Collection of sample

This test is performed with the patient's serum. There is no restriction for a fasting sample. The test can be done by a random blood sample the patient.

About 3 to 5 ml of blood is collected in a plain test tube, and blood is allowed to clot to get clear serum. In infants, the sample may be collected from the heel. The blood sample is centrifuged for 5 to 10 minutes and the serum is separated for the test.

The patient's serum is stable at 4° C for 3 days and protects it from the light.

Note: Bilirubin is photo-sensitive (photo-oxidized) so keep the sample in dark place otherwise false-negative results may obtain.

Precautions

  • Avoid sample from hemolysis
  • Do not expose the sample to light. Exposure of sample to light may decrease the value.
  • If there is a delay in performing the test then keep the sample in dark and refrigerate it.
  • Avoid shaking of the test tube as it may lead to an inaccurate result.

Pathophysiology

  • Serum bilirubin is a very useful test to evaluate liver functions. Raised level of bilirubin can be seen in the hepatic and post-hepatic type of jaundice.
  • Clinically jaundice appears when the level of bilirubin is more than 2 mg/dl.
  • Direct (or conjugated) bilirubin: It is water-soluble and dissolves in water and is synthesized in the liver form indirect bilirubin.

Normal Values

  • Total bilirubin 0.3 to1.0 mg/dL or 5.1 to 17.0 mmol/L
  • Direct bilirubin 0.1 to 0.3 mg/dL or 1.0 to 5.1 mmol/L
  • Indirect bilirubin 0.2–0.7 mg/dL

Raised level of direct bilirubin is seen in

  • Gallbladder tumors
  • Gallstones
  • Dubin-Johnson syndrome
  • Rotor syndrome
  • Obstruction of extrahepatic ducts or inflammatory scarring
  • Can be resolved by the surgery
  • Drugs may cause cholestasis

Let us be honest – most of the information you currently know about mental health is something you learned as an adult, and even now we are only starting to understand certain snippets of the discussion. In fact, to look at the outstanding lack of knowledge among the general public regarding this subject, notice that only two states in the United States have enacted laws that officially allow mental health to be taught as a mandatory subject in schools – Virginia and New York.

That means that they will update their curriculum for all schools beginning from elementary to high school, which will include information about mental health. In addition, Virginia plans to incorporate education on mental health into health and physical education classes, according to CNN.

While these initiatives are good, they can only be effective when adequate resources are also included in the picture. Here are some vital lessons on the issue that we need to start teaching our children in schools.

Mental health is just as important as other aspects of health, so it is vital to take care of it.

As serious and prevalent as physical illnesses are, it is very important to understand that mental health is also in the same league. Therefore, this warrants a serious and extensive discussion on mental health, even among young people.

You may not have been through such discussions as a student in school – and that has also contributed to the widespread ignorance of the problem. The rising numbers of suicide, cases such as depression and drug abuse cases should act as a warning, even among young people. There is also a high level of stigma around the discussion of mental health cases, which should not be happening – and this is making the young people going through these problems to feel like they are ‘abnormal’.

It is very good to open up about your feelings and emotions, even the negative ones

Figure 1179.2

If there is one thing that most of us were constantly told as children, is never to complain or voice out negative thoughts because these showed that you had a ‘negative’ attitude towards life in general. However, voicing out these feelings is more beneficial than you may think, especially when you do not know how else to handle the problem you face.

The worst thing you can force someone with a mental illness to do is to stay silent. This is exactly why there need to be educational campaigns, and encourage people to speak up without feeling stigmatized or feeling like they need to be taken to the hospital.

You cannot feel happy all the time

One of the lessons we learn as we grow older is that not every day is a happy day, and struggles are a normal part of life. Children and younger people can feel very vulnerable, especially when they begin to wonder why they struggle with negative thoughts, unlike their peers who may look happier.

Sometimes, it is good to not be okay and to have the courage to admit that. Young people get stressed too about many things, and it is good to remind them that they are not alone in their frustration – it is important to remind them that they are important, and to teach them to encourage each other and be mindful of each other’s welfare.

That there are skills that exist, which can help you when you are struggling with mental health

Figure 1179.3

You definitely know about mental health illnesses like bipolar disorder, anxiety, ADHD, and depression, but if someone asked you about coping skills to handle someone else or yourself when you have these conditions, would you know? Probably not, unless you get certain information on the subject when you click here or use any other authority resource.

For most people, their knowledge of mental illnesses is something they know because you see a famous person going through it, and there is also a growing discussion about it in the entertainment spheres. However, for kids and young people, there is a high tendency they might bully a peer who shows signs of mental health issues, instead of helping them to cope with the issue. At the end of the day, the affected individual finds out that no one really cares about their mental health, not even those in authority – and that can lead to suicide, drug abuse or other issues such as self-harm.

It is therefore essential to teach young people and children coping skills, and remind them that mental illness does not discriminate the people it affects. Teach them the ways they can use to help someone with the conditions, ways of dealing with the new diagnosis, tell them about people who have survived, and also how to practice daily self-love and care.

Therapy is a good thing

There is nothing to be ashamed of about going to therapy sessions, unlike the opinions of some people. That harmful mentality can spread to children, and they can bully someone who is going through the recovery process.

Figure 1179.4

Teachers and parents need to remind their young people that therapy and medication are good because it shows the affected person is dealing with the problem. that will also teach them to give as much support as they can to their affected peer, and they will also understand that the medicines and therapy sessions will not change personalities – only assist to deal with the situation.

Getting a diagnosis of a mental illness does not make you a bad person

Figure 1179.5

Having a mental illness does not make you a dangerous person or unstable, it just means you have an extra item on your plate to deal with. It is vital that children understand that, as this will remind them to support their friends struggling with mental illnesses.

They also need to know that mental illness does not make a person look crazy, as even the most normal-looking person might be suffering from any of them.

Final thoughts

Mental illness is not handled well in schools, and there is a lot of prejudice on the subject that does not need to be there. When we deal with the problem as early as possible, we are also encouraging young people to stand up to negative vices such as bullying and teach them to be considerate of others.

Why is this test performed?

This test is performed for the diagnosis and differentiation of jaundice. This test is also done in a patient with hemolytic anemia in adult and newborn. This test is very useful to evaluate liver functions and for the follow-up of a patient with treatment.

Collection of sample

This test is performed with the patient's serum. There is no restriction for a fasting sample. The test can be done by a random blood sample the patient.

About 3 to 5 ml of blood is collected in a plain test tube, and blood is allowed to clot to get clear serum. In infants, the sample may be collected from the heel.

The blood sample is centrifuged for 5 to 10 minutes and the serum is separated for the test. The patient's serum is stable at 4° C for 3 days and protects it from the light.

Precautions

  • Avoid sample from hemolysis
  • Do not expose the sample to light. Exposure of sample to light may decrease the value.
  • If there is a delay in performing the test then keep the sample in dark and refrigerate it.
  • Avoid shaking of the test tube as it may lead to an inaccurate result.

Pathophysiology

  1. This is the end product of hemoglobin metabolism.
  2. From the breakdown of RBC, hemoglobin is released in form of Heme and Globin. Heme is further metabolized to Biliverdin and this is transformed into bilirubin.
  3. The raised level of bilirubin is the indicator of liver dysfunction.
  4. Bilirubin is a component of bile which is transported from the liver and stored in the gallbladder and from that organ, it is it is delivered to the intestine.
  5. Bile formed in the liver. It is made up of bilirubin, bicarbonate (HCO3), phospholipids, cholesterol, bile salts, and water.
  6. Further metabolism of bilirubin takes place in the intestine.
  7. Most of it is metabolized in the intestine and discharged in the feces.
  8. An increased level of bilirubin causes the yellow color of the skin and jaundice (conjunctiva).
  9. The bilirubin which is not conjugated to the liver, attach to albumin (carrying protein) is called Indirect bilirubin.
  10. The bilirubin conjugate with the glucuronic acid. This process takes place in the liver and gives rise to direct or conjugated bilirubin. Now conjugated bilirubin is no more bound to protein.
  11. Jaundice occurs when the bilirubin level is above 2.5 mg/dl.
  12. When the bilirubin level exceeds 15 mg/dl then the treatment is immediately started to avoid the brain damage.
  13. While physiologic jaundice appears after 3 to 4 days and subsidies itself.
  14. In the newborn, when the liver can not conjugate bilirubin and if the level increases then this indirect bilirubin can cross the blood-brain barrier which may lead to toxic injury to the brain and called Kernicterus.

Types of jaundice

Types of jaundice are defined as follows:

  • Pre-hepatic jaundice: The etiology is before the liver like excessive hemolysis of RBC.
  • Hepatic jaundice: Dysfunction of the liver caused by hepatic diseases e.g. hepatitis.
  • Post-hepatic jaundice: The cause is after the liver like cancer, gallstone, etc. These are the obstructive type of jaundice.
Table 1178.1 Different type of Jaundice and their causes
Type of Jaundice Causes Pathophysiology
Conjugated hyperbilirubinemia Drugs like cyclosporine and estrogen
Dubin-Johnson syndrome
Pregnancy
There is a defect in the transmembrane secretion of conjugated bilirubin into the canaliculus. This is also called hepatocellular jaundice.
  Mechanical obstruction by stones or strictures, tumors, and primary biliary cirrhosis There is a defect in the flow of conjugated bilirubin through canaliculi and bile ducts. Called cholestatic jaundice.
  Sepsis Like above
Unconjugated hyperbilirubinemia Drugs like Rifampicin and Gilbert syndrome There is a defect in the uptake of unconjugated bilirubin into hepatocytes
  Right heart failure and Cirrhosis There is a defect in the delivery of unconjugated bilirubin to liver
  Extravascular hemolysis Heme is converted to unconjugated bilirubin
  Crigler-Najjar syndrome and Hypothyroidism There is a defect in the conjugation of bilirubin in the hepatocytes
Table showing the Different type of Jaundice and their causes

Calculation of total, direct and indirect bilirubin

Total bilirubin is calculated as follows:

Total bilirubin = Direct bilirubin + Indirect bilirubin

Direct bilirubin is calculated as follows:

Direct bilirubin = Total bilirubin – Indirect bilirubin

Indirect bilirubin is calculated as follows:

Indirect bilirubin = Total bilirubin – Direct bilirubin

Normal Values

  • Total bilirubin 0.3 to 1.0 mg/dL or 5.1 to 17.0 mmol/L
  • Direct bilirubin 0.1 to 0.3 mg/dL or 1.0 to 5.1 mmol/L
  • Indirect bilirubin 0.2 to 0.7 mg/dL or 3.4 to 11.9 mmol/L

Total bilirubin in

  • Umbilical cord blood less than 2 mg/ dl

Normal values of total bilirubin in infants

  • 0 to 1 days less than 6 mg/ dl
  • 0 to 2 days less than 8 mg/ dl
  • 3 to 5 days less than 12 mg/dl
  • after 5 days less than 0.2 to 1.0 mg/ dl

Physiologic jaundice of the newborn

  • This is found in the newborn when the liver is immature and an insufficient amount of conjugating enzymes. This will lead to an increased amount of unconjugated bilirubin.
  • This unconjugated bilirubin can cross the blood-brain barrier and give rise to encephalopathy (Kernicterus).

Bilirubin level more than 15 mg/dl in newborn needs immediate treatment.

  • This is treated by the exchange of blood or light therapy.

Raised Bilirubin level is seen in

  • Diseases that cause liver damage, such as cirrhosis, hepatitis, or mononucleosis.
  • In some infections, such as cholecystitis, and an infected gallbladder.
  • In some inherited diseases, such as Gilbert’s syndrome. Although jaundice may occur in some people with Gilbert’s syndrome, the condition is not harmful.
  • In some diseases that cause blockage of the bile ducts, such as cancer of the pancreas or gallstones.
  • Medicines that may increase the level of bilirubin. This consist of many antibiotics, diazepam (Valium), some types of birth control pills, phenytoin (Dilantin), flurazepam (Dalmane), and indomethacin (Indocin).
  • Rapid destruction of red blood cells in the blood, such as from an allergic reaction to blood received during a transfusion (called a transfusion reaction) or sickle cell disease.

Decreased Bilirubin level is seen in

  • Medicines that may decrease the level of bilirubin. This includes phenobarbital, vitamin C (ascorbic acid), and theophylline.

Bilirubin levels that may require treatment in a full-term, healthy baby

  • 24 hours or younger infant needs to be treated if the level of bilirubin is more than 10 mg/dL or more than 170 mmol/L.
  • 25 to 48 hours infant needs to be treated when the level of bilirubin is more than 15 mg/dL or more than 255 mmol/L.
  • 49 to 72 hours infant needs to be treated when bilirubin level is more than 18 mg/dL or more than 305 mmol/L
  • Older than 72 hours infant need to be treated when the bilirubin level is more than 20 mg/dL or more than 340 mmol/L

Causes of direct hyperbilirubinemia

If the direct bilirubin level is more than 50%.

  1. Gallbladder tumors
  2. Gallstones
  3. Dubin-Johnson syndrome
  4. Rotor syndrome
  5. Obstruction of extrahepatic ducts or inflammatory scarring
  6. Can be resolved by the surgery
  7. Drugs may cause cholestasis

Causes of Indirect hyperbilirubinemia

If the indirect bilirubin level is less than 15 to 20%.

  1. Hepatitis
  2. Increased RBC hemolysis ( Erythroblastosis fetalis)
  3. Sickle cell anemia
  4. Congenital enzyme deficiency
  5. Cirrhosis
  6. Gilbert syndrome
  7. Crigler-Najjar syndrome
  8. Drugs
  9. Transfusion reactions
  10. There is no role of surgery

Why is this test performed?

This test is evaluated in different conditions and diseases such as nephrotic syndrome, liver diseases, kidney diseases, in a patient suspected of malnutrition, and patients severe burn. See also: Procedures for the collection of blood for hemotological investigations.

Collection of sample

For the estimation of serum albumin, patient's serum is needed. A random blood sample may be used for the test, however, fasting sample is preferred.

About 3 to 5 ml of blood is collected in a plain test tube and blood is allowed to clot to get clear serum. The blood sample is centrifuged for 5 to 10 minutes and the serum is separated for the test. The patient's serum is may be stored at 4° C which may be stable for 72 hours.

Precautions

  • Fasting blood sample is preferred.
  • Specimen with lipemia or hemolysis should be avoided.

Pathophysiology

  1. This is the richest protein in the blood.
  2. Plasma proteins are separated into three major groups:
    (a) Albumin
    (b) Globulins
    (c) Fibrinogen
  3. The most common method is electrophoresis. It forms 5 bands named as:
    (a) Albumin
    (b) α1 fraction
    (c) α2 fraction
    (d) β fraction
    (e) γ fraction
  4. Total protein is made up of 40 to 60% of albumin.
    (a) Because of its low molecular size and high concentration in blood, it is found in urine, cerebrospinal fluid (CSF), interstitial fluid, amniotic fluid, and most of the extravascular fluids.
    (b) Due to its negative charge at normal pH, it is highly water soluble.
    (c) The half-life of albumin is about 15 to 19 days.
    (d) It is extremely sensitive to liver damage.
    (e) It helps to maintain the osmotic pressure in the blood vessels, without which the fluid will leak out.
    (f) It synthesized in the liver, that is why it reflects the functions of liver and kidney.
    (g) Albumin binds calcium, bilirubin, free fatty acids, and a number of drugs.
    (h) Low level of albumin causes Edema.
    (i) In acute or chronic liver diseases, malignancy, Amyloidosis, and malnutrition decreased synthesis in the liver is seen.
    (j) The role of albumin in transporting calcium, bilirubin, bile acids, metal ions, and drugs will be the variation in its concentration.
    (k) The presence of albumin in the urine represents kidney diseases.
    (l) Dehydration causes an increase in the level of albumin (Hyperalbuminemia).
    (m) The albumin performs a role of carrier protein for calcium, bilirubin, progesterone, and drugs.
    (n) Albumin provides nutrition to the tissues and binds various molecules like vitamin, hormones, and drugs.

Terminologies

Hypoalbuminemia

It is defined as a condition in which the level of albumin in blood/serum is lower than the normal values.

Hyperalbuminemia

It is defined as a condition in which the level of albumin in blood/serum is higher than the normal values.

Normal Values

  • Normal range 3.4 to 5.5 g/dl (35 to 55 g/L)
  • Male 4.2 to 5.5 g /dl
  • Female 3.7 to 5.3 g/dl
  • Cerebrospinal fluids 15 to 45 mg/dl
  • Urine (Spot Urine) 1 to 14 mg/mL
  • 24-hour Urine 15 to 45 mg /24 hours
  • Newborn 2.8 to 4.8 g/dl

Why is this test performed?

This hormone test is evaluated in different conditions, such as Hyperaldosteronism, Cushing's syndrome and Virilizing syndrome.

Lab tests for various adrenal abnormalities

Primary Adrenal Insufficiency (Addison's disease):

This is due to the diseases of the gland.

  • Level of sodium in serum is low.
  • Cortisol level is decreased.
  • Glucose level is decreased.
  • ACTH level is raised.
  • Potassium, calcium, and blood urea level are raised

Adrenal Hyperfunction leads to:

  • Increased level of Aldosterone causes Hyperaldosteronism.
  • Increased level of Cortisol causes Cushing's syndrome.
  • Increased level of Androgens causes Virilizing syndrome.

Primary Hyperadrenalism:

  • Level of Cortisol is raised.
  • ACTH level decreases.

Secondary Hypoadrenalism (secondary or tertiary Adrenal insufficiency):

This is due to external factors which lead to under activity of the glands.

  • ACTH level is low.
  • Cortisol level is decreased.

Adult adrenogenital syndrome:

  • There is an elevated level of:
    1. Urine 17-ketosteroids
    2. DHEA
    3. ACTH
  • There is a decreased level of:
    1. Cortisol

Congenital Adrenal Hyperplasia:

  • Decreased level of:
    1. Cortisol
    2. Aldosterone
  • There is an elevated level of:
    1. ACTH
    2. Androgens level

Primary Hyperaldosteronism (Conn's syndrome):

  • There is a decreased level of:
    1. Renin
    2. Potassium
    3. No response to aldosterone suppression test
  • There is an elevated level of:
    1. Serum sodium
    2. Aldosterone urine and blood

Cushing's syndrome:

  • There is an elevated level of Glucose, Sodium, and Cortisol.
  • There is no diurnal variation of ACTH and it is absent.
  • There is a decreased Potassium level.

Collection of sample

For the estimation of Adrenal Gland Hormones, patient's serum is needed. The 24-hour urine sample is also collected along with blood sample.

For the estimation of Cortisol level, patient's serum is required. 24-hour urine sample is also collected in a plastic container containing boric acid. The serum is stable for 2 days if kept at 2° to 8° C.

For catecholamines (Epinephrine and Norepinephrine), plasma in EDTA or heparin is needed. The sample is transported along with an ice-pack, centrifuged immediately at 4° C, and plasma is separated. Plasma is freeze until the test is run. 24-hour urine sample may also be collected in a plastic container containing 6 ml of 20% HCl and refrigerate during collection.

Estrogen can be estimated in serum. The blood sample is collected in a plain test tube, centrifuged immediately, serum is separated and refrigerated until the test is performed. 24-hour urine sample is also collected in a plastic container containing boric acid.

Aldosterone test can be done from the plasma (EDTA, citrate or heparin). Patient's blood serum may also be used for the test. Patient must be upright for 2 hours before the sample is taken. 24-hour urine sample is also collected in a plastic container containing boric acid.

Precautions before performing the Adrenal gland tests

  • Fasting blood sample is required.
  • Avoid herbal medicines and any medication which interfere with the test.
  • Avoid nuclear scan before this test.
  • Avoid exercise or physical activity.
  • Reduce the stress before performing this test.
  • Aldosterone AM sample is higher than PM.
  • Cortisol highest level is 8 AM and >50% less at 8 PM.

Normal Values

  • Plasma Epinephrine <50 pg/mL
  • Norepinephrine 110 to 410 pg/mL
  • Cortisol serum 5 to 20 µg/dL
  • Urine cortisol (free) 20 to 90 µg/ day
  • Aldosterone (recumbent) 50 to 150 ng/L
  • Aldosterone (upright) 150 to 300 ng/L

Estrogen

  • Male 20 to 80 pg/mL
  • Female Luteal phase 160 to 400 pg/mL
  • Follicular phase 60 to 200 pg/mL
  • Postmenopausal <130 pg/mL

Proper self-care is important for physical health and mental wellbeing after an abortion.

To remain connected with the world on the network has become an important requirement for the people. On being disconnected from the digital world for a few hours, they may miss some important updates, messages, news and many more things. Sometimes, they are even at the loss for not being connected to the internet. This is the reason why mobile devices are widely popular. They help the individuals to remain connected to the internet.

When you are on the road, you can turn on your mobile phone’s hotspot for accessing the internet connectivity. At some places like hotels or restaurants, you may get the Wi-Fi Facility but some of them provide the wired connections. At that time, it can be a trouble for you to access the internet if you don’t have the laptop with you. Hence, there is a need for a portable travel router which helps in staying connected with the internet.

Are the travel routers different from the commonly used routers?

Router is a kind of networking device that allows the data packets to get transferred between the networks. It performs the actions related to the networking and enables the users to stay connected to the internet. It also analyses the data to be transferred and then send it on the other network.

Different types of routers are there with small changes in their specifications. Travel router is a kind of router that works on the wireless technology. It allows the users to remain connected with the wireless internet at any place. It provides the secured network connection with many more features like built-in data storage capability. Best travel routers work in the same way as the common routers just with a difference that they are wireless and small in size.

No need to keep on adding the network to your device

When you are traveling or you need to check on different properties, you will have to add a new network every time you find a new network. This can be frustrating for you. Sometimes, you may have to wait to get the password for the secured connection. However, if you are traveling with your travel router, you will not have to add the network repeatedly. Your device will remain connected to the travel router all the time. It can remove the Wi-Fi deadspot so that wireless connections can be extended. Portable travel routers have the inbuilt modem which eliminates the need for tethering. Thus, you can enjoy internet connectivity.

Battery powered router connection

Travel routers are battery powered. They have the rechargeable battery so you can remain connected to the network. Travel routers are available in different battery capacities to make it easier for the customers to buy the right router according to their usability.

Latest models of the travel routers are available with the USB port for charging. Thus, you don’t need to take multiple chargers along with you for different devices. You just have to look for the USB charging point which can be easily found to recharge the batteries of the travel router. This allows your router to allow internet connectivity on your devices.

Medical Ethics have always played a crucial role in patient and healthcare services provided by healthcare organizations, especially in the recent times. The Changes in medical ethics have advanced to an extent that some medical practitioners have faced legal convictions because of their incognizance.

A crew of medical professionals successfully performed Pakistan’s first-ever mechanical heart transplant at the National Institute of Cardio Vascular Diseases (NICVD) - Karachi on Monday, July 9, 2018.

It is being seen as a milestone in the history of Pakistan’s medical science while the use of this technology is never known and never done in Pakistan’s history. The mechanical heart is transplanted to 62-years old Nafeesa Begum.

INTRODUCTION: Mental Retardation

Mental retardation (MR), defined as a failure to develop a sufficient cognitive and adaptive level. It is one of most common human disease. Also, 1-3 % of the human population has an IQ below 70. Recent research has discovered that MR is related to the presence of certain mineral elements in the body above-normal levels, especially cadmium and lead (Mike et al. 1983). It has been estimated that half of all cases are due to environmental factors, that include prenatal exposure of the fetus to toxic substances, environmental contaminants, infections, radiations, illness of mother (eg exposure to rubella, Cytomegalovirus) and malnutrition etc. (Birgitta et al. 2003). The prevalence of Intellectual disability (ID) also referred to as mental retardation is between 1% and 3% (Roeleveld et al. 1997; and Wen 2002). And ID is present in every social class and culture (Leonard and Wen 2002). Also, there are approximately 30% more males with MR are diagnosed than females (American Psychiatric Association 2000; Miclaren and Bryson 1987). Alzheimer’s disease (AD) is a mental retardation mostly caused by cadmium. Also, blood cadmium concentration in Alzheimer’s disease and non-demented subjects were studied. Smokers had higher cadmium level than non-smokers.

Chest pain and projection will have a spread of causes, that is completely different in adults and youngsters. Reasons will embrace the organic process and abdominal problems, like acid reflux or lesion. Sometimes, a heart problem causes symptoms in adults.

Biological Oxygen Demand (BOD)

It is also known as Biochemical Oxygen Demand (BOD). It is defined as the amount of oxygen consumed during the process of degradation and eventual stabilization of unstable organic substances by the biochemical activities of aerobic and other microbes. This degradation of the chemical complex is a desirable process and the final product is called stabilized wastewater. The aerobic bacteria consume oxygen during the process of oxidization of the organic and other oxidizable inorganic substances. The immensity of biochemical degradation depends on the population of bacteria. An actively growing population of bacteria will consume more oxygen to quickly decompose unstable complexes. Biological/Biochemical Oxygen Demand (BOD) is reduced with the decrease in the quantity of these complexes in the wastewater. Therefore, it can be surmised that BOD is directly proportional to the level of degradable chemical complexes; high concentration of chemical substances will result in the high BOD.

The BOD is a very useful measure of the efficiency of methods of wastewater treatment. A method in which amount of BOD reduced quickly is considered as most effective and efficient method. Therefore, exactly stabilized effluent, when discharge in the body of water, does not cause reduction of oxygen in the water.

Wastewater Disposal Methods

It is a well-known fact that the wastewater should be treated properly and effectively before its disposal into receiving water bodies. Disposal of wastewater may be accomplished with or without treatment.

Disposal of Wastewater by Treatment Methods

There are different methods available for the removal of microorganisms and stabilized the putrescible organic and inorganic chemicals in the wastewater. These methods are known as wastewater treatment methods. It is a very interesting fact that usually microorganisms are used to reduce the large burden of wastewater, which is organic matter. With few exceptions, wastewater treatment plants are integrated with physical, chemical and microbiological methods to concern with the different problems related to wastewater.

According to distinct types of treatment, they are divided into four types. Each type of treatment process has a special purpose, targeting the removal of all sources of materials and reducing the burden of microorganisms from the wastewater.

Primary Treatment of Wastewater

This process is mainly designed to remove the total solids from the wastewater by sedimentation and render it adequately free from pathogenic bacteria by chlorination. Initially, large objects are removed by bar screens from the wastewater flow. It removes a significant amount of particulate matter. The collected objects are then put into the grinder and released back into the wastewater flow.

The wastewater is then allowed to flow to a series of large primary settling compartments in which most of the organic matters and dense inorganic particles such as grit and sands are removed. Usually, there are two types of settling compartment, (a) grit compartment and (b) sedimentation tank or quiescent settling compartment. In grit compartment, wastewater flows very slow which permits large and heavy particulate matter to settle out. In the next step, the municipal and industrial wastes (particulate organic matters) in wastewater are removed in the sedimentation tank. In sedimentation tank, wastewater is allowed to stay for 1 to 3 hours during which most of the suspended organic matter settles out. The sedimented material is in the form of a semi-solid mass called sludge. The efficiency of sludge formation can be increased by the addition of various chemicals to coagulate the suspended particles which enhanced the sedimentation rate. The sludge is not allowed to remain in the bottom of sedimentation tank for a long period because of anaerobic bacteria produce gases during metabolism that tend to resuspend the settled material and increased the odor. Therefore, the sedimentation tank is equipped with scrapper mechanisms that occasionally removes the bottom sludge to a collection hopper. The underflow sludge becomes a waste product of the process. The remaining liquid portion of the wastewater which leaves the tank is called effluent.

 

To be continue...

Aspiration metabolism unwellness is a type of metabolism unwellness that mightiness occur if a person breathes thing in instead of swallowing it. The germs from food particles, spit, vomit, or other substances may infect the airways and lead to aspiration metabolism unwellness.

There are certain bacteria which cannot be stained by Gram's method. In 1882, Paul Ehrlich developed a method of staining such type of bacteria. This method was named, and still known as acid-fast staining and the bacteria were named as acid-fast bacteria. In the same year, Ehrlich's method was improved by Zehil and Neelsen. Nowadays, Ziehl-Neelsen method is believed as most important differential staining procedure used for the identification of acid-fast species of Mycobacterium, Actinomyces, and Nocardia. There are many acid-fast bacteria which are pathogenic, such as M. tuberculosis (tuberculosis), A. israelii (actinomycosis), M. leprae (leprosis), and N. asteroides (nocardiosis).

Acid-fast bacteria may be defined as those cells which keep the color of the primary dye (carbol fuchsin) even after the process of decolorization by the acid-alcohol solution. Those bacteria which fail to do so are known as non-acid-fast bacteria.

Acid-fast bacteria are coated with a thick waxy material, mycolic acid, which makes the bacterial cells highly resistant to the penetration of dyes. The penetration of dye is promoted by using heat as mordant. The heat invades the dye through the waxy coat and into the cytoplasm.

PURPOSE

  • Differentiation between acid-fast and non-acid-fast bacteria.
  • Diagnosis of pulmonary tuberculosis from sputum smear. See also: Examination of Sputum

NEEDS

Specimen

Sputum, body fluid, pus, or swab of cells taken from the location of an infection; a sample of bacteria grown and isolated in culture.

Reagents

  1. Carbol fuchsin
  2. Acid-alcohol solution
  3. Methylene blue

Equipment

  1. Bunsen burner
  2. Wire loop
  3. Glass Slide
  4. Spirit lamp
  5. Microscope

PROCEDURE

Acid-Fast staining by Ziehl-Neelsen method

  1. Take a clean glass slide and prepare a thin smear from the specimen using sterile technique. The smear should be extremely thin covering a large area of the slide.
  2. Dry the smear is air and then fix the slide by passing the slide through the flame.
  3. Cover the slide with carbol fuchsin. Keep it for 5 minutes over a spirit lamp with constant heating but not boiling. Do not allow the stain to dry over the slide.
  4. When the slide is cooled, wash it with tap water.
  5. Flood the slide with acid-alcohol and leave it for 3 minutes. Wash the slide with tap water and drain.
  6. Counterstain with methylene blue for 2 minutes.
  7. Wash the slide with tap water and keep it for dry.
  8. Observe the slide under oil immersion objective.

OBSERVATION

Microscopic examination reveals acid-fast tubercle bacilli as short, straight or slightly curved bright red rods. Non-acid-fast cells appear blue.

Acid-Fast Staining by Mobin Method

In 1985, a Pakistani microbiologist, Abdul Mobin Khan developed a method for the staining of acid-fast bacteria. In this method, heating of flooded primary dye on smear is not required. However, initial fixing of the smear over the flame is necessary in order to increase the permeability of the cell wall and promote the newly formulated primary dye to penetrate the cell.

Needs

Specimen

Sputum, body fluid, pus, or swab of cells taken from the location of an infection; a sample of bacteria grown and isolated in culture.

Reagents

  1. Mobin stain
  2. 1% H2SO4
  3. Crystal violet

Equipment

  1. Wire loop
  2. Bunsen burner
  3. Glass slides
  4. Microscope

Procedure

  1. Using sterile technique, prepare a thin smear from the specimen covering a large area of the glass slide.
  2. Dry the smear in the air and then fix it by passing the slide 20 times through the flame.
  3. Place the smear on the staining rack and cover it with Mobin stain. Keep it for 10 minutes.
  4. Pour off the stain and wash the slide with tap water.
  5. Decolorize the smear by 1% H2SO4 solution till it is light pink.
  6. Wash the slide with tap water and keep it for dry.
  7. Observer the slide under oil immersion objective.

Observation

Microscopic examination reveals acid-fast tubercle bacilli as short, straight or slightly curved red rods while non-acid-fast bacteria as blue.

In 1883 (originally published in 1884), Dr. Hans Christian Gram (1853-1938) developed a technique for the classification of bacteria into two broad groups, Gram-positive and Gram-negative. It is the most important staining technique for the classification and differentiation of bacteria.

The Gram stain consist of four reagents; crystal violet (use as a primary dye), Gram's iodine (use as a mordant), ethyl alcohol (use as a decolorizer), and safranin (use as a counterstain). The Gram-negative, on the other hand, lose the primary dye (crystal violet) when decolorized and, thus, take the color of counterstain (safranin).

The Gram-reaction rely upon the chemical nature of the bacterial cell wall, especially the lipids which comprise 11-22% in Gram-negative cell wall and 1-4% in the Gram-positive cell wall. In the Gram-negative cell wall, the amount of lipids is very high, when the cell is dissolved in alcohol, it leads to the formation of large pores in the cell wall. The dehydrating result of alcohol cannot fill these pores which cause the liberate of primary stain making the cell colorless. Such cells take the color or counterstain (safranin). On the contrary, the amount of lipid is very low in the Gram-positive cell wall and easily dissolved by in ethyl alcohol, causing the formation of very small pores. These pores are further closed by the dehydrating effect of alcohol which does not permit the primary dye (crystal violet) to leave the cell.

PURPOSE

Identification, differentiation, and classification of the bacteria.

NEEDS

Specimen

Sputum, body fluid, pus, or swab of cells taken from the location of an infection; a sample of bacteria or fungi grown and isolated in culture.

Reagents

  1. Crystal violet
  2. Gram iodine
  3. Ethyl alcohol (95%)
  4. Safranin
  5. Ceder wood oil

Equipment

  1. Bunsen burner
  2. Wire loop
  3. Glass slides
  4. Microscope

PROCEDURE

  1. Prepare a smear of the specimen, dry in air and then fix it in low flame.
  2. Flood the smear with crystal violet, and keep it for 1 minute. Wash the smear with running tap water.
  3. Pour Gram's iodine on smear and after 1 minute, wash it with tap water.
  4. Pour alcohol on the smear until the purple color no longer comes from the smear.
  5. Pour safranin on the smear and after 45 seconds, wash it with tap water and keep the smear dry in air.
  6. Observe the stained smear under oil immersion lens and note down the arrangement, shape, and Gram-reaction of the cells.

OBSERVATION

The Gram-positive bacteria appear in purple color and Gram-negative bacteria appear in pink color.

A tickle in the chest may feel like flap or pressure. galore underlying factors can cause this symptom, and some, so much as colds and seasonal allergies, will go away on their own. Others may require medical attention.

Inflammation is when the lining of the stomach becomes inflamed or swollen. This normally happens after the stomach lining has been damaged. inflammation that is durable or revenant is best-known as degenerative inflammation.

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