Clinical Chemistry Blog Notes 15

Drug Testing: a Requirement

2009-09-10T19:37:00.002+08:00

In our modern world today, drugs is said to be one of the factors that can affect the education of students. It can cause change in the students attitute towards life, towards school.

For me, drug testing should be done prior to admission to school. This is because this is one way of ensuring the guidance of the school towards the students. This can serve as the first line of protection and concern. The school will surely not want an addict as a student, and if they are encountering certain problems, and they become users because of this, the school can give them counselling assistance.

If drug testing will be required, it would be best if they do not just do random sampling. This is because this random sampling can yield a low percentage. The other users will not be identified, thus, they will not be given the attention they need.

Yes to drug testing as a school requirement, just as long as it goes for EVERYONE. No exception for anyone.

Answers to Pop Quiz!

2009-09-07T13:01:00.003+08:00

1. Transcribe EMIT.
Enzyme Multiplied Immunoassay Technique

2. When is EMIT commonly used?
commonly used in screening blood (serum) for therapeutic drug monitoring (TDM)

Fill in the blanks:

3. EMIT is a homogenous kind of assay.
4. EMIT is the separation using antibody specificity.
5-7. Quantitation is done by measuring enzyme-substrate reactions using visible spectroscopy, and standard curve.
8. The test makes use of antibodies that are enzyme linked that react only when the sample is positive with the drug being tested.
9 & 10. The specimens of choice for EMIT are blood and urine.

Pop Quiz! EMIT

2009-08-26T11:52:00.004+08:00

1. Transcribe EMIT.

2. When is EMIT commonly used?

Fill in the blanks:

3. EMIT is a ________ kind of assay.

4. EMIT is the separation using ___________ specificity.

5-7. Quantitation is done by measuring ____________reactions using visible ___________, and ___________.

8. The test makes used of __________________ that react only when the sample is positive with the drug being tested.

9 & 10. The specimens of choice for EMIT are __________ and _________.

In your own words, explain the principle of EMIT, and why it is widely used.

EMIT - Enzyme-Multiplied Immunoassay Technique

2009-08-18T21:41:00.006+08:00

What is EMIT?

E- Enzyme

M- Multiplied

I- Immunoassay

T- Technique

Emit is:

cheapest and simplest technique
an analytical method used in Clinical Toxicology
commonly used in screening blood (serum) for TDM (Therapeutic Drug Monitoring) and as a primary screening procedure of abused drugs and their metabolines in the urine.
it is the first homogenous assay to be widely used.
the separation using antibody specificity (antigen binding).
measurement of enzyme-substrate reactions using visible spectroscopy, and standard curve.
produces reliable results
the test utilizes antibodies that are enzyme linked and react only with the specific substance in the sample(urine or blood) is positive with the particular drug being tested.

Components of the Assay & Principle:

drug in the specimen (urine/serum)
Ab -- Antibody
Ag -- Antigen
substrate
enzyme labeled antigen
enzyme bound to drug
reagent enzyme Ag

Ag being measured competes for the Ab binding sites with the antigen that has been labeled with an enzyme

---->

the antibody reagent blocks any enzymatic activity when it is bound with the reagent enzyme Ag complex (thus preventing the formation of the product with a substrate)

---->

then the free Ag-enzyme complexes compete with the Ag (in the sample)

---->

forming a

color change

which are proportional to the concentration of the Ag present in the tested sample.

References: Clinical Laboratory Diagnosis by Henry et. al.

My TOP 10

2009-07-29T14:39:00.009+08:00

This writing project is brought to you by the yearly Top 10 Emerging Influential Blogs of 2009: Visit the site to know more about this project by Ma'am Janet.

These are my choice for the Top Ten Emerging Influential Bloggers

1. Holly Jahangiri - It's All a Matter of Perspective: Mine
http://jahangiri.us/news/

2. Dr. Lorenzo Bernardino - Zorlone
http://zorlone.blogspot.com/

3. Jan Geronimo - Writing to Exhale
http://writingtoexhale.com/

4. Roy dela Cruz - The Struggling Blogger
http://thestrugglingblogger.168center.com/

5. Angel Cuala - Fatherbloggerdotcom
http://fatherblogger.com/

6. Kelvin Servigon - Kelvinonian Ideas 2
http://kelvinonian.com/

7. Irene - Lifelots
http://lifelots.blogspot.com/

8. Bing - I Love/Hate America
http://www.ilovehateamerica.com/

9. Luke - A Walk in the Dark
http://darkestshade.blogspot.com/

10.Dee - Tales from the Mom Side
http://www.talesfromthemomeside.com/

The contest is sponsored by:

Absolute Traders, My Brute Cheats, Business Summaries, Fitness Advantage Club, Events and Corporate Video, http://www.eventsatwork.com/, Dominguez Marketing Communications, Red Mobile, Budget hotel in Makati, Lucio C. Tan Group of Companies and Blog4Reviews.com.

Thyroid Video

2009-07-14T21:27:00.002+08:00

Credits to: http://www.youtube.com/watch?v=0BrOS1W9Lpk

Let’s check your answers!

2009-06-20T12:47:00.008+08:00

Thyroid hormone and calcitonin are the two hormones secreted by the thyroid gland.

Follicles are sphere thyroid cells adjoining core of a viscous substance called colloid.

Triiodothyronine(T3) and Tetraiodothyronine (T4) are the two active forms of thyroid hormone.

Calcitonin is secreted by parafollicular C cells and involved in the calcium homeostasis.

Thyroid gland is a hefty endocrine gland situated in the base of the neck and has a comparable form to that of the butterfly.

Thyroid hormone is concerned with regulation of the metabolic rate , neurologic development and numerous other body functions.

Calcitonin is a 32-amino acid linear polypeptide hormone that is produced in humans primarily by the parafollicular cells.

150 ug/day is the recommended minimum intake of iodine per day.

Thyrotoxicosis is a result of excessive thyroid hormone ingestion or leakage of stored thyroid hormone from storage.

Thyroid Autoimmunity uses bioassay to determine the presence of autoimmune hyperthyroidism.

Case 1

What additional test/s can you suggest to diagnose the patient's disease?

The additional tests that can be performed to differentiate hyperthyroidism and hypothyroidism are the T3 Test, T4 Test, Total T4 Test which are increase in hyperthyroidism and TSH Level is decrease. While in hypothythoidism it is vice – versa. The T3 Test, T4 Test, Total T4 Test are decrease and TSH level is increase.

Based on the clinical manifestation presented what is your primary diagnosis?

The primary diagnosis of the patient’s is she is experiencing postpartum hypothyroidism which cannot be identified easily because the signs and symptoms of being pregnant with that of hypothyroidism are just the same. But after birth of the baby there is a noticeable retarded growth which is also a sign of deficiency in thyroid hormone.

What are the possible signs and symptoms of her disease?

According to Harrison’s Principle of Internal medicine, 17^th Edition the signs of hypothyroidism are dry coarse skin; cool peripheral extremities, puffy face, hands, and feet (myxedema), diffuse alopecia, bradycardia, peripheral edema, delayed tendon reflex relaxation, carpal tunnel syndrome, serous cavity effusions while the symptoms are tiredness, weakness, dry skin, feeling cold, hair loss, difficulty concentrating and poor memory , weight gain with poor appetite, dyspnea, hoarse voice, menorrhagia (later oligomenorrhea or amenorrhea).

Case 2

Aside from the test listed above what additional test can you suggest to diagnose the patient's disease?

Aside from serum TSH and autoantibody test T3 Test, T4 Test, Total T4 Test can be performed to confirm hypothyroidism. The presence of autoantibody indicates that the T- cell of the body attacks its own thyroid gland.

Based on the clinical manifestation presented what is your primary diagnosis?

Based on the clinical manifestations the patient is experiencing hashimotos’ thyroiditis which is a condition caused by inflammation of the thyroid gland. It is an autoimmune disease, which means that the body inappropriately attacks the thyroid gland--as if it was foreign tissue.

What are the possible signs and symptoms of her disease?

Symptoms of Hashimoto's thyroiditis include weight gain, depression, mania, sensitivity to cold, fatigue, panic attacks, bradycardia, tachycardia, high cholesterol, reactive hypoglycemia, constipation, migraines, muscle weakness, cramps, memory loss, infertility and hair loss.

Hashimoto's thyroiditis is often misdiagnosed as depression, cyclothymia, PMS, and, less frequently as bipolar disorder or as anxiety disorder. Testing for TSH and anti-thyroid antibodies can resolve any diagnostic difficulty. (wikipedia.org)

References:

Harrison’s Principle of Internal medicine, 17^th Edition

Pathologic Basis of Disease 7^th Edition, Robbinson et. al.

en.wikipedia.org/wiki/Hashimoto's_thyroiditis

http//www.medicine.net

Picture retrieved from:

vidadeunconsultor.blogspot.com

Quiz: Thyroid Gland

2009-06-16T19:44:00.013+08:00

1. ______________ and ______________ are the two hormones secreted by the thyroid gland.

2. ______________ are sphere thyroid cells adjoining core of a viscous substance called colloid.

3. ______________ and ______________ are the two active forms of thyroid hormone.

4. ______________ is secreted by parafollicular C cells and involved in the calcium homeostasis.

5. ______________ is a hefty endocrine gland situated in the base of the neck and has a comparable form to that of the butterfly.

6. ______________ is concerned with regulation of the metabolic rate , neurologic development and numerous other body functions.

7. ______________ is a 32-amino acid linear polypeptide hormone that is produced in humans primarily by the parafollicular cells.

8. ______________ is the recommended minimum intake of iodine per day.

9. ______________ is a result of excessive thyroid hormone ingestion or leakage of stored thyroid hormone from storage.

10. _____________ uses bioassay to determine the presence of autoimmune hyperthyroidism.

Case Analysis:

Case 1

Maureen is a 35 year old wife. After 10 years of married life Maureen got pregnant. She experienced fatigue, poor attention, weight gain, numbness and tingling of the hands and feet which are usually observable in a normal pregnancy. After giving birth Maureen experienced complications such as anemia and eclampsia. There is also a growth retardation of the fetus.

What additional test can you suggest to diagnose the patient's disease?

Based on the clinical manifestation presented what is your primary diagnosis?

What are the possible signs and symptoms of her disease?

Case 2

Kaikai a 24 year old female is experiencing mild weight gain, intolerance to cold, dry skin and heavy irregular menses. She also experienced fatigue. Upon examination the physician notices facial swelling and enlargement of the thyroid gland. Laboratory examinations are requested.

Laboratory Results:
Thyroid Autoantiboes - present
Serum TSH - high

Aside from the test listed above what additional test can you suggest to diagnose the patient's disease?

Based on the clinical manifestation presented what is your primary diagnosis?

What are the possible signs and symptoms of her disease?

Thyroid Gland

2009-06-02T17:04:00.019+08:00

Endocrine system also composed of thyroid gland. It is a hefty endocrine gland situated in the base of the neck and has a comparable form to that of the butterfly. It is divided into two lobes connected by isthmus bridge. (Gerald Tortora, et. Al.)

The thyroid gland is accountable for the production of two hormones namely thyroid hormone and calcitonin. According to Bishop et. al. calcitonin is secreted by parafollicular C cells and involved in the calcium homeostasis while on the other hand the thyroid hormone is for regulating body metabolism, neurologic development and numerous other body functions. It is concerned with regulation of the metabolic rate by the secretion of thyroid hormone which is stimulated by the thyroid stimulating hormone from the pituitary gland and requires trace amount of iodine. The recommended minimum intake of iodine is 150 ug/day and below 50 ug/day results to inadequate production of thyroid hormone leading to hypothyroidism.

Thyroid cells are organized into follicles. Follicles are sphere thyroid cells adjoining core of a viscous substance called colloid. The major component of colloid is thryglobulin which is manufactured by thyroid follicular cells.

The two active forms of thyroid hormone are the triiodothyronine (T3) and tetraiodothyronine (T4) which are then secreted into the circulation.

Test for Thyroid Evaluation

TSH
It is the most useful test assessing thyroid function.

Serum T3 and T4
It is measured by radioimmunoassay, chemuluminometer assay and immunometric techniques.

Thyroglobulin
It is an ideal tumor marker for thyroid cancer patients

Thyroid Autoimmunity
It uses bioassay to determine the presence of autoimmune hyperthyroidism.

Clinical Significance

Hypothyroidism
It is diagnosed by a low free T4 level which is often associated with enlargement of thyroid gland also known as goiter.

Thyrotoxicosis
It is a result of excessive thyroid hormone ingestion or leakage of stored thyroid hormone from storage.

Grave’s Disease
It is an autoimmune disease in which antibodies are produced that activates the TSH receptor.

References:

Clinical Chemistry 5th Edition

Michael C. Bishop, et. al.

Principles of Anatomy and Physiology 11th Edition
Gerald J. Tortora
Bryan Derrickson

Links:

wikipedia.org

lindsey08-lindsey

kellyshaye16

diarowena17

Picture retrieved from:

flickercreativecommons