Helicobacter Pylori

PEPTIC ULCER DISEASE

Peptic ulcer are open sores that develop on the inside lining of your stomach or upper small intestine. Not long ago, the common belief was that peptic ulcers were a result of lifestyle. A great deal has changed. Doctors now know that many ulcers are caused by the corkscrew-shaped bacterium Helicobacter pylori, not stress or diet. And instead of taking months or years to treat, ulcer can often be cured in 2 to 4 weeks.


WHAT IS H.PYLORI?

H.Pylori is a spiral-shaped bacteria first found in the human stomach in 1982. It is associated with a variety of gastrointestinal diseases, particularly peptic ulcer and also increases the risk of developing stomach cancer. Nearly all duodenal ulcers and approximately 80% of gastric ulcers are associated with H.pylori infection. Studies have shown the removal of this infection produces significantly higher ulcer healting rates and even cure of the disease. H.plyori infectes more than half of the world's population and is transmitted from person to person. H.pylori can also be found in soe drinking water.


WHO SHOULD BE TESTED ?

1. Patients presenting with recurrent dyspeptic symptoms eg. epigastric pain, abdominal discomfort and nausea suggestive of peptic ulcer should be considered for H.pylori testing.
   
   
2. Patients with newly diagnosed gastric ulcer of those with a history of gastric ulcer who have recurrent symptoms should also be tested for H.pylori.
   
   
3. Because H.pylori is associated with gastric adenocarcinoma, patients with a family history of this stomach cancer should be tested for H.pylori antibodies.
   
   

HOW TO TEST FOR H.PYLORI INFECTION

H.pylori infection is treatable. However, testing for infection before initiating therapy is required to prevent over-treatment and ensure cost-effectiveness. The diagnosis of an active H.pylori infection can be made using one of the noninvasive methods including urea breath test, stool antigen test and blood serology test, or one of several invasive biopsy-based tests that require endoscopy.



BLOOD TEST FOR H.PYLORI INFECTION

Serologic test for H.pylori specific IgG antibody, provides an accurate, simple and less costly way to detect the infection. These methods detect antibodies to H.pylori, which are produced by our immune response to the infection. The accuracy of the test is up to 98% but they may not distinguish active from past infection. The test provides useful information to the doctors in the management of of gastrointestinal problems without having to perform invasive procedures. Repeating the test a few months after treatment may provide a clue to the response towards medications.

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Thalassaemia

Thalassaemia is an inherited form of anaemia with a wide spectrum of severity, varying from the perfectly healthy to the severely anaemia and sometimes stillborn.

Normal red blood cells contain haemoglobin which has 2 main types of melecular chain, alpha and beta. Production of these chains are controlled by genes. An inherited defect in one of these genes results in thalassaemia.

There are 2 main types of Thallassaemia :


(A) ALPHA-THALLASSAEMIA

In this group, there is defective synthesis of the alpha chain. As 4 genes control the formation of this chain, there are 4 types of alpha-thallassaemia according to the number of defective genes present :-

1. 1 defective gene - silient carrier
   Healthy, no anaemia.
   
   
2. 2 defective genes - Alpha-thallassaemia trait
   Healthy, may be mildly anaemia with red blood cell abnormally.
   
   
3. 3 defective genes - Hemoglobin H Disease
   Varies in severity, some may have no disability whilst others may develop anaemia which can be aggravated by certain infections and drugs. Disorder includes bone deformities, enlarged liver and spleen. However, it is usual for affected persons to live a normal life span.
   
   
4. 4 defective genes - Hydrops fetails
   Incompatible with life, results in fetal death before birth.
   
   

The above disorders are hereditary especially in the case of first 2 groups where symptons are not apparent and patients are generally not aware of the disorder until or unless they go through blood examinations.


(B) BETA-THALASSAEMIA

There are 2 main types of disorders from defective synthesis of the beta chain.

1. Beta-thalassaemia minor
   This is in the form of heterozygus or partial inheritance. There is no abnormal physical findings apart from mild anaemia. In most cases, patients become aware of their conditions only after having gone through blood examinations or upon the birth of a child.
   
   
2. Beta-thallasaemia major
   This is in the form of homozygus or complete inheritance, and is usually a severe disorder, through the degree of severity varies widely. Sufferers usually develop anaemia by the third month after birth, with enlargement of liver and spleen and followed by bone deformities and retardation of growth. The anaemia progressively becomes worse, prompting the need for regular blood transfusions. This causes excessive iron deposition in the body tissue and subsequently causes damage to the heart, liver and other organs. Death frequently occurs during adolescence.
   
   

DIAGNOSIS
As symptoms are not apparent in most thallasaemia patients other than those with thallasaemia major, diagnosis in only through blood tests.

Examination of the red blood cells can reveal certain abnormalities that indicate the presence of this disorder. The diagnosis is confirmed by a test called Haemoglobin Electrophoresis.



TREATMENT
People with thallasaemia minor require no treatment apart from receiving folic acid supplement and to avoid oxidant drugs in cases of patients with HbH disease. However, thallasaemia major sufferers often require regular blood transfusions to survive. This may cause an overload of iron in the body to toxic level, making chelation therapy to reduce absorption of iron necessary. Surgery to remove the speeln may be required when blood transfusion requirements become too excessive. The only known method to cure beta-thallasaemia major is by bone marrow transplantation. The success rate may exceed 80%.


PREVENTING
The incidence of thallasaemia can be reduced if carriers and people with thallasaemia trait are aware of their conditions and avoid marrying each other. If you have reasons to believe that any of your immediate family members (parents, siblings, children) could be an unfortunate sufferers of thallasaemia, you are advised to go for a blood test to determine your condition.

Couples who suspect that they could be at risk can now undergo early intrauterine diagnosis of thallasaemia, and where appropriate, termination of pregnancy.

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HbA1c

Why Get Tested?
To monitor a person's diabetes and to aid in treatment decisions.


When To Get Tested?
When first diagnosed with diabetes and then 2 to 4 times per year.


Sample Required?
A blood sample drawn from a vein in the arm or from a fingerprick.


What Is Being Tested?
The test measures the amount of hemoglobin that carries glucose molecules. By measureing HbA1c, you get an idea of the average amount of glucose in your blood over the last few months. As glucose circulates in your blood, some of it spontaneously binds to hemoglobin (the red protein that carries oxygen in your red blood cells). This combination is called hemoglobin A1c(HbA1c). The amount of HbA1c formed is directly related to the amount of glucose in your blood. If your diabetes is not well controlled, your blood glucose levels are high, causing higher HbA1c levels. HbA1c levels do not change quickly since red cells live for 2-3 months. Because of this, the amount of HbA1c in your blood reflect the average amount of glucose in your blood during the last few months.


How Is The Sample Collected For Testing?
Your blood may be drawn from a vein in your arm or in some cases a drop of blood from a fingerprick may be used.


How Is It Used?
The test for HbA1c indicates how well you have controlled your diabetes over the last few months. Even though you may have some very high or very low blood glucose values, HbA1c will give you a picture of the average amount of glucose in your blood over that time period. The result can help you and your doctor know if the measures you are taking to control your diabetes are successful.


When Is It Ordered?
Depending on the type of diabetes that you have, how well your diabetes is controlled, and your doctor, your HbA1c may be measured 2 to 4 times each year. The American Diabetes Association recommends testing your HbA1c :

4 times each year if you have Type I or Type II diabetes and use insulin or
2 times each year if you have Type II diabetes and do not use insulin.

When someone is first diagnosed with diabetes or if control is not good, HbA1c may be ordered more frequently.


What Does The Test Result Mean?
A healthy person without diabetes will have an HbA1c between 4% and 6%. If you are diabetic, the closer your HbA1c is to 6% the better your diabetes in control. For every 1% increase in HbA1c, blood glucose increases approximately 30mg/dl and the risk of complications increases.

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Prostate Gland

What Is Prostate Gland?

Only men have the prostate gland and it is part of the male genital system. It feels like a rubbery mas on rectal examination and is like the size of a large marble. The prostate gland lies on the floor of the pelvis and positions itself between the penis and the bladder.


What Does The Prostate Gland Do ?

It secretes a protein-like mixture rich in albumin for the sperms to live on and it also acts as a transport medium for the sperms. Semen is a mixture of sperms and a collection of fluids secreted by the seminal vesicles, bulbo-urethral glands and the prostate gland.


What Can Go Wrong With The Prostate Gland?

There are 3 main problems:

1. Infection
2. Benign enlargement
3. Cancer
   
   

1. Infection
Acute infection causes pain, fever, chills and a burning sensation when passing urine. Chronic infection may present with vague symptoms like pain or discomfort or no symptoms at all. Some men may be carriers of sexually transmitted disease like Chlamydia, syphills and gonorrhoea. Testing prostatic secretions and urine will identify the offending bacteria.

2. Benign Prostatic Enlargement or Hypertrophy
This is a very common condition, 70% of men have it by the age of 60 and 90% of men by the age of 70. The enlargement of the prostate gland causes compression on the urethra and inteference with the passage of urine. The common symptons are delayed starting, poor weak flow, terminal dribbling and some retention of urine in the bladder.

Sometimes there is acute retention of urine in the bladder causing severe pain and and distress to the patient. Inspite of the common nature of this condition only a small percentage (5-10%) of patients require an operation called prostatectomy which will relieve the obstruction to the passage of urine.


3. Cancer Of The Prostate Gland
It is the most common cancer in man (21%) followed by lung cancer (19%) and bowel cancer (15%). Every year it is the second most common cause of cancern death in men (12%) behind lung cancer (34%) and ahead of bowel cancer (11%). Treatment depends on the staging of the cancer and may comprise a combination of surgery, radiotherapy and hormone therapy.


Screening And EArly Detection of Prostate Cancer

There is a protein in the blood called Prostate Specific Antigen, PSA. It is produced by cells in the prostate gland and is though to play a role in preventing semen from coagulating.

60% of men with early stage prostate cancer already have an elevated PSA level above the highest value found in the normal population (4 ng/mL). Therefore, the blood test of PSA can be used to screen for the presence of this cancer.

PSA levels usually begin to rise 2 - 3 years before prostate cancer begin to invade the surrounding tissue. Therefore annual tests allow early detection of most cancers while still confined within the prostate gland. This augurs well for curative treatment. PSA is therefore a very useful screening test for prostate cancer in men after 40 years of age.

Infection and benign enlargement of the prostate may also caused elevated PSA levels in the blood. The level of PSA in benign hyperthrophy of the prostate is relatively stable or rise slowly. The PSA level in prostate cancer is also 10 times higher for any given gland size than when no cancer is present.

The symptons of prostatitis will be recognised by your doctor and the PSA levels will fall to normal after treatment.


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Homocysteine & Coronary Heart Disease

What Is Homocysteine?

Homocysteine is an amino acid that is produced in the human body. Researches have shown that high levels of homocysteine increase the risk of coronary heart disease. In persons with other risk factors of coronary heart disease eg. hypertension, high cholesterol, smoke, etc, the chances of getting a heart attack will multiply.


Why Is High Homocysteine Level Harmful?

High homocysteine levels in the blood can cause cholesterol to change to a form that is more damaging to the arteries. They can also make blood clot more easily and increase the risk of atherosclerosis (blockage in the arteries). A blockage may result in a heart attack or stroke. Up to 20% of people with heart disease have high homocysteine levels.


What Causes A High Homocysteine Level?

Food that contribute to the hemocysteine level in the blood include meats, eggs, milk, cheese, white flour, caned and highly processed foods. Homocysteine is normally changed into other amino acids for use by the body. However, the enzymes needed to break down homocysteine require folic acid, vitamins B6 and B12 to do the job. If we are deficient in these nutrients, homocysteine levels begin to rise.

Other possible causes of high homocysteine levels include low levels of thyroid hormone, kidney disease, psoriasis, some medicines, or inherited deficiences in the enzymes used to process homocysteine in the body.


What Is The Desired Homocysteine Level?

Homocysteine is measured by blood test. It can be measured at any time of day and does not require special preparation (such as fasting).

For people with no major risk factors for coronary heart disease and do not have atherosclerosis, homocysteine level of up to 15 umoI/L are acceptable. A healthy homocysteine level is less than 10 umoI/L, especially for those who suffer from blockages in any blood vessel, or have other major risk factors of heart disease.


How Can I Lower A High Homocysteine Level?

Eating more fruits and vegetables can help lower homocysteine level by increasing folic acid intake. Good sources of folic acid include cereals, lentils, asparagus, spinach and most beans.

If adjusting your diet is not enough to lower your homocysteine, you will also need to take specific vitamins. A higher dosage of folic acid, vitamin B6 and B12 can help to reduce homocysteine levels in the blood. Vitamin B supplements generally have no side effects.

If taking these vitamins doesn't lower your homocysteine level, your doctor may have you try a higher dose. Or you may need to have some tests to see if you have a health condition that causes high homocysteine levels.


What Happens Next?

It is important to get your homocysteine level rechecked after you have been taking the multivitamin and folic acid for 1 to 2 months. If your homocysteine level remains high, your doctor may change your treatment. If you have a high homocysteine level. You will probably need to have your level checked regularly - may be 2 or 3 times a year. As the cause of cornary disease involves other factors, checking of blood pressure, cholesterol, glucose, etc. may also be required at regular intervals.

Health Screening

What Is Health Screening?

It is an periodic evaluation of the body system to determine an individual's health status. It consists of varied procedures which the physician uses to asses the individual's well being.


What Are The Benefits of Health Screening?

1. Allows early detection of diseases previously unknown to the patient. They include heart disease, hypertension, diabetes mellitus and cancer which are the leading causes of death in developed countries and often have no sympton until the advanced stages when treatment may be too late.
   
   
2. Promote health consciousness among patients.
   
   
3. A comprehensive health screening program that helps in early disease detection is more cost effective than treating the disease itself
   
   
   

What Does Health Screening Involve?

A basic health screening program includes the following :-

1. Review of medical history
   It is an initial interview to determine the patient's previous medical illness, family medical history and present medical symptoms and medications.
   
   
2. Laboratory tests
   Laboratory tests reveal disease and internal status not easily detected by physical examination. It also helps in making accurate diagnosis, assessment of disease status and monitoring the effect of treatment.
   
   
3. Physical examination
   
   
4. Pap smear
   
   
5. ECG
   
   
6. X-ray
   
   
7. Ultrasound
   
   

Who Should Go For Health Screening?

All adults can and should go for health screening. It is particularly recommended for those with a family history of serious illness, those above 40 years of age, and those with high risk of developing significant disease due to diet, lifestyle, nature of work, environment or other circumstances.


How Often Should One Go For Health Screening?

Below 40 years of age - once every 2 years or when necessary
40 years and above - annually


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Microalbumin

Why Get Tested ?
To get screened for a possible kidney disorder.


When To Get Tested?
Annually after a diagnosis of diabetes or hypertension.


Sample Required?
A urine sample.


What Is Being Tested?
Albumin is a protein that is present in high amounts in the blood. When kidneys are functioning properly, no albumin is allowed to leak through into the urine. In kidney failure (the last stage of a slow process of decline in kidney function), large amounts of protein are spilled into the urine. Well before this amount of damage happens, small changes in the blood-filtering parts of the kidney allow very small amounts of albumin to leak through, usually as a result of having diabetes. This condition is called microalbuminuria, and the test that measures this very small amount of albumin is called microalbumin.


How Is The Sample Collected For Testing?
You will be asked to collect either a random sample or urine while you are at the doctor's office or laboratory, or you may be requested to collect a complete 24 hours urine sample. Your doctor or the laboratory will give you a large container and instructions for properly collecting a 24 hours sample.


How Is It Used?
Diabetes is a very common cause of kidney failure. Studies have shown that identifying diabetics in the very early stages of kidney disease (microalbuminuria) help patients and doctor adjust treatment. With better diabetic control and better control of the other complications, such as high blood pressure, the progression of diabetic disease can be slowed or prevented.


When Is It Ordered?
The National Kidney Foundation recommends that Type II diabetics under the age of 70 and Type I diabetics over the age of 12 be screened annually for microalbuminuria. In addition, microalbumin may be ordered when a person is first diagnosed with diabetes.


What Does The Test Result Mean?
Moderately increased microalbumin levels in urine indicate that a person is in one of the very early phases of developing kidney disease. Very high levels are an indication that kidney disease is present in a more severe form. Normal levels are an indication that kidney function is normal.

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Pap Smear

WHAT IS A PAP SMEAR TEST ?

It is a simple test during which cells are removed from the neck of the womb or cervix. These cells are examined under a microscope to check for changes or abnormalities which could lead to cancer.


HOW IS A PAP SMEAR DONE? DOES IT HURT?

Your doctor will use an instrument called speculum to help open your vagina and show the cervix so that a sample of cells can be collected with a small spatula or brush. The procedure may cause discomfort and sometimes pain but it should be minimal if you are not tensed.


WHY SHOULD WOMEN DO PAP SMEAR?

Pap Smear helps to detect cervical cancer, even long before it has developed. Cervical cancer can spread to other organ and cause death, but when found early in the precancerous stage, complete cure is the rule.


RISK FACTORS FOR CERVICAL CANCER

1. Multiple sexual partners
   
   
2. First sexual intercourse before age of 18
   
   
3. Genetial Warts (HPV) or other venereal disease
   
   
4. Sexual partner with genital Warts
   
   
5. Smoking
   
   
6. History of abnormal Pap Smear

HOW RELIABLE IS THE TEST ?

It is about 70% sensitive, which means it may miss abnormal cells 30% of the time. Therefore, regular Pap Smears are very important to allow more chances to detect abnormality. Even though not 100% sensitive, regular Pap Smear is still an effective screening test and had been proven to reduce cervical cancer death.


WHEN SHOULD WOMEN START DOING PAP SMEAR?

The rest should be done following the onset of sexual activity continuing for the rest of a woman's life. Usually, Pap Smear are done once a year until three consecutive normal results are obtained. After this, the frequency of the test depends on recommendation from your doctor.


WHAT IS THE PREPARATION BEFORE GOING FOR PAP SMEAR ?

Avoid using vaginal medications, creams or douches for at least 72 hours, and abstain from sex for 24 to 48 hours before the examination. Schedule the test at about 2 weeks after the first day of the last menstrual period.

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