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Honours / Skill Enhancement Course (SEC)

Unit 1: Diagnostics Methods Used for Analysis of Blood 

Blood composition, Differential Leucocyte Count (DLC) using Leishman's stain, Platelet count using haemocytometer, Erythrocyte Sedimentary Rate (ESR), Packed Cell Volume (PCV)

Q. What is PCV?
This is a directly measured value obtained from centrifuging blood in a microhematocrit tube in a microhematocrit centrifuge. The PCV is measured as the height of the red cell column in a microhematocrit tube after centrifugation. It is the quickest and most readily available measure of the red blood cell component of blood. Human blood is made up of red blood cells (RBCs) or erythrocytes, white blood cells (WBCs) or leukocytes and platelets which are suspended in a fluid called plasma. Packed Cell Volume or Hematocrit Test is performed to measure the proportion of blood made up of erythrocytes or RBCs. The Packed Cell Volume Test is performed as a part of Complete Blood Count (CBC) Test in regular health check-ups, to diagnose and determine the severity of conditions causing anemia (lower than normal RBC, hemoglobin, or hematocrit), or polycythemia (higher than normal RBC, hemoglobin, or hematocrit), to monitor treatment efficacy for anemia or polycythemia, to determine if blood transfusion is necessary, to assess dehydration etc.
Q. What is Differential Leucocyte Count (DLC)?
Differential count is a very useful tool in clinical diagnosis. Differential count involves determination of the number of each kind of white blood cells (collectively called leucocytes) in a sample of 100 cells for clinical diagnosis purposes. Altogether, there are five different kinds of leucocytes in man- neutrophils, eosinophils, basophils, lymphocytes and monocytes. The first three are considered to be the member of a group, named as granulocytes, while the rest two belong to another group, known as agranulocytes. Three important criteria are considered most useful for the purpose of identifying the leucocytes. They are- cytoplasmic granules, cell size, nuclear shapes of the leucocytes.
A leukocytes’ count, on the contrary, above 10,000 white blood cells per µl of blood, called leukocytes usually indicates infection, allergy, varied diseases, dehydration and emotional disturbances. 

Unit 2: Diagnostic Methods used for Urine Analysis 

Urine Analysis: Physical characteristics; Abnormal constituents, Urine culture

Q. What is the procedure to determine the colony count in urine?
i)Mix the urine sample by  gentle shaking.
ii)Take a standard loop (3mm diameter equal to 0.01 mL) and flame- sterilize. Use a platinum-rhodium fused loop that, after flaming, must be allowed to cool completely before picking up the urine specimen. Hold the loop vertically, immerse it just below the surface of the urine sample and pick up one loopful of the urine sample. Avoid air bubbles.

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Figure: Streaking for colony count without dilution (A) Transfer the urine sample with a sterilized calibrated loop to a culture plate, (B) Make sure that the loop is lifted out of the sample container perpendicularly, (C)Make a single streak in the centre of the plate, (D)Then spread out the streak at right angles.

Standard loop is not available, use any loop and determine the volume of fluid (water) that the loop holds by the weight method. Weigh a weighing paper (wax paper), put 10-loopfuls of water on the wax paper and reweigh. The difference of weight, divided by 10, is the volume of the fluid that the loop holds.

iii)Place one loopful of the well-mixed urine sample on a blood agar plate and another loopful on an EMB or MacConkey agar plate.
iv)Streak both plates, by making a straight line down the centre of the plate and then streaking for isolation, by a series of very close passes at a 90° angle through the original line.
(The sample should be spread out over the entire plate, with no empty areas. Do not sterilize the loop in between streaks).
v)Flame-sterilize the loop after spreading out the inoculum and incubate both plates under aerobic conditions at 37°C for 18-24h.
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Unit 3: Non-infectious Diseases 

Causes, types, symptoms, complications, diagnosis and prevention of Diabetes (Type I and Type II), Hypertension (Primary and secondary), Testing of blood glucose using Glucometer/Kit

Q.What do you mean by benign hypertension?
Benign hypertension is the high blood pressure that does not cause any problem. It is defined as the essential Hypertension that runs a relatively long and symptomless course. In early stages of this condition, there is moderate increase in blood pressure, with systolic pressure of 200mm Hg and the diastolic pressure of about 100 mm Hg. However, in resting conditions and sleep, the blood pressure returns to normal level. Later, there is a further   increase in blood pressure and it does not come back to normal level I in resting conditions. Persistent increase in pressure over the years causes development of vascular, cardiac or renal diseases. 

Q. Mention the significance of the HbA1c.
HbA1c is an important indicator of long-term glycemic (Glycemic control is a medical term referring to the typical levels of blood sugar (glucose) in a person with diabetes mellitus) control with the ability to reflect the cumulative glycemic history of the preceding two to three months. HbA1c not only provides a reliable measure of chronic hyperglycemia but also correlates well with the risk of long-term diabetes complications. Elevated HbA1c has also been regarded as an independent risk factor for coronary heart disease and stroke in subjects with or without diabetes. The valuable information provided by a single HbA1c test has rendered it as a reliable biomarker for the diagnosis and prognosis of diabetes. This review highlights the role of HbA1c in diagnosis and prognosis of diabetes patients.

Q. Mention some ways of preventing Type -I Diabetes.
1.Preventing Cognitive Issues
Type 1 diabetes can lead to changes in brain function, leading to cognitive issues such as confusion and memory loss. Memory issues in particular can be caused by both high blood sugar (hyperglycemia) and low blood sugar (hypoglycemia), so steady blood sugar levels are important. To manage your diabetes, follow your doctor's advice and take your insulin as needed. Regular exercise, a nutritious diet, healthy lifestyle habits, and reduced stress can also help you avoid brain changes.
2.Preventing Skin Disorders
Even your skin can be affected by type 1 diabetes. People with diabetes are more prone to skin conditions, including bacterial, fungal, and yeast infections. In addition to managing your blood sugar, reduce your risk for this diabetes complication with good skin care. Keep your skin clean and well-moisturized. Clean and cover any cuts, scrapes, and burns. Never let skin issues fester. See your doctor if you have a skin problem that doesn't heal quickly.
3.Preventing Eye Problems
The longer you live with type 1 diabetes, the more likely you are to develop eye-related diabetes complications. The most common eye complication is diabetic retinopathy, a disease that destroys the small blood vessels in the retina of the eye. Almost everyone with type 1 diabetes will experience some degree of retinopathy, and 20 to 30 percent will develop the advanced form that can lead to blindness. To lower your risk for vision loss, keep both your blood sugar and your blood pressure under control. See an eye doctor at least once a year, and report any changes in your vision that occur in between regular visits.
4. Preventing Teeth and Gum Issues
Young adults with diabetes have twice the risk for gum (periodontal) disease as their peers who don't have the condition do. For people with diabetes who are over age 45, who smoke, and have poor diabetes control, the risk is nearly five times greater than that of their peers is. This comes from the ability to fight infections. Having diabetes and gum disease can create a vicious cycle — gum disease can make controlling your blood sugar more difficult, and diabetes makes you more prone to gum disease. To help prevent gum disease, visit your dentist regularly for checkups and take good daily care of your teeth by brushing, flossing, and using mouthwash.
5. Preventing Heart Disease and Stroke
Your heart health can be at greater risk if you have type 1 diabetes. If you're overweight, smoke, and don't control your blood sugar well, you could be two to four times more likely to develop cardiovascular disease than someone without type 1 diabetes is. Excess sugar in your blood can damage blood vessel walls. Controlling your blood sugar can reduce your risk for a heart attack or stroke from damaged blood vessels by more than 50 percent. Losing weight, not smoking, and keeping your blood pressure in check can all help, too.
6. Preventing Kidney Disease
7. Preventing Nerve Damage
8. Preventing Sexual Dysfunction
9. Preventing Foot Problems
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Unit 4: Infectious Diseases 

Causes, types, symptoms, diagnosis and prevention of Tuberculosis and Hepatitis, Malarial parasite (Microscope based and ELISA based)

Q. How can tuberculosis be diagnosed?
(i)Tuberculosis can be diagnosed by sputum culture, but because the organisms grow very slowly, cultures must be kept for at least 8 weeks before they are declared negative. Genetic probes are also of value in identification of mycobacteria. 
(ii)Chest X-rays fail to reveal lesions outside the lungs and detect only relatively large ones within them. Therefore, screening is now done by skin tests rather than by X-ray examinations. In a skin test, a small quantity of purified protein derivative (PPD), a protein from tuberculosis bacilli, is injected intracutaneously and examined 48 to 72 hours later for an induration, or a raised, not necessarily reddened bump. Induration is a delayed hypersensitivity reaction to the PPD.
(iii)A positive skin test indicates previous exposure and some degree of immune response. It does not indicate that the person now has or has ever had tuberculosis—the immune response may have prevented infection or eliminated or walled off organisms. In fact, health care workers, teachers, and others who have frequent skin tests may eventually develop a positive response due to sensitization to the test material itself.

Unit 5: Clinical Biochemistry 

Lipid profiling, Liver function test. PSA test

Q.State the significance of PSA test.
)Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in a man’s blood. 
ii)For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter (ng/mL) of blood.
iii)The blood level of PSA is often elevated in men with prostate cancer, and the PSA test was originally approved by the US Food and Drug Administration (FDA) in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. 
iv)In addition to prostate cancer, a number of benign (not cancerous) conditions can cause a man’s PSA level to rise. The most frequent benign prostate conditions that cause an elevation in PSA level are prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH) (enlargement of the prostate).

Lipid Profiling

Liver Function Test

Prostate Specific Antigen Test:

Unit 6: Clinical Microbiology

Antibiotic Sensitivity Test

Q. Why someone needs antibiotic sensitivity test?
i)An antibiotic sensitivity test is used to help find the best treatment for a bacterial infection. It may also be used to find out which treatment will work best on certain fungal infections.
ii)One needs this test if the infection that has been shown to have antibiotic resistance or is otherwise hard to treat. These include tuberculosis, MRSA (Methicillin-resistant Staphylococcus aureus infection is caused by a type of staph bacteria that's become resistant to many of the antibiotics used to treat ordinary staph infections), and C. diff (Clostridium difficile), also known as Clostridioides difficile and often referred to as   C. difficile or C. diff, is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon.). 
iii)One may also need this test for bacterial or fungal infection that is not responding to standard treatments.
In clinical medicine, antibiotics are most frequently prescribed on the basis of a person's symptoms and medical guidelines. This method of antibiotic selection is called empiric therapy, and it is based on knowledge about what bacteria cause an infection, and what antibiotics bacteria may be sensitive or resistant to in a geographical area. For example, a simple urinary tract infection might be treated with trimethoprim/sulfamethoxazole. This is because Escherichia coli is the most likely causative bacterium, and may be sensitive to that combination antibiotic. However, bacteria can be resistant to several classes of antibiotics.] 
iv)This resistance might be because a type of bacteria has intrinsic resistance to some antibiotics, because of resistance following past exposure to antibiotics, or because resistance may be transmitted from other sources such as plasmids. Antibiotic sensitivity testing provides information about which antibiotics are more likely to be successful and should therefore be used to treat the infection.
v)Antibiotic sensitivity testing is also conducted at a population level in some countries as a form of screening. This is to assess the background rates of resistance to antibiotics (for example with methicillin-resistant Staphylococcus aureus), and may influence guidelines and public health measures.

Unit 7: Tumours 

Types (Benign/Malignant), Detection and metastasis; Medical imaging: X-Ray of Bone fracture, 


PET, MRI and CT Scan (using photographs).

Q.Distinguish between malignant and benign tumor.

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