Routine Laboratory Investigations discusses the need for and types of laboratory investigations that can be performed. It covers classifications of tests based on where they are done, their sensitivity and specificity, and frequency of use in dental practice. Commonly used hematological investigations include complete blood count, erythrocyte sedimentation rate, bleeding time, and clotting time. Tests of blood glucose levels are among the most frequently used serum chemistry investigations. The document emphasizes correctly interpreting results in the context of a patient's history and clinical findings.
Atlas on bethesda system for reporting cervical cytologyAshish Jawarkar
This is an atlas with more nearly 100 images, authentic taken from NCI web atlas. Useful to understand and report pap smears. The subject has been presented in a way which will help students reproduce in exams.
Atlas on bethesda system for reporting cervical cytologyAshish Jawarkar
This is an atlas with more nearly 100 images, authentic taken from NCI web atlas. Useful to understand and report pap smears. The subject has been presented in a way which will help students reproduce in exams.
COMPARISON OF CONVENTIONAL PAPANICOLAOU STAIN WITH MODIFIED ULTRAFAST PAPANIC...SURAMYA BABU
• Body fluid cytology is vital in diagnosis of various neoplastic and non neoplastic lesions and conventional Pap stain is the staining method of choice for the same.
• MUFP is a quick and cheap staining technique which gives good interpretation of cytological features with easily available reagents.
• Preservation of cell morphology and nuclear staining are superior with conventional Papanicolaou technique whereas cytoplasmic staining is comparable with conventional pap and MUFP techniques.
• Though background of stained smears was slightly better with conventional Pap staining; MUFP was superior in case of hemorrhagic samples.
COMPARISON OF CONVENTIONAL PAPANICOLAOU STAIN WITH MODIFIED ULTRAFAST PAPANIC...SURAMYA BABU
• Body fluid cytology is vital in diagnosis of various neoplastic and non neoplastic lesions and conventional Pap stain is the staining method of choice for the same.
• MUFP is a quick and cheap staining technique which gives good interpretation of cytological features with easily available reagents.
• Preservation of cell morphology and nuclear staining are superior with conventional Papanicolaou technique whereas cytoplasmic staining is comparable with conventional pap and MUFP techniques.
• Though background of stained smears was slightly better with conventional Pap staining; MUFP was superior in case of hemorrhagic samples.
Are laboratory tests always needed frequency and causes of laboratory overu...Hossamaldin Alzawawi
This article is discussing the importance of monitoring clinical laboratory resource utilization and how the team has implemented a monitor system to assess clinical laboratory resource overuse.
Point of Care Testing (POCT) refers to medical testing that is conducted outside of a laboratory setting, typically near or at the location of a patient. This can include testing in a physician's office, at home, in the field, or in a hospital room. POCT is usually performed using portable, handheld, or small benchtop devices. Here are some main features and advantages of POCT:
Convenience and Speed: Since POCT can be done at or near the patient's location, it eliminates the need to send samples to a lab and wait for the results. This can result in quicker diagnosis and treatment.
Immediate Decision Making: With instant results, healthcare providers can make immediate decisions about a patient's care, leading to improved patient outcomes.
Reduced Costs: While some POCT devices can be expensive, they may reduce overall healthcare costs by shortening hospital stays, reducing the number of follow-up visits, and preventing complications.
Simplicity: Many POCT devices are designed to be user-friendly, allowing non-laboratory personnel or even patients themselves to conduct tests.
Connectivity: Modern POCT devices often come with connectivity options, enabling the integration of test results into electronic health records.
Versatility: There's a wide range of tests available for POCT, from blood glucose testing to rapid strep tests and coagulation tests.
However, it's also important to note some challenges with POCT:
Quality Control: Ensuring the accuracy and reliability of POCT results can be challenging, especially if tests are being conducted by non-laboratory personnel.
Cost: Some advanced POCT devices can be costly, and there may be additional costs associated with training and quality control.
Regulation and Oversight: Because POCT is performed outside of the traditional lab setting, there can be challenges related to oversight, regulation, and ensuring that tests meet necessary standards.
In summary, while POCT offers many advantages in terms of speed and convenience, it's essential to ensure that tests are accurate, reliable, and meet necessary standards.
Rapid diagnostic tests (RDTs) in India play a crucial role in the detection and management of various diseases, including infectious diseases like malaria, dengue, and more recently, COVID-19. Here's an overview of RDTs in India:
Importance in Disease Management: In a vast and diverse country like India, with varied healthcare infrastructure across its regions, RDTs provide a quick and effective way to diagnose diseases, especially in remote areas where sophisticated laboratory setups might not be available.
Malaria and Dengue Detection: RDTs for malaria (based on the detection of antigens produced by malaria parasites) and dengue (based on the detection of dengue NS1 antigen and anti-dengue antibodies) are widely used. They offer results in less than
Rapid Diagnostic Tests (RDTs) in India play a crucial role in the quick detection and diagnosis of various diseases. They are espec
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. CONTENTS:
1. Definition
2. Need for Lab investigations
3. Applications
4. Classifications
5. Crucial Q&As prior to Lab Investigations
6. Laboratory Investigations (Frequently and infrequently
required)
a. Haematological Investigations
b. Biochemistry Investigations
3. Contents:
c. Microbiological Investigations
d. Immunological Investigations
e. Histopathological and Cytopathological
Investigations
7. Common Clinical Scenarios
8. Conclusion
9. References
4. Definition:
Laboratory studies are an extension of physical examination in which tissue, blood, urine
or other specimens are obtained from patients and subjected to microscopic, biochemical,
microbiological or immunological examination.
Information obtained from these investigations help us in identifying the nature of the
disease.
4
5. Need for:
Evidence shows Case History and Clinical examination usually reveal most if not all of
clinically relevant data
Hence there remains a need to confirm our clinical impression
Lab investigations supplement rather than replace other methods for gathering
information
It is a known fact that with the help of lab investigations, some underlying systemic
conditions of which the patients are unaware of, are often identified in dental practice
for the first time
6. CHARACTERISTICS OF A LABORATORY
TEST
Accuracy
Cost
Interfering factors
Morbidity
Precision
Reference Range
Sensitivity
Specificity
Specimen collection
Sensitivity
The probability that
a patient with
disease has positive
test
Specificity
The probability that
a healthy patient has
a negative test
7. Applications:
Confirming or rejecting clinical diagnosis
Providing suitable guidelines in patient management
Providing prognostic information of the diseases under consideration
Detecting diseases through case-finding screening methods
Establishing normal baseline values before treatment
Monitoring follow up therapy
Providing information for Medico-Legal consultations
7
8. Classifications:
Based on where investigation is done:
Chair side
Investigations
Laboratory
Investigations
Acts as a precursor to
laboratory investigations
Significantly higher
sensitivity and specificity
Egs : Toluidine blue
staining for grading
dysplasia, Electric Pulp
testing for tooth vitality,
Radiographs
Egs: Glycated
Haemoglobin estimation,
Peripheral smear histology
8
9. Classifications:
Based on specificity/sensitivity:
Screening Tests Diagnostic Tests
An ideal screening test is 100%
sensitive
An ideal diagnostic test is 100% specific
Useful in a large sample size at
risk; typically cheaper
Useful in symptomatic individuals to establish
diagnosis or asymptomatic individuals with +ve
screening test; expensive
Egs : blood glucose estimation for
screening diabetes,
Haematocrit values for anaemia,
VDRL test for syphilis
Egs: Glycated Haemoglobin estimation, OGTT
Peripheral smear histology
9
11. Haematology:
Deals with investigations of abnormalities of blood cells, their precursors
and of the haemostatic & clotting mechanisms
Microbiology:
• In this discipline body fluids, mucosal surfaces and excised tissues
are examined by using microscopical, cultural and serological
techniques.
To detect and identify the causative micro organism
Eg: Antibiotic sensitivity testing
11
12. Biochemistry:
Also called chemical pathology
Deals with investigations of the metabolic abnormalities of
the body in disease states.
Investigations are carried out by assays of various normal
and abnormal compounds found in body fluids viz. blood,
urine, CSF, saliva etc.
12
13. Immunology:
Deals with the detection of abnormalities in the immune
system
Primary role to Identify a disease is by observing the
presence of an antibody in the patient that resulted from
the infection(entry of pathogen)
The semi quantitative measure of the amount of antibody
present in serum is called a Titre.
13
14. Histopathology:
Deals with the identification of structural changes in diseased
tissues through microscopic examination of appropriately
stained tissue sections obtained from biopsy procedures.
Cytopathology:
Scientific Study of role of individual cells or cell types in disease.
Clinician collects a sample of abnormal cells from lesional tissue scrapings
or by means of tissue aspiration.
Cells are then stained and studied under light microscopy
14
15. Classifications:
Based on frequency of dental use: (by Sonis, Fazio & Fang )
Frequently used:
• CBC- Hb, Hct, Absolute
and differential WBC
• Bleeding studies – BT,CT,
PT, aPTT
• Peripheral Blood Smear
• Random Blood Glucose
Occasionally done:
• Tests for disturbance of
bone – Ca, P, ALP
• ESR
• Urinalysis
• Screening Test for
Syphilis
Rarely ordered:
• Enzyme testing
• Bilirubin Estimation
• Creatinine
Estimation
• Acid Phosphatase
• BUN
15
16. Crucial Q & As prior to Lab Investigations:
1. For a given situation, WHAT investigation is appropriate?
Often a dental practitioner is faced with a dilemma of what investigation to
order in a given clinical scenario.
The plan of investigation should be therefore decided from the facts
obtained from history taking and clinical examination
Investigations are useful only when the appropriate tests are requested, and
interpreted in the light of history, clinical findings, knowledge and
experience.
Before any investigations are initiated, Patient Consent must be obtained
16
17. Crucial Q & As prior to Lab Investigations:
2. What sample to be collected for the Test?
Samples should optimally be the most likely entity which harbours the
causative organism or abnormal constituents of body fluids like
electrolytes, chemical compounds or antigens
17
18. Crucial Q & As prior to Lab Investigations:
3. How to collect specimens?
Success or failure of the investigation depends on the procedures carried
out in collection, preservation and transport of the specimens.
In cases of microbiological and culture tests, the specimen must be material
from the actual site of infection and should be collected with minimum of
contamination from adjacent tissues or secretions.
In cases of tissue collection, the site of collection as well as the vicinity
with respect to the lesion assumes importance
Apart from this the timing (When??) of specimen collection is also
important
18
19. Crucial Q & As prior to Lab Investigations:
3. How to collect specimens?
In general specimens collected from swabs are inferior in material
collection when compared to aspirates.
In cases of collection of blood samples for haematology, it can be collected
either via skin , venous or arterial puncture
If a clinician wishes to study its cellular components, its important that the
blood sample remain unclotted.
If blood specimen has been refrigerated, it must be brought back to room
temperature for investigations as cold specimens yield false values.
19
20. Crucial Q & As prior to Lab Investigations:
4. What Information to be furnished to the laboratory?
Specimens should accompany properly filled out forms from the clinician
Preliminary details include: Name, Address, Hosp. No. , Gender & Date of
Birth
Other important details are
Exact nature of the specimen
Source of the specimen
Nature of investigation requested
Date and time of specimen collection
Brief Clinical Details
Tentative Diagnosis
Current Therapy if any
20
21. Crucial Q & As prior to Lab Investigations:
5. Estimated cost and time expense?
The clinician should comprehensively detail the patient about the
cost aspect of the following investigation in order to allow the
patient to make an informed choice of undertaking it.
The clinician should also provide a realistic estimate of the time
duration required from the collection of specimen from patient till
obtaining the results and its interpretation
21
22. Crucial Q & As prior to Lab Investigations:
6. Expected risks and discomfort to patient, clinician and personnel?
The patient must be beforehand explained about the possible risks of the
investigative procedure, if any
Verbal informed consent is adequate for non invasive procedures, but for
invasive procedures a signed, witnessed and a written informed consent is
necessary.
All body fluids and tissues are considered potentially infectious.
Barrier precautions must always be employed to prevent transmission to
other patients or staff during investigations.
22
23. Crucial Q & As prior to Lab Investigations:
7. Interpretation of results?
Clinician’s knowledge of pathology is essential for interpreting results.
The clinician should be able to assess the false negative results in non-
quantitative tests
For quantitative tests, the normal values may vary between different lab
settings. Hence communication with laboratory personnel becomes very
important in these settings.
It must also be remembered that a value just outside the range of normal
does not necessarily indicate abnormality.
23
24. FACTORS TO BE CONSIDERED:
Should be ordered as a result of suspicious oral findings or if
aspects of your treatment can potentially affect the systemic
health of the patient
The strength and weakness of the test should be known and the
results must be accurately interpreted
The financial costs to patients and to the dentists’ practice
should be carefully considered
Privilege for writing laboratory tests may vary
27. Red blood cell (RBC) count is a count of the actual number of red blood
cells in a person's sample of blood.
Hemoglobin measures the amount of the oxygen-carrying protein in the
blood.
Hematocrit measures the percentage of a person's blood that consists of red
blood cells.
Red blood cell indices are calculations that provide information on the
physical characteristics of the RBCs:
• Mean corpuscular volume (MCV) is a measurement of the average size
of RBCs.
• Mean corpuscular hemoglobin is a calculation of the average amount of
oxygen-carrying hemoglobin inside a red blood cell.
• Mean corpuscular hemoglobin concentration (MCHC) is a calculation of
the average percentage of hemoglobin inside a red cell.
Reticulocyte count which is a measurement of the absolute count or
percentage of young red blood cells in blood.
EVALUATION OF RBC
28.
29. Haematological Investigations:
Erythrocyte Sedimentation Rate(ESR or Sed Rate):
In certain febrile diseases as well as in others the amount of circulating
fibrinogen is increased
The resultant increased viscosity of blood slows down the sedimentation rate
of erythrocytes
ESR indicates the speed with which the erythrocytes settle in uncoagulated
blood
Values:
Men < 50 years - <15 mm/hr.
Women < 50 years - <20 mm/hr.
Men >50 years - <20 mm/hr.
Women >50 years - <30 mm/hr.
29
31. Haematological Investigations:
Bleeding Time:
Measures the time for haemostatic plug formation
Normal Bleeding time – 2-7 mins
Any clotting factor deficiency or platelet abnormality will lead to increased BT
Prolonged in
Thrombocytopenia
Acute leukaemia
Aplastic anaemia
Liver diseases
Von-Willebrand’s disease
31
33. Haematological Investigations(infrequently required) :
1. Prothrombin Time (PT):
Time in seconds that is required for fibrin threads to form in citrated or oxalated
plasma
Normal time – 11-14 secs
Measured against a Control PT in terms of INR
INR = PTTest / PTNormal
Normal INR = 1 ; Abnormal INR > 1.5
Measures extrinsic and common pathway – Factors I,II, V ,VII, X
33
34. MANAGEMENT OF PATIENTS USING INR
PERIODONTAL TREATMENT Safe (INR) Borderline (INR) Adjustment (INR)
Prophylaxis < 3.5 ≥3.5
Scaling and root planing <2.5 2.5 to 3.5 >3.5
Extraction <2.5 2.5 to 3.5 >3.5
Gingivoplasty <2.5 2.5 to 3.5 >3.5
Multiple Extractions (<4 teeth) <2.5 2.5 to 3.5 >3.5
Gingivectomy <1.5 1.5 to 2.5 >2.5
Minor flap surgery <1.5 1.5 to 2.5 >2.5
Full arch extractions ≥1.5 ≥1.5
Extensive flap surgery <1.5 ≥1.5
35. Haematological Investigations(infrequently required) :
Prothrombin Time (PT):
Increased PT
Disseminated Intravascular Coagulation
Patients on Warfarin Therapy
Vit K deficiency
Early & End stage Liver failure
35
36. Haematological Investigations(infrequently required) :
Activated Partial Thromboplastin Time (aPTT):
Time in seconds that’s required for a clot to form in citrated or oxalated plasma
Performance indicator of both the intrinsic & common pathways
Typical reference range – 30-40 secs
Increased aPTT seen in :
Patients on Heparin Therapy
Von – Willebrand’s disease
Disseminated Intravascular Coagulation
Early Stage Liver failure/ Wilson’s disease
Haemophilia
36
37. Haematological Investigations(infrequently
required) :
Serum Iron and Total Iron Binding Capacity:
Iron deficiency is usually detected on the basis of the amount of iron
bound to transferrin in the plasma(serum iron) and the total amount of
iron that can be bound to the plasma transferrin in vitro
Normal values
Serum iron – 80-180 µg/dl
TIBC – 250 – 370 µg/dl
37
39. Serum chemistry:
Serum is that portion of blood remaining after whole blood has been
allowed to clot
Responsible for fluid maintenance Intra and extra cellularly
Responsible for the optimal osmotic gradient, nerve and muscle
function and hydration
39
40. Serum chemistry(frequently used):
1. Blood Glucose estimations:
Fasting Blood Sugar(FBS): Normal values – 70-90 mg/100ml
Random Blood Sugar(RBS): 110-130 mg/100ml
Post Prandial Blood Sugar(PPBS): <140 mg/100ml
High values are seen in Diabetes mellitus, Cushing’s disease,
pheochromocytoma, in patients taking corticosteroids
Low values seen in insulin secreting tumours, Addison’s, Pituitary hypo
function
40
41. Serum chemistry(frequently used):
2. Oral Glucose Tolerance Test:
Used for the definitive diagnosis of diabetes mellitus and for
distinguishing diabetes from other causes of hyperglycaemia like
hyperthyroidism
Should be performed on only healthy ambulatory patients who are
not under any drugs which may interfere with glucose estimation
41
42. Serum chemistry(frequently used):
Oral Glucose Tolerance Test:
Criteria for Interpretation:
1. Fajans and Conn Criteria
2. Wilkerson Point System
3. The University Group Diabetes Program Criteria
42
44. Serum chemistry(frequently used):
Oral Glucose Tolerance Test:
Wilkerson Point System:
A score of 2 or more indicates diabetes
FBS > 110 mg/dl - 1 Point
1 hour > 170 mg/dl – 0.5 point
2 hour > 120 mg/dl – 0.5 point
3 hour > 110 mg/dl – 1 point
44
45. Serum chemistry(frequently used):
Oral Glucose Tolerance Test:
University Group Diabetes Program Criteria:
Based on the sum of 1,2 and 3 hr. levels of Blood sugar
If sum >/= 500 mg/dl a diagnosis of diabetes is made
45
46. Serum chemistry(frequently used):
3. Glycated Haemoglobin(HbA1c):
Hb becomes Glycated by ketoamine reactions between glucose and
other sugars.
Once Hb is Glycated, it remains that way for a prolonged period(2-3
months)
Hence it provides a definitive value of blood sugar control of 2-3 month
duration
The HbA1c fraction is abnormally elevated in diabetic patients with
chronic hyperglycaemia
It is considered to be a better indicator for diabetic control compared to
blood glucose levels
46
48. Serum chemistry(infrequently used):
Serum Calcium, Phosphorus:
Indicated on suspicion of Paget’s disease, fibrous dysplasia, primary and
secondary hyperparathyroidism, osteoporosis, multiple myeloma or
osteosarcoma
The concn. Of Serum Ca varies inversely with serum P
Normal level Serum Ca – 9.2-11 mg/dl
Normal level Serum P – 3- 4.5 mg/dl
At levels less than 7 mg/dl Serum Ca, signs of tetany may appear
48
49. Serum chemistry(infrequently used):
Serum Alkaline Phosphatase: (ALP)
ALP produced in small amounts in the liver but most notably in
osteoblasts
Normal values:
ADULT CHILD
King Armstrong Units 4-13 15-30
Bodansky Units 1.5-4.5 5-14
International Units
(IU/l)
30-85
49
51. Serum chemistry(infrequently used):
Serum Alkaline Phosphatase: (ALP)
This test is very useful for diagnosing biliary obstruction.
Even in mild cases of obstructive disease, this enzyme is elevated.
It is not very useful for diagnosing cirrhosis.
If a patient has bone disease, this test may be highly inaccurate, as ALP is
also found in bone tissue.
51
52. Serum chemistry(infrequently used):
Total Protein & Albumin/Globulin Ratio:
These proteins are important in coagulation, transport a variety of
hormones, act as buffer systems and help maintain osmotic pressure
Normal range:
Total protein – 6 – 8.3 g/dL
A/G ratio - 1.2 – 2.0
52
53. Serum chemistry(infrequently used):
Serum Bilirubin: (Brb)
Bilirubin is a bile pigment derived from the breakdown of Haemoglobin
Normal value: 0.1 – 1.2 mg/100ml
Levels beyond 3.0 mg/100ml may indicate jaundice
High values may also indicate haemolytic anaemia, biliary obstruction,
hepatitis and Gilbert’s disease
53
54. Saliva Chemistry(infrequently done):
Secretions are collected directly from individual parotid and
submandibular & sublingual glands by use of small rubber cups(Curby
cups) pressed lightly against gland orifices
Salivary function studies include:
1. Measurement of Na, K, Cl concentration in saliva
2. Measurement of total salivary flow
3. Rate of flow of saliva from orifices
4. Rate of discharge of radio-opaque dye from salivary gland following retrograde
sialography
5. Rate of uptake and secretion of 99m Tc-pertechnate by salivary glands
54
55. Saliva Chemistry:
Normal values for unstimulated saliva are
K – 25 mEq/L
Na - <10 mEq/L
Cl - 15-18 mEq/L
Increase in K or Na values may indicate generic inflammation or
sialodenosis
In parotid enlargement accompanying cirrhosis
Parotid flow rate and salivary concn of Na,K,Cl, salivary amylase & protein
increases
Immunoglobulin levels remain normal
55
56. Saliva Chemistry:
In Sjogren’s Syndrome
Flow rate is reduced
Salivary phosphate concn is reduced
Na & Cl concn is elevated
Salivary IgA concn elevated
Urea and K concn unchanged
Abnormal protein bands can be distinguished by electrophoresis
56
58. Microbiology:
Culture and sensitivity tests are used to isolate and identify causative micro
organisms of an infection
May be obtained from blood or urine
Particularly helpful in evaluating infections related to throat, sinuses, root
canals or bone.
Sensitivity tests may also be ordered when patient relapses, the
identification of the organism is uncertain or the disease is severe
Most common limitation is the delay in receiving the report
Another problem is: in-vitro testing may not necessarily predict the same
result as in-vivo testing
58
60. Immunofluorescence Procedure:
Direct
Immunofluorescence
• Addition of fluorescent
labelled Ab to patient
tissue
• Wash
• Visualizing under
fluorescent microscope
Indirect
Immunofluorescence
• Addition of patient
serum to tissue
containing known Ag
• Wash
• Add fluorescent
labelled Anti globulin
• Wash
• Visualize
Sandwich Technique
• Refers to the fact that
the Ag is sandwiched
between 2 layers of Ab
only one of which is
labelled
• Incubation and washing
• Labelled antiserum is
applied to the section
which identifies
location of tissue
component
60
61. ELISA: Enzyme-Linked Immunosorbent Assay
61
ELISA detects substances with antigenic
properties (mainly proteins)
Based on enzymatic color-reaction
Slides by Mathias Bader and Simon Loew
62. Basic principle of ELISA
62
Enzyme is used to detect the binding of Antibody - Antigen
Enzyme converts colorless substrate into colored product, indicating the
presence of Antibody - Antigen complex
ELISA can be used to detect either presence of Antigens or Antibodies
Slides by Mathias Bader and Simon Loew
63. Applications
63
Medical diagnostic to detect presence of antibodies in patient
HIV Test
But: high material costs
Drug tests
West Nile Virus
Slides by Mathias Bader and Simon Loew
ELISA test identifies P. gingivalis and C. rectus . By test. P. gingivalis,
as identified by ELISA, had the highest degree of sensitivity and
specificity (0.90 and 0.82 respectively) to clinical indicators of adult
periodontitis. [J Periodontol 1994;65:576–582].
64. Histopathology and Cytopathology:
Histopathology refers to the microscopic
examination of tissue in order to study the
manifestations of the disease
Cytopathology refers to the scientific study of role
of individual cells or cell types in disease
64
65. Tissue Biopsy:
A biopsy is a controlled & deliberate removal of tissue from a living organism for
the purpose of microscopic examination
Relatively simple procedure producing little discomfort when compared to
exodontia or periodontal surgery
65
Avoidance of Delay for Biopsy:
1. Rapid growth
2. Absent local factors
3. Fixed lymph node enlargement
4. Root resorption with loosening of
teeth
5. History of malignancy
66. Exfoliative Cytology:
Developed by Dr. George Papanicolaou who is also known as “Father of
cytology”
In this, the surface of the lesion is either wiped with a sponge material or
scraped to make a smear.
The appreciation of the fact that some cancer cells are so typical that they
can be recognized individually has allowed the development of this
diagnostic technique
66
68. Clinical Scenario 2:
Patient presents with
chronic fatigue, pallor
and paleness of
conjunctiva
Preliminary investigations:
CBC inc. Hb/Hct/Red cell indices
Absolute LC/DLC
Occasionally:
Peripheral smear/
Serum Iron/ TIBC
Rarely:
Schilling’s Test
68
69. Reviewing clinical laboratory test results about a patient's
condition can provide valuable information for
Diagnosis and management of orofacial conditions
Guidance on assessing the patient's ability to tolerate the
proposed dental treatment
A prognosis based on a particular treatment
70. EVALUATION OF WBC
when a patient is being treated with a
medication that suppresses WBC
production (such as antineoplastic agents),
the patient is at a greater risk for
postoperative infection, and dental
treatment should be deferred until the
WBC result is back to normal.
For invasive dental treatment,
perioperative antibiotics are indicated in
patients with ANC less than 1,000
cells/mm3 in order to minimize the risk of
infection. When the ANC falls below 500
cells/mm3, intravenous antimicrobial
therapy may be necessary to prevent sepsis
resulting from invasive dental treatment.
71. EVALUATION OF RBC
Patients with polycythemia may
experience orthopnea in the dental
chair, dizziness, headache, red facial
coloring, and dyspnea.
Hgb and Hct are necessary parts of
the assessment for anemias and in
patients with burning mouth
disorders and aphthous stomatitis.
Differ routine dental treatment in
Patient with severe anemia
72. EVALUATION OF PLATELETS
Bleeding disorders or bone marrow
diseases, such as leukemia, require
the dental healthcare provider to
determine the number of platelets
present and/or their ability to function
correctly prior to invasive surgery.
Minor dentistry: counts should be
greater than 50,000/cubic mm
73. Conclusion:
Lab investigations have become an integral component of a complete
examination of the patient
They confirm the authenticity of our clinical impression and also
provides a prognostic know how post treatment
As Periodontists, we should have a thorough knowledge about different
investigations pertaining to our field of study
We should also know how to correlate our history taking and clinical
examination so as to order for the most appropriate investigation
73
74. References:
1. Perio 2000: Laboratory testing of patients with systemic conditions in periodontal practice
by Angelo Mariotti
2. Young DS,Bermes EW,Specimen collection and processing: sources of biological variation
3. Scully C, Wolff A. Oral Surgery in patients on anticoagulant therapy
4. Stern.R. Karplis, Kinney, Glickman. Using International normalized ratio to standardize
prothrombin time
5. J Periodontol 1994;65:576–582
6. Bricker, Langlais, Miller ; Oral Diagnosis, Oral Medicine and Treatment Planning ; 2nd
edition
7. Mitchell, Standish, Fast ; Oral Diagnosis/Oral Medicine ; 3rd edition
8. Coleman , Nelson ; Principle of Oral Diagnosis
74