MEDICAL LAB TECHNOLOGY

Leptospirosis Infections in Humans

2011-04-13T11:43:00.002+08:00

Incubation Period The incubation period in humans is usually 7 to 12 days, with a range of 2 to 29 days.

Clinical Signs Human infections vary from asymptomatic to severe. Many cases are mild or asymptomatic, and go unrecognized. Some serovars tend to be associated more often with some syndromes (e.g., severe disease is often associated with serovar icterohaemorrhagiae).However, any serovar can cause any syndrome. In humans, leptospirosis is usually a biphasic illness. The first phase, called the acute or septicemic phase, usually begins abruptly and lasts approximately a week. This phase is characterized by nonspecific signs including fever, chills, headache and conjunctival suffusion. Myalgia, which typically affects the back, thighs or calves, is often severe. Occasionally, a transient skin rash occurs. Other symptoms may include weakness, photophobia, lymphadenopathy, abdominal pain, nausea, vomiting, a sore throat, cough, chest pain and hemoptysis. Mental confusion, neck stiffness and other signs of aseptic meningitis have been reported in this phase. Jaundice can be seen in more severe infections. These symptoms last for approximately 4 to 9 days, then are typically followed by a 1 to 3 day period during which the temperature drops and the symptoms abate or disappear. The second phase of leptospirosis, called the immune phase, is characterized by the development of anti-Leptospira antibodies, and the excretion of the organisms in the urine. This phase can last up to 30 days or more, but does not develop in all patients. During the immune phase, the patient becomes ill again. Nonspecific symptoms seen in the first stage, such as fever and myalgia, recur but may be less severe than in the first stage of disease. Two forms of disease, icteric and anicteric, are seen. Most infections are of the anicteric form. The most important symptoms in this form are associated with aseptic meningitis. A severe headache, stiff neck and other meningeal symptoms occur in approximately half of all patients, and usually last a few days. Occasionally, these signs may be present for up to two weeks. Less common symptoms include cranial nerve palsies, encephalitis, confusion and changes in consciousness. Deaths are rare in the typical anicteric form; however, a syndrome of fatal pulmonary hemorrhage, without jaundice, has recently been reported. The icteric form is more severe. It occurs in 5-10% of all patients, is often rapidly progressive, and may be associated with multiorgan failure. The most commonly involved organ systems are the liver, kidneys and central nervous system (CNS). In the icteric form, there may be no period of improvement between the septicemic and immune phases. Jaundice can be severe and may give the skin an orange tone, but it is not usually associated with severe hepatic necrosis. Acute renal failure occurs in 16-40% of cases. Some patients also have pulmonary symptoms, with clinical signs ranging from cough, dyspnea, chest pain, and mild to severe hemoptysis, to adult respiratory distress syndrome. Cardiac involvement can result in congestive heart failure, myocarditis and pericarditis. Hemorrhages may also be seen; epistaxis, petechiae, purpura and ecchymoses are the most common signs, but severe gastrointestinal bleeding, adrenal or subarachnoid hemorrhage, and pulmonary hemorrhages can occur. Rare complications include stroke, rhabdomyolysis, thrombotic thrombocytopenic purpura, acute acalculous cholecystitis, erythema nodosum, aortic stenosis, Kawasaki syndrome, reactive arthritis, epididymitis, nerve palsy, male hypogonadism, Guillain-Barre´ syndrome and cerebral arteritis. Deaths can occur from kidney failure, cardiac involvement. pulmonary hemorrhage or other serious organ dysfunction. Convalescence from the icteric form may take 1-2 months. Although jaundice can persist for weeks, liver function returns to normal after recovery, and hepatic disease is rarely the cause of death. Most patients also recover kidney function Anterior uveitis occurs up to a year after recovery in 2-10% of cases. Most of these patients recover full vision. Iridocyclitis and chorioretinitis can also be complications, and may persist for years. Abortions, fetal death, and rare congenital infections in newborns have been reported. Abortions can occur at any time, including the convalescent period.

Communicability Direct person-to-person transmission is rare but possible. Leptospira organisms are found in the urine during the second (immune) phase of the disease. Most people excrete these bacteria for 60 days or less, but shedding for months or years has been documented. Other routes of transmission are also possible: one infant was infected during breast feeding, and a case of transmission during sexual intercourse was reported.

Diagnostic Tests Leptospirosis can be diagnosed by culture, detection of antigens or nucleic acids, or serology. Serum chemistry values and analysis of the CSF may support the diagnosis. In humans, Leptospira can be isolated from the blood, cerebrospinal fluid or urine. Culture can be difficult and may require up to 13 to 26 weeks. Identification to the species, serogroup and serovar level is done by reference laboratories, using genetic and immunologic techniques. Leptospira spp. can also be identified in clinical samples by immunofluorescnce and immunhistochemical staining, as well as DNA probes and polymerase chain reaction (PCR) techniques. Darkfield microscopy can be used but is not specific. Most human cases of leptospirosis are diagnosed by serology. The most commonly used serologic tests are the microscopic agglutination test (MAT, previously known as the agglutination-lysis test) or ELISAs. The MAT test is serogroup but not serovar specific, and can be complicated by cross-reactions. Less commonly used tests include complement fixation,radioimmunoassay,immunofluorescence,counter immunoelectrophoresis and thin layer immunoassay. The macroscopic slide agglutination test may be used for a presumptive diagnosis, but is not specific. A high titer with consistent symptoms is suggestive of an acute case, but a rising titer is necessary for a definitive diagnosis. Few serovarspecific assays are available in human medicine.

Treatment Severe leptospirosis is treated with antibiotics. The use of antibiotics for the mild form of disease is controversial, and the research is still inconclusive. Antibiotics used in humans include doxycycline, ampicillin, amoxicillin, penicillin and erythromycin. Supportive treatment and management of complications such as renal failure, hepatic complications, hemorrhages and CNS disease may also be necessary.

p53 and Cancer

2010-04-01T07:50:00.000+08:00

p53 mutations have been documented in around 50% of cancers making it the most common genetic event in human malignancies. Located on chromosome 17p13, it encodes a 53 kilodalton modular nuclear phosphoprotein, which functions predominantly as a transcriptional regulator. p53 protein within a cell integrates signals arising from a wide range of cellular stresses and directs cellular responses through several downstream genes via its conserved domain viz N-terminal, SH3-binding, sequence-specific DNA binding, tetramerization and C-terminal.

Under normal circumstances of cell growth, p53 protein has a relatively short half-life, being mainly controlled through an autoregulatory loop in which Mdm-2 binds p53 and targets it for nuclear export and ubiquitin-dependent proteolysis. In times of cellular stress, p53 is phosphorylated by protein kinases at several sites, becomes stabilised, and act via different pathways that ultimately lead to protection through growth arrest or apoptosis of the damaged cell. In the event of p53 protein inactivation via various mechanisms there will be loss of its protective functions, allowing damaged cell to continue in the cell cycle and placing the cell at risk of malignant transformation.

Can Your Laboratory Afford Not to Automate?

2010-03-31T16:28:00.001+08:00

In today’s healthcare environment, laboratories must increase productivity and faced substantially reduced operating budgets. We are often pushed to meet our physicians’ demands for timely report that only a staff twice the current size could comfortably handle. For many, laboratory automation will be the key to Achieving this goal, to reduce many of the labour-intensive tasks involving sample preparation and analysis, and dramatically improved the quality and consistency of test results.

Medical errors can originate in the laboratories if patient samples are mislabeled, if results are inaccurate or if information does not reach physicians before they need to make crucial treatment decisions. Laboratories worldwide are now installing functional automation systems and information technology applications to increase capacities, eliminate sources of errors, standardize and speed the processes to help us rid many of the problems in the manual methods. Complete automation of the testing process is the goal of the next generation total laboratory automation. This automation is targeted to include the steps of specimen processing, transport, and loading into instrument systems, as well as the automatic release and distribution of test results. These systems also consolidate tests that were traditionally performed by different sections of a laboratory, providing high-volume broad-menu work stations. With automation, laboratories progressed from labour intensive processes to streamlined efficient processes that produce more results with greater reliability.

Through our technology may be automated and speed complex operations, but in reality, it is not as simple nor eliminated errors. We may only have replaced them with new errors. It then become our responsibilities to ensure the software and instrumentation we buy is going to work correctly and when required, to manually check the test process against what is happening with the software.

The use of fabric softener ‘Softlan’ as a tissue softener prior to paraffin wax sectioning

2010-03-30T00:58:00.001+08:00

Fabric softener such as ‘Softlan’ has been used before in the reconstitution of mummified or desiccated tissue prior to paraffin wax sectioning for light microscopical examination. A method in which a fabric softener ‘ Softlan’ is used to soften hard tissue. The paraffin tissue blocks are soaked in diluted Softlan (1 part into 5 parts of tap water) at room temperature for five minutes before sectioning.

A comparison of results obtained by this method is made with those obtained by soaking overnight in fabric softener, placing in decalcifying solution Shadon TBD-1 Rapid Decalcifier for surface decalcification, and without treatment at all. Section obtained were found to be better and more complete with no effects on the nuclear and cytoplasmic staining

Vaccination - Current Situation and Perspective

2010-03-29T08:10:00.005+08:00

In the last 200 years, since the time of Edward Jenner, vaccination has controlled many major diseases namely, small pox, diphtheria, tetanus, yellow fever, pertussis, hepatitis B, haemophilus influenza type B, poliomyelitis, measles, mumps, rubella. Vaccination has eradicated smallpox and many countries including Malaysia has been certified poliofree by WHO.

The impact of vaccination on the health of the global population is well known and well documented. With the exception of safe water, no other modality, not even antibiotics has had a major impact on mortality reduction and population growth. Vaccines remain undoubtedly one of the most effective and safest of health interventions. Nevertheless, immunization services face many challenges. Immunization safety - ensuring and monitoring the safety of all aspects of immunization, including vaccine quality, storage and handling, vaccine administration and disposal of sharps is one such challenge. Other issues include the concern about excessive mercury exposure to infants who received multiple thimerosal containing vaccines, vaccine shortages due to converging factors such as phasing out of the production of traditional less expensive vaccines used in developing countries by vaccines manufacturers in favor of more expensive combination vaccines.

Even though conventional vaccines constitute the greatest achievement of modern medicine, successful vaccines have yet to be introduced for many deadly and debilitating diseases such as malaria, AIDS, dengue and hepatitis C. This gap exists because standard immunization methods work poorly or pose unacceptable risks when targeted against certain illnesses. An alternative strategy involving the deliberate introduction of a DNA plasmid carrying an antigen coding gene that transfect cells in vivo and results in an immune response DNA vaccines. DNA vaccines or DNA based immunization has been called "the third vaccine revolution' and if used for human vaccination will have distinct advantages over traditional vaccines in cost and ease of production, delivery and since almost all plasmids can be manufactures in essentially the same way, substantial economies of scale can be achieved.

Laboratory Statistics Internet Resources

2009-05-05T20:12:00.002+08:00

Analyse-it : Clinical Laboratory method evaluation tools.

Stat Soft: Electronic Textbook Statistical analyzes resources and search engine of general statistical concepts.

Rice Virtual Lab in Statistics : Online statistics book with links, simulations/demonstrations, case studies, & analysis lab. Dr. David M. Lane at Rice University, Houston, Texas.

Statistical Laboratory : University of Cambridge, UK.

Clinical Laboratory Software : Software applications for the clinical laboratory. Source is Philippe Marquis, MD, Biologist, METZ - FRANCE. Lots of free software to download.

Guide to Basic Laboratory Statistics : An informal guide to elementary inferential statistical methods used in the laboratory.

CDC Data and Statistics : Links to healthcare data and statistical sources. Centers for Disease Control and Prevention, Atlanta, GA.

Berrie's Statistics Page : Some animations in QuickTime format that illustrate certain aspects of statistical distributions.

Tables of Essential Clinical Laboratory Statistics : Stats Software for the Clinical Laboratory. David G. Rhoads Associates, Inc.

Stat Notes: An Online Textbook by G. David Garson at North Carolina State University Raleigh, NC.
Virtual Laboratories in Probability and Statistics : by Kyle Siegrist, Department of Mathematical Sciences, University of Alabama Huntsville.

Statistics in Laboratory Medicine (mathematical logic) : by Dr. Robert McLay, Department of Pathology & Laboratory medicine, Tulane University School of Medicine.

SurfState Australian : An online introductory text on Statistics by Keith Dear of the University of Newcastle, Australia.

Westgard QC Homepage : Tools, Technology and Training for Healthcare Laboratories.

Westgard QC : Desirable specifications for total error, Imprecision, and bias, derived from biological variation.

Phlebotomy Internet Resources

2009-05-05T19:59:00.002+08:00

Center for Phlebotomy Education : A comprehensive resource for health care professionals who perform, supervise, or teach phlebotomy.

Flash Card Quiz on Medical Lab Tube Selection QUIA Corp., an online education support organization.

Phlebotomy Internet Resources : Medical Laboratory Technology, Austin Community College, Austin,Texas.

Blood Collection: Routine Venipuncture & Specimen Handling : Web path Tutorial.

Phlebotomy Quizzes Online from Terry Kotrla, Austin, Texas.

Phlebotomy Professionals, Inc. : Providing nationwide (USA) phlebotomy services.

Phlebotomy.ORG.AU : The Official Website of the Australian Phlebotomy Association Inc. Instructional material and links on this website.

Phlebotomy Self-Test : Try testing your knowledge. If you didn't do as well as expected, go to the Welcome Phlebotomy web site listed below.

Welcome to Phlebotomy : A comprehensive overview of the "ART" of blood drawing. Library of Links : List of interesting resources for the phlebotomist. Phlebotomy Dictionary of Terms : A glossary of terms related to phlebotomy. From SUNY Upstate Medical University, Syracuse, New York.

Evaluation of Safety Devices for Preventing Percutaneous Injuries Among Health-Care Workers During Phlebotomy Procedures : Morbidity and Mortality Weekly Report , CDC, January 17, 1997, Volume 46, Number 02.

OSHA Bloodborne Pathogens Standards - Goal of this regulatory standard is to prevent exposure to disease; prevent disease if exposure occurs. Source: www.drneedlestick.com .

Pre-Analytical Factors Affecting Laboratory Results Emphasis: Phlebotomy By Julie C. Paulson Happel, M.T. (ASCP), M.A. From Virtual Hospital web site.

Specimen Collection and Transport Related Online Resources

Specimen Collection, Preperation, and Handling : Detailed instruction with illustrations and references by Lab Corp of Americaï¿½
Australia: Specimen Collection and Transport Guidelines - The Blue Book: Guidelines for control of infectious diseases.
Toxicology in UK: Specimen Collection and Transport
Didn't find what you was looking for? Already seen all of the above web sites? Go to Simplify and the major search websites to find the latest phlebotomy related websites.
For the current status of phlebotomy regulations in California visit www.phlebotomywest.com Web site.

Molecular Diagnostics Internet Resources

2009-05-05T19:48:00.002+08:00

Journal of Molecular Diagnostics : Pathology and The Association for Molecular Pathology publish Journal of Molecular Diagnostics. Stanford University Libraries' HighWire Press (TM).

Molecular Diagnostics : Testing Services homepage - listing of services and resources of the Department of Pathology , University of Pittsburgh, S-417 BST, 200 Lothrop Street, Pittsburgh, PA 15261, (412) 648-9550.

Web Resources of Interest to Users of Fluorescent Probes : Web sites are grouped into noncommercial and journal sites and commercial sites. This extensive listing of links compiled by Molecular Probes, Inc.

On Line Analysis Tools For Molecular Biologists.

What's a RFLP? : A definition and discussion from the course Biology: The Foundations of Living Systems , Brown University, RI.

Restriction Fragment Length Polymorphism : Brief definition.

DNA Chip Technologies - Series of 3 articles by Cliff Henke published September 1998 in IVD Technology Magazine. Part1: Research fundamentals and industry catalysts. Part 2: State-of-the-art and competing technologies. Part 3: What does the future hold?

Motorola's Biochip Center

Molecules and Microspheres 101 : Quick course on molecular applications in diagnostic laboratory medicine from Luminex, Austin, Texas. Luminex is a cross-functional team of biologists, chemists, engineers and software developers focused on refining and advancing the capabilities of our technology, LabMAP (Laboratory Multi-analyte Profiling).

GEN-PROBE : Select GEN-PROBE (molecular biologicals) from the Menu. Vendor: bioMerieux, France

Clinical Microsensors Check out this web site for the latest developments in molecular diagnostics.

Blood and Tissue Nematodes Internet Resources

2009-05-04T01:48:00.002+08:00

Onchocerciasis in a Refugee Child : case study of a child with "river blindness" contracted in Guatemala

Insect Parasitic Nematodes : Website on blood and tissue nematodes which have an insect biological vector in its life cycle. Site maintained by Dr. Parwinder Grewal, Department of Entomology at The Ohio State University, Columbus, OH. Below are the links on nematodes compiled by Dr. Grewal:

Parasitic Nematodes Home Page - University of Nebraska - Lincoln, Nematology.
Entomopathogenic Nematology at Rutgers.
Entomopathogenic Nematodes - University of Florida, Entomology & Nematology.
Insect parasitic nematodes - COLORADO STATE Cooperative Extension .
Cornell University Biocontrol site: Nematodes.
USDA Nematology Lab Home Page.
UC-Davis Dept. of Nematology.
Entomopathogenic Nematodes - Oregon State University.
Biological Control of Nematodes.
Midwest Biological Control News.

Phylum Aschelminthes (roundworms, tapeworms and flukes)
Pinworms ( Enterobius vermicularis ) : Graphic Images of Parasites, College of Veterinary Mediicine, Oklahoma State University.

Introduction to Platyhelminthes : Discussion and illustrations of the flatworms in the phylum. Flatworms are in the Class Trematoda, often referred to as the flukes.

A Parasitic Point of View : An brief discussion of the flatworms and tapeworms in the phylum Platyhelminthes.

Information on Flukes (Trematodes) from the Schistosome Study Group at the University of Cambriage, Great Britain.

Roundworms and Tapeworms

Tapeworms : Description, life cycles and photos of the Cestoda parasites of humans.

Tapeworms : Summary information about the common human tapeworms from Travel Health Online web site.

Cestoda Image List Images of all the tapeworms from Columbus State University, Georgia USA.

Taenia saginata : Illustrative case history of this tapeworm in Dec. 2, 1999 -- Vol. 341, No. 23 -- issue of the New England Journal of Medicine - Images in Clinical Medicine.

Table of all known tapeworms : compiled by Dr. Juergen Buche.

Parasitology at a German University - resources, links, journals, photos

Worms-on-the-Web : This site contains nematode links on the WWW. The Genome Network host.

Nematodes: Worms of the World - MLO cover story (January 2001) by Dr. Phyllis Pacifico, Wright State University, Dayton, Ohio.

Phylum Protozoa
Primary Amoebic Meningoencephalitis (PAM) : Information from the Blue Book's Guideline for the Control of Infectious Diseases. Public Health Division, Victoria, Australia.

Primary Amebic Meningoencephalitis in Texas, 1983-1996 . Disease Prevention News, Vol. 57, No. 15, July 21, 1997, pdf text.

A Patient's Guide to Identification, Naegleria fowleri . Basic discussion of the parasite and PAM.

PAM: Primary Amoebic Meningoencephalitis - Naegleria fowleri : "The ameoba is most active when the water temperature is greater than 80 degrees." , pdf.

Amebic Meningoencephalitis EMedicine Journal > Pediatricts > Parasitology Search Results.

More Information On Primary Amoebic Meningoencephalitis from the CDC and other sources. 1. Primary amoebic meningoencephalitis (PAM), Naegleria fowleri 2. Amoebic Meningoencephalitis : Information from the National Center for Environmental Health at the CDC. (Page has moved)

Phylum Arthropoda
EntoWeb ...a resource for students and teachers. Department of Entomology , Texas A&M University, College Station, Texas. Links to resources on mites, ticks, scorpions, spiders and all others in the phylum arthropoda.

Arthropod and Other Animal Bites : Discussion of arthropod bites, including the black widow spiders. Pdf/Adobe Acrobat.

Zoological Record : Internet Resource Guide for Zoology from Biosis and the Zoological Society of London, UK.

Tick Research Laboratory at the University of Rhode Island: link to resources on Lyme Disease, Babesiosis, Ehrlichiosis, tick images, and more

Phylum Arthropoda from University of Michigan's Museum of Zoology Animal Diversity Web Site.

Class: Insecta web site devoted to insects with photos and information gleaned from the Spencer Entomology Museum at the University of British Columbia.

Insects, Science and Society: Entomology : Entomology course of Professor L.G. Higley with the University of Nebraska Department of Entomology. Scroll down to the "Bug of the Week" on the menu and learn about interesting creatures of the arthropod world.

The Human Botfly ......Do you know what it is? Find the answer at this website.

Mosquitoes.com : Mosquitoes - biological vectors of parasitic and other infectious diseases. Find information on how to prevent mosquito and other insect bites on this web site.

Black Widow Spider Fact Sheet : From The Ohio State University Extension Service - find information about habits, control and prevention of the black widow spider.

Acri: Mites - Here you will find information about mites found around the world. Excellent photographs of mites.

Parasitology Methods and Procedures
STILLQUICK : For the transport and processing of stool samples for parasitological examinations. From a company in Paris, France. Protocol for STILLQUICK is in English.

Protocols for O & P Testing: Clinical Practice Guidelines, British Columbia Medical Services Plan

Stool Collection for Ova and Parasites : from the Virtual Children's Hospital of Iowa.

Parasitology Guidelines: Clinical Practice Guidelines, Alberta Medical Association.

ELISA Kits for the diagnosis of toxocarosis, aveolar echinococcosis, cystic hydatid disease and visceral leishmaniasis from Bordier Affinity Products of Switzerland.

Organizations and Societies Devoted to Parasitology
McGill University Center for Tropical Diseases : Visit this web site for education and resources on parasitic infectious diseases.

British Society For Parasitology Internet links : Yet more resources and information devoted to parasitology.

Links to Sites Related to Tropical Diseases : Center for Tropical Diseases at the University of Texas Medical Branch at Galveston.

Parasitological Society of Southern Africa : Access their Parasitology and Related Links from this page.

Pasteur Institute: Parasitology Resource Page - Pasteur Institute, Paris, France.

Zoological Record : Internet Research Guide for Zoology from Biosis and the Zoological Society of London. This web site page includes parasitology links.

Malaria, Toxoplasma and Hemoflagellates Internet Resources

2009-04-30T01:52:00.003+08:00

Malaria - Plasmodium spp.
Malaria Parasitic Disease Information site of the CDC, Atlanta, GA.

WHO/TDR Malaria Database : Malaria database of the World Health Organization; website is intended for malaria research.

Malaria in South Africa General Information and Malaria Research Programme: Entry page to websites with Malaria content relevant to the Southern African continent; also additional malaria links.

Malaria: An On-line Resource : an excellent resource on malaria. Pages devoted to diagnosis, history, prophylaxis, treatment, teaching and testing, and links. This resource is presented by the Division of Laboratory Medicine at Royal Perth Hospital, Perth, Austrialia. It is provided for the information of Medical Practitioners and Laboratory Scientists. It is regularly updated and provides the generally accepted best current practice. Highly recommended site.

Malaria : Description of Malaria - BS 224 course in the Department of Microbiology & Immunology, University of Leicester, UK.

Malaria Prevention and Control : Navy Medical Department Pocket Guide to... U.S. Navy Environmental Health Center, Technical Manual NEHC-TM PM 6250.1, Last Revision: September 2000.

Malaria Consortium : The Malaria Consortium is a leading international organization of multi-disciplinary experts working to reduce the global burden of malaria.
Malaria Links in English but you can switch to links in French, Italian, German or Spanish.

History of Malaria : Source is The Malaria Capers by Robert S. Desowitz. International Development Research Centre.

Malaria: An Online Resource covering diagnosis, treatment, history and a "Test and Teach".

Laboratory Diagnosis of Malaria : morphologic features of each species is listed with illustrations (Royal Perth Hospital).

Malaria: A Reemerging Disease in Africa : from the July-September 1998 issue of the EIA journal.

Transfusion - Transmitted Malaria -- Missouri and Pennsylvania, 1996 - 1998 : Report of 3 case histories in MMWR April 02, 1999/48 (12); 253 - 256.

Malaria Database: resources for scientists working in malaria research from W.H.O.

Mega List on malaria links. : Chances are if you haven't found the information your seking on malaria, you will find it here.

Other Malaria and Parasitology Sites on The Web : Provided by W.H.O.

Toxoplasmosis - Toxoplasma gondii
Toxoplasmosis : What You Should Know About Toxoplasmosis. This web site will answer your questions about toxoplasmosis; how people get infected, dangers of this parasite, the definitive host, prevention, among other questions

Toxoplasma antibodies: detection of toxoplasmosis

Hemoflagellates - Leishmania and Trypanosoma
Trypanosomiasis, African : Information about the cause of African Sleeping Sickness, Trypanosoma brucei , from Center for Infectious Diseases.

American Trypanosomiasis : Reports on Chagas Disease from the Texas Department of Health and Zoonosis Control Division.

AABB Chagas' Biovigilance Network : The Chagas Disease Bio vigilance Network records screening and confirmatory results from the testing of donors for antibodies to Trypanosoma cruzi, the agent of Chagas disease.

Leishmania donovani: Toxonomic classification, definitive host spectrum, vector, geographical distribution, morphology ,life cycle stages, and more.

Leishmaniasis : Description from the web site of Parasitology Department at Ohio State University.

Leishmania : Slides of L. donovani and L. mexicana . Source is the Atlas of Parasitology, the Carlo Denegri Foundation of Italy.

Leishmania mexicana and tropica : Images of these species from Bugs on The Web.

Parasitology Internet Resources

2009-04-30T01:28:00.004+08:00

Identification and Diagnosis of Parasites of Public Health Concern : web site of the Division of Parasitic Diseases , National Center for Infectious Diseases at the Centers for Disease Control & Prevention. The experienced parasitologist or microbiologist will find this web site helpful in the selection of diagnostic procedures, diagnostic assistance, descriptions of parasites and parasitic diseases, training opportunities, and an excellent image library - Parasite Image Library.

Parasitology-Online : Journals, Features, News.

Para-Site Online : Current Issues, New Information, Quizzes, Procedures, FAQs. Web site source is Lynne Garcia, a well-published and respected medical parasitologist in the field.

Diagnostic Parasitology Course at the University of Delaware. Excellent illustrations of trophozoites, cysts, ova, and other life cycle stages of medically important parasites. A MUST SITE for MLT and CLS students taking a parasitology course in their curriculum, or for laboratorians wanting a refresher course. Find out what Charcot-Leyden crystals are and the significance of finding them in fecal smears.

Image Photo-Gallery from the University of Utah: Also a MUST SITE for studying medical parasitology. From the Index Page you can link onto images of the protozoa, cestodes, trematodes, and nematodes.

Journal of Parasitology: Official journal of American Society of Parasitologist

Yahoo's directory for Parasitology web sites

Parasites and Health - CDC : Identification and Diagnosis of Parasites of Public Health Concern.

Armed Forces Institute of Pathology's Continuing Medical Education WWW Site - a web site for good clinical case studies.

Parasites and Parasitological Resources : Site from The Ohio State University created by Dr. P.W. Pappas. This site contains excellent images and is a good source for general information on human parasites of medical importance.

Parasitology Images and Links: From the Nebraska State Museum web site; The list for parasitology includes the Queenlands University of Technology Parasitology Images List.

Parasitology Pages at Queensland University of Technology, Brisbane, Australia.

University of Nebraska's Parasitology Links : extensive web listings related to parasitology.

Parasite Images: Collection of Parasitology Images of Medical Importance.

Parasitology Images: 250 parasitology images from Oklahoma State University College of Veterinary Medicine.

Atlas of Medical Parasitology : Includes case reports and updates. Atlas is available on CD Rom. A project of Carlo Denegri Foundation (Italy). This is a great morphology study resource for the medical parasitology student.

David Gibson's Parasitological URLs : British Society for Parasitology ~ Parasitology resources, descriptions, images, and more.

Parasitology List : Queensland University of Technology's Parasitology Pages.

Lots of Parasitology Links : Links2Go web site search on parasitology/parasites.

The World of Parasites : Use the world map to locate where diseases such as filariasis exist and the parasite implicated. Visit the home page of Dr. Jim Martin at McGill University in Canada for information on PARASITISM & SYMBIOSIS.

Metin Korkmaz's Parasitology Resources : A very good list of links to all aspects of parasitology.

More Medical Parasitology Links : Also on this page you will find search engines for locating the newest listings on "medical parasitology" and "parasitic diseases", plus a PubMed search engine.

Protozoa as Human Parasites: Descriptions with life cycles of the human protozoan parasites.

Parasitology sites on the World Wide Web

Course Modules : introductory course in clinical parasitology.
Parasitology Images: over 450 images; Parasites & Parasitology Resources, Ohio State University.
Metin Korkmaz's Parasitology Resources : Images, information on parasites, and more.

The Schoenbaum Library Parasitology Resources : General resources, journals and organizations.

Course Outline : home page for Dr. Rodger's course in clinical. parasitology (see link above)

Cutaneous Parasites Home Page : A dermatological menagerie of the creatures that bite, sting, infect, and infest human skin

CellsAlive: live scanning EM photos of parasites..see dust mite in action

Color Atlas of Parasitology: link to sample photos of parasites

Intestinal Protozoa : discussion of the intestinal protozoa from ASCP

Parasitic Diseases: link to sites with case studies in parasitology

Infectious Diseases : link from here to infectious diseases, then to topics on parasitology

Karolinska Institute Library: Parasitic Diseases: resource web site for parasitology

Trichinella Page : description, illustrated life cycle, summary chart, links

Giardiaisis : information on Giardia lamblia from the Bug Book, US Food & Drug Administration. Giardiaisis is the most frequent cause of non-bacterial diarrhea in North America

Giardia lamblia : case studies, method of infection, and locations from Travel Information Homepage

Giardiaisis : Water Quality Association's discussion on Giardia lamblia

Giardia & Cryptosporidium : description of these two intestinal protozoan parasites found here

Giardia & Cryptosporidium : discussion from US Environmental Protection Agency - link to the Microbiology Home Page for discussion of other microorganisms & parasites from this site

Control of Intestinal Parasites from the World Health Organization's Division of Control of Tropical Diseases.

Cryptosporidiosis Fact Sheet : from CDC's National Center for Infectious Diseases

Coccidial Research at Kansas State University. : update information on intestinal coccidian parasites

CliniWeb: Intestinal Diseases, Parasitic - Oregon Health Science University's web site

Parasitology Lectures on the Internet
Clinical Parasitology : by Professor J. D. MacLean at McGill Centre for Tropical Disease, McGill University Faculty of Medicine, CA.

Medical Mycology, Parasitology and Virology : Professor James Veselenak, Ph.D., M(ASCP), University of Illinois at Springfield. Lectures are in pdf format.

Brush up your malaria identification skills. Teach and Test : Helpful hints and case presentations. Malaria self test module. Royal Perth Hospital, Perth, Australia.

PATHOPHYSIOLOGY I: Parasitology Lecture Slides : Columbia University Medical Center, NYC.

Teaching Notes and Resources: PARASITOLOGY : A parasitology course by Professor John Barrett at Aberystwyth University, Wales, UK.

Virology Internet Resources

2009-04-30T01:14:00.002+08:00

Virology : All the Virology on The WWW.

Institute For Molecular Virology : This is a research institute devoted to fundamental research in virology on the University of Wisconsin Madison Campus.

On-Line Virology Handbook and Case Studies : from the Department of Laboratory Medicine at Yale School of Medicine.

Virology Lectures : Notes and Resources in Virology from the Department of Microbiology and Immunology at the University of Rochester Medical Center, Rochester, New York.

Jamestown Canyon "JC" Virus General information on the J C virus, now implicated in brain tumors in children.

J C viral protein linked to brain tumors in children. : The J C virus infects about 65% of all children by the age of 14 and may play a role in malignant brain tumor found in these children, according to recent publications.

Hepatitis C: An Epidemic for Anyone very informative site developed at the C. Everett Koop Institute at Dartmouth College.

Hepatitis C Foundation Home Page : Disease Facts, Diagnosis Information, Literature, Other Resources, Latest News on Hepatitis C.

Viral Hepatitis

Viral Hepatitis Index Page : National Center for Infectious Diseases at CDC.
Viral Hepatitis A
Hepatitis A Fact Sheet
Viral Hepatitis B
Hepatitis B Fact Sheet
Viral Hepatitis C
Hepatitis C Fact Sheet
Hepatitis D (Delta) : Seven slides and bibliography.
Hepatitis E Slide
Hepatitis G Fact Sheet

West Nile Virus News
Questions and Answers on the West Nile Virus.Source CDC.

Avoiding mosquito bites is the best way to prevent infection with the West Nile virus.
Information about WNV and Blood Safety : Center for Biologics Evaluation & Research ,U.S. FDA.

CBC West Nile Virus : Fact sheets compiled by the Canadian Broadcasting Company National News.

Hardin MD - West Nile Virus List : Hardin Library for the Health Sciences, University of Iowa.

Infections Internet Resources

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Infections of the Genital Tract
Infections of the Female Genital Tract : from Path Notes at Cornell University Medical College, NY City.

Bacterial Vaginosis: An Update : Article published in the March 15, 1998 issue of the American Family Physician.

Infections of the upper genital tract : website of Professor Dr. Mithat Ernus.

Prevention of Perinatal Group B Streptococcal Diseases: CDC presentation on slides.

Syphilis - Lecture by Dr. Kenneth Boockvar, M.D., New York Presbyterian Health Care, University of Columbia.

Infections of the Urinary Tract
Outpatient Urine Culture: Does Collection Technique Matter? : By E. Lifshitz, MD & L. Kramer, RNC, BSN. In Internal Medicine, Vol. 160 No. 16, September 11, 2000.

Urinary Tract Infections Tutorial : By Dr. John Heritage at Leeds University, UK. This is an excellent UTI study resource designed to introduce the microbiology student to the causes, symptoms and laboratory diagnosis of urinary tract infections.

Urinary Tract Infections in Adults ~ Urinary Tract Infections in Children : informative resource from NIDDH - National Kidney & Urologic Diseases Information Clearinghouse.

Dr. Reddy's Pediatric Office on the Web(TM) 's resource on UTIs in children.

How to prevent bladder infections : from the Department of Obstetrics & Gynecology at the University of Iowa Health Science Center.

Go to Web Path's Urinalysis Tutorial for information on the UA in the diagnosis of UTIs

Gastrointestinal Tract Infections
Gastrointestinal Infections - Basic information from Columbia University Collge of P & S Complete Home Medical Care web site.

Gastrointestinal Infections - Support notes for the Microbiology component of the University of Leeds Laboratory and Scientific Medicine Course. University of Leeds, UK.

Gastrointestinal Tract Infections - Dr. Neal Chamberlain's Medical Microbiology course resources. Kirksville College of Osteopathic medicine, Kirksville, Missouri.

Wound Infections
Wound Infections : over 35 links from a MEDLINE search of wounds of the upper extremities

Skin and Wound Infections : from Dan de Regnier's microbiology course in the CLS Program at Ferris State University, Big Rapids, MI

Microbiologic and Clinical Values of Primary Broth Cultures of Wound Specimens Collected with Swabs

Antibiotic Prophylaxis in Elective Surgery

Swine Flu Internet Resources

2009-04-30T00:36:00.005+08:00

What is Swine Influenza?

Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans. The classical swine flu virus (an influenza type A H1N1 virus) was first isolated from a pig in 1930.

How many swine flu viruses are there?

Like all influenza viruses, swine flu viruses change constantly. Pigs can be infected by avian influenza and human influenza viruses as well as swine influenza viruses. When influenza viruses from different species infect pigs, the viruses can reassort (i.e. swap genes) and new viruses that are a mix of swine, human and/or avian influenza viruses can emerge. Over the years, different variations of swine flu viruses have emerged. At this time, there are four main influenza type A virus subtypes that have been isolated in pigs: H1N1, H1N2, H3N2, and H3N1. However, most of the recently isolated influenza viruses from pigs have been H1N1 viruses.

Swine Flu in Humans

Can humans catch swine flu?

Swine flu viruses do not normally infect humans. However, sporadic human infections with swine flu have occurred. Most commonly, these cases occur in persons with direct exposure to pigs (e.g. children near pigs at a fair or workers in the swine industry). In addition, there have been documented cases of one person spreading swine flu to others. For example, an outbreak of apparent swine flu infection in pigs in Wisconsin in 1988 resulted in multiple human infections, and, although no community outbreak resulted, there was antibody evidence of virus transmission from the patient to health care workers who had close contact with the patient.

How common is swine flu infection in humans?

In the past, CDC received reports of approximately one human swine influenza virus infection every one to two years in the U.S., but from December 2005 through February 2009, 12 cases of human infection with swine influenza have been reported.

What are the symptoms of swine flu in humans?

The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea.

Can people catch swine flu from eating pork?

No. Swine influenza viruses are not transmitted by food. You can not get swine influenza from eating pork or pork products. Eating properly handled and cooked pork and pork products is safe. Cooking pork to an internal temperature of 160°F kills the swine flu virus as it does other bacteria and viruses.

How does swine flu spread?

Influenza viruses can be directly transmitted from pigs to people and from people to pigs. Human infection with flu viruses from pigs are most likely to occur when people are in close proximity to infected pigs, such as in pig barns and livestock exhibits housing pigs at fairs. Human-to-human transmission of swine flu can also occur. This is thought to occur in the same way as seasonal flu occurs in people, which is mainly person-to-person transmission through coughing or sneezing of people infected with the influenza virus. People may become infected by touching something with flu viruses on it and then touching their mouth or nose.

What do we know about human-to-human spread of swine flu?

In September 1988, a previously healthy 32-year-old pregnant woman was hospitalized for pneumonia and died 8 days later. A swine H1N1 flu virus was detected. Four days before getting sick, the patient visited a county fair swine exhibition where there was widespread influenza-like illness among the swine.

In follow-up studies, 76% of swine exhibitors tested had antibody evidence of swine flu infection but no serious illnesses were detected among this group. Additional studies suggest that one to three health care personnel who had contact with the patient developed mild influenza-like illnesses with antibody evidence of swine flu infection.

How can human infections with swine influenza be diagnosed?

To diagnose swine influenza A infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may shed virus for 10 days or longer. Identification as a swine flu influenza A virus requires sending the specimen to CDC for laboratory testing.

What medications are available to treat swine flu infections in humans?

There are four different antiviral drugs that are licensed for use in the US for the treatment of influenza: amantadine, rimantadine, oseltamivir and zanamivir. While most swine influenza viruses have been susceptible to all four drugs, the most recent swine influenza viruses isolated from humans are resistant to amantadine and rimantadine. At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses.

What other examples of swine flu outbreaks are there?

Probably the most well known is an outbreak of swine flu among soldiers in Fort Dix, New Jersey in 1976. The virus caused disease with x-ray evidence of pneumonia in at least 4 soldiers and 1 death; all of these patients had previously been healthy. The virus was transmitted to close contacts in a basic training environment, with limited transmission outside the basic training group. The virus is thought to have circulated for a month and disappeared. The source of the virus, the exact time of its introduction into Fort Dix, and factors limiting its spread and duration are unknown. The Fort Dix outbreak may have been caused by introduction of an animal virus into a stressed human population in close contact in crowded facilities during the winter. The swine influenza A virus collected from a Fort Dix soldier was named A/New Jersey/76 (Hsw1N1).

Is the H1N1 swine flu virus the same as human H1N1 viruses?

No. The H1N1 swine flu viruses are antigenically very different from human H1N1 viruses and, therefore, vaccines for human seasonal flu would not provide protection from H1N1 swine flu viruses.

Swine Flu in Pigs

How does swine flu spread among pigs?

Swine flu viruses are thought to be spread mostly through close contact among pigs and possibly from contaminated objects moving between infected and uninfected pigs. Herds with continuous swine flu infections and herds that are vaccinated against swine flu may have sporadic disease, or may show only mild or no symptoms of infection.

What are signs of swine flu in pigs?

Signs of swine flu in pigs can include sudden onset of fever, depression, coughing (barking), discharge from the nose or eyes, sneezing, breathing difficulties, eye redness or inflammation, and going off feed.

How common is swine flu among pigs?

H1N1 and H3N2 swine flu viruses are endemic among pig populations in the United States and something that the industry deals with routinely. Outbreaks among pigs normally occur in colder weather months (late fall and winter) and sometimes with the introduction of new pigs into susceptible herds. Studies have shown that the swine flu H1N1 is common throughout pig populations worldwide, with 25 percent of animals showing antibody evidence of infection. In the U.S. studies have shown that 30 percent of the pig population has antibody evidence of having had H1N1 infection. More specifically, 51 percent of pigs in the north-central U.S. have been shown to have antibody evidence of infection with swine H1N1. Human infections with swine flu H1N1 viruses are rare. There is currently no way to differentiate antibody produced in response to flu vaccination in pigs from antibody made in response to pig infections with swine H1N1 influenza.

While H1N1 swine viruses have been known to circulate among pig populations since at least 1930, H3N2 influenza viruses did not begin circulating among US pigs until 1998. The H3N2 viruses initially were introduced into the pig population from humans. The current swine flu H3N2 viruses are closely related to human H3N2 viruses.

Is there a vaccine for swine flu?

Vaccines are available to be given to pigs to prevent swine influenza. There is no vaccine to protect humans from swine flu. The seasonal influenza vaccine will likely help provide partial protection against swine H3N2, but not swine H1N1 viruses.

Internet Resources for Swine Flu:

WHO is coordinating the global response to human cases of swine influenza A (H1N1) and monitoring the corresponding threat of an influenza pandemic. Information on this page tracks the evolving situation and provides access to both technical guidelines and information useful for the general public.Up-to-date numbers of cases are included in the most recent disease outbreak. Latest Information:

Swine influenza - update 4
Update for Travellers - Swine Influenza
WHO Scientific Review on the current outbreaks of human infections with swine influenza to be held on 29 April
Director-General's statement on swine influenza
Viral gene sequences to assist update diagnostics for swine influenza A(H1N1) - GenBank accession numbers
Instructions for shipments of swine influenza A(H1N1) specimens and virus isolates to WHO Collaborating Centres for influenza
Influenza Fact Sheets - Influenza is caused by a virus that attacks mainly the upper respiratory tract – the nose, throat and bronchi and rarely also the lungs

CDC H1N1 Flu (Swine Flu) - International Human Cases of Swine Flu Infection

Influenza A (H1N1) - WHO is coordinating the global response to human cases of influenza A (H1N1)

MedlinePlus: H1N1 Flu (Swine Flu) - Services and providers for Swine Flu in the U.S

Infections of Respiratory Tract Internet Resources

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Infections of the Upper Respiratory Tract
Group A Strep Blog beta-streptococcal disease resource page.

Fact Sheet description of group A Streptococcal infections: NIH's National Institute of Allergy and Infectious Diseases.

Beta streptococcus group A : Information on this microorganism from the Rockefeller Institute.

Streptococcus : Basic description of the streptococci from The Rockefeller University's Laboratory of Bacterial Pathogenesis and Immunology

Group A Strep descriptions of the various manifestations of streptococcal infections - Queens Hospital, London, England.

Causes for sore throat other than group A streptococcus.

Upper Respiratory Tract Infection - Lecture by Dr. Sridhar Ramaswamy, M.D., New York Presbyterian Health Care, University of Columbia.

Infections of the Lower Respiratory Tract
Pathology of Tuberculosis Tutorial from Web Path.

Tuberculosis - Lecture by Drs. Ariel Pablos-Mendez, M.D., M.P.H. and Charles A. Knirsch, M.D., M.P.H., New York Presbyterian Health Care, University of Columbia.

Tuberculosis Resources by Columbia University Medical Informatics.

From this site you can link to the Bureau of Tuberculosis Control of New York City Department of Health. Ask HOAH about tuberculosis.

NPIH : CDC National Prevention Information Network's

Treating Tuberculosis : From PennToday, a publication of the Pennsylvania Health System, Universsity of Pennsylvania.

Clinical Review of 74 Cases with Miliary Tuberculosis : From the Department of Infection and Inflammation, Graduate School of Medicine, and Department of Internal Medicine, University Hospital, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8397 Japan.

Drug Resistant TB - Rising Tide of Multi drug Resistant Tuberculosis in Developing Countries: Can Anything Be Done? article by William Bishai, M.D., Ph.D. at Johns Hopkins School of public Health.

Chlamydia pneumoniae - MRL Diagnostics' micro-immunofluorescent assay (MIF).

The CDC's Flu Web Site : Influenza Prevention and Control.

Pandemic Influenza: A Planning Guide for State and Local Officials (Draft 2.1) : Predicted Flu Pandemic 2000-200, CDC, Atlanta, GA.

Influenza Activity -- United States, 1998 - 1999 Season CDC Morbidity and Mortality Weekly Report March 12, 1999 -- Volume 48 (09); 177 - 181 -- electronic version of the MMWR Weekly Report.

Antiviral Drugs For Influenza : Also from this web page, link to information from the CDC on the prevention and control of influenza.

Swine Flu: The strain responsible for the 2009 swine flu outbreak in humans

Infections Control Internet Resources

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Opportunistic Infections
Recommendations to Help Patients Avoid Exposure to Opportunistic Pathogens. : MMWR, August 20, 1999/48 (RR10); 61 - 66.

1999 USPH/IDSA Guidelines for the Prevention of Opportunistic Infections in Persons Infected with Human : MMWR August 20, 1999/48 (RR10); 1 - 59. Immunodeficiency Virus (HIV).

Emerging Infectious Diseases
Preventing Emerging Infectious Diseases: A Strategy For The 21st Century : National Center For Infectious Diseases, CDC.

List of links on emerging disease from NIH.

Prespectious : Insights on Emerging Diseases article in the journal of Emerging Infectious Diseases

Tuberculosis Infections : "Supplementing Tuberculosis Surveillance with Automated Data from Health Maintenance Organizations", from Emerging Infectious Diseases, November - December 1999, Volume 5, No.6 issue of the journal.

Infection Control
National Nosocomial Infections Surveillance : From this site you will find additional links on Infection Control (CDC).

Infectious Diseases : links from Boston University Community Outreach Health Information System.

Hospital Epidemiology Services : Resources, links, mission from National Insitutes of Health.

HIP : Hospital Infection Program - Public Health Service of the CDC.

Hospital-Borne Infections : Information on nosocomial infections, link to 1996 report of National Nosocomial Infections Surveillance report on risks of infection by type of intensive care unit.

Infection Control and Epidemiology : Association for Professionals in Infection Control and Epidemiology, Inc.'s web site filled with resources on this important topic of healthcare administrators and practitioners.

U.S. Public Health Service Guideline on Infectious Disease: Issues in Xenotransplantation. : MMWR, August 24, 2001/50 (RRLJ); 1-16.

EID: Emerging Infectious Diseases journal...tracking trends and emerging/reemerging infectious diseases worldwide - - current issue in the Emerging Infectious Diseases Journal.

Infectious Disease News: search current and back issues of the journal.

Mycology Internet Resources

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Doctor Fungus : The on-line reference to all things mycological - image bank, ask dr. fungus, site map, links to other mycology related websites, etc.

Aspergillosis : Technical information on this toxic mold from the CDC. There are 5 species of Aspergillus know to be human pathogens.

Tease mount prep of Aspergillus : Can you identify the species?

Mycoinfo (Mycology Information) : "The World's First Mycology E-Journal".

Mycotic Diseases : Veterinarian cases

Hair Loss in a 5-year-old Boy : Case study report published in September 1997 issue of AMA's Archives of Dermatology

Index of Mycology Resources : From "About Fungi" to "Zygomycota" this list of links has it all!

Mycology Index Page from the University of Kansas.

Mycological Resources on the Internet : Discussion Groups and News. University of Kansas.

Mycology Image Library : Department of Medical Microbiology & Immunology, University of Wisconsin Madison.

Mycology Online : Internet resource of clinically significant mycological diseases.

Fungal Infections of Man - Mycoses : Brief tutorial with graphic illustrations of fungi.

Medical Mycology Review Questions : from Loyola University Medical Center at Chicago.

Mycology Course from the State University of New York at Syracuse Health Science Center.

Aspergilloma Case Study : From the list of case studies by Martha L. Warnock, MD and Marcia J. McCowin, MD of the University of California at San Francisco.

Case history of North American Blastomycotic Osteomyelitis in a child. : from the teaching files of Children's Hospital, Birmingham, Alabama.

Valley Fever Information Sheet on Coccidiodies immits in animals : from the Family Veterinarian web site.

www.Candida Page.com : The Candida page - lots of annotated links on Candida albicans and Candidiasis by Don Wiss.

Candida albicans information : a good source for research information on this true yeast organism.

Anaerobic Organisms, Nonfermentative Gram-Negative Bacilli, Coccobacilli and Meningitis Internet Resources

2009-04-23T01:06:00.003+08:00

Anaerobic Organisms
Anaerobic Systems : Information and products from Anaerobic Systems, Morgan Hill, California. They have a great poster on anaerobes. Contact information can be access from their homepage.

Clostridium tetani : The anaerobic spore forming bacterium which causes tetanus

Botulism (Clostridium botulinum ) : Causative agent of Clostridium food poisoning

Clostridium septicum Infection and Hemolytic Uremic Syndrome : article from Emerging Infectious Diseases : Vol. 4, No. 2, April - June 1998

Clostridium WEB Page : source on the clostridia from Oklahoma State University.

Nonfermentative Gram-Negative Bacilli and Coccobacilli
Pseudomonas aeruginosa : Bacteriology Lecture Topic of Kenneth Todar at University of Wisconsin-Madison.

Pseudomonas aeruginosa and other related organisms : Lecture notes of Dr. Glenn Songer at the University of Arizona.

The Other Pseudomonads : Other Pseudomonas organisms are covered on this web site from the University of Michigan - please note some organisms have been listed by the former taxonomic designation

Meningitis and Other Infections of the Central Nervous System
Meningitis Information Resource : Basic information and find links to other web sites devoted to meningitis

Meningococcal Meningitis : Facts on this disease, it's spread and signs and symptoms from McKinley Health

Bacterial Meningitis Fact Sheet and Related Links : Division of Bacterial and Mycotic Diseases of the CDC

Meningitis Foundation of America, Inc. : Information on acute bacterial meningitis, link to their home page and support groups, etc.

Meningitis Outbreak Hotline : Information on endemics and epidemics

Meningitis Outbreaks: Travel Information from National Center for Infectious Diseases of the CDC. From this web page you can check out other infectious disease travel advisories.

Lyme Disease Internet Resources

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Lyme Disease Foundation located in Hartford, Connecticut, a site for authoritative information and links for both the health care professionals and those individuals interested in this tick borne disease.

Lyme Disease: Diagnosis - Good photo of the typical "bull's-eye" rash. Back link to find other pages on this disease and links to other tick-borne infectious diseases. CDC's Division of Vector-Borne Infectious Diseases, Atlanta, GA. Recommended site.

Lyme Disease : A comprehensive web site for general information about Lyme disease

Lots of Links On Lyme Disease : Over 6500 categorized links on Lyme disease.

Lyme Net : The Lyme Disease Network Online.

Spot Light on Lyme Disease : Fact sheet, case studies, map, photos of ticks

More Information on Lyme Disease and Other Tick Related Illnesses : from the web site of the Nassau County Department of Health, Long Island, New York.

Glossary of Microbiology: over 1500 words in the glossary

WHO: World Health Organization, health issues, information, publications, news, & search engine

Actinomycetes - Streptomyces Internet Resource Center : Actinomycetes researchers from around the world. Department of Microbiology, Medical School, University of Minnesota.

Sexually Transmitted Diseases (STD) Internet Resources

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AIDS-HIV : Yahoo's hot links to general information and testing on HIV

AIDS/HIV In site : Gateway to AIDS Knowledge - Medical Information, Prevention and Education, Social Issues, Statistics and Epidemiology

AIDS/HIV

The Body : An AIDS and HIV Information Resource

HIV Antibody Testing : Information on HIV testing protocols, and more.

Chlamydia: The Silent Epidemic : The most common sexually transmitted disease (STD) in the United States today is Chlamydia -- but most people don't know it exists.

Chlamydia Screening & Incidence of PID : Study at University of Washington shows early diagnosis and treatment of Chlamydia reduces the risk of pelvic inflammatory disease (PID) - a common cause of infertility

Gonorrhea : Fact sheet on gonorrhea from National Institutes of Health

Gonococcal Infection (clap) : Communicable Disease Fact Sheet from New York State Department of Health.

Herpes Simplex : General information with illustrations

Herpes Homepage: General information about herpes simplex virus

Herpes Simplex : Information on herpesvirus from Leichester University in UK

Primary Syphilis : Illustrations of primary syphilis in male and female patients

Sexually Transmitted Diseases : CDC National Prevention Information Network's resources links

Congenital Syphilis - United States 1998 : Report in the September 03, 1999 issue of the MMWR Weekly.

Comprehensive List of STDs : Complete coverage of most sexually transmitted diseases contracted in the US (Boston University)

Sexually Transmitted Diseases and Their Symptoms : diseases covered include chlamydia, gonorrhea, pediculous (crabs), hepatitis, genital herpes, and syphilis. Take the quiz at the bottom of web pages and learn more.

Common STD's in South Australia : Information on all common STDs from the Department of Health

Flesh Eating Group A Streptococcus

2009-04-21T02:33:00.003+08:00

Group A Streptococcus - Streptococcus pyogenes
Streptococcus pyogenes is a gram-positive cocci bacteria which hemolyzes red blood cells in sheep blood agar. Members of the species typically exhibit this characteristic. Group A streptococcus is presumptively identified in the microbiology laboratory by this appearance on sheep blood agar. The organism is catalase-negative (it lacks the catalase enzyme which all staphylococci bacteria possess) and a positive PYR reaction (it possess the enzyme pyrrolidonylarylamidase - PYR - which is absent in staphylococci). Definitive biochemical tests are performed to confirm the isolation of group A streptococcus since it is know to cause serious complications described below. Group A streptococcus is the leading cause of acute bacterial pharyngitis/tonsillitis, or "strep throat" occurring worldwide. Strep throat is seen most commonly in children, but all ages may be infected by this bacteria. Acute bacterial pharyngitis occurs most commonly in the winter or spring and has an abrupt onset of symptoms which are sore throat, headache, high fever, and swollen cervical lymph nodes. If untreated or inadequately treated, pharyngitis caused by group A streptococcus can lead to rheumatic fever which affects the heart, and post acute streptococcal glomerulonephritis, a serious condition in which the kidneys loss their ability to function properly. Both conditions can be life-threatning, but are not seen at the same time in a patient. When the rash appears with the throat infection, the condition is referred to as scarlet fever.

Scarlet fever resembles strep pharyngitis, but the condition is accompanied by a skin rash that appears first on the upper chest and spreads to the trunk, neck, arms, and legs. The skin appears to be pealing as that seen in a severe sunburn. This, too, is a serious condition, and can progress to a necrotizing fasciitis if the infection spreads to the fascia, the protective covering which is underneath the skin. For more illustrations go to the streptococcal pharyngitis resource web page from the Medical Reference Library - Healthway Interactive. Click on the desired photograph for a larger view.

Sheep blood agar with colonies of beta-hemolytic group A streptococcus

Flesh Eating Bacteria

Necrotizing fasciitis is a bacterial infection of the fibrous tissues that covers the body beneath the skin. It also covers the muscles of the body and serves as a protective covering. Fasciitis refers to an inflammation in the fascia which is a natural immune response due to bacterial infection or injury to the tissues. Necrotizing fasciitis is a serious condition and medical attention. should be sought immediately. Until recently this condition was rarely seen in Texas but sporadic has been seen in patients throughout the world including the US. This condition was once referred to as hospital gangene. Typically, two bacteria are implicated which are group A streptococcus and Staphylococcus aureus.

For more information on this "flesh eating bacteria" link to Communicable Disease Centers' National Center for Infectious Diseases or National Necrotizing Fasciitis Foundation (NNFF).

MMWR - link to the CDC's Morbidity and Mortality Weekly Report then use the searchable INDEX for case histories on fasciitis caused by group A strep.

Medical Tribune News Service Elderly at Risk for contracting "Flesh-eating Bacteria"

Group A Strep Page pictures..stories..links..survivor of this disease

Fact Sheet description of group A Streptococcal infections: NIH's National Institute of Allergy and Infectious Diseases

Streptococcus : Basic description of the streptococci from The Rockefeller University's Laboratory of Bacterial Pathogenesis and Immunology

Group A Strep descriptions of the various manifestations of streptococcal infections - Queens Hospital, London, England

Causes for sore throat other than group A streptococcus

Necrotizing Fasciitis links and a picture of this variant of group A strep causing acute necrotizing fasciitis on a leg **caution** don't got to this site if you have a weak stomach.

A View on The Flesh Eating Bacteria : group A streptococcus

Invasive Group A Streptococci : From Bug Bytes of John W, King, M.D. at the Infectious Disease Department, LSU Medical Center - Shreveport, LA.

Staphylococcus aureus: An Emerging Super Bug

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Staphylococcus aureus, a catalase-positive, gram-positive cocci-shapted bacteria, has been implicated in hospital acquired infections since the 1950s when the organisms developed a resistant to penicillin. Even during the golden age of antibiotics, about 50% ofS. aureus strains were found to be resistant to penicillin and later penicillian derivative drugs. The organism quickly became resistnat to newer and more powerful antibiotics, such as tertracycline and the aminoglycosides. S. aureus is a member of the family Micrococcaceae which comprises four genera: Micrococcus, Staphylococcus, Planococcus, and Stomatococcus. Staphyolococcus are natural habitants of skin and mucouse membranes of humans. The bacterial can be found throughout the environment from dust to door knobes. It is common even in the most cleanest healthcare facilities. Most species of Staphycococcus are oppertunistic pathogens, S. aureus , however, has been considered a serious bacterial pathogen since the organism developed a resistance to penicillin in the 1950s.

Staphyococcus aureus : Extracellular Enzymes and Toxins

Coagulase
Deoxyribonuclease (DNase)
Beta lactamase (penicillinase)
Exfoliatins
Staphylokinase
Lipase
Hemolysins
Leukocidins
Enterotoxins
A, B, C, C2, D, E and F
TSST-1: toxic shock syndrome toxin

Characteristics of the Cell Wall and Surface of S. aureus

Protein A: binds to antibody molecules which makes the organism resistant to phagocyctosis and fixation of complement
Capsular polysaccharide: enables the organism to resist phagocytosis
Peptidoglycan: cell wall consituent which allows the organism to attach to host's cell membranes and resist unfavorable environmental conditions
Teichoic acid

Web Site Resources on S. aureus
Four Pediatric Deaths from Community-Aquired Methicillin-Resistant Staphylococcus aureus - Minnisota and North Dakota 1997 - 1999. : MMWR 1999 August 20, 1999/48 (32) ; 707 - 710
.
HA-MRSA : Methicillin Resistant S. aureus - - Infection Control Fact Scheet from the CDC, Atlanta, GA,

VISA : Vancomycin Resistant - Publication from the CDC on this resistant strain of Staphylococcus aureus.

WHO Emerging Pathogens Report - - 1997 report of vancomycin intermediate resistant S. aureus

Fact Sheet on S. aureus The Doc Shop Mall, Arizona Healthcare Network Web Site

Microbiology Internet Resources

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Yahoo Groups CE Clinical Microbiology

Microbes Info The Microbiology Information Portal

Recommended Reading
Prevalence and Risk Factors for Carriage of Methicillin-Resistant Staphylococcus aureus at Admission to the Intensive Care Unit : Archives of Internal Medicine - Vol. 163 No. 2, Jan. 27, 2003. The authors recommend MRSA screening for all ICU admissions.

Linezolid versus Vancomycin for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections : By Dennis L. Stevens, Daniel Herr, et al. Clinical Infectious Diseases, 2002;34:1481-1490.

General Microbiology
Learning Microbiology can be fun! Try your hand at this Online Resource: Outbreak!: Teaching Clinical and Diagnostic Microbiology Methodologies with an Interactive Online Game. An ERIC Source.

Microbiology Textbooks Online Internet Resources
Medical Microbiology, 4th Edition. Edited by Samuel Baron. © The University of Texas Medical Branch at Galveston. You may down load the entire text.

Polymicrobial Diseases. Edited by Kim A. Brogden and Janet M. Guthmiller. Copyright © 2002 ASM Press.

Microbiology And Immunology OnLine. University of South Carolina, School of Medicine.

Bailey & Scott's Diagnostic Microbiology, 12th Edition. By Betty A. Forbes, PhD, D(ABMM), F(AAM), Daniel F. Sahm, PhD, D(ABMM), F(AAM) and Alice S. Weissfeld, PhD, D(ABMM), F(AAM). Registration required to access the reference material.

General Microbiology Review
Microbiology. Review your knowledge of microbiology or use these questions to help you prepare for an examination in general microbiology. Developed as a study guide for medical students covering the basic sciences.

Another site to learn microbiology...John L's Bacteriology Pages : link to his Bacteriology Site and Selected General Microbiology Topics pages among many other resources related to microbiology.

Gram Stain Internet Resources
The Gram Stain, The Gram Stain From A M.D.'s Perspective : Application, procedure and interpretation of Gram stained smears are covered on this web site from Loyola University Medical Center at Loyola University Chicago. Link to excellent Gram stained images of medically important bacteria.

Bob's Brief Guide To Gram Stains! : by Bob R. Bogle, in cooperation with the Southern Arizona Antimicrobial Resistance Survey.

Gram Stain Tutorial from the Pharm 5825 course at the College of Pharmacy, University of Minnesota.

More Learning Opportunities Internet Resources
Active Learning Centre Home Page : This site is a compilation of self-assessment tests/databases in different areas of knowledge. All tests follow the same format and are capable of asking either multiple-choice, matching or essay-type (self-graded) questions.

General Microbiology Lectures : By Dr. Christopher J. Woolverton, Associate Professor, Department of Biological Sciences, Kent State University, Kent, Ohio.

Medical Microbiology Lectures : From the course MBMB 403: Medical Microbiology, Southern Illinois University Carbondale.

Infectious Diseases Lectures : Pathophysiology Courses, Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AK.

The Basic Microbiology Laboratory Tests, Media and Techniques : Link to these topics from the Introduction to Clinical Microbiology course at the University of Texas - Houston Medical School.

Microbiology Image Library
Image Library : American Society of Microbiology.

Microbiology Lectures Internet Resources
Infection and Immunity Lecture Index and Tutorials : Second Year Lectures, University of Wales College of Medicine, UK. Click on the Fourth Year Lectures Index at the bottom of this page for additional lectures and tutorials.

Microbiology : Med Student Cafe, lots of educational links.

Microbiology and Immunology On-Line : Online resources and lectures developed by the faculty of the Department of Microbiology and Immunology for second-year medical students at the University of South Carolina School of Medicine.

Microbial Diseases Of The Skin And Eyes - Part of lecture series on microbial diseases of the body.

Review of Medical Microbiology : Select the topic of interest from the Table of Contents. Source: Dr. Patrick J. Davis at the University of Texas at Austin and Dr. David S. Burgess also at UT and the University of Texas Health Science Center at San Antonio.

Links to Microbiology and Infectious Diseases sites : Dr. Neil Chamberlain's favorite links.

Microbiology Tutoring Links : Link to Microbiology Laboratory Reviews. From University of Houston (Texas).

Microbiology Lab Manual : By Gary E. Kaiser, Ph.D. at Community College of Baltimore County, Catorsville, MD.

World Lecture Hall : Several college-level microbiology courses have been listed on this Web site of the University of Texas at Austin.

Microbiology Case Studies : Inflammation Laboratory, from WebPath The Internet Pathology Laboratory, University of Utah School of Medicine

Related Microbiology Resources : Online list of the Department of Microbiology at the University of Minnesota.
Hardin MD Infectious Diseases/Bacterial Diseases/Microbiology Listings : Microbiology Gateway to Online Resources. Hardin Library for the Health Sciences , University of Iowa.

Infectious Diseases - List on infectious diseases compiled by Gerald J. Tritz, Ph.D.

Microbiologyprocedure.com : Information on Microbiology Techniques, Methods, Procedure, Education Referral Website

Staphylococcus aureus : My blog page on this gram-positive coccal organism, an emerging superbug.

Flesh eating beta-strep group A: link to web sites from this blog for in depth coverage.

Group B Streptococcal Infections : CDC Fact Sheet.

Prevention of Perinatal Group B Streptococcal Diseases : CDC presentation on slides.

Group B streptococcus : discussion of group B streptococcus, ICQ account required.

Coccal Infections : Information from the Merck Manual Home Edition about infections caused by staphylococci, streptococci, pneumococci, and meningococci.

History of Microbiology : Karen Kiser's web page contains microbiology related links as well as the history of microbiology (St Louis Community College).

Bactitech's Web Site : Microbiologist Judy Dilworth's collection of lab and microbiology links are worth checking out.

The Microbe Files : Web site devoted to microbiology of Dr. Ron Hurlbert at Washington State University. Link to Dr. Hurlbert's Course Fundamentals of Microbiology.

Infectious Diseases WebLink - Online resources on infectious diseases.

MedMark's Infectious Diseases Site: over 200 links to societies, institutes, centers, labs, departments, education, training, and more.

VRE : Fact Sheet on Vancomycin Resistant Enterococci - Queen Mary Hospital, England. Check out the top stories of the week here.

Resources Page of the Association of Public Health Laboratories. Lots of interesting and useful links.

Morbidity and Mortality Weekly Report: MMWRweekly report published by CDC, Atlanta, GA.

Fact Sheets : Information on infectious diseases prepared by the Virginia Department of Health, Office of Epidemiology.

Blue Book : Guidelines for Control of Infectious Diseases -- Public Health Division, Dept. of Human Services, Victoria, Australia.

Ed Uthman, MD discusses Exotic Infections : historical notes and numerous links to other related resources can be found on this page.

Infectious Diseases WebLink - also contains CDC and Medline web search engines.

Links from the web site of The Laboratory of Bacterial Pathogenesis and Immunology at The Rockefeller University.

Bugs on The Web: site features articles on various facets of microbiology; case studies; and more.

Advanced Case Studies: more case studies from Web Path.

Microbiology Resources: links to microbiology topics from UNMC.

Escherichia coli O157:H 7 : CDC database search results on this pathogenic strain of E. coli

E. coli research database collection from ECDC, a research data base on Escherichia coli

E. coli Index : research database from United Kingdom

A dangerous strain of Escherichia coli that might be present in hamburger, chicken, or other meat products. This dangerous organism can cause bloody diarrhea, severe kidney problems, and even death.
E. coli O157: H7 - Procedure for Isolation and Identification from Stool Specimens

Human Infections with Shiga Toxin-producing Escherichia coli other than Serogroup O157 H7 in Germany : article in the October - December 1998 issue of the Emerging Infectious Diseases discusses this new organism

Microbial Underground's Salmonella Page : general information on Salmonellosis and typhoid fever - - this site includes related web links

Information on Salmonella enteritidis infections from CDC. Egg-associated salmonellosis is an important public health problem in the United States and several European countries.

LeprosyHansen's disease : Brief discussion of this disease from the Hawaii Department of Health

Introduction to Leprosy, From this page you access other web pages that covers, historical types, classification, transmission, diagnosis, and immunity of the disease caused by Mycobacterium leprae.

Medical Microbiology: a look at the microbial world...CIA..lab notebook..and more.

Microbiology Network : Communication resources for microbiologists; user groups, discussion groups, virtual library, and more.

Cool Web Site Links from the Ohio Branch ASM. Lots of good links.

Laboratory Safety Internet Resources

2009-04-20T19:59:00.002+08:00

CLIA Laboratory Safety : Source is the Virtual Hospital, University of Iowa Health Care.

Annual Clinical Laboratory Safety Training : at the Washington University in St. Louis' School of Medicine. If your working on a clinical laboratory safety training plan, this is a great reference for you.

Environmental Health & Safety Links of Washington University in St. Louis' School of Medicine. Find a link on this web page for an in service safety training power point presentation.

Laboratory Safety Links of the Texas Department of Health Bureau of Laboratories, Austin, Texas.

Laboratory Safety - Knowing How to Produce Safe Science . Training material available from the Howard Hughes Medical Institute.

Laboratory Safety Recommendations : Recommendations for Listing Dangerous Biological Agents and Toxins and for Establishing Standards and Procedures Governing Their Possession and Use , Howard Hughes Medical Institute.

Laboratory Safety and Accreditation: Safety How to's The Pro's -Healthsafetyinfo.com.

NIH's Laboratory Safety and Chemical Hygiene website : Online resources on chemical hyigene, ergonomics, hazardous material, and lab safety.

NSF International, the Public Health Safety Company .

Princeton University Laboratory Safety Manual : A collection of resources for individuals working in research and teaching laboratories.

Sites Related to Laboratory Safety : This website is a good source of information on safety practices in the laboratory. Source: Microbiology/Biology Department at Penn State Altoona.

New Needlestick Legislation : Hot Topics in Healthcare, October 1999.

Needle Stick Injuries : General information from the Hypodermic Needle Incinerator, Johannesburg, South Africa

MSDS Resources
Material Safety Data Sheets : Over 250,000 MSDS files in the database provided by Cornell University.

Where To Find Material Safety Data Sheets On The Internet : The Internet Resource for MSDS, a great gateway and maybe the largest collection of MSDS. A great place to start your search.

Laboratory Management Internet Resources

2009-04-20T19:40:00.002+08:00

Tech Staffing Issues - IDVTrials.com - What has happened to all the techs? by Pennell C. Painter, Ph.D.

Behavioral Interviewing Techniques : Go to this web site for information on behavioral interviewing and back link to a Guide for Interviewing from the Career Center at the University of Missouri.

CLIA 88 Regs : Current CLIA Regulations (including all changes through 01/24/2003). Division of Laboratory Systems (DLS), CDC.

CDC Index of Publications page.

CDC Prevention Guidelines Systems .

Division of Laboratory Systems: CLIA Regulations, Laboratory Guidelines/Standards.
CLIA : Implementing CLIA amendments of 1988, CDC source.

Checklist for CLIA Compliance : from Laboratory Solutions Inc.

CLIA Guidelines: Subpart M - Personnel for Moderate and High Complexity Testing.

CLIA Requirements for Analytical Quality : Click here to find out what's new with CLIA '88 and see the clinical quality requirements mandated by this public law.

DLS : Division of Laboratory Systems - - Ensuring Excellence in Laboratory Practice.

JCAHO Accreditation: information on accreditation of healthcare facilities by JCAHO.

CLMA : Clinical Laboratory Management Association. Select topic of interest from menu on their home page.

NCCLS: National Committee for Clinical Laboratory Standards - a resource for managers and bench supervisors.

Tools, technology and training for quality management in healthcare laboratories : WesTgard Quality Corporation (WQC) -- free article, essays, lessons and download tutorials and quality control software.

Laboratory Manual : Department of Pathology at the University of Duke Medical Center. Use this web site as a resource on the format of an online laboratory manual, or use it to retrieve laboratory test information.

Waived Tests: information about waived lab testing, national reimbursement ave. from InfoLab, Inc.
Home Health Care : Home health monitoring information from University of Illinois' Health Science Center at Chicago.

COLA , a national healthcare accrediting organization devoted to the improvement of health care services.

HCFA : Health Care Financing Administration - the federal agency that administers the Medicare and Medicaid Insurance Programs.

FDA : U.S. Food and Drug Administrations - find information of the Year 2000 Compliance.

OSHA : Occupational Safety & Health Administration's homepage - U. S. Department of Labor.

Technical Links : Not sure where to start, click here and begin your search.

CDC Prevention Guidelines Database : The Prevention Guidelines Database is a comprehensive compendium of all of the official guidelines and recommendations published by the CDC for the prevention of diseases, injuries, and disabilities.

Guidelines for Laundry in Health Care Facilities : Reference: Guideline for Handwashing and Hospital Environmental Control, 1985; Garner, J.S., Favero, M.S., in Guidelines for Protecting the Safety and Health of Health Care Workers.

Compliance Directive 2-2.44D : Enforcement Procedures for the Occupational Exposure of Bloodborne Pathogens. Dated 11/05/99.

Selecting, Evaluating and Using Sharps Disposal Containers : U.S. Department of Health and Human Services (NIOSH) Publication No 97-111. January 1998.

Communication of Hazards and the Chemical Hygene Plan : The Clinical Laboratory Improvement Act (CLIA): The Physician Office Laboratory Risk Management, Ruthanne R. Hyduke, M.A., Virtual Hospital

Prudent Practices in the Laboratory: Handling and Disposal of Chemicals : This online book is prepared by a National Research Council (NRC) committee and made available by the National Academy Press (NAP) .

Clinical and Related Wastes Guidelines for Management : Risk Management Office, University of Sydney, Austrailia.

NAACLS: National Accrediting Agency for Clinical Laboratory Sciences.

CAP: College of American Pathologist's information on HCFA and Medicare regulations of interest to pathologists & CLS.

Forensic Science Internet Resources

2009-04-19T17:14:00.001+08:00

Medical and Forensic Sites: presented by University of New Mexico, Office of medical Investigation.

Forensic Science Resources : Carpenter's list of forensic web sites.

Forensic Resources: International and national listings on this one.

The Why Files : The science of crime; University of Wisconsin -- fingerprinting, DNA identification and other methods and techniques used in criminal investigation.

Forensic Entomology.

NBME: National Board of Medical Examiners.

ABAFT: American Academy of Forensic Science.

American Board of Forensic Anthropology Web Site.

CAFE: American College of Forensic Examiners.

Center for Forensic Studies.

Forensic Science Web Pages

SOFT: The Society of Forensic Toxicologists.

Victorian Institute of Forensic Pathology, Melbourne, Australia

Flow Cytometry Internet Resources

2009-04-19T17:08:00.002+08:00

Information on Flow Cytometry : Overview on flow cytometry at Dartmouth-Hitchcock Memorial Hospital, Lebanon, NH. Website page credit: Marc Langweiler.

Clinical Applications of Flow Cytometry : Purdue University Flow Cytometry Laboratories, Purdue University, West Lafayette, IN.

Powerpoint lecture slides : Prepared by faculty at Purdue University Flow Cytometry Laboratories, Purdue University, West Lafayette, IN.

National Flow Cytometry Resource : The NFCR is part of the Bioscience Division at Los Alamos National Laboratory in Los Alamos, New Mexico. The NFCR is a NIH National Center for Research Resources Center ( http://www.ncrr.nih.gov )dedicated towards the development and availability of advanced flow cytometry instrumentation and applications. Great gateway for flow cytometry resources.

Flow Cytometry on the Web : WWW links from the Salk Institute CCMI, La Jolla, California.

Flow Cytometry Home Page - University of Massachusetts, Amherst, MA. (Note, page is no longer updated but is retained for reference purposes.)

Flow cytometry - - The Cancer Biology & Genetics Division Laboratories : Queen's University at Kingston, Canada.

Case Studies in Flow Cytometry : Journal article appearing in Volume 2, Number 2, August 2002.

"Conjugation of Monoclonal Antibodies" : Tutorial by Mario Roederer, PhD.

"Which Statistic When?" : A tutorial on the statistics often used when analyzing flow cytometry data by Geoffrey Osborne. John Curtin School of Medical Research, Canberra City, Australia.

Clinical Cytometry Society Web Site : CCS is a non-profit society organized to foster the development and implementation of clinical applications of cytometry in the diagnosis and management of human pathologic conditions. Lots of good resources can be accessed from this site.

Medical Lab Electronic Journals Internet Resources

2009-04-19T16:52:00.002+08:00

The Free Medical Journals Site - Sign up for free medical journals.

International Network for the Availability of Scientific Publications (INASP) : a Gateway to more than 500 selected websites for health professionals, medical library communities, publishers, and NGOs in developing and transitional countries. INASP Health Links .

American Journal of Clinical Pathology

American Journal of Hematology

Advance for Administrators of the Laboratory - Merion Publications, Inc.

Advance for Medical Laboratory Professionals - Merion Publications, Inc.

ADVANCE for Medical Laboratory Professionals Online Edition of The Nation's Medical Laboratory Biweekly.

Archives of Pathology & Laboratory Medicine CAP Publication.

Biochemistry - American Chemistry Society publication.

Blood Cells, Molecules and Diseases.

Blood - Journal of the American Society of Hematology.

BMJ : British Medical Journal

CAP Today

Clinical Chemistry - International Journal of Laboratory Medicine and Molecular Diagnostics

Clinical Laboratory Management Review - abstracts only.

Clinical Laboratory News

Clinical Laboratory Science.

CRC Journals - Critical reviews of the clinical laboratory science and related disciplines.

Electronic Journal Showcase - Hardin Meta Directory.

Emerging Infectious Diseases : CDC publication.

Hemofiltration - International Journal on Hemofiltration and Blood Purification Techniques.

Journal of Clinical Laboratory Analysis - Wiley-Liss, Inc.

Journal of Histochemistry & Cytochemistry - a Histochemical Society publication.

Journal of Information Technology in Medicine.

Journal of Postgraduate Medicine (www.jpgmonline.com) now provides free access to full text of articles since 1980. It is quarterly publication Staff Society of Seth G. S. Medical College and K. E. M. Hospital, Mumbai, India.

Journal of Technology Education.

JAMA : Journal of the American Medical Association.

Journal of the American Society for Clinical Laboratory Science.

Medical Education Online.

Medicine on the Net.

MLO Online: Medical Laboratory Observer , the management resource for laboratory professionals since 1969.

New England Journal of Medicine.

TeleHealth Magazine

The Scientist : The News Journal for the Life Scientist.

Vantage Point - CLMA newsletter.

Dictionaries & Encyclopedia Internet Resources

2009-04-19T16:45:00.002+08:00

MEDLINEplus Dictionaries List : Link to general and medical dictionaries.

Medical Encyclopedia : The adam Health Illustrated Encyclopedia includes over 4,000 articles about diseases, tests, symptoms, injuries, and surgeries. It also contains an extensive library of medical photographs and illustrations. MEDLINEplus - U.S. National Library of Medicine.

On-Line Medical Dictionary Published by the Dept. of Medical Oncology, University of Newcastle upon Tyne, UK.

Cancer Dictionary - Cancer.gov Dictionary, National Cancer Institute.

DermPath Tutor - Dictionary - by Mary Seabury Stone, M.D. and Thomas L. Ray, M.D., Department of Dermatology, University of Iowa College of Medicine.

Oral Pathology Dictionary - University of Southern California (USC) School of Dentistry, Los Angeles, CA.

Pathology Dictionary - Gross and Microscopic Images. Creighton University Scool of Medicine, Omaha, Nebraska.

Specialty Dictionaries : From yourditionary.com. Select from a large list of dictionaries, all subjects included.

Cytopathology Internet Resources

2009-04-19T16:39:00.001+08:00

CytoPathNet An online cytopathology resource center. General information about pap smears, cervical cancer, automated cytology, quality assurance, and more.

CytoLink the online, multimedia cytology information center. Interesting cytopathology related cases presented monthly.

Cytopathology Links :CAP's links to cytology and cytopathology, cytopathology organizations, journals, books, and multimedia websites.

Johns Hopkins Cytopathology Website : Discussion forum, news, resources, CME courses, online tutorials, and more. Division of Cytopathology, Department of Pathology at the Johns Hopkins University School of Medicine & Johns Hopkins Health System, Baltimore, Maryland.

Internet College of Cytology : Link to Internet Thesaurus on Cytology, Archive of Cytology Photomicrographs, Case Discussions, and more.

Links : of the International Society of Cytology.

Cancer Cytopathology Online : Current issues of cancer and cancer cytopathology. John Wiley & Sons, Inc.

Cytopathology Tutorial (Pap Smears) : WebPath - The Internet Pathology Laboratory.

Images in Cytopathology : from the pathologists at the University of Texas School of Medicine in Houston.

Cervical Cytopathology Image Collection : Extensive image collection.

Jode's Web of Cytopathology : This personal website includes extensive links to organizations, journals, and medical research tools, as well as virtual hospitals and related medical jobs.

The Virtual Cytopathology Study Set: Myth or Reality : An interactive presentation discusses the applications, technique, and principles of Fine Needle Aspiration (FNA), and its application. By B. Al-Khafaji, MD, M. Lougee, Ph.D., Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan

Analytical and Quantitative Cytology and Histology

Cytogenetics Internet Resources

2009-04-19T16:14:00.002+08:00

Clinical Genetic Education Resources (Courses and Lectures) : Gateway for resources on medical genetics, Genetics Education Center , University of Kansas Medical Center.

Human Genetics Teaching Materials : Medical School Curriculum, University of Michigan, Ann Arbor, MI.

Human Genetics Overview : Overview and Lectures, Department of Genetics, New Jersey University of Medicine & Denistry.

Cytogenetics Gallery : Cytogenetics is the study of chromosomes and chromosome abnormalities. The Gallery prepared by the Department of Pathology at the University of Washington, Seattle.

Human Genome Project The DNA human genome has been decoded. Go to this web site for information.

GenLink WWW Genetic Resources :Lots of information on genetics and cytogenetics. Links and Database Queries.

OMIM - Online Mendelian Inheritance in Man : National Center for Biotechnology Information. This human genes and genetic disorders database compiled and maintained by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and other institutions.

The Human Gene Map : The human transcript map. Site hosted by National Center for Biotechnology Information : National Institutes of Health.

Atlas of Genetics and Cytogenetics in Oncology and Haematology : Concise and updated reviews on genes, cytogenetic and clinical entities in cancer By Jean-Loup Huret, Genetics DIM, University Hospital F-86021 POITIERS France.

Cytogenetics and Chromosomal Disorders : Basic information. Biomedical Hypertextbooks, Colorado State University.

Cytogentic Resources : Large list compiled by Information for Genetic Professionals : Genetics Education Center at the University of Kansas Medical Center, Kansas City.

Cytogenetic and Genome Research Journal.

Clinical Chemistry Internet Resources

2009-04-19T15:16:00.003+08:00

American Association for Clinical Chemistry : Information about clinical chemistry. You can read the full text of Clinical Chemistry online at this web site.

Links of Interest in Clinical Chemistry : clinical chemistry journals, societies and associations, pathology links and other items of interest can be found on this web site page. From Illinois State Academy of Science.

Clinical Chemistry and Laboratory Medicine Online version.

Chemistry Teaching Resources : From Umea University, Sweden. Many links on this page.

Clinical Chemistry Sequence Page of James F. Thompson,Ph.D., MT(ASCP) at Austin Peay State University, TN. Find many interesting chemistry related hot links on Dr. Thompson's web page.

Lab Scanner - Clinical Laboratory Data Analysis : Lab Scanner is a simple data mining application that is designed for use by pathologists and clinical laboratory personnel, James H. Harrison, Jr. M.D.,Ph.D., Univ. of Pittsburgh Medical Center.

Chemistry Lectures by Roger L. Bertholf, Ph.D. , Associate Professor of Pathology, Director of Clinical Chemistry & Toxicology, University of Florida Health Science Center/Jacksonville. These lectures are Microsoft Power Point. If you do not have Microsoft Power Point installed on your computer, you will have to download Power Point Viewer to load and view these presentations.

Serum Proteins : Information, links to images, case studies from the Path Guy, Ed Friedlander, M.D., Pathologist.

Fluid, Electrolyte and Acid-Base Homeostasis : Part of clinical chemistry lectures in the Department of Medical Laboratory Sciences at The University of Texas Southwestern Medical Center at Dallas. (pdf file)

Clinical Chemistry Links from website of David G. Rhoads Associates, Inc.

Dade Behring Online : Clinical Chemistry Systems for medical laboratory to the POC Lab.

Links for Chemists : Chemistry Section of The WWW Virtual Library . Site host - Links for Chemists - is the University of Liverpool, Great Britain, UK.

Clinical Chemistry Case Studies from the University of Leeds, Great Britain, UK.

The Canadian Society of Clinical Chemists Web Site : The Virtual Library, publications, links and more.

Clinical Chemistry Laboratory at the Yale-New Haven Hospital. See the side bar for links from this website page.

Biology and Molecular Biology Links : Dept. of Molecular & Cellular Biology, Harvard University.

Clinical Analyte Unit Conversion : Analyte conversion calculator provided by Jay Clinical Services . Dennis Jay, Ph.D., DABCC, FACB.

Estimation of Creatinine Clearance : from The Drug Monitor. Also on this web page, you can hot link to other clinical chemistry calculators.

Online Clinical Calculator : Choose from 11 clinical formulas. From Medical College of Wisconsin.

Oxford Medical Informatics : From this web page you can access links of interest on topics in clinical chemistry. Source: Oxford Radcliffe Hospital, Oxford, United Kingdom.

Drugs of Abuse : from Web Path Tutorials, The Internet Pathology Laboratory, Department of Pathology, Medical Center, University of Utah.

Elemental Composition of the Human Body : An elemental assessment of the human body by none other than Ed Uthman, MD, Pathologist, Houston/Richmond, Texas, US.

Endocrine System Lecture : From an undergraduate biology honors course at the University of Maryland.

Immunology Internet Resources

2009-04-19T14:52:00.003+08:00

Allergy, Asthma, and Immunology Online

Allergy/Immunology: Hardin MD Immunology Directory

Latex Allergy : Internet information on latex allergies from the Allergy Internet Resources.

Digestive Tract Immunology Hypersensitivity & Food Allergy : Stephen Gislason, MD.

Immunology Links - Roitt's Essential Immunology : A comprehensive listing of immunology links (Organizations, Publications, Resources).

Antibody Resource Links : Online educational resources about antibodies.

MedMark's Immunology Site: over 200 links to societies, institutes, centers, labs, departments, education, training, and more

Worldwide Immunology Resources : Online resources of Eric Murtz, Depart. of Microbiology of the University of Massachusetts at Amherst.

Yahoo's directory for Medical Immunology: immunology resources and links

Jerry's Immunology Page : page contains information on basic terms and concepts ~ ~ scroll down for additional links

The Immunology Link : home page contains information and additional immunology links

The Macrophage Home Page : What are macrophages?...what do they do? Clink on this site and find out how important macrophages are in the immune system ~ ~ scroll to the bottom of this web site and find additional links on the immune system and inflammation

Sonia's Immunology List : an interesting and informative list of resources in the discipline of clinical immunology. Check out the sites in the Primary Immune Deficiency Webring at the bottom of this page.

Immunology Today Online : Elsevier of United Kingdom.

Immunology Link: online journals, free literature searches, other links to immunology resources.

Louisiana State University Health Science Center: links to immunology, microbiology, and parasitology resources.

Immunology Module; Module on genetics, basic immunology, and immunohematology.

HepNet : Hepatitis Information Network; publications, papers, and related links.

Autoimmune Diseases : Links to the autoimmune diseases from ClinWeb International, hosted by Oregon Health Sciences University.

Autoimmune Diseases : Immunology Lecture No. 34 by Dr. Jack Brown, Department of Microbiology, University of Kansas.

American Autoimmune Related Diseases Association, Inc. : The AARDA is an association devoted to informing the public about the autoimmune diseases which includes all branches of medicine.

Lupus : Advances and remaining challenges; extensive online bibliography on lupus.

Lupus : St. Thomas Lupus Trust, UK.

Antinuclear Antibodies : "The meaning of anti-nuclear antibodies (ANA) Lay Definition of Lupus : A Lupus Support Group Website.

Immunopathology Lab: case studies covering autoimmune diseases and hypersensitivities from the Web Path tutorials.

Autoimmune Diseases On-line : A comprehensive online library of resources on autoimmune diseases.

Directory of Autoimmune-Related Diseases : Resources from the American Autoimmune Related Diseases Association.

Autoimmune Diseases in Women - The Facts : Autoimmune diseases affect women more than men. This web page contains information of the autoimmune diseases seen in females. (Please note: They are not exclusive to females.)

Systemic Lupus Erythematosus Case Study from Web Path - The Internet Pathology Laboratory

Lupus Overview : Information from the Mayo Clinic, Rochester, MN.

Scleroderma From A to Z : Reliable general information on this autoimmune disease. - Link to related topics from this web page

Antinuclear Antibodies in SLE and Sjogren's Syndrome (Information from the University of Washington)

Antiphospholipid Syndrome : General information about this autoimmune disease

INOVA Diagnostics, Inc. Description of ANA Hep-2 testing.

Screening for Antinuclear Antibodies by Enzyme Immunoassay : article published by ARUP Institute for Clinical & Experimental Pathology.

Arthritis Source: Laboratory testing in rheumatic diseases; acute phase reactants, ESR, CRP, RF, ANA, synovial fluid analysis.

Human Chorionic Gonadotropin : For a great reference on hCG, applications, principle, sources of errors, interpertations, visit this Web site of Laurence A. Cole, Ph.D. at the Department of OB/GYN, Health Science Center and School of Medicine, University of New Mexico.

Hepatitis
Hepatitis C Foundation Home Page : Resource on Hepatitis C virus infection

Link to information on hepatitis C and HIV/AIDS from Secialty Laboratories Home Web Page .

Tutorials
Immunology Problem Sets & Tutorials : Biology Department, Univ. of Arizona.

Immunology Tutorials from MedWebPlus. Several topics to choose from menu.

The Immunologic Basis of Allergic Diseases : Medical Education Information Center, Texas Medical Center, Houston, TX.

Perform a Virtual ELISA Test : Biointeractive.org.

Immunology Tutorials : SBU Immunology Laboratories, University Hospital, State Univ. of New York at Stony Brook.

Anemia Internet Resources

2009-04-19T14:32:00.002+08:00

Anemia - Lecture on anemia by Dr. Dolores J. Bacon, New York Presbyterian Health Care, University of Columbia.

Anemia: An Approach to Diagnosis A clinical approach to diagnosis by Dr. Thomas G. DeLoughery, Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland. OR.

Aplastic Anemia Answer Book

Iron Deficiencies in Adults: A comprehensive management guide for IDA in adults

Iron Deficiencies in Children: A comprehensive management guide for IDA in children

Iron Metabolism : Facts on iron metabolism and link back to heme synthesis

Megaloblastic Anemia : An outline of the megaloblastic anemia from "down under."

Sickle Cell Disease: Description of sickle cell anemia

Sickle Cell Disease: Defined by the Cold Springs Gene Research Laboratory; also find link to The Sickle Cell Disease Association of America, Inc

The Sickle Cell Information Center home page: a resource for news and research updates on sickle cell disease from The Georgia Comprehensive Sickle Cell Center at Grady Health System, Atlanta, GA.

Sickle Cell Anemia/Thalassemia Web Server : provides current information on sickle cell disease and thalassemia, includes basic and clinical research, management of patients, and new developments in the field

Sickle Cell Disease Association of America : Information on this genetic disease. September is National Sickle Cell Awareness Month.

Thalassemia: F. A. Rice's lecture notes on thalassemia with a review of hemoglobin development and structure

Beta Thalassemia : most common form of thalassemia described at this web site

Case History: Sickle cell thalassemia discussed

Thalassemia Society of America : Leading the fight against thalassemia. Information for the patient and the professional. Links and Resources.

Leukemia and Lymphoma Internet Resources

2009-04-19T14:26:00.002+08:00

The Leukemia & Lymphoma Society From this page you can link to educational material and publications resoruces. Formerly The Leukemia Society of America.

Atlas of Leukemia (AML, ALL, AUL) : Basic information on laboratory diagnosis of leukemia with illustrations from Medicine Online

Leukemias: Microscopic Images - Source: Division of Hematolog/Oncology, Department of Medicine at The University of Virginia Health System,Charlottesville, VA. (Recommended)

CancerNet: National Cancer Institute - information for the patient and public, health professional, and basic researchers

List of URLs for Leukemia Patients : General information, hot links, facts about leukemia, treatments, and more.

Medicine OnLine: Leukemia sources.

Leukemia Resource: Leukemia Information Center.

Leukemia Information Center: Cancer and Treatment Information, Memorial Sloan-Kettering Cancer Center.

Leukemia: Normal & Malignant Hematopoiesis: textbook reference.

Pediatric Leukemia: University of Pennsylvania Cancer Center.

Hodgkin's Disease: description of the disorder; link BACK to other hematological disorders and diseases.

Hematology Images Selected images of leukemia blood smears.

Dr. John Krause's Hematopathology Page - Tutorials and links to other online resources. Source: Dr. Krause, Department of Pathology, Tulane University School of Medicine, New Orleans, LA.

Hematology Teaching Files Link to lecutres on anemias , hemoglobinopathies, leukemias, and many other topics. Source: Dr. John Matthews, Division of Hematology/Onclogy, Queen's University Department of Medicine, Kingston, Ontario, Canada.

Chronic Myelogenous Leukemia (CML) - Discription of CML with illustrations and related links by Dr. John W. Kimball.

Myeloproliferative Disorder and Myelodysplastic Syndromes Internet Resources

2009-04-19T14:20:00.004+08:00

Myeloproliferative Disorders (MPD)
National Cancer Institute : General information on the myeloproliferative disorders

Myeloproliferative Disorders: Defined, newsletter, medical resources, MPD glossary, and much more.

MPD Research Center, Inc., New York : Find hot links and MedHunt's search engine for internet medical resources.

MPD-SUPPORT-L Web Site, members.aol.com/mpdsupport offers interesting information on chronic myelogenous leukemia, polycythemia vera, essential thrombocythemia, agnogenic myeloid metaplasia, chronicmyelogenous leukemia, and myelofibrosis. Anyone interested in learning about these myeloproliferative diseases my join the list.

Myelodysplastic Syndromes (MDS)
Aplastic Anemia & Myelodysplastic Syndrome : Information from the Aplastic Anemia & MDS International Foundation, Inc. formerly the Aplastic Anemia Foundation of America.

Case studies of RA, RAEB, RAEB in transformation : Clink on the illustrations for more information.

MDS : Information on these disorders from National Cancer Institute.

Haematology Internet Resources

2009-04-19T14:01:00.003+08:00

Proficiency --Cell Identification: Photographic Images Program: The Cytohematology laboratory of the Wadsworth Center designs and carries out the New York proficiency testing program in the area of cell identification. Link to other proficiency resources from this page.

Hematology Peer Group Information Hub : Peer group devoted to hematology. Find useful links, announcements, and message board at this site.

Hematology by Cancer Network.

Weber State University: Case of the Month: case studies in hematology.

Hematography (TM) : "A better way to teach and evaluate proficiency in blood cell identification". : Also a new case study will appear each month on this web site from the University of Minnesota.

Hematology Case Studies : Source is Hematography Case Studies (University of Minnesota).

RBC Tutorial: RBC case studies from Web Path Tutorials, The Internet Pathology Laboratory, Department of Pathology, Medical Center, University of Utah.

WBC Tutorial: WBC case studies from Web Path.

Blood Smear: Preparation and Staining Procedure from the University of Texas Medical School, Department of Pathology and Laboratory Medicine, UTMB, Galveston, Texas.

Laboratory Evaluation of Leukocyte Disorders : Take the Quiz over Leukocyte Disorders. From Maui Research and Technology Center at Kikei, Hawaii.

Hematology Case Studies: Medical Rounds at the University of Colorado.

Hematology Homepage of the School of Medicine at University of California - Davis. Link to case studies (anemia, hemostatis, others), hemostasis lectures and image Data Bank.

Case Studies, Teaching Files, Online Notebooks, and More : Link here for hematology case studies and other learning resources.

Hematologic Diseases : A wide field of topics to chose from on this web site - ClinWeb International maintained by Oregon Health Science University.

HemaSurf: an interactive atlas of hematology

Hematopathology Lab: advanced case studies in clinical hematology from Web Path.

Hematoma(tm) : new hematology case study each month from UMMC

Med Files: hematology case studies and teaching files from various resources.

Pat Letendre's Hematology web sites.

BloodLine's Malignant Hematology Links - BloodLine: The Online Resource for Hematology Education and News.

BloodLine's Homepage : The online hematology resource - challenging case studies, links, photomicrographs and more.

MedMark's Hematology Site: over 200 links to societies, institutes, centers, labs, departments, education, training, and more.

Hardin MD's Meta Directory on Hematology : links and resources in hematology

CancerWeb: Links to hematology tutorials and guides.

Understanding Anemia: Chapter 1 of Dr. Uthman's new textbook - links to other web sites.

Lab Test Information: Hematology Accession : Madigan Army Medical Center, Department of Pathology.

Myoglobin, Hemoglobin, Role of 2, 3-BPG : Biochemistry of these molecules; link to Dr. Paul Reisberg's lectures; web site of Michael W. King, Ph.D.

Hemochromatosis : Mega list of links on this hematologic disorder from Genome.

Hematology In Internet : Galenica's hematology links.

NYC-Hematology Online Resources : A large collection of links covering hematological disorders such as anemias, leukemias, myelodysplastic syndromes, myeloproliferative disorders and lymphomas.

Cytohematology Proficiency Testing: Transparencies : Page includes index for all photographic transparencies used in the New York State Proficiency Tests for cell identification.

Blood Morphology Atlases
Atlas of Hematology : Nagoya University School of Medicine

Haematology Atlas : Department of Haematological Pathology, University of Stellenbosch and Tygerberg Academy Hospital

Blood and Bone Marrow Atlas : University of Kansas Medical Center

HemaSurf:An Interactive Atlas of Hematology, view hundreds of blood film images

Urinalysis and Body Fluids Internet Resources

2009-04-15T22:39:00.003+08:00

Urinalysis Tutorial : from Web Path - The Internet Pathology Laboratory

Urinalysis : learn the basics of this important laboratory test. Good illustrations of organized sediment and crystals in this tutorial. Also from Web Path

Urinalysis Tutorial from the Virtual Hospital - Ruthanna Hyduke, M.A., Department of Pathology, University of Iowa Hospitals and Clinics.

Part I: Specimen Collection and Gross Chemical Analysis.

Part II: The Urine Microscopic Examination.

Urinalysis Cases and Images. : Mary Ann McLane, Ph. D., CLS(NCA), Medical Technology Department, University of Delaware.

The Microscopic Examination of Urine : by Michael Dion of Rosemont College in Montreal, Canada.

Urinary Sediment : By Richard Dion. Department of Technologie de Laboratoire Mï¿½dical, Collï¿½ge de Rosemont, Montreal. English or French versions.

Urinary Sediment : Microscopic Examination of Urine Sediment - by Reginaldo Luzon, MT(ASCP) and Jammie Woo, Ph.D. at the Health Science Center at Syracuse (N.Y.), SUNNY.

Urinary Sediment Atlas : Developed by Nobuko Imai of Japan. An excellent atlas with sharp photos of urinary casts, sediment, and parasites seen in the urine.

Urinalysis - Resources by Ed. Friedlander, MD, Pathologist.

Pfizer's Urinalysis in Perspective link to microphotographs of urinary casts.

Chapter 31 Microhematuria - Lecture by Dr. Tatyana Z. Morton, M.D., Presbyterian Health Care, Columbia University.

Q & A : What is the significance of microscopic hematuria? : by Frederick R. Jelovsek, MD, MS, Woman's Diagnostic Cyber.

Protocol for Macroscopic and Microscopic Urinalysis.

Medt1000: Orientation & Lesson 2-1 Introduction to Urinalysis : MLT urinalysis course, excellent illustrations of the urinary system.

Clue Cells : Gardnerella vaginalison a Pap smear.

Vaginal Infections : Step by Step Method of Examination.

More illustrations of stained preparations : Sources is the Laboratorio Alvaro in Brazil.

Clinical Evaluation of Genitourinary Disorders. : Merck Manual.

Stages of Kidney Disease : from Diabetes Net - diabetesnet.com

Dr. Baer's Renal Lecture Notes : Meds Phase IIC Renal Physiology. Queens University, Kingston & Onterio, Canada.

Polycystic Kidney Disease : from Health Answers - healthanswers.com/.

Peritoneal Fluid - Analysis : covers paracentesis from the Health Library.

Georgia Urology : nation's (U.S.) largest private practice urology group; link on to UROLOGY TOPICS .

Body Fluids from CliniWeb International, Oregon Health Science University.

Body Fluids : How to do chamber cell counts and other aspects on body fluids explained. Back link to the Hematology web site for other topics. Source is Jackson-Madison County General Hospital, Union University and Tennessee Healthcare, Inc. Back link to their hematology resources.

Microscopic Properties of Urine : A course outline on urinalysis & body fluids from the Medical Laboratory. Medical laboratory Technology Program at The University of Texas at Brownsville and Texas Southmost College, Brownsville, TX.

Exposure to Blood or Body Fluids : resources and additional links on the subject from Dr. Ken Corbert at University of Calgary, Canada.

Body Fluids Lectures of Medical Physiology 301 : By Dr. Joe Potlak, Department of Physiology, College of Medicine, University of Vermont, Berlington, VT.

Body Fluids Lectures : Notes to support lectures given by The Reverend Dr. David C.M. Taylor on body fluids, University of Liverpool, UK.

CSF Background A & P of CNS : Good illustration of C.N.S.

Path Notes: Joint Fluid : covers arthritis and related body fluid information - Cornell University Medical College, New York City.

Seminal Fluid Analysis : part of Martin Steinbeck, MT(ASCP)'s body fluid lecture series.
Metabolic Diseases Diagnosed By Urinalysis

Maple Syrup Urine Disease : MSU is a branch-chain ketonuria - Support Group and Resources

Blood Banking and Transfusion Medicine Internet Resources

2009-04-15T21:45:00.005+08:00

AABB : Home Page of the American Association of Blood Banks.

Blood Banking Tutorial from Web Path Tutorials, The Internet Pathology Laboratory, Department of Pathology, Medical Center, University of Utah.

California Blood Bank Society : Information on Blood banking, Immunohematology, and transfusion medicine.

Blood Line's Transfusion Medicine Links .

Current Issues in Transfusion Medicine : Newsletter published by the Section of Transfusion Medicine and Laboratory Immunology at The University of Texas M. D. Anderson Cancer Center, Houston, Texas.

TraQ Program : A transfusion quality control management resource website. British Columbia Provincial Blood Coordinating Office, BC, Canada.

Review of the Australian Blood Banking and Plasma Product Sector : Produced by Health Services Division, Commonwealth Department of Health and Aged Care.

Dr. Karl Landsteiner - Biography : Noble Prize in Medicine for work on the ABO Blood Groups.

Brief History of Blood Banking Around the World :Blood Banking ï¿½ www. bloodbook.com.

Resolving ABO blood typing discrepancies
ABO Blood Group Systems

ABO Blood Types and Parentage

Blood Type and Rh Information

Human Genetic Diversity

Visit these two web pages on blood banking/transfusion medicine compiled by Pat Letendre, Medical Laboratory Science, University of Alberta, Canada
Blood Banking/Transfusion Medicine

AABB Chagas' Biovigilance Network : The Chagasâ€™ Disease Biovigilance Network records screening and confirmatory results from the testing of donors for antibodies to Trypanosoma cruzi, the agent of Chagasâ€™ disease.

Blood Bank Case Studies

Cord Blood Related Web Sites
A Word or Two About Private Cord Blood Banking.

Benefits of Family Umbilical Cord Blood Banking Confirmed : New story from TechMall for all the latest in technology new stories.

Medical Parasitology

2009-04-13T18:40:00.001+08:00

Medical Parasitology introduces parasites of medical importance. It covers all pathogenic protozoa and also nematodes (worms) which cause intestinal manifestations. Medical Laboratory Technologists are exposed to laboratory procedures to detect and diagnose parasitic infections. Medical Parasitology starts with blood nematodes, trematodes and cesstodes. It is then followed by the field of entomology. Medical Laboratory Technologists will be taught on phylum arthropoda especially insects of medical importance. They will be exposed to laboratory procedures including worm and ova counting techniques and methods to identify different types of mosquitoes, larvae and eggs.

Main Reference Textbooks:
Heelan J.S. & Ingersoll F.W. 2002. Essentials of Human Parasitology. Delmar.
Atlas of Medically Important Parasites JW Mak 2005 1st rev.ed UY Print ISBN9833049001

Additional Reference Material:
Essentials of Tropical Medical Parasitology, JPO Oyerinde 2000 University of Lagos Press ISBN9780176152

Medical Laboratory Technology Programme

2009-04-11T02:57:00.002+08:00

Medical Laboratory Technology prepares future Medical Laboratory Technologist for a career in Medical Laboratory Technology. Medical Laboratory Technologists perform laboratory tests and analyses on human blood, body fluids and tissues to assist doctors in the diagnosis and management of diseases. This programme is specially design to equip future Medical Laboratory Technologist s with extensive theoretical knowledge and relevant practical skills to meet the needs of the medical laboratory industry.

The aims of the programme are to produce competent professionals to contribute to the field of laboratory medicine so as to help fulfill the nation’s need for health care. Those who aspire to become clinical scientists, research scientists or academicians can further their studies for a Bachelor’s degree in Biomedical Science, Forensic Science and thereafter, a Master’s degree or PhD degree in related disciplines. Medical Laboratory Technologists have a variety of career opportunities. They can work in public or private hospital laboratories, private clinical laboratories, public health laboratories, universities and research institutions. In order to carry out their role in these aspects, Medical Laboratory Technologists must acquire good knowledge and skill in various branches of medical science disciplines:
Anatomy and Physiology
BiochemistryBa
sic Applied Science
Biology and Human Genetics
Biostatistics
Cytology
Clinical Biochemistry
Immunology and Serology
Haematology
Histopathology
Medical Laboratory Science
Medical Microbiology
Medical Parasitology
Immunohaematology

Immunohematology

2009-04-07T23:06:00.002+08:00

Immunohematology introduces the theory of genetic and immunology of blood group antigens and antibodies. Medical Laboratory Technologists are exposed to the knowledge regarding the function of blood bank in transfusion medicine. Emphasis of Immunohematology is also on the acquiring of technical skill in testing ABO and Rh blood group and ensuring supply of safe and compatible blood to patients.

It introduces the Medical Laboratory Technologists with the knowledge and techniques to solve problem of incompatible cross-matching, to determine the causes of transfusion reactions as well as to perform investigations of hemolytic transfusion reactions by way of antibody identification. Medical Laboratory Technologists will also be exposed to the theory of blood bank management including quality control system. The role of aphaeresis in transfusion medicine is also included.

Main Reference Textbooks:
Textbook of Blood Banking and Tansfusion Medicine 2005 Sally V Rudman
Immunohematology: Principles and Practice, Quinley, Lippincott

Additional Reference Material:
Transfusion Medicine,2nd ed 2005 ISBN00443066485 Churchill Livingstone

Medical Microbiology

2009-04-06T02:34:00.001+08:00

Medical Microbiology introduces different types of micro organisms based on their structure, characteristics, morphology, replication and effects on human health. Medical Laboratory Technologists will also acquire the basic techniques used in microbiological study like culturing, staining and microscopic examination of bacteria. This exposes Medical laboratory Technologists with all the common pathogenic bacteria encountered in clinical practice.

Medical Laboratory Technologists will learn how to detect and recognize them based on their shape, arrangement, staining reaction, colony feature and other relevant tests. Serological testing of some infectious disease is also included. This enables Medical Laboratory Technologists to understand the methods and principles to investigate various types of infections. Medical Laboratory Technologists also learn about the organisms which cause infections in various types of clinical samples.

Main Reference Textbooks:
Tortora, Funke, B.R.& Case, C.L.2004. Microbiology: An Introduction. 9th ed.

Color Atlas and Textbook of Diagnostic Microbiology 3rd d.2005, Koneman

Additional Reference Materials:
Oxford Handbook of Clinical and Laboratory Investigations 2003,Drew Provan and Andrew Krentz, Oxford University Press

Essentials Microbiology, Stuart Hogg

Histopathology

2009-04-03T10:05:00.001+08:00

Histopathology is the branch of science concerned with the study of microscopic changes in diseased tissues. Most often, biopsy samples of abnormal tissue are submitted for histopathology to determine the presence or absence of disease and, if present, the type and severity of the disease. Medical Laboratory Technologists are expected to understand normal tissue histology and their functions as well as the morphology of the tissue after manifestation of pathology. They should also recognize the significance of each type of abnormality.

In addition to the theoretical knowledge, the Medical Laboratory Technologists are also required to be proficient in their laboratory skills such as mastering the usage of different techniques and procedures and knowing what types of fixatives and dyes are suited for use in different samples. Of equal importance, they should also be well-versed in matters of lab safety and quality control procedures. This equips the Medical Laboratory Technologists with knowledge and technical know how in preparing tissue section using appropriate microtome and special staining technique to stain tissues for their various contents like mucin, microorganism, glycogen, collagen, muscle and others.

Main Reference Textbook :
Bancroft JD, Gamble M. Theory and Practice of Histological Techniques. 5th Edition. Chruchill Livingstone: New York. 2002.

Additional Reference Materials:
Basic Histopathology, a colour atlas and text, 4th Edition Weather, 2003, Churchill & Livingstone

Pathologic Basic of Disease 7th ed, Robbins & Cotran, Elsevier

Cytology

2009-04-03T09:37:00.001+08:00

Cytology is the branch of diagnosis medicine, which deals with the study of individual cells, and/or tissue fragments spread on laboratory slide and stained appropriately. In cytology, the Medical Laboratory technologists learned how to identify the normal cells of the female genital tract, how to detect abnormalities from infections and inflammation as well as the basics of the Pap test. As a continuation to that, Medical Laboratory Technologists study on how to differentiate between benign lesions and potentially malignant lesions on the cytology smears. More will be explained on different types of carcinoma that occur in cervical cancer. There will also be an emphasis on the proper running of a cytological laboratory.

Medical Laboratory Technologists should be able to tell if a sample shows an abnormality and also what is the nature of that lesion. They should also be well-versed in the laboratory management aspects of cytology, such as quality control, how to effectively run a lab and how to handle samples from the moment they arrive until the report is dispatched back to the physician. Cytology deals with the study of epithelial cells and non-epithelial cells. It gives an understanding of normal cytology of female genital tract through microscopic examination of Pap smear. Medical Laboratory Technologists are also exposed to epithelial changes due to inflammations, infections, hormonal influences as well as regenerative and degenerative processes.

Main Reference Textbook:
Diagnostic Cytology and its Histopathology Basis, Koss,L 4th Edition, Lippincott

Additional Reference Materials:
The Manual of Cytotechnology, American Society of Clinical Pathologist, 1997
A Manual of cytotechnology

Basic Histopathology, A color atlas and text, 4th Edition 2002. Wheather

Hematology

2009-04-02T21:40:00.004+08:00

Hematology is a study of the formation and maturation of blood cells. Many hematologic diseases involve failure of maturational mechanisms, abnormal cell differentiation, or failure of regulation of cell proliferation. The pathophysiology of many blood disorders can be explained by study of the proliferative capacity and the degree of differentiation seen when marrow cells are studied microscopically and cultured. The degree of demand, the adequacy of reverses, and the proliferative and differentiation capacity of the bone marrow govern the number of normal and abnormal cells seen in the peripheral blood and bone marrow in certain diseases.

This equips the Medical Laboratory Technologists with theoretical knowledge and technical skill to investigate and diagnose various types of anaemia including iron deficiency anaemia, folae/B12 deficiency anaemia, thalassemia and abnormal haemoglobins. This enables the Medical Laboratory Technologists to understand leukaemia based on classification, aetiology, clinical manifestations and various features.Medical Laboratory Technologists are equipped with the knowledge and technical skill to detect and diagnose this disease through Full Blood Picture, bone marrow study and cytochemistry and also exposes the theory of hemostasis and methods to investigate bleeding and clotting disorders.

Main Reference Textbooks:
Clinical Laboratory Haematology, April 2003, Shirlyn Mckenzie, Prentice Hall

Essential Haematology 5th Edition 2006 A.V.Hoffbrand

Additional Reference Materials:
Practical Haematology, Sir John Dacie & Lewis, 10th Edition, 2004

Anderson’s Electronic Atlas of Hematology 2002 Shauna C Anderson, Lippincott

Anatomy and Physiology

2009-04-02T21:16:00.002+08:00

Anatomy and Physiology introduces the structures of human body including all the organs and their components. Medical Laboratory Technologists are also exposed to the physiological function and process of each organ or body system.

Main Reference Textbooks:
Marieb, E.N. Essential of Human Anatomy & Physiology. 6th ed. 2000. Addison Wesley Longman

Illustrated Clinical Anatomy 2005, Peter Abrahams, Hadder Arnold

Additional Reference Materials:
Tortora,G.10th ed. Principles of Anatomy and Physiology.2003 Wiley & Johnson.
Principles of Anatomy and Physiology (2003 10th with CD-ROM)

Human Physiology & Mechanism of Disease, Gayton
Human Anatomy & Physiology

Medical Laboratory Science

2009-04-02T20:52:00.005+08:00

Many discoveries and inventions happen in a laboratory. The field of laboratory medicine is very interesting and it contributes a lot to the mankind. This gives Medical Laboratory Technologists the basic knowledge and understanding necessary to enter the field of medical laboratory technology. Acquiring sound knowledge and developing technical expertise is the route to become an excellent Medical Laboratory Technologist. If you desire to be one, you can!

The Medical Laboratory Technology prepares the future Medical Laboratory Technologists by formal instruction and clinical experience to perform laboratory procedures that aid physicians, pathologists and, other healthcare providers, in the diagnosis and treatment of disease in the hospital, clinic, or research laboratory. Medical Laboratory Technologists will be introduced to the basic of medical laboratory in a nutshell and also learn basic scientific principle and other related laboratory equipments.Medical Laboratory Science explains the role, duty, responsibility and mission of Medical Laboratory Technologist in health care system. It introduces all aspects of laboratory practice including the handling and care of chemicals, laboratory instruments, apparatus, laboratory animals and biological materials as well as concept of safe laboratory practice.

Main Reference Textbook:
Textbook of Medical Laboratory Technology, Sood, Jaypee Brothers Medical Publishers
Textbook of Medical Laboratory Technology

Additional Reference Material:
Oxford Handbook of Clinical and Laboratory Investigations 2003, Drew Provan and Andrew Krentz, Oxford University Press

Acute Lymphocytic Leukemia (ALL)

2008-11-18T23:53:00.003+08:00

About 3,970 new cases of acute lymphocytic leukemia (ALL) are diagnosed each year in the United States. It is the most common type of leukemia under the age of 19. Children are most likely to develop the disease, but it can occur at any age. Acute lymphocytic leukemia may be called by several names, including acute lymphoid leukemia and acute lymphoblastic leukemia.

ALL results from an acquired (not inherited) genetic injury to the DNA of a single cell in the bone marrow. The disease is often referred to as acute lymphoblastic leukemia because the leukemic cell that replaces the normal marrow is the (leukemic) lymphoblast. The effects are: 1) the uncontrolled and exaggerated growth and accumulation of cells called "lymphoblasts" or "leukemic blasts," which fail to function as normal blood cells and 2) the blockade of the production of normal marrow cells, leading to a deficiency of red cells (anemia), platelets (thrombocytopenia), and normal white cells (especially neutrophils, i.e., neutropenia) in the blood. In most cases, the cause of acute lymphocytic leukemia is not evident. Few factors have been associated with an increased risk of developing the disease. Exposure to high doses of irradiation, as carefully studied in the Japanese survivors of atomic bomb detonations, is one such factor. Unlike other forms of leukemia, acute lymphocytic leukemia occurs at different rates in different locations. There are higher leukemia rates in more developed countries and in higher socioeconomic groups.

The current causes of acute lymphoblastic leukemia in children or adults are not known. Scientists continue to explore possible relationships with life-style or environmental factors but no firm conclusions have yet been reached. Given the amount of study, this suggests that multifaceted complex factors may be involved. It is extremely disconcerting to patients and their families to wonder what they may have done differently to avoid the disease. Unfortunately, at the present time there is no known way to prevent the disease. Acute lymphocytic leukemia occurs most often in the first decade of life but increases in frequency again in older individuals. Acute lymphocytic leukemia can develop from primitive lymphocytes that are in various stages of development.

The principal subtypes are uncovered by special tests on the leukemic lymphoblasts called "immunophenotyping." Phenotype is the physical characteristics of the cells and these are measured using immune tools. The subclassification of cell types is important since it helps to determine the best treatment to apply in each type of leukemia. The principle subtypes are T lymphocyte and B lymphocyte types, so named because the cell has features that are similar to normal T or B lymphocytes. In addition, the B cell type can be divided into a precursor B cell type, as well. Once these features are determined the term used may be acute T lymphoblastic leukemia or acute precursor (or pre) B cell lymphoblastic leukemia. Other markers on the lymphoblasts that can be detected with immunophenotyping and may be useful to the physician include the common acute lymphoblastic leukemia antigen, cALLa, now called CD 10.

Most patients feel a loss of well-being. They tire more easily and may feel short of breath when physically active. They may have a pale complexion from anemia. Signs of bleeding because of a very low platelet count may be noticed. These include black-and-blue marks occurring for no reason or because of a minor injury, the appearance of pinhead-sized, red spots under the skin, called petechiae, or prolonged bleeding from minor cuts. Discomfort in the bones and joints may occur. Fever in the absence of an obvious cause is common. Leukemic lymphoblasts may accumulate in the lymphatic system, and the lymph nodes can become enlarged. The leukemia cells can also collect on the lining of the brain and spinal cord and lead to headache or vomiting.

• Medical history and physical examination
• Complete blood counts
• Bone marrow examination
• Cytogenetics
• Immunophenotyping

To diagnose the disease, the blood and marrow cells must be examined. In addition to low red cell and platelet counts, examination of the stained (dyed) blood cells with a light microscope will usually show the presence of leukemic blast cells. This is confirmed by examination of the marrow which almost always shows leukemia cells. The blood and/or marrow cells are also used for studies of the number and shape of chromosomes (cytogenetic examination), immunophenotyping, and other special studies, if required.

Blood and bone marrow samples are used to diagnose and classify the disease. The following tests are used in the further classification of the disease. Examination of leukemic cells by cytogenetic techniques permits identification of chromosomes or gene abnormalities in the cells. The immunophenotyping and chromosome abnormalities in the leukemic cells are very important guides in determining the approach to treatment and the intensity of the drug combinations to be used. This is a laboratory test that enables the physician to determine the type of disease that is present in the patient. It uses the antigens (proteins) on the cell surface and the antibodies produced by the body that match the antigen.

A method that uses the reaction of antibodies with cell antigens to determine a specific type of cell in a sample of blood cells, marrow cells, or lymph node cells. The antibodies react with specific antigens on the cell. A tag is attached to an antibody so that it can be detected. The tag can be identified by the laboratory equipment used for the test. As cells carrying their array of antigens are tagged with specific antibodies they can be identified; for example, myelogenous leukemic cells can be distinguished from lymphocytic leukemic cells. Normal lymphocytes may be distinguished from leukemic lymphocytes. This method also helps to subclassify cell types, which may, in turn, help to decide on the best treatment to apply in that type of leukemia or lymphoma. The antigen on a cell is referred to as cluster of differentiation or "CD" with an associated number. For example, CD7 and 19 may be present on leukemic lymphoblasts and CD13 and 33 on leukemic myeloblasts.

Cytogenetic examination of tissue is the process of analyzing the number and shape of the chromosomes of cells. The individual, who prepares, examines and interprets the number and shape of chromosomes in cells is called a cytogeneticist. In addition to identifying chromosome alterations, the specific genes affected can be identified in some cases. These findings are very helpful in diagnosing specific types of leukemia and lymphoma, in determining treatment approaches, and in following the response to treatment.

The WBC's seen here are lymphocytes, but they are blasts--very immature cells with larger nuclei that contain nucleoli. Such lymphocytes are indicative of acute lymphocytic leukemia (ALL). ALL is more common in children than adults. Many cases of ALL in children respond well to treatment, and many are curable

Acute Myelogenous Leukemia (AML)

2008-11-17T18:55:00.003+08:00

About 11,920 new cases of acute myelogenous leukemia are diagnosed each year in the United States. Acute myelogenous leukemia (AML) may be called by several names, including: acute myelocytic leukemia, acute myeloblastic leukemia, acute granulocytic leukemia or acute nonlymphocytic leukemia.

AML results from acquired (not inherited) genetic damage to the DNA of developing cells in the bone marrow. The effects are: 1) the uncontrolled, exaggerated growth and accumulation of cells called "leukemic blasts" which fail to function as normal blood cells and 2) the blockade of the production of normal marrow cells, leading to a deficiency of red cells (anemia), and platelets (thrombocytopenia) and normal white cells (especially neutrophils, i.e., neutropenia) in the blood. In most cases the cause of AML is not evident. Several factors have been associated with an increased risk of disease. These include:

• Exposure to high doses of irradiation, as carefully studied in the Japanese survivors of atomic bomb detonations
• Exposure to the chemical benzene, usually in the work place
• Exposure to chemotherapy used to treat cancers such as breast cancer, cancer of the ovary or the lymphomas. Alkylating agents and topoisosomerase inhibitors are most frequently associated with higher risk
• Therapeutic radiation, depending on the dose and setting

AML is not contagious and is not inherited. Uncommon genetic disorders such as Fanconi anemia, Schwachman-Diamond syndrome, Down syndrome and others are associated with an increased risk of AML. Older people are more likely to develop the disease. Very rarely, AML may occur in unexpectedly high frequencies in certain families. It is thought that these families transmit a susceptibility gene(s) to offspring through the germ-line. AML incidence increases dramatically among people who are over the age of 40. It is most prevalent in the sixth, seventh, eighth and ninth decades of life.

Leukemia is a malignant disease (cancer) of the bone marrow and blood. AML can occur in a variety of ways; different types of cells may be seen by the physician in blood or marrow. Since most patients have one of seven different patterns of blood cell involvement, these patterns have formed a sub classification which is shown in the table. If there are cells that are developing features of monocytes (monocytic type) or red cells (erythroleukemic), these designations are used and so forth. Even though the leukemia cells look somewhat like blood cells, the process of their formation is incomplete. Normal, healthy blood cells are insufficient in quantity.

The sub classification of the disease is important. Different types of therapy may be used and the likely course of the disease and prognosis may be different. Additional features may be important in guiding the choice of therapy, including: abnormalities of chromosomes, the cell immunophenotype, the age and the general health of the patient, and others. Most patients feel a loss of well-being. They tire more easily and may feel short of breath when physically active. They may have a pale complexion from anemia. Several signs of bleeding caused by a very low platelet count may be noticed. They include black-and-blue marks or bruises occurring for no reason or because of a minor injury, the appearance of pin-head sized spots under the skin, called petechiae, or prolonged bleeding from minor cuts. Mild fever, swollen gums, frequent minor infections like pustules or perianal sores, slow healing of cuts or discomfort in bones or joints may occur.

• Medical history and physical examination
• Complete blood counts
• Bone marrow examination
• Cytogenetic studies
• Immunophenotyping

To diagnose the disease the blood and marrow cells must be examined. In addition to low red cell and platelet counts, examination of the stained (dyed) blood cells with a light microscope will usually show the presence of leukemic blast cells. This is confirmed by examination of the marrow, which invariably shows leukemic blast cells. The blood and/or marrow cells are also used for studies of the number and shape of chromosomes (cytogenetic examination), immunophenotyping and other special studies, if required.

Blood and bone marrow aspirate are used for specific laboratory tests to diagnose and classify the disease. The following tests are used in the diagnosis of the disease. Examination of leukemic cells by cytogenetic techniques permits identification of chromosomes or gene abnormalities in the cells. The immunophenotype and chromosome abnormalities in the leukemic cells are very important guides in determining the approach to treatment and the intensity of the drug combinations to be used. This is a laboratory test that enables the physician to determine the type of disease that is present in the patient. It uses the antigens (proteins) on the cell surface and the antibodies produced by the body that match the antigen.

The method uses the reaction of antibodies with cell antigens to determine a specific type of cell in a sample of blood cells, marrow cells, or lymph node cells. The antibodies react with specific antigens on the cell. A tag is attached to an antibody so that it can be detected. The tag can be identified by the laboratory equipment used for the test. As cells carrying their array of antigens are tagged with specific antibodies they can be identified; for example, myelogenous leukemic cells can be distinguished from lymphocytic leukemic cells. Normal lymphocytes may be distinguished from leukemic lymphocytes. This method also helps to subclassify cell types, which may, in turn, help to decide on the best treatment to apply in that type of leukemia or lymphoma. The antigen on a cell is referred to as cluster of differentiation or "CD" with an associated number. For example, CD7 and 19 may be present on leukemic lymphoblasts and CD13 and 33 on leukemic myeloblasts.

Cytogenetic examination of tissue is the process of analyzing the number and shape of the chromosomes of cells. The individual, who prepares, examines and interprets the number and shape of chromosomes in cells is called a cytogeneticist. In addition to identifying chromosome alterations, the specific genes affected can be identified in some cases. These findings are very helpful in diagnosing specific types of leukemia, in determining treatment approaches and in following the response to treatment.

Chronic Myelogenous Leukemia (CML)

2008-11-16T19:42:00.005+08:00

About 4,600 new cases of chronic myelogenous leukemia (CML) are diagnosed each year in the United States. Chronic myelogenous leukemia may be called by several names, including chronic granulocytic, chronic myelocytic or chronic myeloid leukemia.CML results from an acquired (not inherited) injury to the DNA of a stem cell in the marrow. This injury is not present at birth. Scientists do not yet understand what produces this change in the DNA in patients with CML. This change in the stem cell's DNA confers a growth and survival advantage on the malignant stem cell. The result of this injury is the uncontrolled growth of white cells leading, if unchecked, to a massive increase in their concentration in the blood. Unlike acute myelogenous leukemia (AML), chronic myelogenous leukemia permits the development of mature white blood cells that generally can function normally. This important distinction from acute leukemia accounts for the less severe early course of the disease. Most cases of chronic myelogenous leukemia occur in adults. Only 2.6 percent of leukemias in children ages 0-19 are CML. The frequency of the disease increases with age from about one in 1 million children in the first 10 years of life to nearly two in 100,000 people at age 50, to one in 10,000 people at age 80 and above . The disease in children is similar in behavior to that of adults; however, the outcome of stem cell transplantation is better in younger individuals.

Chronic myelogenous leukemia is distinguished from other leukemias by the presence of a genetic abnormality in blood cells, called the Philadelphia chromosome. The changes that result in this chromosome "causing" chronic myelogenous leukemia have been studied intensively. In 1960, two physicians studying chromosomes in cancer cells noticed that a chromosome in CML patients was shorter in length than that of the same chromosome in normal cells. They named this shortened chromosome the Philadelphia chromosome, because the observation was made at the University Of Pennsylvania School Of Medicine in that city. The total of 46 chromosomes in normal human cells is composed of 22 pairs of chromosomes numbered 1 to 22 and two sex chromosomes (either an X and Y in males or two X's in females). The Philadelphia chromosome (No. 22), which is an abnormally short chromosome, is usually referred to as the Ph-chromosome. Further studies established that two chromosomes, usually chromosome Nos. 9 and 22, were abnormal. Pieces of the chromosomes, which are broken off in the blood cells of patients with chronic myelogenous leukemia, switch with each other. The detached portion of chromosome 9 sticks to the broken end of chromosome 22, and the detached portion of chromosome 22 sticks to the broken end of chromosome 9. This abnormal exchange of parts of chromosomes is called a translocation. This translocation of chromosome pieces occurs only in the stem cell and in the various blood cells derived from that stem cell. The chromosomes of the cells in other tissues are normal.

The breakage on chromosome 9 disrupts a gene referred to as "ABL" (for Abelson). The breakage on chromosome 22 involves a gene referred to as "BCR" (for breakpoint cluster region). The human ABL gene is mutated by the breakage of chromosome 9. The mutated gene is translocated to chromosome 22 and fuses with the remaining part of the BCR gene. This fusion between BCR and ABL leads to an abnormal fused gene, called BCR-ABL. Despite these changes, the BCR-ABL gene can function. The function of a gene is to direct the production of a protein in the cell. In chronic myelogenous leukemia, the protein produced by the BCR-ABL gene is abnormal. The protein produced is an enzyme called tyrosine kinase. The ABL when fused to BCR results in an elongated protein when compared to the protein made by the normal ABL gene. This elongated protein (enzyme) functions abnormally and leads to dysfunctional regulation of cell growth and survival. Evidence points to the abnormal protein as the cause of the leukemic conversion of the hematopoietic stem cell. The mutated gene results in an abnormal or mutated protein, which is responsible for the development of the disease.

The cause of the chromosomal breakage in virtually all CML patients is not known. In a small proportion of patients, the cause of the breakage is exposure to very high doses of radiation. This effect has been most carefully studied in the Japanese survivors of the atomic bomb, whose leukemia risk was significantly increased. A slight increase in risk also occurs in some individuals treated with high dose radiotherapy for other cancers, such as lymphoma. Exposures to diagnostic dental or medical x-rays have not been associated with a heightened risk of chronic myelogenous leukemia.

The onset of chronic myelogenous leukemia is associated with symptoms that usually develop gradually. Most patients feel a loss of well-being. They tire more easily and may feel short of breath when physically active. They may have a pale complexion from anemia. Discomfort on the left side of the abdomen from an enlarged spleen is a frequent complaint. Patients may experience excessive sweating, weight loss and inability to tolerate warm temperatures. Increasingly, the disease is discovered during the course of a "routine" medical examination. Since the disease worsens over weeks or months, most patients would have symptoms develop soon after such a medical examination in any case.

• Medical history and physical examination
• Complete blood counts
• Bone marrow examination
• Cytogenetic Analysis
• Polymerase Chain Reaction (PCR)

To diagnose the disease, the blood and, in most cases, the marrow cells must be examined. The white cell count invariably increases, often to very high levels. Examination of the stained (dyed) blood cells with a light microscope shows a characteristic pattern of white cells: a small proportion of very immature cells (leukemic blast cells), and a larger proportion of maturing and fully-matured white cells (myelocytes and neutrophils). In addition, a sample of marrow is examined to confirm the blood findings and to determine if there is an abnormality of chromosomes. This test, which measures the number and normalcy of chromosomes, is referred to as a cytogenetic analysis. The presence of the Philadelphia chromosome in the marrow cells, a shortened chromosome number 22, high white blood cell counts, and other characteristic blood and marrow findings, confirm that the disorder is chronic myelogenous leukemia. Cytogenetic examination of tissue is the process of analyzing the number and shape of the chromosomes of cells. The individual, who prepares, examines and interprets the number and shape of chromosomes in cells is called a cytogeneticist. In addition to identifying chromosome alterations, the specific genes affected can be identified in some cases. These findings are essential in verifying that the disease is BCR-ABL positive CML.

The chromosome abnormalities that characterize chronic myelogenous leukemia can be detected by other techniques as well. Fluorescence in situ hybridization (FISH) is another method to identify cells in which the nucleus that contains chromosomes with the 9:22 translocation characteristic of CML. FISH is also useful to follow the effects of treatment since it can reveal whether there has been a significant decrease of CML cells in the blood.A very sensitive test of blood cells, the polymerase chain reaction or PCR, can increase very small amounts of either RNA or DNA and make them easier to detect. The alteration in DNA caused by the chromosome breakage in CML can be detected by this very sensitive method. PCR is more sensitive than FISH and can detect one BCR-ABL-positive cell in a background of about 500,000 normal cells.

Here is another view of a peripheral blood smear in a patient with CML. Often, the numbers of basophils and eosinophils, as well as bands and more immature myeloid cells (metamyelocytes and myelocytes) are increased. Unlike AML, there are not many blasts with CML

The Role of Genetic Testing in Medical Practice in The 21st Century

2008-10-31T23:31:00.005+08:00

The practice of medicine has been revolutionized by the progress made in genetics. Genetic testing has become the gold standard in the diagnosis of many disorders. The decoding of entire human genome by Human Genome Project have improved our understanding and discovery of the genetic basis of many disorders. There are more than 6000 different single gene disorders identified to date. Many more disorders are being identified and characterized everyday with the discovery of the genes involved. The prevention of many genetic disorders is now made possible by preconceptional carrier testing, prenatal diagnosis or preimplantation diagnosis with the availability of various new molecular testing.

However, there is still a gap between the discovery of the genes, the diagnostic testing and the actual prevention of many of these conditions. Majority of the genetic disorders has a variety of mutation mechanisms, which make molecular testing difficult even for the proband. Unless the mutation is characterized in the proband, accurate and rapid prenatal diagnosis may not be possible. Furthermore, variable expressivity and severity of some genetic diseases create dilemma and obviate the benefits of prenatal diagnostic testing, for example the disorders coded by mitochondrial DNA. In addition, many of the conditions are too rare and not cost effective to be carried out by routine molecular diagnostic laboratory. A list of genetic testing available including the laboratories performing the test is available at www.genetests.org. Ethical issues surrounding genetic testing, the availability of treatment and severity of the disease, social and culture peculiarities will continue despite the growing availability of molecular diagnostic testing for many genetic disorders.

Hopefully, the advances in genetic testing will enable the early detection, prevention and effective therapy based on the molecular understanding of many common chronic diseases with complex inheritance such as hypertension, asthma, diabetes, stroke and ischemic heart diseases. Genetic characterization of individuals will also enable pharmaceutical companies to design the best drugs tailored to the genetic make-up of individuals hence achieving the best response with least side effects. The possibility of having one's genome stored in chips for various purposes can also be achieved in future.

Oral Glucose Tolerance Test (OGTT)

2008-10-22T00:12:00.001+08:00

Oral glucose tolerance test (OGTT) measures the body ability to use glucose and indirectly reveals about production, activity and function insulin in body. Oral glucose tolerance test is fairly dependable with ambulatory patients that do not suffer from any other severe chronic conditions. The test-OGTT- is better be proceeded by at least 3 days of adequate carbohydrate diet in order to obtain proper result, and should be performed in morning after the subject has fasted for about 8-14 hours.

Result as shown in table above was fairly remote or far-away rather than being within normal blood glucose ranges. It only came once in normal blood glucose range when it showed 7.5 entering with acceptable readings. Although our subject had fasted all these hours for about 14 hours his readings was out of the normal ranges. This indicates diabetic risk or threat. Impaired glucose tolerance is category of oral glucose tolerance test curve which is significantly abnormal values but not sufficient or enough to make diagnose as diabetes.

This involves fasting blood glucose level less than 140mg/100ml (7.77 mmol/L) and a single point on the OGTT curve at or above 200mg/100 ml (11.1 mmol/L). Impaired glucose tolerance can not be diagnosed diabetes as once; it shows a condition between normality and diabetic and diabetic risk or possibility. However in our case it can’t be said impaired glucose tolerance because Fasting blood glucose is higher than 140 mg/100 ml (7.77 mmol/L) and OGTT curve is above 200mg/100ml (11.1 mmol/L) in more than one single point. Therefore the subject should undergo through further diabetic tests to figure out if there is any problem.

Oral glucose tolerance test (OGTT) is not the best way to establish a diagnosis of diabetes mellitus. In fact it has relatively few indications that can also be considered as other types of diagnosis established from OGTT. These indications include 1) borderline fasting or postprandial blood glucose, 2) persistent glycosuria, 3) glycosuria in pregnant women. Oral glucose tolerance test is of little use or value in hospitalized patients or with patient immediately after a severe disease. There are several factors that can affect and alter OGTT readings, they are: bilirubin values more than 20mg/dl, triglycerides in vitro lipemic samples >5000mg/dl, hematocrit values <20%>65% at blood glucose concentrations <200mg/dl,>10mg/dl and glucose value <70mg/dl>8mg/dl, galactose >10mg/dl and maltose >16mg/dl may give falsely elevated results, situation of decreased peripheral blood flow, finger stick may not be appropriate to reflect the true physiological state.

In hyperglycaemia glucose metabolism is severely distorted, body cells can not take up glucose from blood although they are starving. Then great amount of glucose will be present in blood, kidneys reabsorb some of this huge amount and the rest is excreted through urine. Liver plays an important role in glucose metabolism, in normal feeding state glucose flows through blood from intestine to liver which in turn starts performing his storage of glucose to glycogen. Fasting cycle begins as soon as nutrients flow from intestine diminishes. As blood glucose and insulin level fall back to normal glucagon is released, this promotes glycogenolysis and gluconeogenesis in liver. If this fasting is prolonged for overnight several metabolic strategies maintain blood glucose levels.

Under starvation condition which is extremely prolonged fasting, the body makes metabolic changes to ensure that adequate amounts of blood glucose are available to sustain energy production in the brain and other glucose-requiring cells. Furthermore fatty acid and ketone bodies from liver are mobilized to sustain the other tissue.

Determination of Glucose-6-Phosphate Dehydrogenase in Erythrocytes

2008-10-21T23:32:00.003+08:00

The hexose monophosphate shunt is essential in erythrocyte metabolism, liver, adipose tissue and kidney metabolism. The regulation of pentose phosphate is a dehydrogenation step of glucose-6-posphate by G6PD. A decrease in G6PD enzyme in erythrocyte will cause a reduction in NADPH production and haemolysis occurs. G6PD deficiency is an inherited x-linked recessive disease. Its determination is very important since the deficiency of it can cause haemolytic anaemia and neonatal jaundice.

G6PDH is an enzyme of the pentose phosphate pathway that catalyzes the reaction below:

Glucose-6-Phosphate + NADP+ <=> 6-Phosphogluconolactone + NADPH

Individuals whose G6PDH is partly inactive are prone to oxidative stress. This arises because NADPH produced by the pentose phosphate pathway is required for reduction of glutathione, which, in turn, helps reduce peroxides. In the absence of sufficient NADPH, glutathione remains oxidized and peroxides cannot be neutralized.

In this of experiment we have carried out determination of glucose-6-phosphate dehydrogenase in erythrocyte which is a significant enzyme in pentose phosphate pathway. When G6PD is present in erythrocytes at normal level, it can act on glucose-6-phosphate and catalyses NADP+ to NADPH which in turn will emit UV light, absence of UV light indicates a decrease in the enzyme level. A decreased level of G6PD enzyme in erythrocytes will cause reduction of NADPH production and consequently hemolysis will occur (hemolytic anemia).

A mutation present in some populations causes a deficiency in glucose-6-phosphate dehydrogenase with consequent impairment in the generation of NADPH. This impairment is manifested as red cell hemolysis when the susceptible individual is subject to oxidants such as the antimalarial primaquine, aspirin, or sulfonamides or when the susceptible individual eats fava beans (Vicia fava).

The Pentose phosphate pathway supplies RBC with NADPH to maintain the reduced state of glutathione. The inability to maintain reduced glutathione in RBC’s leads to increased accumulation of peroxides, predominantly H202 that in turn results in a weakening of the cell wall and concomitant hemolysis.Therefore, any defect in the production of NADHP could, therefore, have profound effects on erythrocyte survival.

Hemolytic anemia is the red blood cell (RBC) plasma membranes rupture prematurely. The released haemoglobin pours into the plasma and may damage the filtering unit (glomeruli) in the kidneys. The condition may result from inherited defects such as abnormal red blood cell enzymes, or from outside agents such as parasites, toxins, or antibodies from incompatible transfused blood.

The symptom of hemolytic anemia is the reduced number of RBC’s or a decreased amount of haemoglobin in the blood. The person feels fatigued and is tolerant of cold, both of which are related to lack of oxygen needed for ATP and heat production. Also, the skin appears pale due to the low content of red-colored haemoglobin circulating in skin blood vessel. That is why G6PD determination or verification is very significant especially for new born babies as a screening test.

Total Cholesterol in The Blood

2008-10-20T22:14:00.004+08:00

Cholesterol, a complex alcohol constituent of all animal fats and oils. It can be activated to form vitamin D. Cholesterol is one of a group of compounds known as sterols and is related to such other sterols as the sex hormones and the hormones of the adrenal cortex.

A close relationship exists among levels of blood cholesterol in the body, those of other fats or lipids, and the development of atherosclerosis(the disease in which cholesterol, accumulating in the wall of arteries, forms bulky plaques that inhibit the flow of blood until a clot eventually forms, obstructing an artery and causing a heart attack or a stroke. In this disorder, plaques containing cholesterol are deposited on the walls of arteries, particularly those of small and medium size, reducing their inside diameter and the flow of blood. Clotting of blood, such as may occur in the coronary arteries to cause a heart attack, is most likely to develop at places where arterial walls are roughened by such plaques.

Although many foods, particularly dairy products and meat fat, contain cholesterol, the body also synthesizes this sterol from cholesterol-free substances. Nevertheless, investigation indicates that a cholesterol-rich diet causes abnormally high levels of cholesterol and the related fats and lipids in the blood. Evidence strongly indicates that people with such high levels are more likely to develop atherosclerosis and heart attacks than those with lower levels. Also significant is the fact that scientists have identified two forms of cholesterol-carrying proteins in the blood, called high-density and low-density lipoproteins. The low-density form is thought to promote atherosclerosis, whereas the high-density component may retard it.

Persons who have abnormally high levels of cholesterol—especially low-density cholesterol—on a congenital basis can reduce their risk of heart attack by lowering their blood cholesterol. This is done by following a diet low in cholesterol and saturated fats, getting sufficient exercise, and using certain drugs. Cholesterol and its derivatives are secreted through the oil glands of the skin to act as a lubricant and protective covering for the hair and skin. Lanolin, grease extracted from raw sheep wool and composed largely of cholesterol esters, has a variety of commercial uses in lubricants, leather preservatives, ointments, and cosmetics.

In addition, total serum cholesterol comprises all of the cholesterol found in the various lipoproteins. Cholesterol is the major component of LDLs and a minority component of VLDLs and HDLs. Since LDL has consistently been associated with risk of atherosclerosis and since LDL is difficult to measure, serum total cholesterol has been used for many years as a substitute. There is general agreement that a strong correlation exists between considerably elevated serum cholesterol levels and an increased tendency for atherosclerosis.

However, cholesterol is synthesized in the body by the liver, because 500-1000 produced by the liver and 600-1000gm/dl secreted by the body glands in the intestine. There are also specialized proteins, called LDL receptors, that project from the surface of animal cells. The receptors bind LDL particles and extract them from the fluid that bathes the cells. The LDL is taken into the cells and broken down, yielding its cholesterol to serve each cell's needs. In supplying cells with cholesterol the receptors perform a second physiological function, which is critical to the development of atherosclerosis: they remove LDL from the bloodstream.The number of receptors displayed on the surface of cells varies with the cells' demand for cholesterol. When the need is low, excess cholesterol accumulates; cells make fewer receptors and take up LDL at a reduced rate. This protects cells against excess cholesterol, but at a high price: the reduction in the number of receptors decreases the rate at which LDL is removed from the circulation, the blood level of LDL rises and atherosclerosis is accelerated. Cholesterol can only be excreted from the body by way of the liver via these receptors.

On the other hand, cholesterol can cause the heart diseases. These heart diseases can be accelerated by the accumulation of the cholesterol in the blood stream because of the decreased number of the LDL receptors. Thus, the level of cholesterol will be high in the blood stream. After that, the plaque is formed (deposits called plaque that form on the insides of arteries and partially restrict the flow of blood). Plaque deposits are associated with high concentrations of cholesterol in the blood. Blood flow is often further reduced by the formation of blood clots, which are most likely to form where the artery walls have been roughened by plaque. These blood clots can also break free and travel through the circulatory system until they become lodged somewhere else and reduce blood flow there. Reduction in blood flow can cause organ damage. When brain arteries become blocked and brain function is impaired, the result is a stroke. A heart attack occurs when a coronary artery becomes blocked and heart muscle is destroyed.The total cholesterol to HDL cholesterol ratio is a number that is helpful in predicting atherosclerosis, because HDL acts as a protective from high cholesterol in taking cholesterol from extra hepatic tissues to the liver for excretion. The number is obtained by dividing total cholesterol by HDL cholesterol. (High ratios indicate higher risks of heart attacks, low ratios indicate lower risk).

High total cholesterol and low HDL cholesterol increases the ratio, and is undesirable. Conversely, high HDL cholesterol and low total cholesterol lowers the ratio, and is desirable. An average ratio would be about 4.5 ideally. Thus the best ratio would be 2 or 3 or less than 4. Another ratio is LDL/HDL. The LDL/HDL ratio is actually a more pure ratio than total cholesterol/HDL. Because LDL is a measure of bad cholesterol and HDL is a measure of good cholesterol, whereas the total cholesterol is the sum of HDL, LDL, and the VLDL. Even though total cholesterol/HDL ratio is not as accurate or pure as the LDL/HDL ratio, the former is more commonly obtained because the total cholesterol is easier and cheaper to obtain than the LDL cholesterol level.

Furthermore, hypercholesterolemia is caused by the increase of level of the cholesterol in the blood stream. It has two types, one is homozygous in which it affects 1:1,000,000 of the population, while the other one that is heterozygous in which it affects 1:500 of the population. The first type affects those people who have 20 years old and it is due to the absence of LDL receptors. The blood cholesterol level in this case is around 800-1000mg/dl and 20-26mmol/L. However, the second type of hypercholesterolemia affects people who have (20-50) years old. The blood cholesterol levels approximately are 300-600mg/dl and 8.5-15mmol/L.

Quantitative Urinalysis

2008-10-20T21:58:00.000+08:00

Urine was inoculated on both blood agar plate and MacConkey/Eosin-Methylene agar plate. First time urine was inoculated directly on blood agar plate and then on MAC/EMB agar plate after contaminating the urine with broth culture of Serratia marcescens. As a result we have observed that very little colony growth on blood agar plate, whereas on MAC/EMB agar plate more colonies have grown indication mild infection but luckily it didn’t reach acute infection.

1) Colonies growth on blood agar plate. (Very few colonies)

2) Colonies growth on MAC/EMB agar plate.( much more compare to above)

Epidemiology

2008-10-20T21:50:00.001+08:00

Epidemiology is the study of how specific infectious agent survives and spreads through a group of susceptible individuals. Commonly, the two ways are through respiratory and digestive system. Handwashing is the single most important method of controlling microbes in clinical setting. Through this, few microbes of no microbes transfer from person to person. It is known as direct contact. Proper Handwashing also control Fomite transmission.

Fomite is source of microbial infection in clinical area. A Fomite is an inanimate object such as fork or plate which is contaminated with infectious agent. During improper handle, it contaminates the person and transmits to another person through the infected person.

Respiratory secretion also a major source of infection material. Microbes present on fingers by direct or indirect contact may also be introduced into eye, nose, and mouth by accidentals touch. This is yet another reason for following strict aseptic technique procedures while handling infectious material.

Most of personal care product such as lipstick has bacteriostatic agents added which impede the growth of contaminating microbes. Therefore, there is no colony observed in lipstick plate. Using of disinfectant is effective against the growth of microbes.

Serological Testing

2008-10-20T21:47:00.000+08:00

Serological testing simply permits antibodies and known antigens that are added to it to interact and for that interaction to be visualized in some way. This demonstrates the presence of the antibody, which would only be there because the individual was exposed to the antigen. Antibodies directed against a certain etiologic agent almost always react with, and only with, that one agent. Thus, antibody-antigen reactions are described as having high degree specificity.

It is easy to reverse the procedure by taking known antibodies to react with and identify unknown microbes. Because of the specificity of antibody-antigen reaction; such procedure can identify the unknown organism. This provides rapid diagnostic information to the physician, who can then initiate appropriate antibiotic therapy. One procedure tests serum for the presence of antibody against a known disease. The other two to identify unknown microbes by seeing if it will interact with a known antibody. These tests are selected to enable the student to understand very basic aspect of serology.

In the latex agglutination technique, the group-specific antigen is enzymatically extracted from the cell walls of isolated colonies or pure cultures of streptococci. Antigen in the enzyme extract is identified using latex particles conjugated to group-specific antisera. Visible clumping, that is agglutination, will form in the specific latex particle suspension that reacts with the specific extracted antigen. Conversely, the latex remains in suspension if the antigen is not present in the enzyme extract. Clinically, this serological test will be used on bacteria, which have been identified as Gram positive, betahemolytic, and catalase negative cocci, and are presumed to be streptococci.

Febrile antigens generally refer to microbes, which cause fever in the host. Brucella species are examples of microbes that possess such a febrile antigen. Febrile antigens have been demonstrated by agglutination test. The visible agglutination seen is due to specific antibodies interacting with several different epitopes of the antigen. Blood typing also makes use of an agglutination technique. The presence of a significant concentration of antibodies to this antigen indicates at least exposure to these microbes.

Agglutination reaction is a reaction of antibodies with antigens that results in agglutination, the clumping together of cells or other large particles.

Chronic Lymphocytic Leukemia (CLL)

2008-10-19T20:11:00.005+08:00

Each year, nearly 9,730 people in the United States learn that they have chronic lymphocytic leukemia. The disease may be referred to as chronic lymphoid leukemia or as CLL. CLL results from an acquired injury to the DNA of a single cell, a lymphocyte, in the bone marrow. This injury is not present at birth. Scientists do not yet understand what produces this change in the DNA of CLL patients. The change in the cell's DNA gives the CLL cell a growth and survival advantage. The result is the uncontrolled growth of CLL cells in the marrow, leading to an increased concentration in the blood. The CLL cells that accumulate in the marrow do not impede normal blood cell production to the extent that is the case with acute lymphocytic leukemia. This important distinction from acute leukemia accounts for the less severe early course of the disease.

Chronic lymphocytic leukemia is not associated with high-dose radiation or benzene exposures, as is the case with the other three major types of leukemia. CLL is very uncommon in individuals under 45 years of age. At the time of diagnosis, about 95 percent of patients are over age 50 and the incidence of the disease increases dramatically. The risk of chronic lymphocytic leukemia becomes measurable after age 35 and increases dramatically over succeeding decades. Early in the disease, chronic lymphocytic leukemia may have little effect on a person's well-being. The symptoms of CLL usually develop gradually:

• Patients tire more easily.
• They may feel short of breath when physically active.
• They may lose weight.
• They may experience frequent infections of the skin, lungs, kidneys or other sites.

Many CLL patients say they learned they had CLL after a routine check-up. When an enlarged lymph node or an enlarged spleen is found during a physical examination, or when a routine blood test shows a higher than normal number of lymphocytes, a physican will order lab tests to get more information. Diagnosis begins with a medical history and physical examination by the physician. To complete the diagnosis, the blood and, in most cases, the marrow cells must be examined. Physicians use a number of lab tests to look at cells in blood and marrow. A test called flow cytometry is used to find out if a patient has CLL. This test is also called immunophenotyping. Flow cytometry shows if CLL is causing the high number of lymphocytes in the blood. Flow cytometry can also show if the CLL began with a B lymphocyte or a T lymphocyte. B lypmphocyte (or B-cell CLL) is most common.

Depending on the place in lymphocytic cell development in which the malignant transformation occurs, the leukemic cells may be principally B cells, T cells, or NK cells. Most patients have a B cell type of leukemia. A minority have T or NK cell types. These distinctions may be accounted for by the malignant transformation occurring after the common lymphocyte has differentiated into one of the three types of lymphocytes. The malignant event (mutation of DNA) would, therefore, occur at the point, or after, the early specialized lymphocytes were formed.

Other lab tests are done if flow cytometry shows the patient has CLL. A cytogenetic analysis looks to see if there are changes in the chromosomes of the CLL cells. (Every cell in the body has chromosomes that carry genes. Genes contain the instructions that tell each cell what to do.)FISH (fluorescence in situ hybridization) is another test that is used to check for chromosome changes. After CLL treatment begins it can be used to see if treatment is working. This is done by measuring the number of cells with abnormal chromosomes that remain after treatment.

A bone marrow biopsy is used to look at the amount and pattern of CLL cells in the marrow. In patients with more advanced CLL a bone marrow biopsy is usually done as a baseline. The results from the baseline are compared to a repeat bone marrow biopsy after treatment. This is one way to tell how the patient is doing after treatment. This test is not always done for low-risk CLL patients. Doctors also may check the blood for immunoglobulins (gamma globulins.) Immunoglobulins are proteins that help the body fight infection. CLL patients may not have enough of these proteins. With more advanced CLL, low levels of immunoglobulins may be a cause of repeated infections.

These mature lymphocytes are increased markedly in number. They are indicative of chronic lymphocytic leukemia, a disease most often seen in older adults. This disease responds poorly to treatment, but it is indolent.

Specific Gravity (sp gr) and pH parameters in Urinalysis

2008-10-19T19:43:00.004+08:00

Specific gravity (directly proportional to urine osmolality which measures solute concentration) measures urine density or the ability of the kidney to concentrate or dilute the urine over that of plasma. Dipsticks are available that also measure specific gravity in approximations. Most laboratories measure specific gravity with a refractometer.

Specific gravity between (1.002 - 1.035) on a random sample should be considered normal if kidney function is normal. Since the sp gr of the glomerular filtrate in Bowman's space ranges from (1.007 - 1.010), any measurement below this range indicates hydration and any measurement above it indicates relative dehydration.

If sp gr is not > 1.022 after a 12 hour period without food or water, renal concentrating ability is impaired and the patient either has generaliz ed renal impairment or nephrogenic diabetes insipidus. In end-stage renal disease, sp gr tends to become 1.007 to 1.010. Any urine having a specific gravity over 1.035 is either contaminated contains very high levels of glucose, or the patient may have recently received high density radiopaque dyes intravenously for radiographic studies or low molecular weight dextran solutions. Subtract 0.004 for every 1% glucose to determine non-glucose solute concentration.

The glomerular filtrate of blood plasma is usually acidified by renal tubules and collecting ducts from a pH of (7.4 - 6) in the final urine. However, depending on the acid-base status, urinary pH may range from as low as 4.5 to as high as 8.0. Th e change to the acid side of 7.4 is accomplished in the distal convoluted tubule and the collecting duct.

Urinalysis Reagent Strips

Microscopic Examination of Urine

2008-10-16T14:06:00.008+08:00

Urine sample under the microscope ( Morning Sample)

Cotton Fiber

Calcium Oxalate

Granular Casts

Urine sample under the microscope (Afternoon Sample)

Triple Phosphate

Granular Casts

Introduction to Urinalysis

2008-10-16T13:46:00.002+08:00

Urinalysis is a test that analyzes urine. It is comprised of three examinations which are chemical testing for abnormal chemical constituents, microscopic exam for abnormal insoluble constituents and physical or volume analysis for urine.

It can reveal diseases that have gone unnoticed because they do not produce striking signs or symptoms. Examples include diabetes mellitus, various forms of glomerulonephritis, and chronic urinary tract infections.

There are ten parameters tested in urinalysis which are specific gravity (sp gr), pH, leukocyte esterase, nitrite, protein, glucose, ketones, urobilinogen, bilirubin and red blood cell

Normocytic Anemia

2008-10-15T16:52:00.002+08:00

Normocytic, normochromic anemia is the largest, most frequently encountered anemia. If acute blood loss can be ruled out, the diagnosis remains to be intrinsic or extrinsic. Hereditary spherocytosis, drug induced anemia, and anemia secondary to other malignancies are a few of the anemias of this classification.

Normocytic anemia may include hemolytic anemia. The peripheral blood smear and the history often suggest possible causes for the anemia.

Normocytic Normochromic - Hemolytic Anemia

Sickle Cell Anemia

Microcytic Anemia

2008-10-15T16:22:00.001+08:00

Microcytic anemia is based on the protocol for patients who have an automated MCV of less than 75 fl. The three most common causes of microcytic anemias are iron deficiency, thalassemia minor, and anemia of chronic disease. Cases of thalassemia have elevated red counts and lower RDW's than would be expected for the MCV and the degree of anemia. Iron deficiencies are almost always associated with a high RDW. Some anemias of chronic disease may be normocytic and others such as renal disease are microcytic. Anemias of chronic disease do not have decreased iron stores.

Microcytic Anemia - Hypochromic, Target Cells, Microcyte

Macrocytic Anemia

2008-10-15T16:16:00.004+08:00

Macrocytic anemias are less commonly encountered than normocytic or microcytic anemias. These anemias may be caused by marrow failure such as aplastic anemia and myelodysplasis, or caused by deficiencies of vitamin B12 or folic acid; or caused by autoimmune hemolysis or cold agglutinins. A mild degree of macrocytosis with a normal RDW is commonly seen as a result of alcohol abuse. The MCV is greater than 100 fl. in macrocytic anemia.

Peripheral Blood

Bone Marrow

The macrocytic anemias may be further subdivided based upon the degree to which the MCV is raised and the presence of megaloblastic production in the bone marrow.

Slight increase in MCV:

MCV > 100

due to the presence of retics
in some instances of aplastic anemia
myxedema

In all cases the red cell precursors in the marrow are normal in morphology.

Moderate increase in the MCV:

MCV > 105

liver disease

Marked increase in the MCV:

MCV > 110 fl.

megaloblastic due to the lack of vitamin B-12 or folic acid.

Blood Collection from Orbital Sinus in Mice

2008-10-15T01:11:00.000+08:00

Should apply anesthetic before blood withdraw
A convenience and easy apply method for blood collection in mouse
Collect amount up to 0.5 ml

Tools for Blood Collection from Orbital Sinus in Mice

75% alcohol cotton ball for surface disinfection
Hypnorm for general anesthetic
27 G needle with 1 ml syringe for injection
Glass capillary tube and vial for blood collection

Anesthetize a mouse by intraperitoneal injection of Hypnorm

Use a sharp end glass capillary tube to penetrate the orbital conjunctiva and rupture the orbital sinus

Collect blood with a vial

"Lab On A Chip In A Kit"

2008-10-15T01:05:00.001+08:00

Soon, they say, a "Lab On A Chip In A Kit" will be available for home use so that we can test ourselves for certain illnesses. Also, we'll be able to check a chicken breast for salmonella and test the air for toxins. It's doable, but will it be available to help the boomer generation?

Lab On Chip (LOC) is a device that combines several laboratory functions onto one single chip, capable of testing micro and nano particles for diseases, toxins, and just about anything internal or external to us. LOC's are used in several fields, but as medical devices they are the future.

The LOC has to be programmed by specially trained engineers, but once the programming is accomplished, the Lab On A Chip In A Kit can be used by anyone, according to Mark Burns, a professor in the departments of Biomedical Engineering and Chemical Engineering at the University of Michigan. Burns developed the new medical device with graduate student Minsoung Rhee.

Currently the micro-lab device is being adapted for field use by professionals, especially those who work in impoverished countries where access to full scale medical test equipment is minimal to non-existent. Though Burns has figured out the technology for his medical lab on chip, there are several other issues to be resolved to make the Lab On A Chip In A Kit ready for distribution. But not decades!

For boomers and others who might benefit from the lower costs of medical testing, convenience, and immediacy of results that the Lab On A Chip In A Kit would offer, Burns suggests it will be decades before the rest of us will be "analyzing chicken to see if it has salmonella, analyzing yourself to see if you have influenza or analyzing the air to see if it has noxious elements in it."

Why decades to get to us, when the technology is there now to make it happen? And not just the ability to check chickens and flu viruses... LOC technology can already detect cancer cells and other very serious diseases in a matter of seconds. Will we benefit from home use of this technology?

The capability is here.

Introduction to Forensic Entomology

2008-10-13T16:06:00.003+08:00

Forensic Entomology is known as the study of insects and other arthropods for the purpose of uncovering information useful to an investigation. It is a branch of forensic science that involving police, forensic pathologist, entomologist and legal profession.In forensic entomology, insects and other arthropods are used as indicator of post mortem interval (PMI). PMI is the duration (in days) between time of death and the discovery of the body.

What is the relationship between entomology and dead bodies?

Odor of dead tissues will attract flies and flies feed on the tissues as well as the females lay eggs. Insects and other invertebrates form a specialized community of fauna.There is presence of various stages of insects in and around the dead body.

Species of insects arrive and remain at decomposed body in succession, biological clock and duration of instars of relevant species of insects (as part of its life cycle whilst at body) is helpful in determining PMI are the basis for forensic entomology of PMI.

MLT Program at Kuala Lumpur Metropolitan University College (KLMU)

2008-10-11T19:19:00.004+08:00

The Health Sciences Faculty of Kuala Lumpur Metropolitan University College (KLMU) has been steadfastly and physically geared to receive students for its well-structured Diploma of Medical Laboratory Technology (MLT) in its forthcoming intake. The university college has put itself through a substantive learning experience in developing this program - analysing prevailing market trends, adopting a formulaic approach in balancing its teaching staff and investing in a complete range of sophisticated equipment. The program's ultimate aim is clear cut - to equip students with industry-related knowledge, skills and practical experience that will enhance their "marketability" and "self-worth" which would give them a certain competitive edge even with the most demanding employers.

The diploma is comprised of syllabi focused on clinical laboratory and pathology sciences that have been developed according to current market practices, derived from hands-on experiences gained in a broad range of industries. Graduates of the program will thereafter pursue a degree in Biomedical Science, Medical Technology, Biotechnology, Bioinformatics and Forensic Science. KLMU's Health Sciences Faculty has state-of-the-art laboratories, fitted with biohazard cabinets, fume hoods, microscopes, autoclaving equipment, spectrophotometers and autoanalysers which cost about RM1 million to put together.

The diploma covers subjects such as Clinical Biochemistry which focuses on the biochemical components in blood such as glucose, cholesterol and enzymes for the identification of diseases related to the kidney, heart, liver and so on. Another important subject, Hematology is basically a study of blood cells in order to detect anemia, leukemia, thalssemia and the like. Medical Microbiology consists of methodologies to ascertain the types of diseases caused by microorganisms. Besides these, Blood Transfusion Science will train students on how to ensure that blood supply is properly handled and safe for use while Cytology and Histopathology will expose students to the study of cells and tissues.

At the faculty, students are also exposed to the basic medical sciences, biostatistics, English and ICT. Experienced lecturers and medical laboratory technologists are "brought in" from India so that students will have a taste of a more challenging international-based environment which will help them boost their confidence, skills and expertise in operating potentially "complicated" lab equipment. Part of the academic team's responsibility is to also to ensure that students measure up in terms of producing prompt and accurate lab test results, which are necessary to help doctors in the diagnosis and treatment management of patients.

Although local private medical laboratory industry and pharmaceutical companies have grown tremendously over the years, today there are less than 10 public universities and private institutions offering MLT programs. Due to opportunities in this field, it is not surprising that career prospects in the relevant fields are brighter than ever. Some of the more common MLT specialization areas are cytology, microbiology, hematology, and blood transfusion science. As a diploma holder, the graduate would usually start his or her career off as a Medical Lab Technologist. The Pathology Act passed by the parliament in 2007 has made it compulsory for those involved in the field of pathology laboratory to be duly trained and qualified for the job and thus, the need for such a course is even more pronounced than before.

KLMU Health Sciences Faculty is headed by a commendably experienced Dean, Dr. Mohdzir Bin Mohd Yasin whose strong background in medical science and education extends into the areas of anatomy, physiology, biochemistry and biology. Among his past research has been in the areas of vitamin E and the properties of palm oil as an anti-oxidation agent. He has also been the spokesperson at the Asia Pasific Islamic Conference. Also helping to lead the charge at the faculty is Mr. Lim Back Seng, Head of Department for KLMU MLT. Mr. Lim is the Past President of Malaysian Institute of Medical Laboratory Sciences and has been involved in the MLT field as a professional and an educator for 36 years. His teaching philosophy hinged upon the belief of cultivating strong discipline, commitment and developing the character and expertise of his students in order for them to be highly-regarded as competent Medical Lab Technologists.

For MLT student Nurul Hidayah Binti Mohd Raduan, 19, she hopes her ambition to be an expert in criminal forensic, just like the characters in her favorite TV show; Crime Scene Investigation (CSI) would one day be realized after she graduates from KLMU. The university college's permanent campus is being constructed in Wangsa Maju at an estimated cost of RM200 million which will able to house 10,000 students at any time and also provide accommodation for 3,000 students.

Blood Collection from Tail Vein in Mice

2008-10-11T15:58:00.001+08:00

For collection of small amount of blood (Approximate 0.1 ml)

Tools for Blood Collection from Tail

75% alcohol cotton ball for surface disinfection
Small plastic bottle with 1/2 cm diameter holes in both ends as mouse restrainer
Scissors
Pipetteman and tips
A vial for blood collection

Placing a mouse on a cage lid and grasping the loose skin behind the ears by the thumb and forefinger

Push the mouse into the restrainer

Leave the tail of the mouse outside the cover of the restrainer

Amputate the tip of the mouse tail by scissors

Massage the tail and collect blood by pipetteman

The Gene H: It’s Role in Expression of A and B Genes

2008-10-10T11:37:00.007+08:00

The expression of the A and B Genes appears to depend on the action of another gene, known as H. Most individual are homozygous for this gene (HH), though since its allele, h, is an amorphic gene, the heterozygote Hh cannot be recognized. The phenotype h is extremely rare. The genetic sequence leading to the expression of ABH genes on the red cell is believed to be as a precursor mucopolysaccharide substance is converted by the H gene to H substance. This “altered’ precursor substance (H substance) is partly converted by the A and B genes into A and B antigen. Some H substance remains unconverted. The O gene, being amorphic, effects no conversion of H substance. Since no conversion of H substance takes place by the action of the O gene, the H antigen is found in greatest concentration in group O individuals.

The addition of a sugar known as L-fucose to the terminal D-galactose of the basic precursor substance (Type 1 and Type 2 chains) gives the resultant molecule “H” specificity. The Fucose molecule is bound in alpha (1-2) linkage.

The presence of an A gene results in the attachment of the sugar N-acetyl-galactosamine to the substrate formed by the H gene. This gives the resultant molecule “A” specificity.

In much the same way, the presence of the B gene results in the attachment of D-galactose to the substrate formed by the H gene. In the absence of H gene, no L-fucose will be added to the terminal sugar. The A and B genes in this case will not be expressed. An individual of genotype hh will therefore group as “O” even when the A or B genes have been inherited. The order of reactivity usually follows the pattern O> A2 > A2B> B> A1> A1B

Chemical Characteristics of Blood Group Antigens

2008-10-10T10:51:00.002+08:00

A great deal of work has been performed by various experts in attempts to understand the chemical characteristics of the red cell antigens. Apparently the facts remain sketchy. However, it is generally accepted that red cell antigens are glycolipids or proteins. The specificity of the antigens is determined by the sequential addition of sugar residues to a common “precursor substance”. This has proved to be the case in all blood group antigens studied so far. The precursor substance is composed of four sugar molecules in which two are known as D-galactose (GAL), one is N-acetyl-galactosamine (GAL NAc) and the last is N-acetyl-glucosamine (GNAc). Two types of precursor substance have been identified, known as Type 1 and Type 2 chains. These chains differ in the linkage of the terminal galactose molecule to the subterminal N-acetyl-glucosamine. In Type 1 chains the linkage is beta (1-3), whereas in Type 2 chains the linkage is beta (1-4) (Chase snd Morgan, 1991; Painter et al, 1963; Watkins, 1966).

The addition of another sugar to this basic precursor determines the specificity of the antigen with the rest of the polysaccharide chain remaining unchanged. Knowledge of the chemistry of blood group antigens has come mainly from work on the body secretions (semen, tears, saliva and cyst fluids), since blood group substances on the red cells are present in relatively small quantities and some of them are soluble only in alcohol. In secretions, these substances occur in much larger quantities and are soluble in water. It has been established that the same sugars are present on the red cells, though on the red cells they are bound through sphingosine to fatty acid moieties. (compounds of this type are known as glycolipids)

Autoimmune Disease - SLE

2008-10-04T07:40:00.003+08:00

Systemic Lupus Erythematosus (SLE or lupus) is a chronic autoimmune disease that can be fatal, though with recent medical advances, fatalities are becoming increasingly rare. As with other autoimmune diseases, the immune system attacks the body’s cells and tissue, resulting in inflammation and tissue damage. SLE can affect any part of the body, but most often harms the heart, joints, skin, lungs, blood vessels, liver, kidneys and nervous system. The course of the disease is unpredictable, with periods of illness (called flares) alternating with remission. In SLE, the body's immune system produces antibodies against itself, particularly against proteins in the cell nucleus. SLE is triggered by environmental factors which are unknown (but probably include viruses), in people with certain combinations of genes in their immune system. SLE is a chronic inflammatory disease believed to be a type III hypersensitivity response with potential type II involvement.

Hemoglobin Determination Using Cyanmethemoglobin Method

2008-10-04T07:15:00.003+08:00

Principle

In a reagent solution the ferrous ions (Fe2+) of hemoglobin are oxidized to the ferric (Fe3+) state by potassium ferricyanide to form methemoglobin. Methemoglobin subsequently reacts with the cyanide ions provided by potassium cyanide to form cyanmethemoglobin. The amount of cyanmethemoglobin can be measured spectrophotometrically at a wavelength of 540 nm on a spectrophotometer and compared to known hemoglobin standards in order to determine the hemoglobin concentration of the unknown sample. Hemoglobin, the main component of the RBC, transports oxygen to and CO2 from the body’s tissues. Hemoglobin in circulating blood is a mixture of hemoglobin, oxyhemoglobin, carboxyhemoglobin and minor amounts of other forms of this pigment. It is necessary to make a stable derivative involving all forms of hemoglobin in the blood in order to measure this compound accurately. The cyanmethemoglobin (HiCN) derivative can be conveniently and reproducibly prepared and is widely used for hemoglobin determinations. All forms of circulating hemoglobin are readily converted to HiCN except for sulfhemoglobin, which is rarely present in significant amounts. Cyanmethemoglobin can be measured accurately by its absorbance in a colorimeter.

Coulter Instrument Hemoglobin:

After the WBC solution is lysed, the system shines a beam of white light through the WBC aperture bath and then through an optical filter. This transmittance of light (525 nm wavelength) through a standard path length of Hgb solution is compared to the transmittance of such light in the same way through a reagent blank. The system converts this ratio to absorbance. It then converts absorbance to Hgb values in g/dL using a calibration factor.

Abott Cell-Dyne Hemoglobin:

This instrument uses a similar procedure, but is unique in that its reagent is cyanide-free.

Bayer Advia Hemoglobin:

Hemoglobin has dual readings - colorimetric or cyanmethemoglobin and corpuscular hemoglobin concentration mean.

Normal values:
Adult Male 14 - 17 g/dL
Adult Female 12.5 - 15 g/dL
Newborn 17 - 23 g/dL
3-month-old 9 - 14 g/dL
10-year-old 11.4 - 15.4 g/dL

A VERY Simplified Overview of an Immune Response

2008-09-26T10:02:00.001+08:00

You receive a cut.

Bacteria enter the wound.

Many are destroyed rapidly by complement and the phagocytes recruited through acute inflammation (Innate immunity).

Some of the dead bacteria or their breakdown products are taken up by the tissue resident dendritic cells.

The combined action of bacterial products and cytokines (from acute inflammation etc.) activate the tissue dendritic cells.

This causes them to migrate to the local lymph node via afferent lymphatics.

Dendritic cells enter the node in the T cell areas. They become resident there displaying their 'wares'

T cells enter the node from the blood, trafficking through the T cell area to the efferent lymph. Those which recognize the bacterial antigenic peptides displayed on the dendritic cells stop, activate, divide and differentiate; some later become memory T cells.

B cells entering nodes from the blood must cross the T rich area in transit to the B cell rich areas. The antigen-specific ones must acquire antigen too, presumably via the lymph. Then they can have their MHC-peptide complexes recognized by activated T cells and receive help.

Some become IgM secreting plasma cells. Some migrate to the B cell rich areas and form germinal centres. Here B cells proliferate and give rise to progeny with high affinity for antigen through a process called affinity maturation. The products of germinal centres become IgG, IgA etc plasma cells and memory B cells.

Panbio Pan-E Dengue Early ELISA Kit and Dengue NS1 Antigen

2008-09-25T20:11:00.010+08:00

Dengue is an arbovirus belonging to the genus of Flavivirus in the family Flaviviridae.It is the aetiological agent that cause dengue fever (DF) and dengue hemorrhagic fever (DHF).Currently, up to 2.5 billion people living in the tropical belt of the world are at risk of the infection.Annually, 50 to 100 million DF were reported with 500,000 DHF resulting in 25,000 deaths and a high proportion were children.Significant number of patients suspected of having dengue infection had IgM antibody detected in their serum.In 2006, Sabah and Sarawak had reported DF and DHF with significant number of deaths. Detection of dengue antibodies are among many laboratort tests routinely performed to confirm dengue in patients but these antibodies were often undetectable in the early phase of the infection.NS1, a -50-kilodalton glycoprotein, is one of seven non-structural (NS) protein genes of the dengue virus.

Preliminary studies have shown its association in viral RNA replication.Dengue NS1 antigen has been reported to be detected in serum from day 1 after onset of fever. It has been shown that NS1 antigen could be used as a suitable marker of dengue virus infection.Early definitive diagnosis is essential for the successful timely management of the infection.Performing preliminary evaluation of panbio pan-E Early Dengue ELISA kit on patient serum suspected of dengue is recommended and compared it with the panbio Dengue Duo Cassette, panbio Dengue IgM Capture ELISA and Dengue real-time polymerase chain reaction(RT-PCR).In one study reported that panbio pan-E Dengue Early ELISA was able to detect NS1 antigen when panbio Dengue IgM Capture ELISA was still negative in the early phase of the disease.

Info on Medical Laboratory Technology (Health Science)

2008-09-24T00:31:00.001+08:00

As I had observed and told during training in a government hospital, only MLT (Dip/BSc.), Biomed (BSc.) and postgraduate medical students (pursuing Masters in Pathology) are allowed for a full practical rotations in almost all the departments available in the government pathology lab. The reason for this is related with the subjects these students have studied.A government hospital commonly have under their pathology laboratory the following departments (some major hospital may even have more):

Biochemistry department (routine and non-routine biochemistry)
Hematology department
Serology department
Microbiology and parasitology department
Blood bank

As you can see, the subjects learned by MLTs and Biomed students are directly related with the departments stated above. Other practical students in the hospital from pure science program such as BSc.Biochemistry or BSc.Microbiology are not allowed to rotate to other departments that are not related to their study. As explained by the head MLT in the government hospital that I went for my training, the pure science students lack the knowledge in the relevant subjects for them to be able to understand and properly conduct tests in departments other than their own, therefore they are not allowed in other departments. (eg; Biochemist student - conduct practical at Biochemistry department)

All of the above however may not apply in a private laboratory such as Pathlab or Gribbles. I'm not familiar with their protocols. If you find MLT or Biomedical Science interesting, you should choose a good place to study and pursue the course if you wish.

How Much Will Medical Laboratory Technologist earn in Malaysia?

2008-09-23T16:16:00.000+08:00

A friend of mine earns RM1600+, the salary for MLT diploma holders should be around that (± RM100 - RM200). The salary depends on what the Lab (private labs / hospital) offers to you. You should call the IPTS directly for information regarding intakes. As with other courses, you should study hard if you choose to pursue this course.

The job market competition is HIGH due to many IPTS producing MLT graduates right now. Moreover, nowadays the IPTS even competes with each to place their students for final year practical training in Government Hospitals since Government Hospitals have the Labs and experienced staff members.

By the way, it seems that JPA only states PTPL and MSU's MLT program apart from the IPTA/Government colleges (in the list; Teknologi Makmal Perubatan) as recognized. Perhaps this recognition by JPA is due to the Government .MLTs are being trained there as well.

MLT Course offered by IPTS in Malaysia

2008-09-22T00:55:00.004+08:00

Which IPTS in Malaysia that offers Good Medical Laboratory Technology Course.?Many IPTS nowadays offer this course, but choosing which one is up to you. You should take into consideration things like:

How established the course in the IPTS
The facilities available there
The lecturers
The cost of the program
The IPTS surrounding area / location

The Diploma in MLT course is offered by IPTS such as Kuala Lumpur Metropolitan University College, Masterskill, PTPL, Mahsa, MSU and Nilai University College. If you are referring to the "good education quality", then you should evaluate the many aspects of the IPTS that offer this course. Recognition by MQA and JPA is VERY important.

Refer to the sites below:
MQA - http://www.mqa.gov.my/mqr/english/ecarianakr.cfm (type Medical laboratory technology there)

JPA - http://www.interactive.jpa.gov.my/webinter...MainIktiraf.asp

Immune Response

2008-09-21T21:37:00.001+08:00

Lymph Node

2008-09-21T21:15:00.002+08:00

Picture shows the regions of the lymph node where the blood stream (arteries and veins) enter a typical lymph node. For the lymphatic system to function properly in its defensive role, the lymph nodes must be able to "dump" their leukocytes (infection fighting cells) quickly into the general blood stream. It is important to note that white blood cells are not produced in the Lymph nodes initially, only stored there. In the event of a serious infection (a pathogenic virus for example), the lymph nodes often become very swollen. This swelling represents the explosive multiplication of leukocyte numbers in the lymph node's honeycomb of connective tissue.

Protective Equipment - Gloves

2008-09-21T19:55:00.003+08:00

The use of gloves is required when performing finger or heel puncture and phlebotomies. The only exception is that during the collection of units of blood from volunteer donor, the use of gloves is optional. If gloves become torn, punctured, or visibly contaminated, they must be changed. Gloves must also be worn when cleaning up spills or handling waste materials. Cotton gloves liners and specially treated gloves are available for personnel who have allergic reaction to vinyl or latex gloves. Gloves are potentially contaminated and should not be worn outside the laboratory or when using equipment such as computer terminals or telephones if the equipment is designated safe for use without gloves. In some laboratories, equipments is designated “clean” or “dirty”. The “dirty” equipment may be used only when wearing gloves

AIDS Vaccine Trial a Success in India

2008-09-21T16:43:00.000+08:00

I found so much information on the potential vaccine that I didn't know what to do with it all. I also discovered many institutions around the world are at different points with creating a vaccine.

Recently, the International AIDS Vaccine Initiative (IAVI) released a press release citing India's efforts in AIDS vaccine development. According to the release, "The results of the trial of an MVA-based AIDS vaccine candidate (TBC-M4), which was conducted in Chennai, indicated that the vaccine candidate had acceptable levels of safety and was well tolerated."

It is important that AIDS vaccine trials are also conducted in other areas around the world, considering 2.7 million people are infected annually around the globe, according to the IAVI.

Speed of Information in Healthcare System

2008-09-21T16:27:00.000+08:00

In a healthcare system, the speed of information is crucial to patient care. Patient identification, physician orders, and laboratory test data are moving at speeds unheard of a generation ago. Barcode scanners, bidirectional interfaces, physician order entry, expert systems and autoverification are all designed to increase speed.

But ever-decreasing turnaround time makes acceleration the goal instead of always putting information in the hands of the physician in time to make a treatment decision. It's something many bench techs instinctively know: faster doesn't always make a difference to the patient.

The key to "speed" may be meeting expectations every time, suggesting that consistency defines expectations and paces performance. We understand this in the laboratory. A phlebotomy station is easier to staff if patient flow has fewer peaks and lulls. Multiple instruments are easier to load and result if turnaround times are reliable. And any manual process works more smoothly with fewer interruptions. Less variation is easier to work around.

According to this in Clinical Lab Products, many laboratories are adopting a "real-time" performance model without priority distinction. At one hospital this reduced Stat orders from 54 percent to 3 percent. This non-traditional approach to curbing Stat abuse works by improving turnaround times on all testing. More to the point, turnaround times are closer to each other if "batch and rack" testing is eliminated.

We should strive to control the speed of information. If we can do that, maybe everyone will wait a little less.

Blood Type

2008-09-20T22:42:00.000+08:00

If an individual is exposed to a blood group antigen that is not recognized as self, the immune system will produce antibodies that can specifically bind to that particular blood group antigen, and an immunological memory against that antigen is formed. The individual will have become sensitized to that blood group antigen. These antibodies can bind to antigens on the surface of transfused red blood cells (or other tissue cells), often leading to destruction of the cells by recruitment of other components of the immune system.

When IgM antibodies bind to the transfused cells, the transfused cells can clump. It is vital that compatible blood is selected for transfusions and that compatible tissue is selected for organ transplantation. Transfusion reactions involving minor antigens or weak antibodies may lead to minor problems. However, more serious incompatibilities can lead to a more vigorous immune response with massive RBC destruction, low blood pressure, and even death.

A blood type (also called a blood group) is a classification of blood based on the presence or absence of inherited antigenic substances on the surface of red blood cells (RBCs). These antigens may be proteins, carbohydrates, glycoproteins, or glycolipids, depending on the blood group system, and some of these antigens are also present on the surface of other types of cells of various tissues. Several of these red blood cell surface antigens that stem from one allele (or very closely linked genes), collectively form a blood group system.

Blood types are inherited and represent contributions from both parents. A total of 30 human blood group systems are now recognized by the International Society of Blood Transfusion (ISBT). Many pregnant women carry a fetus with a different blood type from their own, and the mother can form antibodies against fetal RBCs. Sometimes these maternal antibodies are IgG, a small immunoglobulin, which can cross the placenta and cause hemolysis of fetal RBCs, which in turn can lead to hemolytic disease of the newborn, an illness of low fetal blood counts which ranges from mild to severe.

Blood Group System - Scianna

2008-09-20T22:11:00.001+08:00

There are three antigens within the Scianna blood group system recognized by the International Society of Blood Transfusion (ISBT) Working Party on Terminology for Red Cell Surface Antigens. The first is Sc1, a high frequency antigen found in greater than 99 % of most populations. This antigen was originally described by Schmidt et al. in 1962 and named Sm. Second is Sc2, described by Anderson et al. in 1963 and named Bua. Lewis et al. reported the original Sm- cells were Bu(a+) and suggested they be renamed Sc1 and Sc2 following conformation that they were the products of alleles. The frequency of Sc2 is about 1% of Northern Europeans but the frequency is much lower in other populations. The incidence of Sc:1,2 is more common in Mennonites, as a selected population. The third antigen is Sc3, a high frequency antigen found on all cells except the extremely rare individuals that type Sc:-1,-2. Reported by McCreary in 1973, it was found while working with a sample of a patient from the Marshall Islands.

The Scianna antigens are encoded by a gene whose chromosomal location is on the short arm of chromosome 1 between 1p36.2-p22.1. The antigens are located on a glycoprotein containing disulfide bonds and an N-glycan, known as the Scianna glycoprotein (function unknown). To date, the antigens have only been found on erythroid cell lines. Individuals of the rare Sc:-1,-2 phenotype (the null phenotype ) do not appear to have any associated red cell membrane defect or anemia. The Sc:-1,-2 phenotype has been found most frequently (when found at all) amongst individuals native of the South Pacific Islands.

The antibodies against the Scianna antigens have been associated with mild to delayed transfusion reactions and mild hemolytic disease of the newborn. It is suspected that the Scianna blood group system could become as complex as some of the other blood groups. Some unique antibodies have been found that hint of an association with Scianna but lack the complete research necessary to qualify for blood group assignment. An example of possible expansion is the report of three Sc:1,-2 individuals that produced allo-antibodies that failed to react with Sc:-1,-2 red blood cells, and the antibodies were mutually incompatible. This is suggestive that there may be three more high incidence antigens within this system. In addition, the low incidence antigen Radin, may be a part of the Scianna system but is not an allele of Sc1 and Sc2.

Blood Group System - XG

2008-09-20T22:09:00.000+08:00

In 1962, Mann reported an antibody which he found in the serum of a multiply transfused Caucasian male (Mr. And) that seemed to be associated with the sex of the donor red cells. In other words, the antigen frequency differed between males (XY) and females (XX) of the same race. Thus, this new antigen was named Xga as it appeared to be controlled by the X (sex) chromosome. The Xg antigen is well developed at birth although cord blood cells may give weaker reactions than adult cells. The Xg system, however, is unusual in that no other antigens have been identified to date. Curiously, most of the antibody producers have been males.

Biochemical analyses have shown that the Xga antigen is located on a 27,000 molecular weight sialoglycoprotein. This protein is encoded for by a gene on the X chromosome at position Xp22-32. The Xg locus is one of the few genes on the X chromosome that are not subject to Lyonization, ie. random "switching off" in females of one of the X genes. Goodfellow and Tippett have observed an interesting association between the Xga antigen and CD99. They found that the CD99 antigen also showed variable expression which appeared to be related to sex. Individuals who are high expressors of CD99 are Xg(a+). Although there are Xg(a-), CD99 low expressors, no "null phenotype" has yet to be found. Since these two proteins may associate with each other in the red cell membrane, the null would presumably lack both the Xg and CD99 proteins. No disease association has been found with a particular Xg phenotype.

Blood Group System - Diego

2008-09-20T22:08:00.000+08:00

The first example of anti-Dia was discovered in Venezuela in 1956, as a cause of hemolytic disease of the newborn. The family was Caucasian but there appeared to be Native American admixture. This led to the recognition that Dia was a useful marker for persons of Mongolian descent while being of very low frequency in other populations. The frequency in Native Americans ranges from 2-36% while 3-10% of Orientals are positive. Anti-Dib was not recognized until 1967 when two examples were reported in two Mexican women that were being transfused.

The Diego system remained a two antigen system until the 1990s when Dia, Dib and the Wright antigens (Wra and Wrb) were determined to be amino acid substitutions on band 3, the anion exchange protein (AE1). The system quickly expanded when other antigens of low frequency were also identified on band 3 including: ELO, Redelberger, Traversu, Warrior, Wulfsberg, VanVugt, Waldner, Bishop, Hughes and Moen. No red cell lacking band 3 has been reported for this system which may indicate that its loss is lethal. There has been only one report of the Di(a-b-) phenotype. Antibodies to Wra are frequently found in patients having autoimmune hemolytic anemia or individuals having a positive direct antiglobulin test.

Blood Group System - Kidd

2008-09-20T22:05:00.000+08:00

Shortly after the development of the antiglobulin test for the detection of red cell antibodies, the first example of a Kidd antibody was reported in 1951. A patient, Mrs. Kidd, was described who produced an antibody that caused hemolytic disease in her newborn son. After determining that the new antigen was independent of the other then-known blood groups, it was given the name Jka. Soon afterwards, the allele was found by Plaut and designated Jkb. In 1959, the first example of the null phenotype, i.e., Jk(a-b-), was founnd in a woman who had produced an antibody that appeared to be anti-Jka plus anti-Jkb. Since the specificities were inseparable, the antibody was renamed anti-Jk3 which recognizes an antigen found whenever Jka or Jkb is present. To date, no low frequency antigens have been associated with the Kidd blood group.

The first example of the Jk(a-b-) phenotype was found in a woman who experienced a delayed transfusion reaction. She was a Filipino of some Chinese and Spanish ancestry. Another family of Filipino-Chinese ancestry was reported that contained three Jk(a-b-) members. Since these first reports, many such individuals of Asian or Polynesian extraction have been identified. One study found a total of 66 (0.9%) Jk(a-b-) donors among 7425 tested; all were of Polynesian backgrounds. Other populations reporting this phenotype include tribes from Mato Grasso, Brasil, Hindus from India and Japanese blood donors. The Jk(a-b-) phenotype is strikingly absent from Caucasians although rare cases have been found in a French, an Australian and a Finnish family. The molecular basis for Jknull has been shown to be splice-site and misense mutations, as well as a partial gene deletion. The Jka/Jkb polymorphism is a A8386 base pair change at amino acid 280, changing Asp to Asn.

Interestingly, the Jk(a-b-) red cells were shown to be resistant to lysis in high concentrations of urea as opposed to normal cells that completely lyze in ~1 minute. This observation led to biochemical studies which identified the Kidd antigens on the urea transport protein which is found not only in red blood cells but also in the kidney. One study of individuals with the Jk(a-b-) phenotype has reported that they have a decreased ability to concentrate urine but this does not appear to cause a health problem.

Blood Group System - Duffy

2008-09-20T21:59:00.000+08:00

In 1950, the Duffy blood group was named for the multiply transfused hemophiliac whose serum contained the first example of anti-Fya. In 1951, the antibody to the antithetical antigen, Fyb, was discovered in the serum of a woman who had been pregnant three times. Using these antibodies three common phenotypes were defined: Fy(a+b+), Fy(a+b-), and Fy(a-b+). Differences in the racial distribution of the Duffy antigens were discovered four years later when it was reported that the majority of Blacks had the erythrocyte phenotype Fy(a-b-). This phenotype is exceedingly rare in Whites. The frequency of the Fy(a-b-) phenotype is 68 percent in American Blacks and 88-100 percent in African Blacks. The molecular basis for the Fy(c-b-) phenotype is the result of a point mutation in the erythroid specific promoter. The absence of Duffy antigens on erythrocytes results in their resistance to invasion by two malaria parasites, Plasmodium vivax and Plasmodium knowlesi. This racial variation in distribution of the Duffy system antigens provides one of the few known examples of selective advantage conferred by a blood group phenotype.

The Duffy genes, located on chromosome one at position 1922-23, have recently been cloned and sequenced. The difference between Fya and Fyb is a change in the amino acid at position 43 from aspartic acid (Fya) to glycine (Fyb). Studies have shown that blacks whose erythrocytes express Fyb antigen also have the antigen on the cells of their kidney, heart, muscle, brain and placenta. The Duffy gene codes for a protein known as a chemokine receptor, which is important in the inflammatory process. Accordingly, the Fy protein is also known as DARC (Duffy Antigen Receptor for Chenokines).

Blood Group System - Lewis

2008-09-20T21:58:00.001+08:00

The first description of an antibody in the Lewis system was published in 1946 by Mourant. Lewis system antibodies are some of the most frequently encountered in pre-transfusion or pre-natal screening. Anti-Lea is the most frequent antibody in the Lewis system, is often naturally occurring and is of the IgM class. Anti-Leb exists in two forms: one reacts only with Le(b+) cells of the A2 or O type (anti-LebH) while the other reacts with all Le(b+) cell regardless of ABO type.

The antigens of the Lewis system are carbohydrate (sugar) determinants carried either on proteins or lipids. Although they were first detected on red cells, the majority of the biochemical studies have been performed on Lewis substances isolated from plasma or saliva. Generally in both Caucasians and Blacks, the three major phenotypes are Le(a+b-), Le(a-b+) and Le(a-b-). These arise through the interaction of two genes- Lewis and secretor. If a Lewis gene is present the donor will be either Le(a+b-) or Le(a-b+); however, if there is no Lewis gene the red cells type as Le(a-b-). In Blacks the Le(a-b-) type occurs with a frequency of 20-25% as compared to 5% in Caucasians. Furthermore, red blood cells from newborns will type as Le(a-b-) regardless of their genetic makeup as the cells have not had time to absorb Lewis antigens from the plasma. Another type which is extremely rare in Caucasians and Blacks, ie. Le(a+b+), is found in the Oriental population and appears to be due to a weak secretor gene.

In 1993, Boren et al. reported that the bacteria Helicobacter pylori used the fucose sugar found in the Leb antigen as a receptor to establish infection. H. pylori has been implicated as the causative agent in gastritis, peptic ulcers and gastric carcinoma. Several studies suggest that transplant patients having the Le(a-b-) phenotype have shorter transplant survival times than those who have a Lewis gene. Interestingly, antibodies raised to cancer cells often have specificity within the Lewis blood group.

Blood Group System - Cartwright

2008-09-20T21:53:00.000+08:00

The first Yt (also known as Cartwright) blood group system antigen, ie. Yta, was described 1956 by Eaton et al. This blood group antigen was proven to be inherited as a dominant character and independent from the other know systems at that time. In 1964, Giles and Metaxas reported the first example of an antibody that detected the product of the expected antithetical allele, Ytb. This latter discovery raised the stature of the Yt system, which then became a chromosome marker of about the same potential usefulness as the Lutheran system.

The two antigens of the Yt system, Yta and Ytb, are both expressed at birth, however in a slightly lower expression level than seen on adult cells. They were shown to be resistant to trypsin treatment, but sensitive to other protein cleaving enzymes. Antibodies to these antigens were implicated in cases of delayed transfusion reactions but were not reported to have caused hemolytic disease of the newborn. No examples of Yt(a-b-) individuals have been found despite numerous studies. From population studies, Ytb appeared to be lacking, or of very low incidence, from Orientals, Amer-Indians and southern Africans; Yta was found lacking in approximately one per thousand individuals of European origin.

This system remained unexciting until it was found that both of these antigens were weak or absent from paroxysmal nocturnal hemoglobinuria (PNH) III red blood cells. With a rush of activity in the early 1990's, it was found that the Yt blood group system antigens represented amino acid substitutions on the GPI-linked glycoprotein, acetylcholinesterase (AchE). This protein probably exists as a dimer (pair) in the red cell membrane. Yta and Ytb are equated to substitutions of a hisitidine and asparagine, respectively, at amino acid position 322 on the GPI-linked glycoprotein. AChE has been assigned a chromosome location at 7q22.

As of this date, there have been only two antigens associated with this system. Based on the present knowledge of the placement on AChE, it is far more likely that any new variants will be found investigating AChE peculiarities and their immune response than by standard serological methods.

Blood Group System - Kell

2008-09-20T21:52:00.000+08:00

The first Kell system antibody was described in 1946, shortly after the implementation of the use of the then recently described rabbit anti-human globulin reagent. The system's clinical importance was obvious from the first case: an example of hemolytic disease of the newborn. As with most systems, over the years, more antigens have been found that were proven by inheritance to be of the Kell blood group system. At present it is a system comprised of 22 blood group antigens, several having been shown to be products of allelic genes. Some of the antigens have also shown a distinct racial prevalence (K antigen is more frequently found in Northern European, the Jsa antigen is most frequently found in those of African descent and the Kpc antigen has been more frequently found in Japanese). All of this was very suggestive of a chromosome location that might have three or more regions with mutation points.

The Kell antigens are encoded by a chromosomal location on the long arm of chromosome 7. They are located on a 93 kDa type II glycoprotein that makes a single pass through the membrane, is glycosolated at five sites and functions as a metalloprotease. The Kell antigen appears to be found on erythroid and nonerythroid tissue (primarily in testis). In nonerythroid tissues, as exemplified by skeletal muscle, Kell is disulfide-linked to XK.

This system, as with several other systems, has examples of "depressed phenotypes" and "null phenotypes". The McLeod phenotype (first detected during the investigation of the cells of a Dr. McLeod) have suppression of all inherited Kell blood group antigens, in addition to a unique red blood cell morphology; acanthocytes. Interestingly, the "null phenotype" cells, referred to as Ko, which by definition have no Kell blood group antigens, has normal discocytes.

The expression of the Kell genes is modified by epistatic effects, both from the Kell locus and from at least two regulatory genes, one of which is X-borne (see Kx).