Cholera



Cholera is an infectious disorder that triggers severe watery diahrrea, which can lead to dehydration and even death if untreated. It is produced by the consuming food or drinking water contaminated with a bacterium known as Vibrio cholerae.

This infectious disease is very common in the regions of poor sanitation, crowding, war, and famine. Common areas comprise some parts of Africa, Latin America and south Asia.

Causes of Cholera

Cholera is caused by bacterium Vibrio choleraewhich is commonly found in water or food contaminated by feces from an infected person. Following are the most common sources of the Cholera infection:

  • Municipal water supplies
  • Foods and drinks sold by street sellers
  • Vegetables grown with water comprising human wastes
  • Raw or undercooked fish and seafood caught in waters contaminated with sewage 
  • By consuming the contaminated food or water, the bacteria release a toxin in the intestines that causes severe diahrrea.

Cholera Symptoms

Symptoms of cholera can start as soon as a few hours or as long as five days after infection. Often, symptoms are mild. But sometimes they are very serious. The infected person having severe watery diarrhea and vomiting, which can cause dehydration. In some cases, the infected people may have less or no symptoms but still spread the infection.

Signs and symptoms of due to dehydration include:

  • Fast heartrate
  • Loss the elasticity of skin
  • Dry mucous membranes (insidemouth, throat, nose, and eyelids)
  • Thirst
  • Low blood pressure
  • Muscle cramps

Cholera Treatment and Prevention

Cholera vaccines are present. A person can be kept himself and his family away from cholera by drinking boiled, bottled or chemically disinfected water. Used the bottled, boiled, or chemically disinfected water for the following purposes:

  • Drinking
  • Cooking food or drinks
  • Preparing ice
  • Washing your face and hands
  • Washing utensils that you use to eat or cook food
  • Washing vegetables and fruits

Avoid the following raw foods:

  • Unpeeled vegetables and fruits
  • Unpasteurized milk and milk products
  • Raw or undercooked meat or shellfish

Hydration is the strength of treatment for cholera. The cholera treatment comprises of oral or intravenous solutions to substitute lost fluids and antibiotics. 

Dengue Fever

INTRODUCTION 

Dengue is a viral infection, of an endemic-epidemic nature, spread by mosquitoes of the genus Aedes, particularly by Aedes aegypti. Dengue virus (DENV) is a member of the Flaviviridae family, which consist of tick-borne encephalitis virus (TBEV), Japanese encephalitis virus (JEV), West Nile virus (WNV) and yellow fever virus. Dengue virus infection may be asymptomatic, may cause a self-limited febrile disease identified as dengue fever (DF), or in a small ratio of cases, may affect in a life-threatening syndrome, the so-called dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). In South- East Asia, dengue disease remains to be a major challenge to public health which is an arthropod-borne viral hemorrhagic fever.

Serotypes of dengue virus

DENV-1, DENV-2, DENV-3, DENV-4 are four serotypes of dengue fever virus. Entirely four strains can cause the full illness. Infection with one of the four serotypes can produce enduring protection to that serotype but only short period defense against the other. On secondary infection the severe difficulty may happen particularly when someone before visible to serotype DENV-1 then exposed to serotype DENV-2 or serotype DENV-3, or if someone formerly exposed to type DENV-3 then gets DENV-2. 

Infection 

The course of infection can be separated into three phases: 

  • Febrile, 
  • Critical 
  • Recovery

Frequently high fever occurs in the febrile phase associated with generalized pain, headache and fever often over 40 °C (104 °F); this generally continues 2 to 7 days. Throughout this phase, a rash arises in about 50-80% of the patients with indications. It occurs in the first or second day of symptoms as flushed skin, or later in the development of infection (days 4-7), it may seem as a measles-like rash. In some causes at this stage petechiae may also appear caused by broken capillaries, particular mild bleeding from nose and mucous membrane of mouth can also happen. In nature the illness itself is classically breaking, biphasic and then recurring for one or two days though there is wide difference in this pattern. 

In certain patients, the infection may continue to a critical stage, in which there is determination of the high fever and characteristically continues for 1 to 2 days. In this stage there may be increased capillary permeability and leakage, which may cause substantial accumulation of fluid in the abdominal cavity and chest. This disorder may lead to reduction of fluid from the circulation and decreased blood supply to vital organs. Through this stage, severe bleeding, particularly from the gastrointestinal tract and organ dysfunction can also occur. In all cases of dengue, dengue shock syndrome and dengue hemorrhagic fever happen in less than 5%, but those patients are at high risk who have formerly been ill with other serotypes of dengue virus. 

In the recovery phase restoration of those fluid occur which had leaked into the bloodstream. This frequently last 2 to 3 days. The upgrading in dengue fever is often remarkable, but there may be a slow heart rate and severe itching. Fluid overload condition may occur at this point, if it disturbs the brain, a reduced level of consciousness or seizures may occur. 

Symptoms

DF is an acute illness of sudden onset with symptoms such a headache, fever, fatigue, sever muscle and joint pain, enlarged glands (lymphadenopathy), and rash. Dengue hemorrhagic fever is a separate disease, caused by dengue virus but much more severe symptoms than DF, so DF should not be confused with DHF. 

Diagnosis

Different laboratory tests are used to diagnose dengue fever. Detection can do by viral antigen detection or specific antibodies, nucleic acid detection by PCR, virus isolation in cell cultures. More exact methods are virus isolation in cell cultures and nucleic acid detection than antigen detection, but because of their cost these tests are not generally used. In the early phases of the infection all tests may be negative. 

Virus definite serum immunoglobulin, IgM, is developed within 5 days of onset of infection while IgG consequently developed within 14 to 17 days. IgM, IgG assays are diagnosis tests while CBC is a good monitoring test. It is very significant that CBC should be performed every day. If lymphocytosis with increase in atypical lymphocytes and platelets less than 100,000/cμmm are seen, then it means that within next 24 hours patient is upcoming in critical state and he should be taken care of. Platelet transfusion is suggested for only those with severe bleeding. There are no definite treatments for dengue fever. 

Well-recognized features of DF are thrombocytopenia, Leukocytopenia and elevation of AST or LDH. Common difficulty of dengue virus infection is liver damage with increased of aminotransferases and reactive hepatitis. Patients have higher levels of AST and ALT with dengue than those patients with non-dengue febrile disorders. 

Dengue infection treatment

Dengue infection have no specific treatment. In dengue infection it is important to take pain killers such as acetaminophen (such as Panadol, Tylenol), take plenty of juices, rest and contact the doctor as soon as possible. It is important to avoid aspirin. 

Epidemiology

Every year it is expected that 2.5 billion individuals are at risk of evolving DF, and that 50 million people actually become ill. About 100 cases of DF are stated per year, according the Infectious Disease Law, this number is increasing. 

Around 975 million of whom living in urban zones in tropical and sub-tropical countries in Southeast Asia, the pacific and Americas. Transmission similarly arises in Africa and the Eastern Mediterranean, and rural populations are progressively being affected. Every year more than 50 million infections are assessed, including 500,000 hospitalizations for dengue hemorrhagic fever, mostly among children, with the incident death rate above 5% in some areas. 

Incidence of Dengue in Pakistan is growing since 1994 and is flattering a significant public health problem. Its occurrence is growing quickly and mainly affecting the old age group. Approximately 700 cases of definite Dengue fever have been described across Pakistan this year. The Dengue investigation cell of Pakistan government has established that 696 people have been ill since August of the last year. Fumigation and dengue consciousness campaigns are in action in earlier years, but it is clear that not sufficient has been completed in Pakistan to control and eliminate this disease.

The signs in children are frequently related to common cold and gastroenteritis, but more vulnerable to severe problems. Unexpected beginning with rash, high fever, and headache, backbone, muscle and joint pains are the characteristics symptoms of dengue fever. Hemorrhagic indications are also common and may range from mild to severe. The break-bone fever name of dengue fever is occupied from the accompanying muscle and joint pains. 

Vitamins

Vitamins

Vitamins are organic compounds (have carbon atom) and are essential micronutrients that are needed in small amount to sustain life. It is important to normal metabolism and certain medical conditions can result in the deficiency of any kind of vitamin. Most of the vitamins obtain from food because the human body either does not synthesize at all or not in adequate amount. 

The requirement of the vitamins depends upon the organism because some organism synthesized a vitamin which other cannot. For example, human needs to take vitamin C while dog can produce sufficient amount of vitamin C for their own needs. 

Vitamin D is not present in sufficient amount in food. The human body synthesized a sufficient amount of Vitamin D by exposure to sunlight. 

The 13 different vitamins are required for normal human metabolism are classified into fat-soluble and water-soluble vitamins.

Fat-soluble vitamins
Liver and fatty tissue are used to stored fat-soluble vitamins. The fat-soluble vitamins are vitamin A, D, E and F. 

Water-soluble vitamins
The water-soluble vitamins are excreted in urine and cannot stored in the body. The water soluble vitamins are all form of vitamin B and vitamin C.

Here, I am going to discuss different types of vitamins, their daily intake, good food sources and disorders causes by their deficiency.

Vitamin A

Vitamin A is fat soluble including retinol, retinal, retinyl esters, retinoic acid and beta carotene. 

Important functions

It is important for the proper function of immune system, keep skin healthy and helping vision in dim light.

Deficiency

Vitamin A deficiency leads to keratomalacia, eye problem like dry cornea and night-blindness.

Recommended daily intake

Daily recommendation of vitamin A for (age 19 – 70) male is 900 μg and female 700 μg.

Food sources

Good food sources of vitamin A are: beef liver, fish, eggs, milk, soy milk, butter, cheese, leafy vegetables, sweet potatoes, squash, spinach, carrots, pumpkins, orange and yellow fruit (apricots, mango and papaya). 

Vitamin B1

Vitamin Bis water soluble and chemically known as thiamin. 

Important functions

The important function of the vitamin Bin the body is release energy from the food. It required for the healthy nervous system, healthy hair, nail, brain and skin. 

Deficiency

The disorder causes by deficiency of vitamin Bare beriberi and Wernicke-korsakoff syndrome.

Recommended daily intake

The daily recommendation of vitamin Bfor (age 19 – 70) male is 1.2 mg and for female is 1.1 mg.

Food sources

Good food sources for vitamin Bare yeast, brown rice, cereal grains, whole-grain rye, liver, egg, oranges, watermelon, kale, potatoes, cauliflowers and asparagus. 

Vitamin B2

Vitamin Bis water soluble vitamin which is chemically known as Riboflavin.

Important functions

Vitamin Bplay an important role in releasing energy from food and in keeping healthy nervous system, skin and eyes. 

Deficiency 

Ariboflavinosis, angular stomatitis and glossitis are disorders which occurs due to the deficiency of vitamin B2.

Recommended daily intake

The daily recommendation of vitamin Bfor (age 19 – 70) male is 1.3 mg and for female is 1.1 mg.

Food sources

Good food sources for vitamin Bare fish, meat, cheese, milk, yogurt, whole and enriched grain, cereal, green leafy vegetables and bananas. 

Vitamin B3

Vitamin B3 is a water soluble and known as niacin.

Important functions

Its play an important part in healthy skin, brain, blood cells and nervous system. In the body it is important for the proper function of more than 200 enzyme. Vitamin Bis the combination of nicotinamide and nicotinic acid. When these chemical break down it produces NAD and NADP. These two chemicals play a key role in a variety of reaction and support cell metabolism. 

Deficiency

The deficiency of vitamin Bcauses a disorder known as pellagra. Pellagra can affect digestive system, nervous system, skin and mucous membrane. 

Recommended daily intake

The daily recommendation of vitamin B3 for (age 19 – 70) male is 16 mg and for female is 14 mg.

Food sources

Good food sources of vitamin Bincluded; poultry, meat, fish, butter, milk, leaf vegetables, mushrooms, potatoes, tree nuts and eggs.

Vitamin B

Vitamin Bis another water-soluble vitamin and chemically known as pantothenic acid. 

Important functions

The body required vitamin Bfor converting food into energy and to synthesize lipids (fats), neurotransmitters, steroid hormones and hemoglobin. 

Deficiency 

The vitamin Bdeficiency may leads to paraesthesia (an abnormal sensation, typically ‘pins and needles`) 

Recommended daily intake

The daily recommendation of vitamin Bfor (age 19 – 70) male is 5 mg and for female is 5 mg.

Food sources

Good food sources of vitamin Bincluded; chicken, eggs yolk, broccoli, mushrooms, avocado, whole grains and tomato products.

Vitamin B6 

The chemical names for vitamin Bare pyridoxine, pyridoxal and pyridoxine and this vitamin is also water-soluble.

Important functions

The important function of this vitamin is lowering the level of homocysteine and may lower the risk of heart diseases. It plays an important role to convert tryptophan to niacin and in producing neurotransmitter serotonin (plays key roles in sleep, mood and appetite). It helps red blood cells production and effects immune function and cognitive abilities. 

Deficiency

The vitamin B6 deficiency may leads to peripheral neuropathy and anaemia. 

Recommended daily intake

The daily recommendation of vitamin Bfor (age 19 – 70) male is 1.3 – 1.7 mg and for female is 1.2 – 1.5 mg.

Food sources

Good food sources of vitamin Bincluded; beef liver, tuna fish, chicken, tofu, chick peas, whole grains, fruits such as watermelons and bananas, vegetables and tree nuts.

Vitamin B7

It a water-soluble vitamin and known as biotin or vitamin H.

Important function

This vitamin involved in the metabolism of fatty acids, leucine and gluconeogenesis (synthesize of glucose from amino and fatty acids).

Deficiency

The disease which may occurs due to deficiency of vitamin Bare; dermatitis or enteritis. 

Recommended daily intake

The daily recommendation of vitamin B7 for (age 19 – 70) male is 30 μg and for female is 30 μg

Food sources

Human body cannot synthesize biotin but the bacteria which is naturally live in our bowel are able to synthesize biotin. Other good source of biotin are egg yolk, liver, peanuts, leafy green vegetables, sunflowers and peanuts.

Vitamin B9

It is also known as folate or folic acid. As it belongs to the group of vitamin B, so it is also water soluble.

Important functions

It is an important part in nuclei acid synthesis.  It is important for new red blood cells production, helps in preventing hair loss and preserving brain and spin health in infants. 

Deficiency 

The disease related to deficiency of vitamin Bis megaloblastic anaemia and congenital deformities (birth defects).

Recommended daily intake

The daily recommendation of vitamin Bfor (age 19 – 70) male is 400 μg and for female is 400 μg.

Food sources

Rich food sources are; liver, leafy green vegetables, broccoli, peas, brussels sprouts, fortified grains products, sunflowers seeds, asparagus, legumes (like black-eyed peas and chickpeas) and orange juice. 

Vitamin B12

Vitamin B12 is water-soluble member of the vitamin B family and chemically known as cobalamin, cyanocobalamin, hydroxocobalamin, methyl-cobalamin and adenosyl-cobalamin.

Important functions

This vitamin plays a key role in neural metabolism, DNA and RNA production, hematopoiesis and fat, carbohydrate and protein metabolism. 

Deficiency

The deficiency of vitamin B12 causes pernicious anemia.

Recommended daily intake

The daily recommendation of vitamin B12 for (age 19 – 70) male is 2.4 μg and for female is 2.4 μg.

Food sources

Good food sources of vitamin B12 are poultry, eggs, meat, fish (especially haddock and tuna), fortified cereals, soy products, milk and dairy products.

Vitamin C

Vitamin C is also known as ascorbic acid and water-soluble.

Important functions

It is important for healthy skin, blood vessels, cartilage and bone vessels. it is playing a key role in wound healing and helping to protect cells and keeps them healthy. 

Deficiency

The deficiency of vitamin C causes scurvy

Recommended daily intake

The daily recommendation of vitamin C for (age 19 – 70) male is 90 mg and for female is 75 mg.

Food sources

Good food sources of vitamin C are oranges, strawberries, blackcurrants, red and green peppers, potatoes, brussels and broccoli. The highest content of vitamin c in all foods are Kakadu palm and camu camu fruits.

Vitamin D

Vitamin D is a fat-soluble vitamin and chemically known as ergocalciferol and cholecalciferol.

Important functions 

It is important for healthy bones and teeth and give protection to body against certain condition such as multiple sclerosis, type 1 diabetes and cancer. It is also important in supporting cardiovascular health and lung function. It plays a key role in regulating insulin level.

Deficiency

The disorders such as rickets (childhood bone condition in which bones become soften and prone to breaks and deformity)and osteomalacia (softening of bones). 

The long-term deficiency of vitamin D can result in hypertension, obesity, diabetes and osteoporosis. 

Recommended daily intake

The daily recommendation of vitamin D for (age 19 – 70) male is 15 μg and for female is 15 μg.

Food sources

The body synthesized their own vitamin D by exposure to sunlight. But the fish oil and fatty fish are the richest sources of vitamin D. Other good food sources of vitamin D are eggs, mushrooms, beef liver and fortified milk.

Vitamin E

It belongs to the group of fat-soluble vitamins and known as tocopherols, tocotrienols.

Important functions

Vitamin E play a key role in neutralizing unstable substances which can damage cells and also acts as an antioxidant. It also important role in protecting vitamin A and lipids from damage. Vitamin E rich food may prevent Alzheimer´s disease. 

Deficiency

The deficiency of vitamin E is rare but may trigger hemolytic anemia (a disorder in which blood cells are breakdown and removed from blood stream to early) in newborn infants. 

Recommended daily intake

The daily recommendation of vitamin E for (age 19 – 70) male is 15 mg and for female is 15 mg.

Food sources

Richest sources of vitamin E included a variety of food such as Avocado, kiwi, almonds, leafy green vegetables, whole grains, wheat germs, milk, eggs, nut and unheated vegetable oil.

Vitamin K

It is another fat-soluble vitamin and chemical names for vitamin E are phylloquinone and menaquinones. 

Important functions

Human body vitamin K is important for regulating blood calcium level, blood clotting and bone metabolism. 

Deficiency

The deficiency of vitamin K is rare but sever deficiency may cause to clotting diathesis (unusual bleeding).

Recommended daily intake

The daily recommendation of vitamin K for (age 19 – 70) male is 110 μg and for female is 120 μg.

Food sources

Milk, egg yolk, kiwi, liver and leafy green vegetables are the richest sources of vitamin K. 

Diabetes

                                              Diabetes Mellitus

Diabetes is a chronic disease which is characterized by high blood sugar level due to defects in insulin action, insulin secretion or both. Insulin is a hormone secreted by pancreas and helps in the regulation of body blood sugar. A person become diabetic either when the pancreas does not produce sufficient amount of insulin or when the body cells not responding properly to insulin. The increase level of blood sugar can cause many serious health problems. 

Types

Diabetes are classified into three main types;

  1. Type 1 diabetes (formerly referred as insulin dependent diabetes mellitus/juvenile diabetes) is a type of diabetes in which very little or no insulin produced by pancreas due to pancreatic beta cells destruction. This type of diabetes affects people at any age but mostly appears during childhood and adolescence.
  2. Type 2 diabetes (formerly called insulin independent diabetes mellitus) is occur when the body cells not responding properly to insulin secreted by pancreas. Type 2 diabetes is the most common type of diabetes and it is estimated about 90% of all diabetes cases worldwide. Among many causes of type 2 diabetes the most important ones are genetics and life style (like lack of exercise, unhealthy diet and obesity) The combine effect of these two factors can trigger insulin resistance in type 2 diabetes.  
  3. Gestational diabetes is another type in which hyperglycemia (high blood sugar) occurs in pregnant without previous history of diabetes. The hormone secreted by placenta during pregnancy causes body cells resistance to insulin.

Symptoms

The symptoms of diabetes are differed and depending on how much your blood sugar is raised. In the beginning of the prediabetes and type 2 diabetes some people may not experience any diabetes symptom. The people affected by type 1 diabetes shows the symptoms very quickly and be more severe. The following sign and symptoms are occurred in type 1 and 2 diabetes:

  • Polydipsia (increase thirst)
  • Polyuria (frequent urination)
  • Increase in appetite
  • Fatigue
  • Irritability 
  • Unexplained weight loss
  • Blurred vision
  • Slow-healing sores
  • Presence of ketones in urine
  • Gums and skin infections


Risk factors 

The diabetes risk factors depend on the type of diabetes.

Type 1 diabetes risk factors

The exact reason of type 1 diabetes is unknown, but some factors may signal a high risk including;

  • Family history
  • Environmental factors
  • Autoantibodies
  • Geography 

Type 2 diabetes

It is difficult to understand for the researcher that why some people develop diabetes and other don´t but following factors high the risk of type 2 diabetes:

  • Excessive body weight
  • Physical inactivity
  • Family history
  • Polycystic ovary syndrome
  • Abnormal level of triglyceride and cholesterol 
  • Older age
  • Race (like blacks, American Indian, Hispanics and Asian-Americans. 

Gestational diabetes

Risk factor are:

  • Family history
  • Age 
  • Weight (overweight before pregnancy)
  • Race (the reason is unknown but gestational diabetes develop in black, Asian and Hispanic women are more likely to)

Diagnosis

The diagnosis of diabetes is based on patient symptoms along with laboratory investigation which consists on;

Glucose measurement 

  • Fasting (a person is considered diabetic if fasting blood sugar is 7 mmol/L (126mg/dl) or higher) 
  • Random (when blood sugar level is 11.1 mmol/L (200mg/dl) or higher indicate diabetes)
  • Oral glucose tolerance test (in this test a patient drinking sugary liquid and then measuring of sugar levels periodically for next 2 hours. When the blood sugar level is higher than 11.1mmol/L (200mg /dl) after 2 hours suggest diabetes)
  • Hb1Ac (when the values of HbA1c test is 6.5 % or higher indicated diabetes)

Other laboratory tests including 

  • Insulin measurement
  • Fructosamine
  • Glycated albumin 
  • Microalbumin 
  • C-peptide.

Treatment and management

  • Healthy diet (fresh fruits, vegetables, food with more fiber, whole grains, low-fat dairy products and legumes (lentils, peas and beans)
  • Regular physical activity (everyone needs to do at least 30 – 60 minutes of moderate (15 to 30 minutes of energetic) aerobic exercise. It is good to move around a bit every 30 minutes)
  • Weight loss 
  • Monitoring blood sugar level 
  • Insulin therapy (type 1 diabetes and many type 2 and gestational diabetic patient need insulin for survive)
  • Oral or other medication (such as Metformin, sulfonylureas, Meglitinides, DPP-4 inhibitors, GAL-1receptor agonists, GLP-1 receptor agonists and SGLT2 inhibitors)
  • Bariatric surgery (people with BMI more than 35 may get benefit from this kind of surgery)

Complications

With over time the uncontrol diabetes causes many serious complications such as cardiovascular disease (atherosclerosis, stroke, heart attack and coronary artery disease with angina), Neuropathy (the nerve damage occur because of the increase amount of sugar in the blood can damage the walls of capillaries that nourish nerves). Nephropathy (kidney damage), retinopathy (eye damage), skin problems (susceptible to fungal and bacterial infections), foot damage, depression and increase risk of dementia (like Alzheimer´s disease), vitiligo, edema and limited joint mobility.   

Prevention

By changing lifestyle may help in diabetes prevention. Some of the following tips are given by American diabetes association 

  • More physical activity
  • Take plenty of fiber
  • Go for whole grains
  • Loss of extra weight
  • Avoid fad diets and make healthier choices
  • Avoid tobacco use (smoking increases the risk of cardiovascular and diabetes disease)

Anaemia



Anaemia

Anaemia is a condition in which the haemoglobin level decreases or the total amount of healthy red blood cells decreases in the blood or decrease in the oxygen carrying ability of the red blood cells.  The main part of the red blood cells is haemoglobin which binds to oxygen and carry it to the cells.

Symptoms

When the level of haemoglobin or red blood cells decrease or become abnormal so, the body cells will not get enough oxygen and develop the anaemia symptoms such as fatigue, weakness, increase heart beat particularly with exercise, pale skin, insomnia, dizziness, frequent headache and leg cramps. The symptoms related with severe anaemia are fainting, chest pain, angina and heart attack. Additional symptoms are related with a particular form of anaemia.  

 Types and causes of Anaemia

A- Anaemia classified in to main three types such as anaemia due to decrease in the production of red blood cells, blood loss or increase in the breakdown of red blood cells.

1-Causes of the decrease production of red blood cells:

  • Iron deficiency
  • Lacks vitamin B12
  • Neoplasms of the bone morrow
  • Thalassaemia

2-Causes of blood loss:

  • Gastrointestinal bleeding
  • Trauma

3-Increased breakdown causes by:

  • Sickle cell anaemia
  • Infections such as septicaemia and malaria
  • Autoimmune disorders for example; autoimmune haemolytic anaemia

B-On the bases of red blood cell size and haemoglobin level in each cell anaemia is classified into;

  • Microcytic anaemia (small sized cells)
  • Macrocytic anaemia (large sized cells)
  • Normocytic anaemia (normal sized cells)

C-Classification of anaemia on the basis of severity;

  • Mild (when the haemoglobin level is 11 g/dl)
  • Moderate (Haemoglobin level is 8 g/dl to 11 g/dl)
  • Severe (Haemoglobin level is less than 8 g/dl)

Diagnosis

Diagnosis of the anaemia depending on the causes and required a number of tests involving:

  • Medical history of the patient such as physical examination, any chronic illnesses and regular medications an
  • Blood tests such as full blood count (including the number, haemoglobin content, size, volume and red blood cells)
  • Measured the levels of vitamins required for red blood cells production, vitamins B12 and folate.
  • Measured the level of the serum ferritin and blood level of the iron.
  • To investigate the rare causes of anaemia special tests are required such as red blood cell fragility, clotting, defects of enzyme, immune attack on red blood cells and haemoglobin.
  • Urine and faecal occult blood test (to detect blood)
  • To measure the level bilirubin and reticulocyte count.
  • Gastroscopy, colonoscopy and in rare cases the bone marrow biopsy is required to investigate the cause of anaemia.

Treatment for Anaemia

The treatment of anaemia depends on the severity and cause, but may consist on:

  • Oral and injectable iron (when the amount of iron is low)
  • Vitamins and mineral supplements
  • Vitamin B12
  • Blood transfusion (if required)
  • Oxygen therapy
  • Antibiotics (in case of infection)
  • Erythropoiesis-stimulating agent
  • Splenectomy

How to prevent anaemia

The types of anaemia can´t be prevented because that cause by a breakdown in the cell-making process. The anaemia which is due to dietary deficiency can be prevented by taking dairy foods, fresh vegetables, legumes, lean, nuts and meats and fresh vegetables. The vitamins and mineral supplements should be taken by vegan on a regular basis. It is important to talk to a doctor and dietitian about your diet.

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Case study; Microbiology

Case; Leo is 23 years old. He is well-behaved and is a motorcycle enthusiast. During the summer, he works as a plattsetter in Sweden. In the second part of the year he goes motorcycle, preferably in Asia. During a motorcycle holiday in Thailand, Kenny is in a serious traffic accident and arrives at a hospital. He is lucky to survive, but gets serious injuries, with multiple fractures and internal injuries. After five days at the hospital, he gets high fever and suspects a catheter-related sepsis.
For this reason, samples are taken for microbiological analysis; from catheterspets, instillation and blood cultures. In addition, basic blood and electrolyte status tests and CRP are taken. In the microbiological analysis, Staphlococci are isolated, which are further typed using MALDI- ToF to Staphylococcus epidermidis. For this reason, a resistance determination is also made (see results below).
The following results are obtained from the laboratory, among other things:
Weight: 85 kg
Length: 183 cm

Resistance determination Staphylococcus epidermidis

Breakpoints for antibiotics

Tests Resuts Age (y) Referense Range
P-Sodium 140 mmol / L 318 137-145 mmol/L
Β-potassium 4.0 mmol / L 318 3,5-4-6 mmol/L
P-CRP 200 mg / L < 3 mg/L
Antibiotics Zon mm Antibiotics Zon mm
Isoxazolyl-pc 20 Fucidic acid 25
Gentamicin 20 Clindamycin 17
TrimSulfa 20 Rifampicin 28
Linezolid 24
Antibiotics S.aureus KNS Antibiotics S.aureus KNS
Isoxazolyl-pc 22/21 27/21 Fucidic acid 24/24 24/24
Gentamicin 18/18 22/22 Clindamycin 22/19 22/19
TrimSulfa 17/14 17/14 Rifampicin 26/23 26/23
Linezolid 21/21 21/21

Answers of the following questions related to the above case.

1-Is it likely that Kenny has a sepsis?

Answer: Yes, Kenny has sepsis.

2-What does the resistance pattern look like for the Staphylococcus that has been isolated? (SIR)?

Answer: I think this is look like staphylococcus epidermidis with methicillin sensitive pattern. But as this case missing beta-lactamase drugs then it seems to methicillin resistant staphylococcus epidermidis.

3-What can be the cause of the disease?

Answer: The cause of the disease is nosocomial infection of staphylococcus epidermidis which is resulted by catheterization.

The principle, advantages, dis-advantages, pre-analytical. analytical and post-analytical errors of the following methods which help in solving the above case.

MALDI-ToF (Matrix assisted laser desorption ionization-time of flight)

Principle: The sample is mixed with matrix (energy absorbent) and then sample crystallizes together with matrix by drying. When the laser bean is passes through causes the ionization of trapped sample in the matrix and generated singly protonated ions of the analytes in the sample. These ions are accelerated at a fixed potential and separated according to mass to charge ratio (m/z). the charge analytes detected by TOF analyzer.

Advantages:

It is a rapid and have good accuracy at species level, correct and faster method.  It not very expensive and no fragmentation is formed because of low internal energy. It is also very useful in subspecies level identification. It is good in taxonomical and epidemiological studies.

Limitations

This method having low analytical sensitivity. It is not suitable in the identification of low amount bacterial in sterile sample such CSF. For such a sample needed more optimization and standardization.

Preanalytical phase

it is important to perform MALDI-ToF is a very sterile condition. It is important to use biological safety cabinets in pre-analytical phase.  It is important to record the bacterial growth medium. It is important to note the patient record. It is important to use lab coat, gloves and glasses. It is important to select the bacterial colony which has to be test. the preparation of the sample for MALDI-ToF is very simple but it need attention that a proper amount of sample is applied by touching the surface of the selected colony. It the direct identification is perform from blood culture the sample preparation step involved the use of lysis solution or lysis filtration.

Analytical phase

It is important to perform the test with quality practice to ensure accurate result. It is important to check the external and internal quality control. The laboratory must calibrate the MALDI-ToF system with the specific calibration standard (extract of E. coli or specific E. coli calibration strain). It is important to use specific positive and negative control for external control. It is important to maintain spectral quality for accurate result.

Postanalytical phase

The result report is also a consideration of the quality control. Different spectral databases are used for the MALDI-ToF reporting. The reporting of the result is also depended on the type of specimen. If the report is not correlate the conventional identification the procedure should be repeat because increase amount of the sample decreases the quality of the result.  If there is no peak formation its means that MALDI-ToF is insufficient in identification while the second sample correctly identified.

Immunoturbidimetry
Principle:The immunoturbidimetric assay is quantitative determination of protein is done by the formation of agglutination of antigen antibody complex. The agglutination causes the turbidity. The light when passes through the mixture some of the light is absorbed by the mixture and change in the intensity of the transmitted light is measured photometrically.
Advantages

It has high reaction analyzer speed, ease of automation and having good precision and accuracy. It is a sensitive, rapid method and blank interference is reduced by using low concentration of PEG (polyethylene glycol).

Disadvantages
It is an expensive, inflexible reagents and inflexible protocol.

Preanalytical phase

The sample for C-reactive protein is collected by standard procedure and in a sterile tube. The reagents for the test should be stored at 2-10 oC. It is important to rejected contaminated, lipemic and hemolyzed sample for CRP. If the sample is not using on the same collecting day so it is important to store at 2-10 oC for 2 months and at -20 oC for longer than a year. The blood sample collected in EDT or sodium heparin anticoagulant tube for plasma and for serum in a tube without anticoagulant.

Analytical phase

It is important to use appropriate immunoassay and specific antibody or antigen for the assay. It is important to check the function and quality control of the equipment. The correct pipetting is important. It is important to used standard laboratory procedure. It is important to maintained regularly of the equipment. The reagent should be properly handled. To check the turbidimeter for wavelength calibration, accuracy, linearity of detector and light should be performed at regular intervals.


Postanalytical phase

The normal level of CRP is less than 3mg/L. The interpretation of CRP result is very important because it is measure in a number of conditions. It is increases in limit from 10-40mg/l in mild inflammatory condition or in viral infection. The serum CRP level increases up to 200mg/l in bacterial infection and severe inflammation. For the sepsis 50mg/l is consider a cut-off value by Pedro Póvoa. IF the level of the CRP is not correlated to clinical feature or have doubt of interference substance so the test should be repeated.