Clinical laboratory professional specialized to external quality assessment (proficiency testing) schemes for Laboratory medicine and clinical pathology. Author/Writer/Blogger
Detection of a fake or adulterated urine sample is necessary before going to the further process of urine testing in the laboratory. Urine adulteration causes false-positive and false-negative results. However, most attempts of a fake or adulteration in a urine sample can be detected either by a trained collection site personnel or by a laboratory technician during the testing process. Coordination and cooperation between the collection site and the testing laboratory provide effective and reliable test results. There are some methods by which fake or adulterated urine can easily identify.
The exercise tolerance test (ETT) is also known as an exercise electrocardiogram (ECG). This test is done to assess the severity of coronary heart disease. In such condition, the blood vessels are narrowed due to the blockage causing irritation for free-flowing blood supply to the heart. Exercise tolerance test (ETT) assess the response of the heart to raised workload and demand of blood. This is obtained by recording the ECG whilst the patient start walking on a treadmill machine.
Once the patient starts walking on the treadmill, heart rate, blood pressure, general condition and ECG will be monitored continuously. After every 3 minutes, the speed and incline of the treadmill will be increased. The patient will be encouraged to exercise for as long as he/she can and the test will be continued until the patient reaches to the desired heart rate and/or cannot exercise anymore (usually 10 to 15 minutes). After the test, the patient will be asked to rest while his/her ECG and blood pressure are recorded and until his/her recordings reach the normal baseline heart rate. All the recordings will be analyzed by a cardiologist (a doctor with special training to treat heart-related diseases).
An electrocardiogram (ECG) test is done by an ECG machine. It records the electrical activity of the heart. The heart produces micro electrical impulses which spread through the heart muscle to make the heart contract. The micro electrical impulses are detected by an ECG machine. The ECG machine amplifies the micro electrical impulses that occur at each heartbeat and records them on to a paper or computer.
An ECG recording is harmless since it records the electrical impulses coming from your body and it does not put any electricity into your body.
An exercise tolerance test (ETT) records the electrical impulses of your heart whilst you exercise. This test is very useful for a patient experiencing chest pain when they exert themselves. This test is also very useful for the detection of rhythm abnormalities.
Some decades ago this was the routine test of choice to investigate a patient for the presence of narrowing of the arteries to the heart. Nowadays it is common for scans of the heart to be done rather than an ETT. The scans that can be done for the heart include:
Small electrodes are stuck on to the patient's chest. Wires from the electrodes are connected to the ECG machine. The patient is asked to walk on a treadmill and the heart rate, blood pressure, general condition and ECG is monitored continuously. After every 3 minutes, the speed and incline of the treadmill are increased. The patient is encouraged to exercise for as long as he/she can and the test is continued until the patient reaches to the desired heart rate and/or cannot exercise anymore (usually 10 to 15 minutes). After the test, the patient is asked to rest while his/her ECG and blood pressure are recorded and until his/her recordings reach the normal baseline heart rate. All the records are analyzed by a cardiologist. The whole process ends in 15-20 minutes.
An exercise tolerance test (ETT), normally do not cause any complications since, in this procedure, micro electrical pulses are recorded produced by the heart contraction. For this purpose, ECG machine is used which does not input electricity into your body.
If you do not have coronary heart disease (CHD) then complications are rare. However, serious complications occur in a small number of people who have coronary heart disease and there are reports of, very rarely, some people who have died during an ETT.
A wart is a viral infection of the surface layers of the skin. The incubation period varies from a few weeks to several months. Warts can be spread by direct or indirect contact with a wart to damaged skin.
A corn is a small, hardened area of skin which often looks yellow compared to the surrounding skin. It is typically round or corn-shaped, pointing down into the skin. Corns most often form on the feet and sometimes on the hands and are caused by constant or repeated friction or pressure.
A callus is rough, thickened skin spread over a wide area. Like a corn, it caused by constant or repeated friction or pressure, but unlike corns, calluses are flat and have normal skin markings.
It is a clear, colorless fluid formed in the ventricles of the brain mainly by choroid plexus (an interlaced structure or meshwork of tiny small blood vessels in the lateral third and fourth ventricles). It is mainly an ultrafiltrate of plasma.
Waste products excreted from the digestive tract are composed of water (up to 75%), indigestible residue, undigested food, food which is digested but not absorbed, bile, epithelial cells, secretions from the digestive tract, inorganic material, and bacteria. The normal amount of feces in an adult is 100-200 grams per day. Examination of feces is helpful in the investigation of diseases of the gastrointestinal tract.
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.
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.
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.
Types of jaundice are defined as follows:
|Type of Jaundice||Causes||Pathophysiology|
|Conjugated hyperbilirubinemia||Drugs like cyclosporine and estrogen
|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.|
|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|
Total bilirubin = Direct bilirubin + Indirect bilirubin
Direct bilirubin = Total bilirubin – Indirect bilirubin
Indirect bilirubin = Total bilirubin – Direct bilirubin
Bilirubin level more than 15 mg/dl in newborn needs immediate treatment.
If the direct bilirubin level is more than 50%.
If the indirect bilirubin level is less than 15 to 20%.