weight loss, a decrease in the number of normal cells and abnormal functioning of normal cells.

  4. When cancer occurs in a hollow organ like the stomach and intestine, it will grow into the lumen of the organ causing obstruction and bleeding. In the stomach, it will cause vomiting while in the intestine, it will lead to constipation.

  5. Some types of cells produce abnormal substances or normal substances in large amounts when they become cancerous. These substances are called cancer markers and they help in the identification, early detection and monitoring of the treatment of the cancer.

  6. The detection of cancer depends on how quickly the cancer causes signs and symptoms or makes itself known through the production of cancer markers. In general, cancers in organs within the abdomen are usually detected late because they can grow to a large size before they are noticed.

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.

  1. Not all cancer cells produce cancer markers. Therefore, the absence of cancer markers or normal levels of cancer markers cannot exclude the presence of cancers.

  2. There is at present no one cancer marker for all cancers. As cancer markers are specific to the type of cells and these cells are present in different organs, the same cancer marker can be present in cancers of these different organs.

  3. When a cancer marker is present at a very high level, it is almost certain that a cancer is present in the body.

  4. As cancer markers can be produced by cells when they are affected by conditions other than cancer, slight increase in the level of cancer markers do not necessary mean the presence of cancer.

  5. As cancer cells grow rapidly and continuously, the amount of cancer markers produced will increase and increase very rapidly. By monitoring the increase in the level of cancer markers over time, cancers can be separated from non-cancerous conditions producing a slight increase in cancer markers.

  6. Cancer markers are very useful in monitoring the effective treatment of cancer that produce cancer markers. The level of the cancer marker is determined before treatment and repeated at each stage of the treatment.

Some common cancer markers
Alpha-fetoprotein
Main organ: liver
Other organs: testis, ovary

Beta HCG
Main organ: choriocarcinoma
Other organs: testis, ovary

CA 15.3
Main organ: breast
CA 19.9
Main organ: pancreas
Other organs: intestine, stomach

CA 125
Main organs: ovary
Other organs: liver, lung, intestine

Carcinoembryonic Antigen (CEA)
Main organ: intestine
Other organs: stomach, pancreas, breast, bronchi

EBV EA + EBNA-1 IgA
Main organ: nasopharynx

Helicobacter pylori antibody
Main organ: stomach

Prostatic Specific Antigen (PSA)
Main organ: prostate

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.