Coomb’s test!

Coomb’s test refers to two clinical blood tests used in  immunology. The two Coombs tests are thedirect Coomb,s test , and the indirect Coombs test .
The more commonly used test, the Direct Coombs test, is used to test for autoimmune hemolytic anemia.
In certain diseases or conditions an individual’s blood may contain IgG antibodies that can specifically bind to antigens on the red blood cell surface membrane, and their circulating red blood cells can become coated with IgG alloantibodies or IgG autoantibodies. Complement proteins may subsequently bind to the bound antibodies.
 The direct Coombs test is used to detect these antibodies or complement proteins that are bound to the surface of red blood cells; a blood sample is taken and the RBCs are washed (removing the patient’s own plasma) and then incubated with antihuman globulin (also known as Coomb”s reagent). If this produces agglutination of RBCs, the direct Coombs test is positive, a visual indication that antibodies  are bound to the surface of red blood cells.
The indirect Coombs test is used in prenatal testing of pregnant women, and in testing blood prior to a blood transfusion. It detects antibodies against RBCs that are present unbound in the patient’s serum. In this case, serum is extracted from the blood, and the serum is incubated with RBCs of known antigenicity. If agglutination occurs, the indirect Coombs test is positive.

iphone is now a stethoscope!

Apple has an amazing new app known as iStethoscope converts your iphone into stethoscope. I’m amazed to see iphone’s versatility.It allows you to listen to your heatbeat and see your heartrate, or listen to other quiet sounds around you. For best results use normal headphones and press the bottom of an to your bare chest. Alternatively, use your earphones and lightly press the inline microphone to the pulse in your neck to hear your heart beating clearly! With a little practice you should be able to find a nice clear sound – when you do, iStethoscope will tell you your current heart rate.

Here is the preview of the app:

Tutorial where to place the iphone and how to use it?

I hope iphone doesn’t replace doctors….. 😉

Fetal circulation!

This is a animation that found out on Google which describes fetal circulation and i guess it will help you in visualizing fetal circulation. Here is the link, Enlighten yourself:

http://www.keele.ac.uk/depts/ms/Flash/cardio.swf

Another reason to be careful of females "DENGUE"

We have to be careful of females because dengue is caused by female anopheles.hahaha…….Jokes apart!! Dengue is spreading in north India and all hospitals are full with dengue patients.There is a need to be aware about dengue and to make you people aware about dengue,here are some FAQs about dengue:

What is dengue fever?

Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. It is an acute illness of sudden onset that usually follows a benign course with symptoms such asheadache, fever, exhaustion, severe muscle and joint pain, lymphadenopathy, and rash. The presence of fever,rash, and headache and other pains)] is particularly characteristic of dengue. Other signs of dengue fever include bleeding gums, severe pain behind the eyes, and red palms and soles.
Dengue strikes people with low levels of immunity. Because it is caused by one of four serotypes of virus, it is possible to get dengue fever multiple times. However, an attack of dengue produces immunity for a lifetime to that particular serotype to which the patient was exposed.

How is dengue fever contracted?

The virus is contracted from the bite of a striped Aedes aegypti mosquito that has previously bitten an infected person. The mosquito flourishes during rainy seasons but can breed in water-filled flower pots, plastic bags, and cans year-round. One mosquito bite can inflict the disease.
The virus is not contagious and cannot be spread directly from person to person. There must be a person-to-mosquito-to-another-person pathway

What are dengue fever symptoms and signs?

After being bitten by a mosquito carrying the virus, the incubation period ranges from 3 to 15  days before the signs and symptoms of dengue appear. Dengue starts with chills, headache, pain upon moving the eyes, and low backache. Painful aching in the legs and joints occurs during the first hours of illness. The temperature rises quickly as high as 104 F (40 C), with relative low heart rate (bradycardia) and low blood pressure (hypotension). The eyes become reddened. A flushing or pale pink rash comes over the face and then disappears.
Fever and other signs of dengue last for two to four days, followed by a rapid drop in body temperature  with profuse sweating. This precedes a period with normal temperature and a sense of well-being that lasts about a day. A second rapid rise in temperature follows. A characteristic rash appears along with the fever and spreads from the extremities to cover the entire body except the face. The palms and soles may be bright red and swollen.

What is the treatment for dengue fever?

Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue, the treatment is purely concerned with relief of the symptoms (symptomatic). Rest and fluid intake for adequate hydration is important. Aspirin andnonsteroidal anti-inflammatory drugs should only be taken under a doctor’s supervision because of the possibility of worsening hemorrhagic complications. Acetaminophen(Tylenol) and codeine may be given for severe headache and for the joint and muscle pain (myalgia).

What is dengue hemorrhagic fever?

Dengue hemorrhagic fever (DHF) is a specific syndrome that tends to affect children under 10 years of age. It causes abdominal pain,hemorrhage (bleeding), and circulatory collapse (shock). DHF is also called Philippine, Thai, or Southeast Asian hemorrhagic fever and dengue shock syndrome.
DHF starts abruptly with high continuous fever and headache. There are respiratory and intestinal symptoms with sore throat, cough,nausea, vomiting, and abdominal pain. Shock occurs two to six days after the start of symptoms with sudden collapse, cool, clammy extremities (the trunk is often warm), weak pulse, and blueness around the mouth (circumoral cyanosis).
In DHF, there is bleeding with easy bruising, blood spots in the skin (petechiae), spitting up blood (hematemesis), blood in the stool (melena), bleeding gums, and nosebleeds(epistaxis). Pneumonia is common, and inflammation of the heart (myocarditis) may be present.
Patients with DHF must be monitored closely for the first few days since shock may occur or recur precipitously (dengue shock syndrome). Cyanotic (bluish) patients are given oxygen. Vascular collapse (shock) requires immediate fluid replacement. Blood transfusions may be needed to control bleeding.
The mortality (death) rate with DHF is significant. It ranges from 6%-30%. Most deaths occur in children. Infants under a year of age are especially at risk of dying from DHF.
Is there an effective treatment for dengue hemorrhagic fever (DHF)?
As with dengue, there is no specific medication for DHF. It can however be effectively treated by fluid replacement therapy if an early clinical diagnosis is made. Hospitalisation is frequently required in order to adequately manage DHF.


What can be done to reduce the risk of acquiring dengue?
There is no vaccine for preventing dengue. The best preventive measure for residents living in areas infested with Aedes aegypti is to eliminate the places where the mosquito lays her eggs, primarily artificial containers that hold water.
Items that collect rainwater or are used to store water (for example, plastic containers, big drums, buckets, or used automobile tires) should be covered or properly discarded. Pet and animal watering containers and vases with fresh flowers should be emptied and scoured at least once a week. This will eliminate the mosquito eggs and larvae and reduce the number of mosquitoes present in these areas.


Tests for Dengue

  • CBC – WBC Count, Platelet Count, Haematocrit
  • S. Protien, S. Albumin
  • Liver Function Tests
  • Urine – microscopic haematuria
  • Dengue IgG & IgM.
How can dengue fever be diagnosed?



The diagnosis of dengue is usually made clinically. The classic picture is high fever with no localising source of infection, a rash with thrombocytopenia and relative leukopenia – lowplatelet and white blood cell count. Dengue infection can affect many organs and thus may present unusually as liver dysfunction, renal impairment, meningo-encephalitis or gastroenteritis.
  1. Fever, headaches, eye pain, severe dizziness and loss of appetite.
  2. Hemorrhagic tendency (positive tourniquet test, spontaneous bruising, bleeding from mucosagingiva, injection sites, etc.; vomiting blood, or bloody diarrhea)
  3. Thrombocytopenia (<100,000 platelets per mm³ or estimated as less than 3 platelets per high power field)
  4. Evidence of plasma leakage (hematocrit more than 20% higher than expected, or drop in hematocrit of 20% or more from baseline following IV fluid, pleural effusionascites, hypoproteinemia)
  5. Encephalitic occurrences.
Dengue shock syndrome is defined as dengue hemorrhagic fever plus which is the worst stage of dengue has symptoms,such as:  



    • Weak rapid pulse,

    • Narrow pulse pressure (less than 20 mm Hg)

    • Cold, clammy skin and restlessness.