ROUTINE INVESTIGATIONS NORMAL RANGE

Below is a set of Routine investigations with there normal range. These values are from a well known hospital in new delhi. It is only for reference purpose, to be more accurate please checkout your own hospital's normal range values.
1. Bl. sugar
   F   :       mg/dl ( 60- 100)
   PP :       mg/dl (90-160)
   R  :        mg/dl (60-  140)

2. Kidney Function Test
   Urea          : mg/dl (15-45)
   Creatinine  : mg/dl (0.6-1.2)
    Uric acid  : mg/dl (2.5-6.0)

3. Liver Function Test
    Total Bil       : mg/dl (0.2-1.2)
    Direct Bil     : mg/dl (0.1-0.3)
    Indirect Bil   : mg/dl (0.2-1.1)
    SGOT         : U/L  (15-50)
    SGPT          : U/L  (15-50)
    Alk. Phos    :  U/L  (50- 300)

4. S. Protiens
    T. prot      :gm/ dl (6.0-8.0)
    Albumin    :gm/dl (3.5-5.5)
    Globulin    :gm/dl (1.5-3.5)

5. Lipid Profile
    T. Cholest     : mg/dl (130-230)
    HDL Chol     : mg/dl (30-65)
    LDL Chol      : mg/dl (50-150)
    VLDL Chol   : mg/dl (up to 40)
    Triglyceride   : mg/dl (50- 200)

6. Serum Electrolytes
    Na  : mmol/l (130-150)
    K   : mmol/l (3.5-5.5)
    Cl  : mg/dl (100-110)
    Ca : mg/dl (8.5-10.5)
    P   : mg/dl (3.5-5.5)

7. Cardiac Profile
    CPK     : U/L ( 50-200)
    Ck-MB : U/L (up to 25)
     LDH    : U/L (up to 260)
     SGOT : U/L (15-50)
   
8. Iron profile
    T. Iron        : ug/dl (60-150)
    TIBC          : ug/dl (250-400)
    UIBC         : ug/dl (150-250)
    Saturation   : % (20-35)

All about the "pill"

Oral contraceptives can be taken by a woman to prevent pregnancy. A prescription is required and the pills are often inexpensive. They also can often be obtained at a family planning clinic if you have no regular physician. The pills have very few side effects, and many that do occur disappear after two or three cycles. Oral contraceptives also keep your cycle regular, can make your periods lighter and shorter, and are effective if used correctly.

How to use

It is a big irony  that many well educated women don’t know how to correctly use OC pills (oral contraceptive pills).

But before talking about this I must let u know that there are two types of pill packs available in d market. 1. 21 day pill pack  2. 28 day pill pack.

Start the pill within five days after the onset of your last menstrual period. During this time, the body is not fertile. Adding the contraceptive pill at this time ensures that there is enough time for the hormones to enter the system before fertility occurs. Some people recommends starting it one a Sunday for each cycle, as it is easy remembered.

Take a pill each day. For 21 day pack users they will have a 7 day pill free period, after which start d next pack. For 28 day pack users its d same, only difference is that they don’t have to stop taking the pill.

Missed pill????

If u have missed a pill there is no need to panic. You can take a pill as soon as you remember, then take that days scheduled pill on the normal time.

(e.g. if u forgot to take the pill of say yesterday and remembered about it at 2 o’clock today, take d pill immediately and then take todays pill on the normal time.)

If u have missed 2 pill on a row, even then the above said method works well. Take one pill immediately (not 2 pills) then take scheduled pill of the day according to time.

If u have missed 3 or more pills in a row then it becomes a matter of concern. U should take a pill immediately (only one) and continue to take the rest pack, but u will have to use other contraceptive methods for the rest of the cycle ( e.g condoms, spermicides).

Smokers more likely to be impulsive

A new study has revealed that people who smoke are more likely to be impulsive and indecisive than those who have never smoked in their life.

Researchers of the Charite - Universitatsmedizin Berlin and Physikalisch-Technische Bundesanstalt (PTB) have found that a specific region of the cerebral cortex of smokers is thinner than that of people don't smoke.

This region is decisive for reward, impulse control, and the making of decisions.

To investigate the relation between cortical thickness and nicotine dependence, the brains of 22 smokers and 21 people who have never smoked in their lives were investigated with the aid of a magnetic resonance tomograph.

The measurements were carried out at PTB and furnished high-resolution three-dimensional images of the brain structure.

On the basis of these data, the individual thickness of the cortex could be determined by means of a special evaluation procedure.

A comparison of the two groups showed that in the case of smokers, the thickness of the medial orbito-frontal cortex is, on average, smaller than in the case of people who have never smoked.

The thickness of this region decreased in relation to the increase in the daily consumption of cigarettes, and depending on how long in their lives the participants in the study had been smokers.

Although it is known from animal experiments that nicotine changes the development of the brain and leads to a damaging of neurocytes, it cannot be ruled out that the reduced thickness of the frontal cortex region found in the case of the participants in the study already existed before they started smoking.

Courtesy: Smokers more likely to be impulsive - The Times of India http://timesofindia.indiatimes.com/life-style/health-fitness/health/Smokers-more-likely-to-be-impulsive/articleshow/6833888.cms#ixzz18eCFUzNE

Delhi Medical Council Provisional Registration

This is for all those daredevils who want to do their Internship in Delhi. I must late u know, unless u already know this that to do your internship in delhi u must get registered with the delhi medical council (DMC). If you have got your provisional from MCI then just follow my article, if not wait for the provisional.

OK, first things first. First get your documents ready coz it is biggest headache. Download the form from this link : http://delhimedicalcouncil.nic.in/forms.html

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Next I am giving the list of document you will need. But the most important part is you must get all the documents attested and should also carry all the original documents Coz they verify your documents then and there.

Here is the list:

Applicants having passed final MBBS examination from Delhi

• Application is to be submitted in the office of the Delhi Medical Council along with four recent passport size photographs with name and signature at the backside.
• Provisional degree/diploma or provisional certificate of having passed the MBBS examination issued by the Dean/Principal/Registrar of the College/University in original alongwith relevant copies be forwarded with this application.
• Certificate of Date of Birth (Secondary School Certificate or equivalent).
• Bank Draft for Rs. 500/- (Rupees Five Hundred only) in favour of the Delhi MedicalCouncil payable at New Delhi should be submitted with the application as nonrefundable fee for provisional registration.
• Identity proof : Photo Identity Card / Passport / Driving License / Electoral Card.

Applicants having passed final MBBS examination from other states

In addition to requirements mentioned at (a) the following are to be complied with

• Marksheets of I, II, III (Part 1 & 2) professional exams
• No objection certificate from College/University
• Class 10th & 12th Marksheets with passing certificates
• Provisional registration certificate (In case already provisionally registered with other State medical Council/MCI.)

Applicants having passed final MBBS/MD’Physician’ examination from outside India

• (b) & (c)
• Screening Test Copy
• Copy of the passport duly attested by a Gazetted officer(from the first page to last page with English transalation of the content in the passport)

All the documents are to be produced in original alongwith a photocopy(in case of category (b)* (c)attested photocopies)
Application for provisional registration is to be submitted in person.

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As u must have read above that for provisional registration you must submit a DD of Rs 500. In case you haven’t made the DD and have reached the door steps of MAMC u must be wondering where to make the DD. Don’t worry I have a solution for that too. There is a syndicate bank behind the DMC office building from where you can get the DD made. They charge Rs 30 extra. As far as I can remember you can get it from counter no. 2.

Do remember to write the DD no. in the registration form.

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Having done all this last but very important and frustrating part is how to get there. Don’t worry I am giving u a detailed and the simplest way in.

Delhi metro is the best part of delhi so have a ride- get down in New delhi station ( it is one stop after Rajiv chok in yellow line) – Take a auto or rickshaw to MAMC ( maulana azad medical collage ) – go to the pathology block- just ask for DMC and you are there.

Free advice –

1. Go early, it opens at 9, and there is a long line, so make sure u get there early.
2. Get your documents attested.

Goa Trip

It has been a long time since my last post. actually i had been preoccupied with my studies. Now having finished my exams here i am with a bang!

I visited Goa recently with my tolly. It was great fun. Goa is a great place to be. A must visit place for all am addmi to burn up your hard earned money coz u get value for your money. A bit expensive though.

Dolphin show in d sea

What keeps smokers thin

Previous studies have shown that smokers have less body fat as compared to non-smokers. Now, a new study by US researchers may help explain the reason.

For the study, researchers from WeillMedical College of Cornell University New York evaluated the levels of alpha2-zinc-glycoprotein1 (AZGP1), a gene linked to weight loss, in 37 healthy non-smokers and 55 healthy smokers. They found that AZGP1 levels were higher in smokers than non-smokers.They could not directly prove that smoking induced increases in AZGP1 are enough to mediate weight loss, but they speculate that the increased AZGP1 levels in smokers could be one mechanism contributing to the weight difference between smokers and non-smokers.

This study is published in the May issue of CHEST, the peer-reviewed journal of the American.

Anemia Classification

Classification of Anemia

Anemias can be classified as :-

1)      Cytometric schemes (i.e., those that depend on cell size and hemoglobin-content parameters, such as MCV and MCHC)

2)      Erythrokinetic schemes (those that take into account the rates of rbc production and destruction)

3)      Biochemical/molecular schemes (those that consider the etiology of the anemia at the molecular level).

An example: sickle cell anemia:

• Cytometric classification: normochromic, normocytic
• Erythrokinetic classification: hemolytic
• Biochemical/molecular classification: DNA point mutation producing amino acid substitution in hemoglobin beta chain                                                                                                                     

A. Cytometric classification :- Because cytometric parameters are more easily and less expensively measured than are erythrokinetic and biochemical ones, it is most practical to work from the cytometric classification, to the erythrokinetic, and then (hopefully) to the biochemical. Your first job in working up a patient with anemia is to place the case in one of three major cytometric categories

1) Normochromic, normocytic anemia (normal MCHC, normal MCV) 
  These include:

·  anemias of chronic disease

·  hemolytic anemias (those characterized by accelerated destruction of rbc's)

·  anemia of acute hemorrhage

·  aplastic anemias (those characterized by disappearance of rbc precursors from the marrow)

2) Hypochromic, microcytic anemia (low MCHC, low MCV).
 These include:

·  iron deficiency anemia

·  thalassemias

·  anemia of chronic disease (rare cases)  

3)  Normochromic, macrocytic anemia (normal MCHC, high MCV) 
These include:

·  vitamin B12 deficiency

·  folate deficiency

B. Erythrokineti classification

You would now want to proceed with classifying your case based on the rate of rbc turnover. If this is high, a normoregenerative anemia exists. Such anemias are seen in hemolysis (excess destruction of rbc's) or hemorrhage (loss of rbc's from the vascular compartment. In these cases, the marrow responds appropriately to anemia by briskly stepping up the production of rbc's and releasing them into the bloodstream prematurely. There are several lab tests that allow you to determine if increased rbc turnover exists:

1) Reticulocyte count :- A sample of blood is stained with a supravital dye that marks reticulocytes. An increased number of reticulocytes is seen when the marrow is churning out rbc's at excessive speed (presumably to make up for those lost to hemolysis or hemorrhage). Most labs will report the result of the reticulocyte count in percent of all rbc's counted. A typical normal range is 0.5-1.5 %. Making clinical decisions based on this raw count is somewhat fallacious.

For instance: A normal person with an rbc count of 5,000,000 /microliter and an absolute reticulocyte count of 50,000 /microliter would have a relative retic count of 1.0%. An anemic person with 2,000,000 rbc's/microliter and the same 50,000 retics/microliter would have an apparently "abnormal" relative retic count of 2.5 % and could be misdiagnosed as having high turnover.

Clearly, one needs to find some way to correct the raw retic count so as to avoid this problem. One can easily calculate the absolute retic count (in cells/microliter) by multiplying the rbc count by the relative retic count. The normal range for the absolute retic count is 50,000-90,000 /microliter.

2) Serum unconjugated bilirubin and urine urobilinogen concentration:-
When red cells, at the end of their 120-day life-span, go to the great spleen in the sky, they are systematically dismantled. Through a series of biochemical steps too boring to go into even here, the heme is changed into bilirubin. The bilirubin is greedily scarfed up by the liver, conjugated with glucuronide, squirted into the alimentary tract in the bile, and converted to urobilinogen by evangelical colonic bacteria. The urobilinogen is excreted in the stool (most of it) or reabsorbed and excreted in the urine (very little of it). This is summarized in the next diagram.

In cases of accelerated rbc destruction, the capacity of the liver to capture bilirubin is saturated, and the concentration of unconjugated bilirubin in serum increases, occasionally to the point of producing clinical jaundice. Moreover, the increased production of urobilinogen that results is reflected by increased urobilinogen concentration in the urine. Unconjugated bilirubin is not water soluble and therefore will not be excreted in the urine, despite its elevation in the serum.

3) Serum haptoglobin concentration :-
When an rbc is destroyed, the liberated hemoglobin binds mole-for-mole with a serum protein, haptoglobin. The "purpose" of this reaction is to keep the kidneys from squandering iron (free hemoglobin is freely filtered by the glomerulus, but hemoglobin-haptoglobin complexes are too big to muscle their way through, so that they are safe to bumble their way back to the reticuloendothelial system where they can be properly disassembled). The serum haptoglobin concentration then decreases. Laboratory measurement of haptoglobin is fairly easy and yields useful information to assist in documenting decreased rbc life span.
In the case of hemolysis which takes place in the bloodstream (rather than in the RES), so-called intravascular hemolysis, additional biochemical phenomena are observed (see diagram, below). Free hemoglobin in excess of that which binds haptoglobin is rapidly filtered into the urine. What remains in the plasma spontaneously degrades into metheme and globin. A portion of metheme binds albumin to produce a measurable compound, methemalbumin, while the remainder binds to a measurable serum protein, hemopexin, which then decreases in serum concentration. All of the substances whose names are boxed in the diagram are those whose laboratory measurement is feasible and helpful in documenting hemolysis.         


4) Bone marrow biopsy:-  This can be used to directly observe any accelerated production of rbc's. The ratio of the number of myeloid to erythroid precursors (the M:E ratio) tends to decrease in high-production states, and the marrow becomes hypercellular. Marrow biopsy is not usually performed just to measure the M:E ratio, but to answer other hematologic questions that have been raised.
The normoregenerative anemias are in contrast to those characterized by inadequate marrow response to the degree of anemia. These are the hyporegenerative anemias. In such cases, the reticulocyte production index is decreased. The classic example is aplastic anemia, in which there is primary marrow failure to produce enough erythrocyte mass. As you have probably come to expect, the distinction of these categories is not always absolute. For instance, in thalassemia major there is a degree of hemolysis (generally associated with the normoregenerative states) and inadequate marrow response to the degree of anemia.

C. Biochemical classification
Finally, one should attempt to determine the etiology of the anemia as specifically as possible. In some cases (e.g., iron deficiency), etiologic classification is easily attained; in others (e.g.. aplastic anemia) the biochemical mechanism of disease may be hopelessly elusive. Generally, biochemical tests are aimed at identifying a depleted cofactor necessary for normal hematopoiesis (iron, ferritin, folate, B12), an abnormally functioning enzyme (glucose-6-phosphate dehydrogenase, pyruvate kinase), or abnormal function of the immune system (the direct antiglobulin [Coombs'] test).