Haemoglobin test

II. Acid haematin method using a haemoglobinometer (Sahli�s method)

In the course of a study of the blood in the anemias of infancy, certain discrepancies were encountered in the acid hematin method of determination of hemoglobin described by Sahli.The study of the cause of these discrepancies has led to a modification of the method to produce accurate determinations comparable with those obtainable when a determination of hemoglobin by measuring its iron content, or by the carbon monoxide hemoglobin method, is made. These modifications consist in: first, the use of N/10 hydrochloric acid as the diluent of the acid hematin instead of water; and second, the employment of heat to bring the reaction of formation of the acid hematin to its endpoint of equilibrium more quickly than it occurs in the cold.

Since the introduction of the acid hematin method by Sahli, various criticisms of it have been made. From the mechanical side these have been well summed up

 instument

1.haenoglobinometter

2.hemoglobin matching box 

3.hemoglobin tube

4.glass rod

5.alcohol  pad

6.N/10 HCL

7.leancet

  

Procedure

1. The diluent is N/10 Hydrochloric acid (HCL). Add it from the dropping bottle provided to the graduated tube, up to mark 2.
2. Measure 0.2 ml (20 �l) of well-mixed blood, with the provided micropipette (Sahli�s pipette) and transfer it to the HCL in the tube.
3. With the pipette beneath the surface of the acid, gently blow the blood.
4. Rinse the pipette by sucking up and blowing out diluent 2-3 times.
5. Thoroughly mix blood and acid using a fine glass rod (HCL will react with the haemoglobin and convert it into acid-haematin, which has a brown color).
6. Wait up to 3 minutes after adding the blood to allow the color to develop sufficiently to achieve an accurate comparison.
7. Add distilled water gradually to the mixture and mix the solution with glass rode.
8. Place the tube in the haemoglobinometer and compare it with the standard.
9. Continue to add distilled water until the sample firstly appears to be detectably pallor than the standard.
10. Note the level of the liquid in the tube.
    
    
    
    
    
    

Disadvantages

 

1.    It is tedious and time consuming to perform, especially with large number of samples.

It is not accurate (its accuracy is of the order � 15 %).

introduction of anatomy

INTRODUCTION OF ANATOMY

The word Anatomy itself is derived from the Greek, meaning 'to cut up.'

Anatomy is the study of the structure and function of the body.

Subdivisions of Anatomy

1.       Gross anatomy is the study of the structure of the body as seen with the naked eye.

2.       Microscopic anatomy is the study of the structure of the body which can be seen only with the aid of a microscope. Microscopic anatomy can be further subdivided into organology (the study of organs), histology (the study of tissues) and cytology (the study of cells).

3.       Histology (Gr. /Histo, web or tissue + logos, study).

Histology refers to "the study of the cells and extracellular matrix of tissues. Today the word histology is used as a synonym for microscopic anatomy Because its subject matter encompasses not only the microscopic structure of tissues but also that of the cells, organs and organ systems.

4.       Embryology (Developmental anatomy) is the study of growth and development of adult structure from the fertilized ovum

5.       Neuroanatomy is the study of the elaborate patterns of connections between cells in the nervous system.

BRANCHES OF ANATOMY

Based on discussion topics

1.       Cytology: Branches of anatomy deals with the study of structures of different types of cells.

2.        Histology: Branches of anatomy deals with the study of structure of different types of tissues.

3.       Neurology: Branches of anatomy deals with the study of structure of nervous tissues.

4.       Myology: Branches of anatomy deals with the study of different types of muscular tissues.

5.       Osteology: Branches of anatomy deals with the study of structures of different types of bone.

6.       Arthrology: Branches of anatomy deals with the study of different types of  joints.

7.       Angiology: Branches of anatomy deals with the study of different types of vessels.

8.       Splanchnology: Branches of anatomy deals with the study of different organs of body.

Base on application

1.     Clinical anatomy. Anatomy that discusses different organs and structures related

2.      Surface anatomy: Anatomy that discusses different organs and structures related to surface marking.

3.     Radio anatomy: Anatomy that discusses different Organs and structures related to radiological image.

4.       Physical anatomy: Anatomy that discusses different organs and structures related to physics.

DIVISIONS OF HUMAN BODY

According to anatomy the human body has been divided into five different divisions. There are

1.       Head & Neck

2.       Thorax

3.       Abdomen

4.       Upper limbs

5.       Lower limbs.

Anatomical Planes

1.       Median plane is the imaginary vertical plane passing longitudinally through the body from front to back that divides the body into two equal right and left halves. Anterior and posterior median lines are the edges of the median plane on the front and back of the body.

2.       Sagittal plane is the imaginary vertical plane passing through any part of the body parallel to the median plane. The sagittal plane that passes through the median plane of the body is often referred to as the median sagittal plane.

3.       Coronal plane is the imaginary vertical plane passing through the body at right angles to the median plane, dividing it into anterior (front) and posterior (back) portions.

4.       Horizontal or transverse plane is the imaginary plane passing through the body at right angles to both the median and coronal planes. A transverse plane divides the body into superior(upper) and inferior (lower) parts.

TERMS RELATED TO POSITIONING SYSTEM

1.       Anterior or ventral: the front of a structure or toward the front.

2.       Posterior or dorsal: in the back part of a structure or toward the back.

3.       Inferior or caudal: situated below or lower than a given point of reference, as the feet are inferior to the legs.

4.       Superior or cranial: situated above or oriented toward a higher place, as the head is superior to the body.

5.       Lateral: on the side or away from the mid-sagittal plane. Two types left lateral & right lateral.

6.       Medial: situated or oriented toward the midline of the body.

7.       Proximal: nearer to a point of reference, usually the trunk of the body, than other parts of the body.

8.       Distal: away from or being the farthest from the midline or a central point, as a distal phalanx.

9.       Transverse: at right angles to the long axis of any common part

10.   Oblique: a slanting direction or any variation from the perpendicular or the horizontal.

Terms of Comparison

1.       Proximal means "nearer to the trunk" or "point of origin" of a vessel. For example, the elbow is proximal to the wrist; and the proximal part of an artery is its beginning.

2.       Distal means "farther from the trunk" or "point of origin" of a nerve. For example, the foot is the distal end of the lower limb,

3.       Superficial means "nearer the skin". For example. The muscles of the thoracic wall are superficial to the viscera in the thoracic cavity.

4.       Deep means "farther from the surface". For example, in the arm, the bone (humerus) is deep to the muscles, fasciae and skin.

5.       Internal means "toward or in the interior of an organ internal carotid artery is or cavity. For example, the  found inside the cranial cavity.

6.       External means "toward or on the exterior of an  organ or cavity example artery is found outside the cranial cavity.

7.       Ipsilateral means "on the same side of the body." For example, the left hand and left foot are ipsilateral.

8.      Contralateral means "on  the opposite sides of the body. For example, the right hand and left hand are

cell

  What is a cell?

Cells are the basic building blocks of all living things. The human body is composed of trillions of cells. They provide structure for the body, take in nutrients from food, convert those nutrients into energy, and carry out specialized functions. Cells also contain the body’s hereditary material and can make copies of themselves. Cells have many parts, each with a different function. Some of these parts, called organelles, are specialized structures that perform certain tasks within the cell. Human cells contain the following major parts, listed in alphabetical order:

Cytoplasm

Within cells, the cytoplasm is made up of a jelly-like fluid (called the cytosol) and other structures that surround the nucleus.

Cytoskeleton

The cytoskeleton is a network of long fibers that make up the cell’s structural framework. The cytoskeleton has several critical functions, including determining cell shape, participating in cell division, and allowing cells to move. It also provides a track-like system that directs the movement of organelles and other substances within cells.

Endoplasmic reticulum (ER)

This organelle helps process molecules created by the cell. The endoplasmic reticulum also transports these molecules to their specific destinations either inside or outside the cell.

Golgi apparatus

The Golgi apparatus packages molecules processed by the endoplasmic reticulum to be transported out of the cell.

Lysosomes and peroxisomes

These organelles are the recycling center of the cell. They digest foreign bacteria that invade the cell, rid the cell of toxic substances, and recycle worn-out cell components.

Mitochondria

Mitochondria are complex organelles that convert energy from food into a form that the cell can use. They have their own genetic material, separate from the DNA in the nucleus, and can make copies of themselves.

Nucleus

The nucleus serves as the cell’s command center, sending directions to the cell to grow, mature, divide, or die. It also houses DNA (deoxyribonucleic acid), the cell’s hereditary material. The nucleus is surrounded by a membrane called the nuclear envelope, which protects the DNA and separates the nucleus from the rest of the cell.

Plasma membrane

The plasma membrane is the outer lining of the cell. It separates the cell from its environment and allows materials to enter and leave the cell.

Ribosomes

Ribosomes are organelles that process the cell’s genetic instructions to create proteins. These organelles can float freely in the cytoplasm or be connected to the endoplasmic reticulum

Cholera

Cholera

Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae.

Cholera was prevalent in the U.S. in the 1800s before modern water and sewage treatment systems eliminated its spread by contaminated water. Only about 10 cases of cholera are reported each year in the U.S. and half of these are acquired abroad. Rarely, contaminated seafood has caused cholera outbreaks in the U.S. However, cholera outbreaks are still a serious problem in other parts of the world, where cholera affects an estimated 3 to 5 million people and causes more than 100,000 deaths each year.

Cholera Causes

Vibrio cholerae, the bacterium that causes cholera, is usually found in food or water contaminated by feces from a person with the infection. Common sources include:

• Municipal water supplies
• Ice made from municipal water
• Foods and drinks sold by street vendors
• Vegetables grown with water containing human wastes
• Raw or undercooked fish and seafood caught in waters polluted with sewage

When a person consumes the contaminated food or water, the bacteria release a toxin in the intestines that produces severe diarrhea.

It is not likely you will catch cholera just from casual contact with an infected person.

Cholera Symptoms

Symptoms of cholera can begin as soon as a few hours or as long as five days after infection. Often symptoms are mild. But sometimes they are very serious. About one in 20 people infected have severe watery diarrhea accompanied by vomiting, which can quickly lead to dehydration. Although many infected people may have minimal or no symptoms, they can still contribute to spread of the infection.

Signs and symptoms of dehydration include:

• Rapid heart rate
• Loss of skin elasticity (the ability to return to original position quickly if pinched)
• Dry mucous membranes, including the inside of the mouth, throat, nose, and eyelids
• Low blood pressure
• Thirst
• Muscle cramps

If not treated, dehydration can lead to shock and death in a matter of hours.

Cholera Treatment and Prevention

Although there is a vaccine against cholera, the CDC and World Health Organization don't normally recommend it because it may not protect up to half of the people who receive it and it lasts only a few months. However, you can protect yourself and your family by using only water that has been boiled, water that has been chemically disinfected, or bottled water. Be sure to use the bottled, boiled, or chemically disinfected water for the following purposes:

• Drinking
• Preparing food or drinks
• Making ice
• Brushing your teeth
• Washing your face and hands
• Washing dishes and utensils that you use to eat or prepare food
• Washing fruits and vegetables

typhoid fever

Typhoid Fever

What is typhoid fever?

Typhoid fever is an acute illness associated with fever caused by the Salmonella typhi bacteria. It can also be caused by Salmonella paratyphi, a related bacterium that usually causes a less severe illness. The bacteria are deposited in water or food by a human carrier and are then spread to other people in the area.

The incidence of typhoid fever in the United States has markedly decreased since the early 1900s, when tens of thousands of cases were reported in the U.S. Today, less than 400 cases are reported annually in the United States, mostly in people who have recently traveled to Mexico and South America. This improvement is the result of better environmental sanitation. India, Pakistan, and Egypt are also known as high-risk areas for developing this disease. Worldwide, typhoid fever affects more than 21 million people annually, with about 200,000 people dying from the disease.

How Do People Get Typhoid Fever?

Typhoid fever is contracted by drinking or eating the bacteria in contaminated food or water. People with acute illness can contaminate the surrounding water supply through stool, which contains a high concentration of the bacteria. Contamination of the water supply can, in turn, taint the food supply. The bacteria can survive for weeks in water or dried sewage.

About 3%-5% of people become carriers of the bacteria after the acute illness. Others suffer a very mild illness that goes unrecognized. These people may become long-term carriers of the bacteria -- even though they have no symptoms -- and be the source of new outbreaks of typhoid fever for many years. 

How Is Typhoid Fever Diagnosed?

After the ingestion of contaminated food or water, the Salmonella bacteria invade the small intestine and enter the bloodstream temporarily. The bacteria are carried by white blood cells in the liver, spleen, and bone marrow, where they multiply and reenter the bloodstream. People develop symptoms, including fever, at this point. Bacteria invade the gallbladder, biliary system, and the lymphatic tissue of the bowel. Here, they multiply in high numbers. The bacteria pass into the intestinal tract and can be identified in stool samples. If a test result isn't clear, blood samples will be taken to make a diagnosis.

treatment of cardiac diseases

Treatment for cardiovascular disease

On this page

Medicines for cardiovascular disease
Hospitalisations
Hospital procedures
Stroke units
Rehabilitation

Medicines for cardiovascular disease

Cardiovascular medicines are key to preventing and treating cardiovascular disease (CVD). With appropriate medication, patients with CVD or those at risk of the disease can improve their quality of life and increase their life expectancy. 

Antithrombotic medicines

Antithrombotic medicines act by preventing the formation of blood clots or by dissolving existing blood clots.
These medicines are usually taken over a long period to reduce the risk of heart attack and death. They also reduce the risk of subsequent strokes and disability among patients with a history of stroke.
In 2008, the defined daily dose (DDD) per 1,000 people per day for antithrombotic medicines was 37.8, up from 34.5 in 2006 (Table 1) (55KB XLS).

Table 1: Prescription rates for cardiovascular disease medications, defined daily dose per 1,000 people per day, 2006 and 2008

Medicine	Change between 2006 and 2008
Antithrombotic medicines
Blood pressure-lowering medicines
Diuretics
Beta-blockers
Calcium-channel blockers
Renin-angiotensin system agents
Lipid-modifying medicines
Other medicines
Nitrates	steady
Antiarrhythmics

Note: indicates an increase and   a substantial increase.
Source: AIHW analysis of data supplied by the DoHA from the Pharmaceutical Benefits Data System.

Medicines to lower blood pressure

Medicines to lower blood pressure, or antihypertensives, are used to treat high blood pressure and have been shown to significantly reduce the number of deaths from heart attacks and stroke.
Diuretic medicines increase water loss through urination, leading to a reduction in blood volume (and hence blood pressure). The prescription rate for diuretics increased slightly from 44.3 DDD/1,000/day in 2006 to 45.6 DDD/1,000/day in 2008 (Table 6.1) (55KB XLS).
Beta-blocking agents reduce the heart's activity by suppressing certain signals to it that cause it to beat faster and harder.
There was a small increase in the supply of beta-blockers between 2006 and 2008 (25.8 to 26.8 DDD/1,000/day) (Table 6.1) (55KB XLS).
Different calcium-channel blockers act on different parts of the heart and circulation to reduce the force of contraction of the heart. This reduces both blood pressure and the effects of angina.
The rate at which calcium-channel blockers were prescribed increased from 48.4 DDD/1,000/day in 2006 to 53.8 in 2008 (Table 6.1) (55KB XLS).
Renin-angiotensin system agents reduce blood pressure by blocking the effects of the renin-angiotensin system, a hormone system of the body which regulates blood pressure.
Between 2006 and 2008, the supply of renin-angiotensin system agents increased from 165.6 to 193.6 DDD/1,000/day (Table 6.1) (55KB XLS).

Lipid-modifying medicines

Lipid-modifying medicines control blood cholesterol level.
There was a large increase in the use of lipid-modifying medicines between 2006 and 2008 (101.0 to 132.2 DDD/1,000/day) (Table 6.1) (55KB XLS).

Other medicines

Nitrates dilate heart blood vessels and reduce the work done by the heart.
The prescription rate of nitrates remained fairly steady between 2006 and 2008 (13.0 and 12.7 DDD/1,000/day) (Table 6.1) (55KB XLS).
Antiarrhythmic medicines are given either to restore normal heart rhythm or prevent serious abnormal heart rhythms (arrhythmias).
The supply of these medicines increased from 0.6 DDD/1,000/day in 2006 to 1.9 in 2008 (Table 6.1) (55KB XLS).

Hospitalisations

All cardiovascular diseases (CVD)

In 2009–10, there were 482,252 hospitalisations with a principal diagnosis of CVD in Australia.
The rate of CVD hospitalisations increases rapidly with age and in 2009–10 almost eight in 10 (78%) were for people aged 55 years and over.
Males had higher rates of CVD hospitalisations than females in all age groups.
The age-standardised rate for males (2,495 per 100,000 people) was 1.6 times as high as that for females (1,603 per 100,000 people).

Figure: Cardiovascular disease hospitalisation rates, principal diagnosis, by age and sex, 2009–10

Source: AIHW National Hospital Morbidity Database. Source data (Table 6.2) (55KB XLS).

Coronary heart disease (CHD)

In 2009–10, there were 153,833 hospitalisations with a principal diagnosis of CHD (2% of all hospitalisations and 32% of hospitalisations for CVD).
The CHD hospitalisation rate was nearly twice as high for males as it was for females in each age group.
Around 60% of hospitalisations with CHD were among people aged 65 years and over.

Figure: Coronary heart disease hospitalisation rates, principal diagnosis, by age and sex, 2009–10

Source: AIHW National Hospital Morbidity Database. Source data (Table 6.3) (55KB XLS).

Stroke

In 2009–10, there were 35,345 hospitalisations in Australia with a principal diagnosis of stroke (0.4% of all hospitalisations). Stroke accounted for 7% of all CVD hospitalisations.
Stroke hospitalisation rates increased rapidly among the most elderly with rates for those aged 85 years and over almost twice as high as for the 75–84 year age group, and 11 times the rate among those aged 55 to 64 years.
Approximately 65% of stroke hospitalisations occurred among people aged 70 years and over.
Between the ages 45 and 84 years, males had higher rates of stroke hospitalisation than females, after which their rates were similar to females.
Beyond 85 years females accounted for 64% of hospitalisations, reflecting the greater proportion living into old age.

Figure: Stroke hospitalisation rates, principal diagnosis, by age and sex, 2009–10

Source: AIHW National Hospital Morbidity Database. Source data (Table 6.4) (55KB XLS).

Hospital procedures

Coronary angiography

In 2007–08, a total of 110,611 coronary angiography procedures were performed in hospital. The majority of these procedures were performed on males: 73,011 procedures (66%) compared with 37,600 (34%) on females.
The rate of coronary angiography procedures was also higher for males than for females: in 2007–08, the age-adjusted rate was 676 per 100,000 males and 319 per 100,000 females.
The rate of coronary angiography procedures increased with age until 75-84 years, after which the rate decreased.

Figure: Coronary angiography procedure rates, by age and sex, 2007–08

Source: AIHW National Hospital Morbidity Database. Source data (Table 6.5) (55KB XLS).

Computerised tomography (CT) brain scan

A computerised tomography (CT) brain scan is often used for stroke diagnosis but can be used for a number of non-stroke conditions, such as head injury. To exclude such cases, only procedures where the principal diagnosis was stroke or transient ischaemic attack (TIA) are used here.
In 2007–08, 34,441 CT brain scan procedures were performed on patients with a principal diagnosis of stroke or TIA.
The procedures were almost evenly divided between males and females, with males receiving 17,457 procedures (51%) and females 16,984 (49%).
However, the rate for CT brain scans was higher in men than women (171 compared with 131 per 100,000 people).

Percutaneous coronary interventions (PCIs)

In 2007-08, a total of 34,972 percutaneous coronary interventions (PCIs) were performed, three-quarters of which (26,109) were for males.
The rate for PCIs for males was much higher than that for females (241 compared with 74 per 100,000 people).
The rate of PCIs increased steadily with age until the 75–84 years age group and then declined for those 85 years and over.

Figure: Percutaneous coronary intervention rates, by age and sex, 2007-08

Source: AIHW National Hospital Morbidity Database. Source data (Table 6.6) (55KB XLS).

Coronary artery bypass grafting (CABG)

In 2007–08, 13,612 coronary artery bypass grafting (CABG) procedures were performed. These procedures were performed much more often on males (10,648 or 78%) than females (2,964 or 22%).
The rate of CABG procedures increased until the age of 75-84 years. Age specific procedure rates were higher for males than for females across all age groups.

Figure: Coronary artery bypass graft rates, by age and sex, 2007-08

Source: AIHW National Hospital Morbidity Database. Source data (Table 6.7) (55KB XLS).

Carotid endarterectomy

The carotid endarterectomy procedure is used to reduce the risk of stroke caused by blockage in the carotid artery.
In 2007-08 there were 2,441 carotid endarterectomy procedures performed on hospitalised patients.
More patients were male (71%) than female (29%). Similarly, the age-standardised rate of procedures was higher for males (17 procedures per 100,000 of the people) than for females (6 per 100,000 people).

Stroke units

Caring for people in specialised stroke units significantly reduces death and disability after stroke compared with conventional care in a general ward. Hence stroke units are an important part of rehabilitation.
Findings from the National Stroke Audit Acute Services Organisational Survey Report 2011 on stroke units in Australian hospitals include:

• the number of stroke units and stroke beds has increased since 2007, from 54 to 74 stroke units and from 391 to 549 dedicated stroke unit beds.
• of the 74 reported stroke units, 70 (95%) were located in urban areas comprising 56 (76%) in metropolitan and 14 (19%) in regional areas.
• there were 549 dedicated stroke unit beds in Australia in 2011; the majority were in NSW (34%), Victoria (24%) and Queensland (20%).
• despite an increase in the number of stroke units and stroke unit beds, access is low when compared to other countries.
• on the day of the survey only 58% of patients across Australia were reported to be receiving stroke unit care.

Stroke rehabilitation aims to maximise a patient's physical, psychological, social and financial independence, and ideally begins the first day after a stroke. Most patients can function better after rehabilitation, hence significantly improving their overall health and wellbeing.
In 2007, there were 4,937 stroke rehabilitation discharge episodes from subacute inpatient rehabilitation programs. In over 80% of these rehabilitation episodes, the patient was later discharged to the community.

Cardiac rehabilitation

Cardiac rehabilitation refers to all measures that help people who have recently had an acute coronary event or heart surgery return to a normal and productive life.
It aims to minimise recovery time, and maximise the patient's physical, psychological and social functioning. It also encourages behaviours to minimise the risk of further cardiac events.
Outpatient cardiac rehabilitation consists of supervised programs that usually commence soon after discharge from hospital (ideally within a few days) and may continue for 2–3 months.
There are no national data on episodes of outpatient cardiac rehabilitation.