Diagnostic tests for dengue
The epidemic arbor viral disease “DENGUE “is caused by an infection with 1 of the 4 stereotypes of virus called Flavivirus. This arthoropod borne illness is predominantly transmitted by mosquitoes of genus Aedes ( Aedes albopictus , Aedes aegypti). Historically this illness was documented in the Chinese encyclopedia of symptoms during chin dynasty (CE 265 – 420). First outbreak of dengue has been recorded in 1635 in west indies , as the time flew this illness became more epidemic gaining new names in accordance with its occurrence (1779 – 1780) as “Break bone fever” in Asia, North America, Africa and ” Dandy fever” in regions of East Africa ( 1820).
Incubation period of dengue is 3 – 14 days and the symptoms may begin after the 2 weeks of transmission. Progression of this illness can be categorized into initial dengue in which symptoms like”Dengue triad “(Fever, headache, rash) can be seen and the severe dengue stage shows dengue hemorrhagic syndrome, dengue shock syndrome. Both of these severe stages include maculopapular rash on the skin, myalgia, vomiting, arthralgia, altered taste sensation, dehydration. Early detection of this disease is less harmful and can be cured effectively where as if left untreated may even lead to fatal risk of life, death.
DIAGNOSIS:
Various sophisticated techniques have been developed these days which are more efficient in diagnosing it. Serological diagnosis has been cardinal in early stages of dengue in which the amount of antibody titers including IgM and IgG are checked in paired serum samples. Viral genome sequences in autopsy, serum, cerebrospinal fluid can be diagnosed using RT-PCR (reverse transcriptase polymerase chain reaction). NS1 (Nonstructural protein) test along with Immunofluorescence essays like MAC –ELISA test are more popular in early detection of illness. In patients suspected with dengue significant low levels of WBC, neutrophils, and platelet counts are seen hence complete blood picture can rule this out. Hematocrit level are known to rise up to 20% hence for every 24 hours, these levels are to be monitored. Coagulation studies include testing prothrombin time, activated partial thromboplastin, fibrinogen levels. Ultrasonography is recommended to rule out the suspicion of pleural effusion and thickened urinary bladder in case of dengue hemorrhagic fever. In case of early coagulation guaiac testing is done followed by typing and cross matching of blood ( In dengue shock syndrome ) .Complete urine examination tests , CSF test , should be done in order to exclude or confirm patient condition of body fluids .Biopsy of skin lesions may reveal any abnormality in blood vessels. Head computed tomography is performed to check any intra cranial bleeding in case of dengue hemorrhagic fever. PRNT (plaque reduction neutralization test) is used to determining the type of stereotype of virus causing dengue in which the serum sample is diluted with viral suspension and the amount of plaque formation units are measured. This quantifies titer of neutralizing antibodies for a virus.
Diagnostic tests for HIV
HIV/AIDS also called as Human immunodeficiency virus/Acquired immune deficiency syndrome. One of the most dangerous STD’s, significantly challenging the gobal world with its devastating effects.HIV is caused by the “LENTI”virus[a class of retrovirus].HIV virus mainly acts on the imunne system of the body,by attacking the CD4 cells.Destruction of these cells results in the loss of defensive actions aganist various types of infections.Over the time,HIV leads to AIDS[Accquired immune deficiency syndrome]. If HIV is left untreated,it leads to AIDS stage.Well,early detection of the infection,using appropriate diagnostic tests helps the patients to live longer with the infection, without reaching to the AIDS stage.
The diagnostic tests for HIV includes;ELISA,westernblot test,polymerease chain reaction,[NAT test].ELISA is the primary test for HIV detection,if it is found to be positive,then western blot test is preffered for the further confirmation.If the ELISA is negative,then the individual should be retested again after a month.While PCR is a technique used to detect virus in the body,which is accurate method.Some of the other tests include antigen tests,antigen-antibody combinations.
ELISA:
Enzyme linked immune sorbent assay,was the first diagnostic test employed for the HIV. It has a high sensitivity.It involes the immune system component i,e.antibodies[igG,igM].Firstly serum from the person is collected,and it is diluted upto 400 folds.The diluted serum is applied on the plate to which HIV antigens are attached.If the person is having HIV antibodies,they may bind to the antigens.Then the plate is washed to remove the all other serum components.”SECONDARY ANTIBODY”-an antibody that binds to the human antibodies itself,is applied to the plate followed by another wash.This secondary antibody is chemically linked to enzyme.Thus the secondary antibody bound to the plate is in proportion with the enzyme on the plate.A substrate is added for the enzyme,and the catalysis by the enzyme leads to fluorescene or in colour of the substances.The most controversial aspect of this test is determining the”cut-off” point between a positive and negative result.
WESTERN BLOT:
Similar to the ELISA,western blot is also an antibody detection test.But unlike ELISA, first the viral proteins are separated and immobilised.Binding of serum antibodies to specific HIV proteins is visualised.
Specific cells of HIV infection are opened and the proteins within are palced into a slab of gel,to which the electric current is applied.Different proteins have different speeds, depending on their size.While the electric charge is levelled by a sodium lauryl sulphate, surfactant. Once the proteins are well separated,they are transferred to the membrane and the further process is continued similar to ELISA.The diluted serum is applied to the membrane and the antibodies in the serum may attached to the the HIV proteins.Antibodies that are not attached are washed away,where as the enzyme linked antibodies attaches to the secondary antibodies and determines to which HIV proteins the person is having antibodies.Commercially prepared western blot test kits contains the HIV proteins alredy on a cellulose acetate strip.
There is no particular specific criteria for interpreteting the western blot results.The number of viral bands present may vary.If viral bands are detected,then the test result is negative.If atleast one viral band is detected for each of the GAG,POL,and ENV gene product groups,then the reult is positive.But the 3-gene product approach of interpretation is NOT For clinical practice.For tests in which less than the required number of viral bands are detected,they are reported as indeterminate.Persons with the indeterminate results are retested for the conclusive results.Almost all the persons with the indeterminant results are found to develop a positive result.
The HIV proteins used in western blotting can be produced by using recombinant DNA techniques called recombinant immunoblot assay[RIBA].
If no antibodies are detected to HIV,that doesn’t mean the person has not be infected.It may take several months for infection to show antibody response of detectable levels. Rapid testing for antibodies to HIV will not give a indicative of true infection.In most the cases,it takes two to six weeks to reach a detectable level of infection.Even these tests are having the high speficity,false positives may do occur.The positive results should be confirmed by using a lab western blot test.
Even ELISA is having high probability to diagnose HIV,it can’t be used alone,should not be reported as ‘positive’ unless confirmed by a western blot.
Rare false results are due to factors unrelated to HIV,found to be more often with the ELISA than western blot.False positives may be asosicated with the medical conditions such as recent acute illness and allergies.
PCR:
Polymerease chain reaction is used to detect genetic material i,e. RNA.It is used for the amplification of the DNA sequences. PCR technique is developed by KARY MULLIS in 1983 and wsa awrded nobel prize in 1993 in chemistry.
The basic underlying principle in PCR is’extensive modifications can be done to perform the wide array of genetic manipulations.Generally PCR employs a originally isolated heat-stable polymerease enzyme i,e. TAQ POLYMEREASE.This polymerease enzymatically assembles a new DNA strands,using single stranded DNA as template.This method is also known as VIRAL LOAD TEST.Viral load assays measure HIV-RNA from virus particles in the blood plasma.This test is also called NUCLEIC ACID TEST [NAT].IT is of 2 types DNA-PCR,RNA-PCR.
DNA-PCR: Used for screening of babies of HIV+ mothers
RNA-PCR: Used to screen blood donations, organ donations.
PCR tests have been developed that can detect the infection,as little as one viral genome among the DNA of vast group of host cells.Infections can be detected earlier. The donated blood can be directly screened for the virus.Unlike ELISA and western bloting, used for antibodies detection,PCR is is more accurate with early detection.
PCR can be used for the earliest detection,but ELISA and western blot are not effective in early detection,as the antibodies takes time to appear in the circulation.
Diagnostic tests for typhoid
Typhoid fever is caused by Salmonella typhi, a Gram-negative bacterium. S. Typhi has several unique features and the genetic basis of many of which is known as a result of early genetic studies and the recent sequencing of the whole genome. The bacteria S. typhi can be identified in the laboratory by several biochemical and serological tests prevalent for its detection.
During an acute infection, the bacterium S. Typhi multiplies in mononuclear phagocytic cells before being released into the human bloodstream. The typhoid organisms pass through the pylorus and reach the small intestine, these bacteria rapidly penetrate the mucosal epithelium either through microfold cells or enterocytes and arrive in the lamina propria.
The Clinical illness is accompanied mainly by a fairly sustained but low level of secondary bacteraemia in the blood.
There are Many factors that also influence the severity and overall clinical outcome of the typhoid infection. They mainly include the duration of illness before the initiation of appropriate medical therapy, the proper choice of antimicrobial treatment, age, also the previous exposure or vaccination history, the changed virulence of the bacterial strain, the total quantity of inoculum ingested and host factors
Types of diagnostic tests:
- Specimens: For the blood culture it is essential to inoculate the media at the time of drawing blood from the patient. Once the specimens have been inoculated, blood culture bottles should not be kept cold. They should be incubated at 37°C and in tropical countries be left at room temperature, before being processed in the laboratory for results.
- Blood: The blood cultured is the primary factor in the isolation of S. Typhi from typhoid patients as the children have higher levels of bacteraemia than adults. The Blood has to be collected by using the highly sterile technique of venous puncture and inoculated immediately into a blood culture collection sample bottle with the same syringe that has been used for collection and further contamination should be prevented.
- Serum: For tests regarding serological purposes, 1 to 3 ml of blood should be inoculated into a tube without anticoagulant. A second sample of blood serum should be collected at the convalescent stage, mostly 5 days later. After blood clotting has occurred the serum should be separated again and stored in aliquots of 200 ml at +4°C. The sample Testing has to be taken place immediately if then the storage can continue for a week without affecting the antibody present. The serum should be frozen at -20°C if longer-term storage is required for preventing any contamination.
- Stool samples: in some cases, even Stools can be collected from acute patients and they are especially very useful for the diagnosis of typhoid carriers. The isolation of S. Typhi from stools is suggestive of typhoid fever. These Stool specimens should be collected in a sterile wide-mouthed plastic container. The chances of obtaining positive results increase with the stools collected. Specimens should preferably be processed within two hours after sample collection. A stool culture may increase the total yield of culture-positive results by up to 5% in acute typhoid fever.
Liver cancer
Cancer begins when the healthy body cells change and grow out of control, from a tumour. This tumour can be both benign and malignant. 80% of primary liver cancer is hepatocellular carcinoma. the other types of cancer include bile duct cancer, and angiosarcoma, defined as the cancer of the blood cells in the liver. Hepatocellular carcinoma begins in hepatocytes, the main functional cells of the liver.
A rare type of liver cancer occurring in young patients is the fibrolamellar carcinoma, grows more invasively, characterized by a prominent central scar, diagnosed by imaging techniques.
The types include:
- Tumour developing in the liver, but have originated from another organ like colon, stomach, ovary, they are called liver metastasis or secondary liver cancers
- Cancers starting in the blood cells of the liver are called angiosarcomas and hemangiosarcomas
- Cancer originating in the bile duct of the liver are called cholangiocarcinomas
- Tumours called hepatoblastomas occurs majorly in infants and children.
The median age of liver cancer in Asia and Africa is 40-50 years.
CAUSE OF LIVER CANCER
Liver cirrhosis is related as the primary reason for liver cancer, as after the liver is affected by cirrhosis, the tissue of the liver is lowly modified at the expense of normal liver cells which consists more of fibrous and scar tissue, hence increasing the probability of tumour growth.
The risk factors involved in liver cancer are :
- Chronic infection with the hepatitis-B virus(HBV) or hepatitis-C virus (HCV): chronic infection when the virus remains in the blood for more than 6 months, causing the decline in the functioning of the liver cells. It affects 50% of the world population for cancer of the liver.
Hepatitis B infection causes liver cancer immediately without cirrhosis, increasing the risk up to 100 fold, while HCV increases the risk up to 17 fold.
- Long-term alcohol abuse: leading cause of liver cirrhosis and liver cancer. Alcohol intake when suffering from hepatitis increases even more.
- Inherited liver conditions: conditions like haemochromatosis which is a higher absorption of iron from food, deposits in every organ or alpha-1-antitrypsin deficiency a protein depositing in every part abnormally, increases the risk of liver cirrhosis and cancer.
- Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis, affect the liver like cirrhosis
- Medical conditions like autoimmune hepatitis, intrahepatic biliary inflammations and Wilsons disease are the serious factors affecting liver leading to cancer,
- Gender: live cancer is 4-8 times common in men than women
- Toxic agents exposure: anabolic steroids, increases the risk of hepatocellular adenoma. Intake of aflatoxin-contaminated food, causes DNA mutations in liver DNA cells, leading to cancer cells.
DIAGNOSIS OF LIVER CANCER
- Ultrasound tests to detect nodules, visible on imaging, determine the type of a tumour based on size.
- Blood test: for alfa-fetoprotein detection, higher levels indicate last stage liver disease.
- Biopsy: to determine the type of benign or cancerous liver cells.
SYMPTOMS OF LIVER CANCER
- Sudden weight loss
- Fatigue
- Loss of appetite after small meal
- Enlarger liver felt as a mass under the ribs on right side
- Enlarged spleen, mass felt on the left side under ribs
- Yellowing of skin and eyes-jaundice
- Swelling and fluid buildup in the abdomen
- Pain in the abdomen, near the right shoulder blade
TREATMENT OPTIONS FOR LIVER CANCER
- Resection of a tumour by surgery
- Liver transplantation
- Local ablation methods
Fatty liver: Causes, diagnosis and treatment
Fatty Liver
The fatty liver disease is defined as a liver condition due to the fat accumulation of fat in the liver. It does not cause severe pain, unlike other liver diseases. It rarely causes pain, does not cause nausea or fatty food intolerance, but can sometimes indicate other health problems.
Fatty liver is not caused simply by eating fatty foods. It is associated with health problems.
Non-alcoholic fatty liver disease (NAFLD) has become progressively more common in comparison with the increasing frequency of obesity and other components of the metabolic syndrome and it is predictable to be the leading sign for liver transplant within the decade.
Fatty liver is a reversible circumstance that can often be resolved with lifestyle modifications. In many cases, fatty liver has veto symptoms. It doesn’t usually cause permanent damage unless it progresses.
Fatty liver can become harmful to the liver if its underlying cause isn’t recognized and treated.
NAFLD is referred to the most common kind of fatty liver disease. This can result in liver damage later particularly when fat accumulation in the liver progresses with severe inflammation
NASH is a chronic disease in which accumulated fat in liver cells causes liver inflammation. The condition very slowly gets worse which is more likely to be a problem if the patient also has another liver disease, such as hepatitis C or B, or if the patient drinks too much alcohol. In some individuals, NASH may gradually progress to scarring of the liver and to more serious chronic liver disease, such as cirrhosis.
NASH typically occurs in citizens who are overweight and diabetic, with high blood cholesterol and triglyceride levels. The patient should therefore minimize or control as many as possible of these risk factors.
Causes
- a poor appetite
- weight loss
- abdominal pain
- physical weakness
- fatigue
- confusion
- an enlarging, fluid-filled abdomen
- jaundice of the skin and yellowing of the eyes
- Confusion
- a tendency to bleed more easily
Causes of fatty liver :
- Obesity (about 20% of people considered obese have fatty liver disease)
- High blood cholesterol and triglycerides
- Type 2 diabetes mellitus
- Heavy alcohol use
- Underactive thyroid
- Certain drugs
- Polycystic ovary syndrome
- Complications late in pregnancy
- Some of these conditions are associated with resistance to insulin, a hormone the body produces to maintain normal amounts of sugar in the blood
Diagnosis
- the fatty liver disease does not root pain, nausea or fatty food intolerance,
- many people do not realise they have it until a routine blood test suggests a liver problem
- . A liver biopsy may be suggested but this is rarely necessary.
- The biopsy shows the liver cells to be examined under a microscope in order to see the degree of fat accumulation, inflammation and more importantly, scarring of the liver.
Treatment:
- limiting or avoiding alcoholic beverages
- managing your cholesterol and reducing your intake of sugar and saturated fatty acids
- losing weight
- controlling your blood sugar
Diagnostic tests for HIV/AIDS
HIV/AIDS also called as Human immunodeficiency virus/Acquired immune deficiency syndrome. One of the most dangerous STD’s, significantly challenging the gobal world with its devastating effects.HIV is caused by the “LENTI”virus[a class of retrovirus].HIV virus mainly acts on the imunne system of the body,by attacking the CD4 cells.Destruction of these cells results in the loss of defensive actions aganist various types of infections.Over the time,HIV leads to AIDS[Accquired immune deficiency syndrome]. If HIV is left untreated,it leads to AIDS stage.Well,early detection of the infection,using appropriate diagnostic tests helps the patients to live longer with the infection, without reaching to the AIDS stage.
The diagnostic tests for HIV includes;ELISA,westernblot test,polymerease chain reaction,[NAT test].ELISA is the primary test for HIV detection,if it is found to be positive,then western blot test is preffered for the further confirmation.If the ELISA is negative,then the individual should be retested again after a month.While PCR is a technique used to detect virus in the body,which is accurate method.Some of the other tests include antigen tests,antigen-antibody combinations.
ELISA:
Enzyme linked immune sorbent assay,was the first diagnostic test employed for the HIV. It has a high sensitivity.It involes the immune system component i,e.antibodies[igG,igM].Firstly serum from the person is collected,and it is diluted upto 400 folds.The diluted serum is applied on the plate to which HIV antigens are attached.If the person is having HIV antibodies,they may bind to the antigens.Then the plate is washed to remove the all other serum components.”SECONDARY ANTIBODY”-an antibody that binds to the human antibodies itself,is applied to the plate followed by another wash.This secondary antibody is chemically linked to enzyme.Thus the secondary antibody bound to the plate is in proportion with the enzyme on the plate.A substrate is added for the enzyme,and the catalysis by the enzyme leads to fluorescene or in colour of the substances.The most controversial aspect of this test is determining the”cut-off” point between a positive and negative result.
WESTERN BLOT:
Similar to the ELISA,western blot is also an antibody detection test.But unlike ELISA, first the viral proteins are separated and immobilised.Binding of serum antibodies to specific HIV proteins is visualised.
Specific cells of HIV infection are opened and the proteins within are palced into a slab of gel,to which the electric current is applied.Different proteins have different speeds, depending on their size.While the electric charge is levelled by a sodium lauryl sulphate, surfactant. Once the proteins are well separated,they are transferred to the membrane and the further process is continued similar to ELISA.The diluted serum is applied to the membrane and the antibodies in the serum may attached to the the HIV proteins.Antibodies that are not attached are washed away,where as the enzyme linked antibodies attaches to the secondary antibodies and determines to which HIV proteins the person is having antibodies.Commercially prepared western blot test kits contains the HIV proteins alredy on a cellulose acetate strip.
There is no particular specific criteria for interpreteting the western blot results.The number of viral bands present may vary.If viral bands are detected,then the test result is negative.If atleast one viral band is detected for each of the GAG,POL,and ENV gene product groups,then the reult is positive.But the 3-gene product approach of interpretation is NOT For clinical practice.For tests in which less than the required number of viral bands are detected,they are reported as indeterminate.Persons with the indeterminate results are retested for the conclusive results.Almost all the persons with the indeterminant results are found to develop a positive result.
The HIV proteins used in western blotting can be produced by using recombinant DNA techniques called recombinant immunoblot assay[RIBA].
If no antibodies are detected to HIV,that doesn’t mean the person has not be infected.It may take several months for infection to show antibody response of detectable levels. Rapid testing for antibodies to HIV will not give a indicative of true infection.In most the cases,it takes two to six weeks to reach a detectable level of infection.Even these tests are having the high speficity,false positives may do occur.The positive results should be confirmed by using a lab western blot test.
Even ELISA is having high probability to diagnose HIV,it can’t be used alone,should not be reported as ‘positive’ unless confirmed by a western blot.
Rare false results are due to factors unrelated to HIV,found to be more often with the ELISA than western blot.False positives may be asosicated with the medical conditions such as recent acute illness and allergies.
PCR:
Polymerease chain reaction is used to detect genetic material i,e. RNA.It is used for the amplification of the DNA sequences. PCR technique is developed by KARY MULLIS in 1983 and wsa awrded nobel prize in 1993 in chemistry.
The basic underlying principle in PCR is’extensive modifications can be done to perform the wide array of genetic manipulations.Generally PCR employs a originally isolated heat-stable polymerease enzyme i,e. TAQ POLYMEREASE.This polymerease enzymatically assembles a new DNA strands,using single stranded DNA as template.This method is also known as VIRAL LOAD TEST.Viral load assays measure HIV-RNA from virus particles in the blood plasma.This test is also called NUCLEIC ACID TEST [NAT].IT is of 2 types DNA-PCR,RNA-PCR.
DNA-PCR: Used for screening of babies of HIV+ mothers
RNA-PCR: Used to screen blood donations, organ donations.
PCR tests have been developed that can detect the infection,as little as one viral genome among the DNA of vast group of host cells.Infections can be detected earlier. The donated blood can be directly screened for the virus.Unlike ELISA and western bloting, used for antibodies detection,PCR is is more accurate with early detection.
PCR can be used for the earliest detection, but ELISA and western blot are not effective in early detection, as the antibodies takes time to appear in the circulation.
Hepatitis C
About Hepatitis C
Hepatitis is defined as the inflammation of the liver. The vital organ plays an important role in the processing of food, enzyme secretion, residual cleaning and metabolism of medicines. Any damage or inflammation of the liver affects the body functions, affecting the body functions. Heavy alcohol toxins, strong medications and autoimmune conditions cause hepatitis C.
Hepatitis C virus (HCV) can lead to both acute and chronic infection. Acute HCV infection is usually asymptomatic and is only very rarely associated with the life-threatening disease.
Many people are not aware of acute conditions, which further develop into the chronic illness, causing severe problems like liver cancer, liver failure.
Transmission:
Hepatitis C is a blood prone virus. The common modes of transmission are:
- Injecting drug through similar syringes
- using again or insufficient sterilization of medical equipment, like syringes, needles in primary healthcare centres
- Transfusion of unscreened blood and blood products
- Clotting factors of unscreened value
- Sexually transmitted from mother to child from womb, only if the mother is infected.
Risk groups for hepatitis C:
- Patients undergoing dialysis for longer term
- Healthcare co-workers who have blood exposure like needle stick to an infected person on their job
- Children born to HCV-infected mother
- People having multiple sex partners
- Received a blood from an already suffering HCV patient
The symptoms are:
- Fatigue Yellow skin and eyes (jaundice)
- Loss of appetite
- Dark-colored urine
- Nausea and vomiting
- Joint Pain
- Abdominal pain
- Clay-colored stool
These symptoms may appear about 6 to 8 weeks after exposure, but this time period can vary among individuals
HCV infection is diagnosed in 2 steps:
- Screening meant for anti-HCV antibodies with a serological test that identifies people who have been infected by way of the virus.
- If the test is positive for anti-HCV antibodies, a nucleic acid test for HCV ribonucleic acid (RNA) is essential to authenticate chronic contamination
Prevention
There is no vaccine for hepatitis C, consequently, prevention of HCV infection depends upon reducing the risk of exposure to the virus in health-care settings and in higher risk populations like, individuals who inject drugs, and throughout sexual contact.
Primary prevention measures include:
- Hand hygiene: with surgical hand preparation, hand washing and use of gloves;
- Safe and proper use of health care injections;
- protected handling and discarding of surgical sharps and waste;
- Comprehensive harm-reduction services to individuals who inject drugs as well as sterile injecting equipment;
- Testing and analysis of donated blood for hepatitis B and C (and for HIV and syphilis);
- Comprehensive training of health personnel
- Encouragement of the correct and regular use of condoms.
Secondary prevention measures include:
- Patient-centric education and counselling on options for care and treatment;
- Complete immunization with the hepatitis A and B vaccines to avert co-infection from these hepatitis viruses and to shield their liver;
- Early and suitable medical management together with antiviral therapy
- Standard monitoring for near the beginning diagnosis of chronic liver disease.
Kidney function test
The kidney is the vital organ of our body. It helps in the filtration and clearance of all the waste from our body. It also helps in elimination of filtered residues in the body. The kidney is constantly in a phase of filtration and elimination of minerals, toxins and other process residues from the blood and in turn, create urine. Hence any kidney absorbability is tested for urine and blood. Presence of blood or pus cells in the urine is an indication that the renal tubules might be damaged. Excessive use of drugs increases the load on the kidney, thus reducing the clearance rate.
Following are some tests mentioned which help in the complete analysis of the kidney functions.
BLOOD TESTS
- Serum creatinine: Creatinine is a waste product produced from the normal functioning of the muscles. A creatinine level higher than 1.2 for women and 1.4 for men is a sign of kidney in-functionality. As the kidney is more damaged, the level rises. Patients having the meal with meats, have the higher protein content, the level may rise.
- Glomerular Filtration Rate(GFR): measures the rate at which kidneys eliminate waste from the body and excessive fluid from the blood. GFR value less than 60, is a sign of reduction in kidney functionality. If it goes below 15, the kidney is probably in the last test of disease, needs immediate treatment.
- Blood Urea Nitrogen(BUN): as nitrogen is a breakdown product from protein foods, it is essential for us to know the concentration in the blood. The normal range is n7-20. As the kidney starts failing, the BUN values increases, meaning the kidney is not able to eliminate nitrogen from the body.
IMAGING TESTS
- Ultrasound: used for checking atrophy or any size-related anomalies in the kidney. Majorly due to damage or traumatic effect.
- CT Scan: checks for any structural abnormalities, like obstructions caused or any tissue damage. This is related to the disease associated with the kidney.
KIDNEY BIOPSY
- Done for many reasons like for identification of specific disease stages and check the treatment response
- Check the anatomical damage occurred to the nephrons
- To check the kidney after transplant for any resistance developed n the recipient’s body
URINE TESTS
- Urinalysis: done by dipstick, it changes colours according to the presence of abnormalities like the excess amount of protein, pus, bacteria and sugar. The presence of pus may be due to damage to the bladder, urinary tract. Other infections like chronic kidney disease, diabetes can be detected.
- Urine protein: to check the excess amount of protein present in the urine. It is a quantitative measurement done to also check the albumin-to –creatine ratio.
- Microalbuminuria: the higher level of dipstick test, used for detecting small amounts of albumin protein in the urine. Done by patients who are at a higher risk of developing chronic diseases like diabetes or blood pressure
- Creatine clearance: measures the clearance rate of the kidney and wastes eliminated per minute.
Morning after-pill or emergency contraception
Morning after pill or emergency contraception pills are over the counter drugs available to prevent pregnancy within 72 hours of unprotected sex or intercourse. There are many popular brands available like i-pill and unwanted 72. They are very high dose of the hormone progestin/levonorgestrel which are known to prevent fertilization/conception by way of delaying to stopping ovulation.
Effectiveness of emergency contraception
If taken within 72 hours, emergency contraception pills are known to prevent pregnancy in 99% of the cases. The user need not to worry about pregnancy if she has consumed the medicine within the stipulated 72 hours.
Side effects of emergency contraception
As all the emergency contraceptive pills are very high dose of the hormones, they are known to cause certain side effects which are common to the early symptoms of pregnancy. This often leads the user confused and baffled that she might be pregnant. However, in most of the cases, it’s not the pregnancy, but the emergency contraception pill, which is producing the symptoms. The symptoms include the following:
- Abdominal pain
- Nausea
- Vomiting
- Fatigue
- Headache
- Dizziness
- Breast tenderness
- Delay in menstruation
- Occasional bleeding or spotting
- Weight gain
These side effects may continue for a month or two. The menstrual cycle may remain disturbed for next few months. In long run, being an steroid, these medicines cause substantial weight gain in the users.
Emergency contraceptives and STDs
Emergency contraceptive pills do not provide any protection from sexually transmitted disease like HIV, gonorrhoea or syphlis. Additional safety measures like condoms should be preferred for protection from such sexually transmitted diseases which could prove life threatening in long run.
Emergency contraception pills are not for regular use. Such high dose of hormone, if taken regularly might cause very serious side effects. So, they should never be used as regular method of contraception and should be avoided as far as possible.
Erectile dysfunction(ED): Causes and Treatments
Erectile dysfunction(ED): Causes and Treatments
Erectile dysfunction (ED), also known as Impotence is the inability of to get or maintain erection during sexual intercourse in human beings. Erection of penis is a natural process during sexual arousal. It is controlled by brain under the influence of various sensory perceptions like touch, visual and smell. This is a hydraulic process commanded by the brain, in which the blood flow to the penis is increased, thus causing the erection. Proper erection ensures successful intercourse.
Causes of erectile dysfunction
Failure to get or maintain erection makes intercourse difficult. This problem might have psychological or physiological causes.
Psychological causes of erectile dysfunction
Psychological reasons of erectile dysfunction include mental stress, lack of adjustment among couples, job pressure, anxiety, lack of privacy, fear of pregnancy or sexually transmitted diseases (STDs) and performance anxiety. This can be easily treated by psychological counselling and placebo medicines.
Physiological causes of erectile dysfunction
Physiological or physical causes of erectile dysfunction are those morphological or chemical changes within the body which make proper erection difficult. The main physiological causes of erectile dysfunction are mentioned as under:
- Diseases like diabetes and multiple sclerosis
- Medicines like anti-depressant and diuretics
- Smoking
- Hormonal imbalances (Testosterone deficiency)
- Nerve disorders
- Prostate surgery
- Ageing
Diagnosis of erectile dysfunction
The cause of erectile dysfunction is diagnosed through the use of various techniques like Magnetic resonance angiography (MRA), Corpus cavernosometry, Dynamic infusion cavernosometry (DICC), Penile biothesiometry, Nocturnal penile tumescence (NPT), Penile nerves function, Duplex ultrasound.
Treatment of erectile dysfunction
Once, the reason behind the erectile dysfunction is identified, treatment procedure could be planned. This mainly includes the following
- Hormone replacement therapy (Testosterone injections)
- Medicines like sildenafil (Viagra)
- Use of penis pumps
- Alternative medicines like herbs and libido booster food/aphrodisiacs
- Prosthetic penile implants to maintain erection
- Psychological counselling
- Proper diet
- Regular exercise