Archive for March, 2010

Low Back Pain – What You Should Know About

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Posted 30 Mar 2010 — by admin
Category Physical Therapy

By:  Amapola Imbag Mallari  MPH, PTRP

Low back pain is a generalized complaint of discomfort over the lumbar area. This reflects an array of injuries over the apophyseal joints, IV discs and the surrounding contractile (muscles and ligaments) and non-contractile (spinal cord, nerves and vascular structures) soft tissues. Nevertheless, worry not because this costly and incapacitating condition is preventable and treatable by laboratory exercises for the back.

Epidemiology

About 50% to 80% of adults will have low back pain at some time in their lives. This is also the leading cause of disability in people younger than 45 years of age and the third leading cause of disability in those older than 45 years old. Current studies suggest a lifetime rate of low back pain of about 60% to 90% and an annual rate of about 5%. This condition is equal in men and women but is greater in incidence in women secondary to osteoporosis.

Risk Factors

The following are the risk factors for low back pain:

  • Occupational Factors. Force, repetition, posture and stress can contribute to low back pain. Exerting too much force on your back can cause injury as overly repetitious tasks can lead to muscle fatigue. In addition, spending too much time in a single posture can make you experience occasional aches and pains at the back.
  • Patient Related Factors: Age, sex, spinal mobility, physical fitness, smoking, anthropometric measurements and psychosocial factors are considered as risks for developing this condition.

Etiology

There are many etiological factors contributing to low back pain. These are:

  • Degenerative diseases of the joint disks
  • Inflammatory (non-infectious) diseases like Ankylosing Spondylitis (bamboo spine as seen laboratory findings)
  • Infectious conditions like osteomyelitis or abscesses inside the spine
  • Metabolic bone diseases including osteoporosis
  • Neoplastic cases when a metastatic tumor has invade the spine
  • Traumatic conditions like vertebral fractures
  • Congenital or developmental cases like scoliosis
  • Musculoskeletal etiology like muscle strains
  • Vascular cases such as hardening of the large arteries (atherosclerosis) running in front of the spine.
  • Psychogenic and post-operative and multiple operations on the back

Laboratory Findings

Clinical suspicion of low back pain requires immediate evaluation and prompt therapy. In the absence of historical or physical examination findings, laboratory or plain radiograph findings often are unrevealing. The laboratory results, however, are just meant to supplement such findings as these are often incidental, most especially with acute types of back pains.

Treatment

As confirmed by history, evaluation and laboratory results, treatment of low back pain begins with the following:

ü  Modification of activities of daily living (ADLs) by allowing the patient to adjust lifestyle and work demands;

ü  Bed rest for not more than three days (as longer bed rest has not been proven to be more beneficial);

ü  Pharmacological treatments such as non-steroidal anti-inflammatory drugs, acetaminophen and narcotic analgesics; and

ü  Physical therapy measures like ice massage and local heat, pelvic traction, transcutaneous electraical nerve stimulation and back flexibility exercises such as the McKenzie and William’s back protocols.

Once low back pain has been treated, it will have an impact on the quality of life of an individual. This article is used to educate patients on the perils of this disabling disease and how the health care providers and family members can be encouraged to guide patients to a wide range of treatments.

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How are Fungi Dispersed?

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Posted 28 Mar 2010 — by admin
Category Microbiology

Microorganisms like fungi are eukaryotic organisms that could be found in air, water and soil. They can be harmful or harmless. They are often called the “garbage disposers” because they feed on rotting, organic matter in the environment.

Fungi dispersal mechanisms differ in some ways for each of the five (5) phyla. In order to understand this, we have first to know the characteristics of a fungus and the different phyla classified under it.

The classifications of the phyla according to their methods of reproduction are: Zygomycotina, Chytridiomycotina, Ascomycotina, Basidiomycotina, and Deuteromycotina.

The first two are considered as lower fungi and are aseptate. The next two are the higher fungi, while the last phyla are considered the fungi Imperfecti which are very useful in the medical field as sources of antibiotics.

Since they do not have an apparent means of locomotion like pseudopodia, cilia and flagella, they are, in other words, “dispersed” into the environment.

What are the mechanisms of fungal dispersion?

1. Fungi causing bread molds and food spoilage usually belong to the class Zymycotina. These are dispersed through their filaments or hyphae which extend over the surface of the material it is growing on. It is through spore formation that it reproduces.

We commonly call these fungi growth on food and water as molds.

They are dispersed when they got blown by air, or through fungi infected water, or get transferred through contact with the mold itself.

2. Some fungi, like the mushroom, (yes the mushroom is a fungi, not a plant), are dispersed from their spores, which may travel through air, soil or water, or in direct contact from one medium to another. This would also bring about a new growth, just like a plant seed.

Some mushrooms are edible and some are not. The edible ones are even considered as special dishes in some countries. The non-edible ones produce toxins, like in Ergot poisoning, where mold-contaminated wheat are ingested by man. The condition would start from nausea, high fever, convulsions, gangrene and eventually death.

3. Dispersal of fungi that are present in human infections, like Candia albicans, Blastomyces dermatitidis or Aspergillus species is done through skin to skin contact.

4. Yeasts are found in food (skins of fruits, vegetables), soil and water. They are very useful in the manufacture of alcoholic beverages because they break down sugars to cause fermentation.

Opportunistic yeasts are also found in humans. They live harmlessly in the skin, mouth and genitor-urinary tract and only cause disease when there is a decrease in the indigenous bacteria in these organs.

They can be dispersed through inhalation of contaminated air or soil. They could also enter through wounds.

Dispersal of the yeast could be done also through dried feces of both birds and bats. When these contaminated materials are blown by air or come in contact with food, the yeast are further spread into the environment.

In conclusion, fungi could be dispersed through budding, spore dispersal, contaminated water, soil and direct contact. It must be noted that these organisms could be both beneficial and pathogenic and these should be considered when treating fungi related conditions.

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What are Complementary Medicine?

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Posted 18 Mar 2010 — by admin
Category Alternative Medicine

Sometimes we adapt treatment with complementary medicine without knowledge of their effectiveness. We fail to recognize the fact that complementary treatment is not for everyone, and that treatment should be individualized where each person should be carefully evaluated before initiating the procedure.

Complementary medicine are those unconventional techniques that are utilized together with the conventional method in treating diseases. While conventional medicine only cures the physical body, complementary medicine purports to be holistic and heal the whole body, including the mind and soul.

Just how effective are complementary techniques? We cannot just say that they are effective or ineffective without hard evidence. Here are some documented cases of their effectiveness and ineffectiveness.

According to the British Columbia (BC) Health Guide, an example of a complementary medicine is acupuncture.
“Acupuncture” when used to treat nausea and vomiting that accompanies chemotherapy or post-surgery pain, is a complementary therapy.” (BC Health Guide)

How effective is acupuncture?

1. Based on a study by Dr. Brian M Berman , et al:
“Participants in the true acupuncture group experienced greater improvement in WOMAC function scores than the sham acupuncture group at 8 weeks”
They have proven that acupuncture was able to ease pain when done as a complementary treatment for osteoarthritis. (http://www.annals.org/cgi/cont ent/abstract/141/12/901

2. Based on a study by Anna Enblom et al, on the relief of nausea caused by cancer treatment by acupuncture, which was presented in Barcelona at the European Cancer Conference (ECCO), the result showed there was no considerable relief of nausea in the cancer patients even when acupuncture was used. (http://www.news-medical.net/? id=30431)
Herbal medicine on the other hand is gaining popularity, but is there a conclusive way of ensuring that their production is within quality control guidelines? Although the Food and Drug Administration (FDA) had established some guidelines, on-going researches are still being done to establish full proof evidence that this complementary medicine really works.

How effective is herbal medicine?

1. A recent research done by Gingko Evaluation of Memory (GEM) led by Dr. Steven Dekosky on the effect of Gingko biloba on patients with Alzheimer’s showed that there was no improvement of the patient who was given 120 mg extract of Gingko. (http://www.medicalnewstoday.c om/articles/129915.php)

2. In 1998, the German Commission E in Germany, which has the function of evaluating the efficacy of phytomedicines, published a book entitled: “Therapeutic Guide to Herbal medicine”. This was a well acclaimed book considered to be of utmost accuracy all over the world. They have conducted a controlled trial on billberry as a treatment for diabetes and found out that there were more toxic effects on prolonged usage, like hypertension and jaundice.

3. In another study of the golden seal’s effectiveness against diarrhea which was done in India, the study’s result showed positive results with 90 % of the patient getting well within 24 hours.

4. In an uncontrolled trial on milk thistle it was found out that silymarin, the major substance found in milk thistle had greatly prevented liver damage. The 4 post operative cholecystectomy patients who had received the silymarin had a reduced cholesterol level.

Based on the studies above, they demonstrate that herbs are not 100 % effective. There are more successful studies however that proved the effectiveness of the herbal medicine against diseases. What you should remember is to select the right herb, prepare the concoction properly and ingest the correct dosage to avoid detrimental side effects. Just like any other ingested substance, herbs could be dangerous when not used properly. Not everyone could use herbal medicine.

Complementary medicine is still being continuously researched on. The decision to use the intervention or not will depend upon your attending physician as he/she would have to consider if the conventional method concurrently used with it is in sync with the procedure .

Reference:
Lawlis, Freeman, Complementary and Alternative Medicine: A Research-Based Approach: Harcourt Health Sciences Company: 2001

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How Fats in the Body are Metabolized

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Posted 08 Mar 2010 — by admin
Category Physiology

Fats or lipids enter the body through the food that we eat. There are many sources of lipids like meat fat, vegetable fat and dairy products.  Fats in the body are metabolized through these simple steps.

Mouth

These foodstuffs are ground into morsels by the mouth and the teeth.  Although salivary amylase is present, it does not have any action on lipids but only on carbohydrates.  The fats then go down into the stomach.

Stomach

Due to the high acidity of the stomach, metabolic breakdown of fats still do not occur.  Fats then move to the small intestines with the help of peristalsis.

Small intestines

Fats are then broken down into small micelles and acted upon by bile salts and bile acids coming from the bile pigment from the gall bladder.  These bile salts act with co-lipase and lipase to complete the digestion of fats.

Absorption

Digestion of the fats into fatty acids occurs. Fatty acids are the simplest forms of fats. They are now absorbed by the intestinal villi and distributed where they are most needed.

Unused fats

When the person is sedentary most of his fats are not  metabolized because the primary source of energy of the body are carbohydrates, so the body has to use the carbohydrates first before it utilizes fats  as source of energy.  That is why when a person does not exercise; fats are not burned off as energy and are therefore stored as triglycerides in the adipose tissues and the liver.

These unused fats could also form plaques in the lining of the blood vessels leading to atherosclerosis, which eventually leads to cardiovascular disorders. This is how fats in the body are metabolized

Significant points to remember:

  1. Meat fat is considered bad fat because they contain less protein. They are the low-density type of fats.
  2. Use fish fat or vegetable fat, they are safer because they contain the high density in protein type of fats.
  3. Exercise regularly to burn off excess carbohydrates and fats.
  4. Most fast foods are rich in bad Trans fats, so be judicious in selecting your food.
  5. Do not eat so many sweets like cakes and chocolates, because when unused, these are converted into triglycerides, which is one type of bad fat.
  6. Eat more fruits and vegetables to help reduce the effects of fats. Fruits and vegetables have anti-toxins and natural constituent that help the body remove impurities.

Know how your fats in the body are metabolized and stay healthy.

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Arterial Puncture: Simple Steps in Performing it

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Posted 06 Mar 2010 — by admin
Category Clinical Chemistry, Laboratory Procedures

Arterial puncture is one method of blood collection. Licensed and skilled personnel should perform it.   Laboratory technologists usually use arterial blood in blood gas analysis (BGA) or analysis of blood gas (ABG).

The procedure is similar to venipucture but should be done under anaerobic (no exposure to air) conditions to avoid escape of gas and shift from intracellular to extracellular fluid.

Materials needed

Luer lock syringe or appropriate syringe

Dry and sterile cotton

Wet and sterile cotton

Test tube rack

Test tube (optional depending on the type of collection vessel)

PPE

Here are the steps in performing arterial puncture.

Step 1

Wear your personal protective equipment properly.

Step 2

Prepare materials by checking each item and arranging them within arm’s reach.  Do not place near the patient, especially if patient is a child.

Step 3

Select the best site of puncture. Arterial puncture sites are at the radial artery, femoral artery or brachial artery.  Be certain that it is an artery instead of a vein, by feeling for the pulsations, which is characterized by a strong beating pulse.  Veins usually disappear when you push hard.

Step 4

Puncture the artery at about 90 degrees angle. When you have correctly hit the vein, blood will push the plunger upwards.  You just have to be ready to remove the needle from the artery when done the collecting the needed volume of arterial blood.

Step 5

After collection, remove the needle smoothly and apply pressure with sterile, dry cotton for 10 to 20 minutes. You could ask assistance from the patient, and then leave the cotton and place micropore.

Step 6

Depending upon the type of syringe used, you must seal the specimen container to ensure anaerobic exposure.  Dispense in sealed containers.

Step 7

The blood sample or arterial blood should be covered at all times.  Label the specimen properly.  If you are not testing the blood immediately then keep it in chilled ice.  Even when transporting, it should be placed in an icebox with crushed ice.

Step 8

Check the wound of the patient. Be certain there is no bleeding, before you allow him to stand.

Step 9

Dispose your used materials in specified containers.   Clean your working area.

Step 10

Wash your hands thoroughly after the procedure.

Licensed personnel should do arterial puncture, as there is the danger of hitting major nerves, which can debilitate or paralyze a person.  It may also cause hemorrhage if there is no correct patient’s after care.

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What is Clinical Chemistry

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Posted 05 Mar 2010 — by admin
Category Clinical Chemistry

Clinical chemistry is defined in layman’s language as the study of the substance in biological fluids most specifically blood,  the methods and principles of determination, the intrinsic and extrinsic precautions, the normal levels and the clinical significance of abnormal values.

It belongs to the same discipline as clinical toxicology, endocrinology, physical chemistry, qualitative chemistry, quantitative chemistry, organic chemistry, inorganic chemistry, general chemistry, and biochemistry.

Clinical chemistry is tackled in three general topics for medical technology students. Clinical chemistry 1 is Pure Blood Chemistry including the following topics: Introduction to clinical chemistry, laboratory math, quality assurance, specimen collection, carbohydrates, lipids, proteins, renal functions tests, and liver function tests.

Clinical chemistry 2 is Special Chemistry, which includes automation, blood gas analysis (BGA), electrolytes and enzymology.  Blood gas analysis is very important in the maintenance of the acidity and alkalinity of blood.  The determination has special precautions like an anaerobic collection and the use of dry heparin as an anticoagulant. Electrolytes, on the other hand, are very important substances too that the body has to maintain concentrations of. An elevation and decrease of the concentration levels indicates an existing pathologic condition.

Clinical chemistry 3 includes Toxicology, endocrinology, and drug testing.  Toxicology is the section that deals with toxins that affect man. These include heavy metals, over-dosage of prescribed drugs, prohibited drugs, strong acids, strong bases and many more.  Drug testing is specifically for drugs of abuse and illegal drugs. For endocrinology, different hormones in the body are studied and are utilized to help in the diagnosis of diseases.

Universities and colleges may differ a little bit from the topics included with each phase of clinical chemistry. What is important is that all of the topics are included and are discussed.

Clinical chemistry also is one very important section in the clinical laboratory because it is here where the concentrations of various substances are determined.  Normal levels of each substance have been established and this is the basis for interpreting whether the results or concentrations of the unknown substance is normal or not. It the values fall below or above the normal levels, and then there is an existing pathologic condition or disease in the person. That is why it is very important that all procedures starting from patient identification, to specimen collection, to assaying, to reporting and recording should be reliable.  Correct diagnosis of the patients’ condition is very important to facilitate successful therapy.

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Identification of Neisseria gonorrhea

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Posted 03 Mar 2010 — by admin
Category Laboratory Procedures, Microbiology

Neisseria gonorrhea is the causative agent of gonorrhea a sexually transmitted disease (STD). They are coffee-bean shaped cocci occurring in pairs. They are gram-negative, intracellular diplococci and they are stained using gram staining.

Identification of Neisseria gonorrhea is easy with a simple smear.

Materials needed

Clean and dry glass slide

Applicator stick with cotton

Grams stain

Personal protective equipment

Procedure

Step 1

Wear your personal protective equipment (PPE), gloves, masks and laboratory gown. Neisseria gonorrhea could infect the eyes and your throat. They could cause gonorrheal blindness and throat infections if not diagnosed immediately.

Step 2

With an applicator stick, collect the specimen from the cervical or vaginal area. Sometimes the doctor collects the specimen during his examination.

Step 3

Make a smear of the secretion on the clean and dry glass slide, not too thick or too thin. Identification of Neisseria gonorrhea is facilitated when the simple smear is properly prepared.

Step 4

Allow to air dry or through exposure to direct flame. This will allow the smear to stick to the slide and not washed off during staining.

Step 5

Place in a staining rack and add crystal violet until all the smear is exposed to the stain. The time will depend upon the staining kit’s instructions. The time varies with newly developed kits.

Step 6

Wash the slide and add acid alcohol to decolorize. The gram-positive bacteria will take up the crystal violet while the gram-negative bacteria like Neisseria gonorrhea will decolorize.

Step 7

Wash with distilled water and add safranin. The gram-negative bacteria will take up this stain and will be colored pink. While the gram positive bacteria will be stained purple or violet, taking up the color of crystal violet.

Step 8

Wash again with distilled water and allow to dry.

Step 9

Focus in the microscope using the low power objective (LPO), then shift to the high power objective (HPO) or shift straight to the oil immersion objective (OIO). When using the OIO, place a drop of oil into the slide to be able to see clearly.

Step 10

Following a four field meander, scan the slide for the presence of gram-negative intracellular, diplococci. You should scan the whole slide, as you may not see them immediately. A large amount of pus cells is usually one indication of the infection. Do not report however as positive unless you have observed the diploccoci in the smear itself. Step 10 Record and report your findings.

Step 11

Dispose of your materials properly.

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Blood pH – How the body maintains its acidity and alkalinity

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Posted 02 Mar 2010 — by admin
Category Clinical Chemistry, Diseases and Conditions, Keeping Healthy

In order for the body to function normally, the maintenance of the acidity and alkalinity of the body is vital. The normal pH of blood is 7.35 to 7.45 with an average of 7.4. This slightly alkaline blood pH must be maintained to avoid detrimental effects like comma and evident death. How the body maintains its acidity and alkalinity is a complex process. Presented here is a simple outline regarding the complex process.

Organs involved

The organs involved in the maintenance of blood pH are the lungs and the kidneys. The lungs exhale carbon dioxide to help with pH control while the kidneys excrete hydrogen ions and bicarbonates according to the needs of the body.

Substances involved

Carbon dioxide and hydrogen are considered acidic substances they are excreted more when the body is too acidic. Bicarbonate is considered an alkaline substance so it is excreted more when the body is too alkaline.

Processes that occur

How the body maintains its acidity and alkalinity is based on the processes that occur in the kidneys and the lungs.

Hyperventilation

When the kidneys are dysfunctional and could not respond to the imbalance in blood pH, the lungs will respond. People hyperventilate to bring out more carbon dioxide, an acidic substance, thereby decreasing the acidity of the blood. When there is alkalosis, hypoventilation occurs to retain more carbon dioxide hence, making the blood more acidic.

Bicarbonate excretion by the kidneys

If the lungs are dysfunctional, the kidneys will respond by increasing or decreasing the excretion of bicarbonate and hydrogen ions. When the body is acidotic or has the condition acidosis, the kidneys will excrete more hydrogen ions and retain more bicarbonate to return the blood pH to normal. When the body is alkalotic, the kidneys will increase the excretion of bicarbonate and decrease the excretion of hydrogen ions. Through these processes, the blood pH is maintained.

Acid-base buffer system in the body

The formation of carbonic acid and bicarbonate is reversible so when the body needs more alkalinity, bicarbonate is formed. If the body needs more acidity, carbonic acid is formed.

Homeostasis is maintained through these processes and normal blood pH is restored. In cases where both the lungs and the kidneys are dysfunctional then medical intervention is needed and appropriate medication or management is given to the patient.

Knowing how the body maintains its acidity and alkalinity is good because you will understand why at times you hyperventilate even when you do not want to.

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