Student's Notes
Muhammad Na'im is presently in Year 4 Medicine. USM. He will enter Year 5 in July 2010 and hopes to graduate by May 2011.
http://jacknaimsnotes.blogspot.com/2009/03/blood-in-urine.html
Tuesday 29 December 2009
Observation of Urine
Visual Inspection of Urine / Urine Appearance
Normal, fresh urine is clear and pale to dark yellow or amber in color. Cloudiness may be caused by excessive cellular material or protein in the urine or may reflect from crystallization or precipitation of salts upon standing at room temperature or in the refrigerator. Clearing of the specimen after addition of a small amount of acid indicates that precipitation of salts is the probable cause of tubidity. A red or reddish-brown color could be from a food dye, consumption of beets, a drug, or the presence of either hemoglobin (from the breakdown of blood) or myoglobin (muscle breakdown). If the sample contains many red blood cells, it would be cloudy as well as red.
http://www.medical-library.net/urinalysis_interpretation.html
Normal, fresh urine is clear and pale to dark yellow or amber in color. Cloudiness may be caused by excessive cellular material or protein in the urine or may reflect from crystallization or precipitation of salts upon standing at room temperature or in the refrigerator. Clearing of the specimen after addition of a small amount of acid indicates that precipitation of salts is the probable cause of tubidity. A red or reddish-brown color could be from a food dye, consumption of beets, a drug, or the presence of either hemoglobin (from the breakdown of blood) or myoglobin (muscle breakdown). If the sample contains many red blood cells, it would be cloudy as well as red.
http://www.medical-library.net/urinalysis_interpretation.html
Urine FEME
FEME stands for Full Examination, Microscopic Examination. Urine FEME is also referred to as Microscopic Urinalysis.
How is it done?
A sample of well-mixed urine (usually 10-15 ml) is centrifuged in a test tube at relatively low speed (about 2000-3,000 rpm) for 5-10 minutes which produces a concentration of sediment (cellular matter) at the bottom of the tube.
The fluid on top is poured off to a volume of 0.2 ml to 0.5 ml left inside the tube.
The sediment is resuspended in the remaining urine by flicking the bottom of the tube several times.
A drop of resuspended sediment is poured onto a glass slide and a thin slice of glass (a coverslip) is placed over it.
The sediment is first examined under low power to identify crystals, casts, squamous cells, and other large objects.
"Casts" are plugs of material which came from individual tubules.
The number of casts seen are usually reported as number of each type found per low power field (LPF).
For an example: "5-10 hyaline casts/LPF."
Since the number of elements found in each field may vary considerably from one field to the next, several fields are averaged.
Then, examination is carried out at high power to identify crystals, cells, and bacteria.
The various types of cells are usually described as the number of each type found per average high power field (HPF).
For example: "1-5 WBC/HPF."
External link
http://www.medical-library.net/urinalysis_interpretation.html
Urine Dipstick Test
Reading The Dipstick
The dipstick yields valuable information which is available by direct observation of the coloured patches on the test strip (dipstick) after brief immersion in the urine specimen. There are a number of parameters which are determined: pH, specific gravity (S.G.), protein, glucose, ketones, nitrite and leukocyte esterase.
Acid/Base (pH)
The dipstick yields the pH, a reflection of acid/base levels. The initial filtrate of blood plasma is usually acidified by the renal tubules and collecting ducts (microscopic structures in the kidneys of which there are millions) from a pH of 7.4 to about 6 in the final urine. in other words, the urine is acidified. However, depending on the acid-base status, urinary pH may range from as low as 4.5 to as high as 8.0. One task nature has assigned to the kidneys is to rid the body of acid.
Specific Gravity (S.G.)
Specific gravity measures urine density which reflects the ability of the kidney to concentrate or dilute the urine relative to the plasma from which it is filtered. Although dipsticks are available that also measure specific gravity in approximations, most laboratories measure specific gravity with a instrument call a refractometer. Specific gravity between 1.002 and 1.035 on a random sample should be considered normal if kidney function is normal. Any measurement below 1.007 to 1.010 indicates hydration and any measurement above it indicates relative dehydration. 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.
Protein
While the dipstick test has a portein measurement, more elaborate tests for urine protein should be performed since cells suspended in normal urine can produce a false high estimation of protein. Normal total protein excretion does not usually exceed 150 mg/24 hours or 10 mg/100 ml in any single specimen. More than 150 mg/day is considered proteinuria. Proteinuria greater than 3.5 gm/24 hours is severe and indicates the nephrotic syndrome. Dipsticks detect protein by production of color with an indicator dye, Bromphenol blue, which is most sensitive to albumin but detects globulins and Bence-Jones protein poorly. Precipitation by heat is a better semiquantitative method, but overall, it is not a highly sensitive test. The sulfosalicylic acid test is a more sensitive precipitation test. It can detect albumin, globulins, and Bence-Jones protein at low concentrations. "Trace" protein is equivalent to 10 mg/100 ml or about 150 mg/24 hours (the upper limit of normal). 1+ corresponds to about 200-500 mg/24 hours; 2+ to 0.5-1.5 gm/24 hours, a 3+ to 2-5 gm/24 hours, and a 4+ represents 7 gm/24 hours or greater.
Glucose
Glycosuria (excess sugar in urine) generally means diabetes mellitus.
Ketones
Ketones (acetone, aceotacetic acid, beta-hydroxybutyric acid) may be present in diabetic ketosis or other forms of calorie deprivation (e.g. starvation). Ketones are easily detected using either dipsticks or test tablets containing sodium nitroprusside.
Nitrite
A positive nitrite test indicates that bacteria may be present in significant numbers. Gram negative rods such as E. coli are more likely to give a positive test.
Leukocyte Esterase
A positive leukocyte esterase test results from the presence of white blood cells either as whole cells or as destroyed cells. A negative leukocyte esterase test means that an infection is unlikely. Without additional evidence there is no need for culture.
http://www.medical-library.net/urinalysis_interpretation.html
The dipstick yields valuable information which is available by direct observation of the coloured patches on the test strip (dipstick) after brief immersion in the urine specimen. There are a number of parameters which are determined: pH, specific gravity (S.G.), protein, glucose, ketones, nitrite and leukocyte esterase.
Acid/Base (pH)
The dipstick yields the pH, a reflection of acid/base levels. The initial filtrate of blood plasma is usually acidified by the renal tubules and collecting ducts (microscopic structures in the kidneys of which there are millions) from a pH of 7.4 to about 6 in the final urine. in other words, the urine is acidified. However, depending on the acid-base status, urinary pH may range from as low as 4.5 to as high as 8.0. One task nature has assigned to the kidneys is to rid the body of acid.
Specific Gravity (S.G.)
Specific gravity measures urine density which reflects the ability of the kidney to concentrate or dilute the urine relative to the plasma from which it is filtered. Although dipsticks are available that also measure specific gravity in approximations, most laboratories measure specific gravity with a instrument call a refractometer. Specific gravity between 1.002 and 1.035 on a random sample should be considered normal if kidney function is normal. Any measurement below 1.007 to 1.010 indicates hydration and any measurement above it indicates relative dehydration. 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.
Protein
While the dipstick test has a portein measurement, more elaborate tests for urine protein should be performed since cells suspended in normal urine can produce a false high estimation of protein. Normal total protein excretion does not usually exceed 150 mg/24 hours or 10 mg/100 ml in any single specimen. More than 150 mg/day is considered proteinuria. Proteinuria greater than 3.5 gm/24 hours is severe and indicates the nephrotic syndrome. Dipsticks detect protein by production of color with an indicator dye, Bromphenol blue, which is most sensitive to albumin but detects globulins and Bence-Jones protein poorly. Precipitation by heat is a better semiquantitative method, but overall, it is not a highly sensitive test. The sulfosalicylic acid test is a more sensitive precipitation test. It can detect albumin, globulins, and Bence-Jones protein at low concentrations. "Trace" protein is equivalent to 10 mg/100 ml or about 150 mg/24 hours (the upper limit of normal). 1+ corresponds to about 200-500 mg/24 hours; 2+ to 0.5-1.5 gm/24 hours, a 3+ to 2-5 gm/24 hours, and a 4+ represents 7 gm/24 hours or greater.
Glucose
Glycosuria (excess sugar in urine) generally means diabetes mellitus.
Ketones
Ketones (acetone, aceotacetic acid, beta-hydroxybutyric acid) may be present in diabetic ketosis or other forms of calorie deprivation (e.g. starvation). Ketones are easily detected using either dipsticks or test tablets containing sodium nitroprusside.
Nitrite
A positive nitrite test indicates that bacteria may be present in significant numbers. Gram negative rods such as E. coli are more likely to give a positive test.
Leukocyte Esterase
A positive leukocyte esterase test results from the presence of white blood cells either as whole cells or as destroyed cells. A negative leukocyte esterase test means that an infection is unlikely. Without additional evidence there is no need for culture.
http://www.medical-library.net/urinalysis_interpretation.html
Urinalysis vs Urine FEME
Are they different?
Urinalysis
Urinalysis consists of 3 parts:-
1) Direct visual observation or inspection of urine
2) Urine dipstick test
3) Urine FEME / Microscopic Urinalysis
Observation of Urine
Normal, fresh urine is clear and pale to dark yellow or amber in color. What is considered as abnormal appearance of urine?
http://www.medical-library.net/urinalysis_interpretation.html
Urine Dipstick Test
The dipstick yields valuable information which is available by direct observation after brief immersion of the urine specimen.
Medical Library: "Urinalysis_interpretation."
Medicine Newbie: "Urine FEME microscopic urinalysis."
Urine FEME / Microscopic Urinalysis
FEME stands for Full Examination, Microscopic Examination. Urine FEME is also referred to as Microscopic Urinalysis. How is it done?
http://www.medical-library.net/urinalysis_interpretation.html
Case Study
http://www.medhelp.org/posts/Urology/urine-FEME/show/599838
Student's Notes
http://jacknaimsnotes.blogspot.com/2009/03/blood-in-urine.html
PowerPoints
http://slideplayer.com/search/urinalysis/
http://slideplayer.com/slide/2649063/#
http://slideplayer.com/slide/4062490/
Urinalysis
Urinalysis consists of 3 parts:-
1) Direct visual observation or inspection of urine
2) Urine dipstick test
3) Urine FEME / Microscopic Urinalysis
Observation of Urine
Normal, fresh urine is clear and pale to dark yellow or amber in color. What is considered as abnormal appearance of urine?
http://www.medical-library.net/urinalysis_interpretation.html
Urine Dipstick Test
The dipstick yields valuable information which is available by direct observation after brief immersion of the urine specimen.
Medical Library: "Urinalysis_interpretation."
Medicine Newbie: "Urine FEME microscopic urinalysis."
Urine FEME / Microscopic Urinalysis
FEME stands for Full Examination, Microscopic Examination. Urine FEME is also referred to as Microscopic Urinalysis. How is it done?
http://www.medical-library.net/urinalysis_interpretation.html
Case Study
http://www.medhelp.org/posts/Urology/urine-FEME/show/599838
Student's Notes
http://jacknaimsnotes.blogspot.com/2009/03/blood-in-urine.html
PowerPoints
http://slideplayer.com/search/urinalysis/
http://slideplayer.com/slide/2649063/#
http://slideplayer.com/slide/4062490/
Wednesday 23 December 2009
Kitchen Table Medicine
You are what you eat!!!!
How often do you actually think about the fact that the nutrients contained in the food you eat are what become your skin, your lungs, even your heart, and every other part of your body?!
http://www.kitchentablemedicine.com/
Monday 21 December 2009
Health Access
Equal access
Do you agree that all patients should be entitled to equal access to healthcare whatever their lifestyle choices?
Source: The Biopsy Report
http://biopsy.wordpress.com/2009/03/26/health-access/
NowClinic
The Virtual Visit May Expand Access to Doctors
OptumHealth, a division of UnitedHealth Group, the nation’s largest health insurer, plans to offer NowClinic, a service that connects patients and doctors using video chat, nationwide next year. It is introducing it state by state, starting with Texas, but not without resistance from state medical associations.OptumHealth believes NowClinic will improve health care by ameliorating some of the stresses on the system today, like wasted time dealing with appointments and insurance claims, a shortage of primary care physicians and limited access to care for many patients.
But some doctors worry that the quality of care that patients receive will suffer if physicians neglect one of the most basic elements of health care: a physical exam.
Q: Why is a physical exam important?
Saturday 19 December 2009
Sunday 6 December 2009
Saturday 5 December 2009
ApoE Polymorphism
This Article
Abstract
Full Text (PDF)
Pubmed/NCBI databases
Gene
GEO Profiles
HomoloGene
UniGene
APOE4 and TBI
APOE4 Gene and outcome of TBI
For the past ten years research has shown, then not shown, an association between comparatively worse outcome in patients with TBI who harbor the APOE4 gene. A meta-analysis (Zhou, W., et al. 2008) showed that the APOE4 gene was significantly associated with poor outcome of TBI six-months after injury, but was not associated with the initial severity of brain injury following TBI. There are many difficulties in showing this in the litigation context, since genetic testing for this purpose is not well received by treating physicians and many facilities are unwilling to do this type of genetic testing. However, brain injury litigators need to keep trying to screen for this, especially in cases where the patient has a comparatively bad outcome which is being contested by the insurance company. Source: http://www.braininjury.com/research-archive.html
For the past ten years research has shown, then not shown, an association between comparatively worse outcome in patients with TBI who harbor the APOE4 gene. A meta-analysis (Zhou, W., et al. 2008) showed that the APOE4 gene was significantly associated with poor outcome of TBI six-months after injury, but was not associated with the initial severity of brain injury following TBI. There are many difficulties in showing this in the litigation context, since genetic testing for this purpose is not well received by treating physicians and many facilities are unwilling to do this type of genetic testing. However, brain injury litigators need to keep trying to screen for this, especially in cases where the patient has a comparatively bad outcome which is being contested by the insurance company. Source: http://www.braininjury.com/research-archive.html
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