antibody test kidney Metropolis Healthcare

*Keeping pace with newer biomarkers in Autoimmunity- new antibody test launched for renal disease*

11th March 2015: One of the major kidney diseases, Nephrotic Syndrome is defined by massive continued loss of urinary proteins and edema (water retention).

One of the major causes of Nephrotic Syndrome is Membranous Nephropathy or Membranous Glomerulonephritis which is a chronic inflammatory disease of the glomeruli (the network of capillaries in kidneys that perform the first step in filtering blood). In Membranous Nephropathy, an antibody-antigen complex otherwise called as the immune complex is formed in the glomerulus. This eventually leads to loss in kidney function and kidney failure.

Membranous Nephropathy can be primary (where cause of the disease is not known; idiopathic) or could be secondary (as a result of an underlying condition like prolonged infection, tumor, cancer and even certain medications etc).

It is important to differentiate primary and secondary since the treatment and disease management varies. In Primary Membranous Nephropathy, an individual undergoes an immunosuppressive therapy or kidney transplant), whereas in secondary, the underlying disease is treated.

PLA2R Antibody Test is used to correctly differentiate the two kinds of disease, evaluate the intensity of the disease, monitor therapy and risk assessment after kidney transplant.

Advantages of the test

  • Serum based test and requires only a blood sample
  • Easy to perform
  • Presents a non-invasive alternative to the common biopsy.
  • Anti-PLA2R autoantibodies are a highly specific and sensitive marker for primary MN.

Additionally to its usage in differentiation of primary and secondary MN, the anti-PLA2R titer reveals a high predictive value for:

Disease evaluation

Anti-PLA2R autoantibody results correlate with disease activity (proteinuria). High titers are directly proportional with a severe course of primary MN.

Therapy monitoring

The anti-PLA2R autoantibody titer decreases in patients undergoing successful immunosuppressive therapy. A relapse of disease is associated with a recurrence of the antibodies. Furthermore, a high anti-PLA2R titer was identified as a considerable risk factor for primary MN patients to not achieve a remission of proteinuria.

 Risk assessment

Up to 40 % of patients with primary MN experience a relapse after kidney transplantation. This risk is particularly high if anti-PLA2R autoantibodies are persistently found during the six months after organ transplantation. Therefore, the titer can be useful to assess the necessity and intensity of an immunosuppressive therapy after transplantation to avoid relapses.

Commenting on the test, Dr Deepak Sanghavi who heads the Immunochemistry section at Metropolis Healthcare said “It is an important test that will help improve outcomes and disease management in such a chronic kidney disease. We have tied up with few hospitals and Institute of Kidney Diseases and offer this test at INR 4,500. Out of the suspected samples that we receive, almost 4 out of 10 returns positive”

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Lead poisoning serious threat to GenNext: Metropolis Study

Mumbai June 2015:Lead poisoning remains one of the most important environmental health concerns globally. It is a cumulative toxicant that affects multiple body systems and is particularly harmful to young children. An analysis of 733 blood samples collected over the past one year by Metropolis Healthcare Ltd reveals that 23.47% of the total samples tested positive with Lead poisoning. At Metropolis, Lead Poisoning is tested using high sensitivity technology called ICPMS (Inductively Coupled Plasma Mass Spectrometry) and Graphite Furnace Atomic absorption spectrometry. Blood, Serum and Urine samples can be tested for Lead.

According to a WHO study, lead exposure is estimated to account for 1,43,000 deaths per year with the highest burden in developing regions. Young children are particularly vulnerable to the toxic effects of lead and can suffer profound and permanent adverse health effects, particularly affecting the development of the brain and nervous system. Lead exposure is estimated to contribute to 6,00,000 new cases of children with intellectual disabilities every year. In growing children, lead poisoning causes low IQ, hyperactivity, attention deficit, learning disabilities and anemia.

Lead-based paint and lead-contaminated dust in older buildings are the most common sources of lead poisoning in children. Other sources include contaminated air, water and soil. Lead also causes long-term harm in adults, including increased risk of high blood pressure and kidney damage. Adults who work with batteries, do home renovations or work in auto repair shops also may be exposed to lead. It can induce brain, kidney, stomach, heart, hearing, muscle and fertility damage. Exposure of pregnant women to high levels of lead can cause miscarriage, stillbirth, premature birth and low birth weight, as well as minor malformations. Women with high blood lead levels develop early osteoporosis, lower backache, joint pain and persistent anemia.

Lead Profile

(Reference range : Normal – 0 – 9 μg/dL , Positive – Above 9 μg/dL)

*Children under the age of 6 are especially vulnerable to lead poisoning, which can severely affect mental and physical development. While the American Center for Disease Control and Prevention suggests that a value below 9 ug/dl is safe in children and adults, the healthcare practitioner takes disease management decision based on the symptoms in the patient.

Please note: The data represents patient sample testing in clinically suspected individuals and hence the % of positivity seen cannot be extrapolated to general population. However, possibility of lead toxicity exists across all age groups & should be considered in appropriate clinical settings.

Commenting on the study Dr.SandeepWarghade, Consulting Pathologist Metropolis HealthcareLtd said, “Lead poisoning can be hard to detect even people who seem healthy can have high blood levels of lead. At high levels of exposure, lead damages the brain and central nervous system and can lead to coma, convulsions and even death, signs and symptoms of lead poisoning usually don’t appear until dangerous amounts have accumulated. Lead poisoning can be treated if detected at an early stage; taking some simple precautions can help protect yourself and your family”.

Major sources of blood lead include leaded contaminated soil, drinking water, petrol emissions, household dust, battery recycling, silver refining, paints (especially yellow), pigments, printing presses, ceramic pottery glazes, cosmetics, colours (including kumkum, sindoor, spices and Holi colours), children’s toys (crayons and painted pencils), plant foods and traditional medicines.

Lead poisoning cases in young children are high because of licking or eating lead-containing paint when it is peeling off the walls or toys. Lead from a mother’s blood can pass to the fetus during pregnancy, possibly giving rise to genetic disorders.

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DNA Sequencing: A Powerful Tool In Genomics

What is sequencing?

A DNA molecule carries information in the form of four chemical groups or bases ie. adenine, cytosine, guanine, and thymidine, represented by the letters A, C, G and T. Nucleic acid sequencing is a method for determining the order of the nucleotide bases in a molecule of DNA. Sanger sequencing (the chain-termination method), developed in 1975 by Edward Sanger, was considered the gold standard for nucleic acid sequencing for the subsequent two and a half decades. Life Technologies has been providing automated capillary electrophoresis platforms for sanger sequencing for almost two decades now.

Importance

Knowledge of DNA sequences has become indispensable for basic biological research, other research branches utilizing DNA sequencing, and in numerous applied fields such as:

  • Diagnostic
  • Biotechnology
  • Forensic Biology
  • Biological Systematics.

The advent of DNA sequencing has significantly accelerated biological research and discovery.

The sequencing of the human genome along with related organisms represents has been one of the largest scientific endeavors in the history of mankind. The information garnered from sequencing has provided the raw data for the exploding field of bioinformatics, where computer science and biology live in symbiotic harmony.

Figure 1: 3500Dx is an automated DNA Sequencer/ Genetic Analyzer from Applied Biosystems. It is an In Vitro Diagnostic Medical Device, specifically suited for clinical market for detection of genetic changes that may indicate disease presence or susceptibility..

Figure 2: Electropherogram – is the computer generated output of automated sequencing. The peaks represent the intensity of the fluorescent ddNTPs. The sequence is printed across the top of the peaks. The DNA nucleotides G, A, T, C are represented by black, green, red and blue peaks respectively.

Role of Human Genome Project

Due to immense potential of DNA sequencing, The Human Genome Project, an international research effort to determine the sequence of the human genome was drafted to identify the genes that it contains. The ultimate goal of the Human Genome Project was to decode, letter by letter, the exact sequence of all 3.2 billion nucleotide bases that make up the human genome. This means constructing detailed genetic and physical maps of the human genome. The Project was coordinated by the National Institutes of Health and the U.S. Department of Energy. Additional contributors included universities across the globe. The Human Genome Project formally began in 1990 and was completed in 2003, 2 years ahead of its original schedule.

Impact of Next Generation sequencing in Genomics

The requirement for electrophoretic separation of DNA fragments for reading DNA sequence content in Sanger-based sequencing was the primary bottleneck for throughput with this method, increasing time and limiting the number of reactions that can be run in parallel. Next generation” or “deep” sequencing (NGS) refers to a new, versatile technology of DNA sequencing that permits high-throughput, highly adaptable whole genome-scale assays at reasonable cost and high accuracy.

NGS Platforms for Genomic Research and Diagnostics

The NGS platforms market is dominated by Illumina, which occupies the largest market share. Other companies with commercial platforms include Life Technologies (Thermo Fisher Scientific) (U.S.), 454 Roche (U.S.), and Pacific Biosciences (U.S.). The recently introduced platforms such as HiSeq X Ten and NextSeq 500 from Illumina will drive the market. Based on steps in the NGS workflow, the overall next generation sequencing market has three major segments, namely, pre-sequencing, NGS platforms and services, and NGS data analysis, storage and management. With NGS based assays there is a shift towards data analysis rather than the technical component.

Applications

NGS technology finds applications in research as well as diagnostic fields. Whole genome sequencing, investigation of genome diversity, metagenomics, epigenetics, discovery of non-coding RNAs and protein-binding sites, and gene-expression profiling by RNA sequencing are some of the reseach based applications. Discovery of new microorganisms and viruses by using metagenomic approaches, analysis of viral genome variability within the host (i.e., quasispecies), detection of low-abundance antiviral drug-resistance mutations in patients with human immunodeficiency virus (HIV) infection or viral hepatitis are all possible with NGS.

The major clinical diagnostic/ IVD applications of NGS are detection of germline variants in cancer as well as other genetically inherited disorders, BRCA1/2 mutation detection in familial breast and ovarian cancers, non-invasive prenatal testing (NIPT), pharmacogenomics and personalized medicine, HLA typing and preimplantation genetic diagnosis/ screening (PGD/PGS). At metropolis, we are offering a variety of sequencing based assays in the areas of Predictive Diagnostics (e.g. BRCA1/2), Drug Resistance Detection (e.g. HIV Drug Resistance), Genetic Disorders (e.g. Beta Thalassemia), Pharmacogenetics (AbacavirHypersentitivty in HIV-1), Companion Diagnostics (EGFR, Kras Mutation) etc.

Additional Requisites

Besides NGS instrument and technical expertise, NGS workflow demands strong bioinformatic pipeline, bioinformaticians, experienced geneticist for medical remarks and reporting and genetic counseling services for analyzing and interpretation of sequencing data.

At Metropolis, we are offering a variety of sequencing based assays in the areas of Predictive Diagnostics (e.g. BRCA1/2), Drug Resistance Detection (e.g. HIV Drug Resistance), Genetic Disorders (e.g. Beta Thalassemia), Pharmacogenetics (AbacavirHypersentitivty in HIV-1), Companion Diagnostics (EGFR, Kras Mutation) etc.

The Cytogenetic department in Metropolis is certified by CAP (College of American Pathologist) and NABL (National Accreditation Laboratory Testing and Calibration). We adhere to global quality standards.

A wide range of cytogenetic tests are offered under single roof i.e. ranging from blood, bone marrow, POC (product of conception), prenatal and solid tumors. We also offer genetic counseling. Our expertise lies in offering genetic counseling to number of genetic disorders for different conditions and different age group.

  • Pre – conceptional, prenatal genetic counseling
  • Post natal (pediatric, pubertal, adults) genetic counseling
  • Pre-marital genetic counseling
  • Counseling in cancer genetics

Research & Development – Our R&D is currently working on the following

  • Prenatal: Karyotyping and FISH from Amniotic fluid
  • Postnatal: Karyotyping and FISH from blood in various pediatric cases, Infertility, BOH, Products of conception
  • Cancer genetics: Karyotyping and FISH in various blood cancers ,solid tumors like breast cancers
  • Sperm FISH: In males with abnormal semen analysis report and repeated pregnancy losses with foetal aneuploidies.

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Low Vitamin D levels – Significance beyond Bone Health: Metropolis Healthcare

Despite ample sunlight in India throughout the year, almost 80% of Indians are deficient in Vitamin D. Prolonged Vitamin D deficiency leads to a host of health issues. Recent studies link Vitamin D Deficiency with Diabetes, metabolic syndrome, blood pressure, heart disease, stroke and may even trigger symptoms of depression in a healthy population.

There are various studies that directly correlate Vitamin D deficiency to PTH levels in the blood which is studied further in detail here.

Vitamin D Deficiency& Parathyroid Hormone (PTH)

Vitamin D deficiency, simply put is having low levels of Vitamin D in body, which causes the bones to become thin, porous and brittle.Vitamin D helps the intestines absorb calcium. Once activated, Vitamin D acts to greatly increase the amount of calcium that the intestines can absorb from food. For patients with vitamin D deficiency, it is difficult for the body to obtain calcium from the diet. This often leads to a rise in the PTH level, since the parathyroid glands must increase the PTH production, in order to increase calcium levels they absorb it from bones. Therefore, people with a normal blood calcium levels and a high PTH level may have secondary hyperparathyroidism, which means that the high PTH level is a normal response of healthy parathyroid glands to another problem (like vitamin D deficiency or kidney failure).The sole purpose of the parathyroid glands is to control calcium within the blood in a very tight range between 9.0 and 10.1. In doing so, parathyroid glands also control how much calcium is in the bones, and therefore, how strong and dense the bones are.

Primary hyperparathyroidism

Primary hyperparathyroidism most of the times results due to a non-cancerous tumor of the parathyroid, called an adenoma. Because of the adenoma, the parathyroid can make too much PTH, which can cause calcium to be too high in the blood, and overtime, lead to poor bone health. Sometimes doctors decide to treat primary hyperparathyroidism surgically, by removing the adenoma. If you have primary hyperparathyroidism, you need to work with your doctor to see if you can take vitamin D. Since you may have high blood calcium, it’s important to make sure you’re under a doctor’s supervision if considering taking vitamin D.

Secondary hyperparathyroidism

Secondary hyperparathyroidism is caused by either long term vitamin D deficiency or kidney failure. With long term vitamin D deficiency, the body may not get enough vitamin D to absorb adequate calcium. This can be corrected by treating vitamin D deficiency. It is important to note that accurate diagnosis is important to get to the core of the disorder and decide course and dosage of treatment accordingly.

How does the Human body ensure that there is adequate amount of calcium in the blood?

The human body can produce Vitamin D3 from direct exposure to sunlight. 7-dehydrocholestrerol is converted to Vitamin D3 with the help of UV Rays. However a large population of India does not face the sun as over 80% of the population is deficient in Vitamin D

  • Poor/inefficient exposure to sunlight
  • Sunscreen, full sleeved clothes acts as an impediment
  • Dark colored skin requires longer exposure to sunlight
  • Poor dietary /supplementary intake

When you get enough vitamin D from good sun exposure and supplementation habits and enough calcium from your diet, this allows you to maintain a healthy calcium level in your blood and keep good amounts of calcium in your bones. Healthy vitamin D and calcium habits also help keep your PTH levels in check.

Prolonged Vitamin D Insufficiency or Deficiency leads to reflex increase in PTH levels in the blood. This is called secondary Hyperparathyroidism, in which PTH mobilizes bone calcium which leads to increased bone fragility and risk of fractures or increased level of calcium in blood. Secondary Hyperparathyroidism is commonly the result of compensatory over secretion of PTH in response to Vitamin D deficiency.

In a recent study done by the R&D team at Metropolis Healthcare, the following are the study results.

According to R&D team in Metropolis Healthcare, when the calcium level in the blood drops, due to Vitamin D deficiency, high levels of Parathyroid Hormone (PTH) are secreted by the parathyroid gland, which absorbs calcium from bones, leading it to become brittle and porous.

How it affects the people?

Many people with Vitamin D deficiency can have increased levels of Parathyroid Hormone (PTH) in the body. The main function of PTH is to maintain calcium levels in the blood stream. With the decrease in Vitamin D levels, there will be drop in the calcium levels, in order to balance the calcium level in the blood, parathyroid gland starts secreting high levels of parathyroid hormone. PTH starts to absorb calcium from bone replenishing the calcium level in the blood, which in turns leads to weakening of bones, making it more fragile or prone to fractures.

The Study

In an analysis of over 7,542 patients who underwent both Vitamin D and PTH tests, the following trends emerged.

An increasing trend can be witnessed from 30 to 40 age group and above, indicating an increasing level of susceptibility with progression in age

Observations:

Elevated PTH levels were found in the age group of 20 – 50 years contributing to 24.11%. Such patients are at a high risk of developing High BP, Diabetes, Heart diseases.

Of these deficient samples 28.98% were of women.Vitamin D deficiency with PTH elevation can have several ill effects on bone and increased risk of high BP, Diabetes & Heart disease.

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How Hormone Therapy could change the lives of Breast Cancer patients in India?

Breast cancer is the second most common cancer in Indian women. The incidence is more in urban than rural women. According to a GLOBOCAN report for the year 2012, the incidence of Breast Cancer in women in India was 144,937. Over 70, 218 women died of breast cancer in India in 2012.

For every 2 women newly diagnosed with breast cancer, one lady is dying of it.

Breast Cancer, like many other cancers is curable if detected early. While there are several risk factors, breast cancer can happen to anyone. There are multiple reasons why Breast Cancer is diagnosed in India in the later stages: Fear, Social Stigma, Shyness on part of the women and an overall lack of awareness of the disease.

There is no one way to prevent breast cancer but we can detect it early and treat adequately. One of the bigger challenges in India is lack of data and research that can contribute effectively to prognosis and treatment decisions.

Surgery, Radiotherapy, Chemotherapy and Hormone therapy are the 4 modalities of treatment of Breast Cancer.Every patient of breast cancer needs to be treated individually and pathology reports play a significant part.

One of the areas where data based analysis has been minimal is in the arena of Hormone Therapy.

One major way of defining a type of breast cancer is whether or not it is:

  • ER positive (Estrogen Receptor)
  • PgR Positive (Progesterone Positive)
  • HER2 neu positive (Receptive to Protein Her 2 Neu, which is produced by cancer cells)
  • Triple negative, that is not positive to receptors for estrogen, progesterone, or HER2

If a patient’s breast cancer’s cells have a significant number of receptors for either estrogen or progesterone, the cancer is considered hormone-receptor positive and likely to respond to hormone/endocrine therapies.

Endocrine therapies for breast cancer are treatments usually taken after surgery, chemotherapy, and/or radiation are finished. They are designed to help prevent recurrence of the disease.

Study Overview

There are several literatures in the west that show higher positivity for ER Pgr and Her 2 neu. However Indian investigations show much lesser percentage ranging from 32% to 58%. Also studies in India have been limited to minimal sample size. Another important factor that greatly affects the results is adherence or non-adherence to stringent quality protocols. Right from fixation of the sample to the choice of fixative and various other guidelines need to be followed meticulously to arrive at a high quality study and a reliable report.

Metropolis Healthcare Study

We carried out a retrospective analysis of 3500 breast cancer patients for ER, PR, CerbB2 receptor expression for the last 3 years i.e. 2012, 2013 and till September 2014. SOPs were circulated amongst all surgeons & laboratories for ideal fixation especially with special respect to 1. Cold Ischemic time 2. Total fixation time 3. Choice of fixative. The IHC was carried out using manual & automated staining with standard clones after grading on H & E. The ASCO/CAP guidelines for reporting ER, PgR& Her 2 neu were applied & complimented with a Quick score.

Result: Of the 3500 cases – 68% were ER positive, 61% PgR positive & 27% positive for Her 2 neu. Triple negative cases were 16%. These figures are in concordance with the quality stringent labs in the world & the US CAP recommendations. Although there have been a few reports of closely similar data from India, most of the Indian data shows a lower positivity percentage and has been analyzed on a smaller patient cohort. This is probably the largest cohort of its type.

Why is this study important?

This study is evidence that more breast cancer patients in India are amenable to hormonal & targeted therapy. However due to lack of research, evidence and awareness, this path has not been approached in a big way

How is Hormone Therapy useful to Breast cancer patients?

  • Hormone therapy can reduce the risk of early-stage hormone-receptor-positive breast cancers coming back (recurring) after surgery.
  • Hormonal therapy medicines can also be used to help shrink or slow the growth of advanced-stage or metastatic hormone-receptor-positive breast cancers.
  • It is also a less painful alternative to chemotherapy
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Allergens to Watch Out for This Winter: Metropolis Study

“Allergy” indicates an abnormally hypersensitive immune reaction to naturally occurring substances called antigens.This immune overreaction can results in respiratory symptoms like breathlessness, coughing, sneezing, runny nose and scratchy throat, skin related symptoms like itching, hives and rashes. In severe cases it can also result in lower blood pressure, asthma attacks, and in a rare event, even death.

Allergy testing is critical to make proper avoidance recommendations, to prevent further harm and provide the required guidance in proper selection and timing of medications. An allergy test comprises of a screening test wherein it is determined whether a person is atopic or not. If the test result is positive, then based on symptoms, age, environment, geographical location, medical history, the patient undergoes a panel test which determines the exact allergen causing problem. There are several panels ranging from inhalant, food, environment, territory specific, indoor etc and over 700 different allergens can be tested for. This method is US FDA approved and Anti-histamines do not have any effect on the test results.

In order to understand the intensity of the allergy pattern in the country, Metropolis Healthcare Ltd, the Pathology Specialist, conducted a comprehensive study on 20,293 tests processed in 2014. Out of 20,293 samples 15.79% showed the positive allergen results in their blood samples.

TypePositiveNegativeGrand Total
Fungus (Mold)37131613532
Dust (Dust mites, House dust, Cockroach dust)131016722982
Food1113980110914
Animal dander18115741755
Pollen (Trees, grasses)2298811110
Grand Total32041708920293

The study reveals the worrying trend in various types of allergens, 43.93% patients were positive for dusts, followed by Pollens, Fungus and Animal dander denotes around 20.63%, 10.50%, 10.31%, respectively.

An analysis of all positive samples reveals the following analysis.

The most common food allergy signs and symptoms include:

  • Hives, itching or eczema
  • Swelling of the lips, face, tongue and throat or other parts of the body
  • Wheezing, nasal congestion or trouble breathing
  • Abdominal pain, diarrhea, nausea or vomiting
  • Dizziness, lightheadedness or fainting

Adding on the study Dr. Deepak Sanghavi, Deputy Chief of Lab Services, Metropolis Healthcare Ltd., Mumbai said “It’s easy to confuse a food allergy with a much more common reaction known as food intolerance. Today allergy blood tests are more convenient and accurate than ever before. When combined with a detailed medical history, allergy testing can identify the specific things that trigger your allergic reactions”

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Water borne diseases and diagnosis

Water-borne diseases are diseases caused due to consumption of contaminated water. Waterborne diseases are very common but often unrecognized. Occurrence is worldwide and the incidence varies from country to country.

Facts and figures on water quality and health (WHO)

  • No safe drinking-water: almost 1 billion people lack access to an improved supply
  • Diarrhoeal disease: 2 million annual deaths attributable to unsafe water, sanitation and hygiene
  • Cholera: more than 50 countries still report cholera to WHO
  • Cancer and tooth/skeletal damage: millions exposed to unsafe levels of naturally-occurring arsenic and fluoride
  • Schistosomiasis: an estimated 260 million infected
  • Emerging challenges: increasing use of wastewater in agriculture is important for livelihood opportunities, but also associated with serious public health risks

Infectious & other causative agents

The most frequent causes of water-borne illnesses are various bacteria, viruses and parasites.

Non-infective agents:

  • heavy metal poisoning, including, cadmium, copper, lead, tin and zinc
  • toxic cyanobacteria (blue green algae) overgrowth in water.

Infective agents:

Bacteria:

damage to gut wall and/or systemic infection:

  • Salmonella spp.
  • Shigella spp.
  • Clostridium perfringens
  • Campylobacter spp.
  • E.coli.
  • Helicobacter pylori
  • Vibrio cholera/V. parahaemolyticus
  • Yersinia enterocolitica
  • S.typhi/Paratyphi
  • Brucella spp.
  • Listeria monocytogenes

Viruses:

  • Hepatitis A and E viruses
  • Noroviruses and other small round structured viruses (SRSV)
  • Rotavirus

Parasites:

  • Cryptosporidium spp.
  • Entamoebahistolytica
  • Giardia lamblia

Clinical features

The most prominent symptom is acute diarrhea, with nausea, vomiting, abdominal pain but the associated dehydration may lead to electrolyte irregularities, acute renal failure, and encephalopathy. Rarely, waterborne illness may be associated with prolonged or more severe complications, such as anemia, shock, hemolytic–uremic syndrome, spontaneous abortion, seizures, and liver, heart, or lung disease.

Nondiarrhoeal waterborne diseases include listeriosis; hepatitis A etc. Systemic involvement is seen in these diseases.

Mode of transmission

Transmission is predominantly via the faecal-oral route or ingestion of contaminated food and water sources. Transmission via aerosols (produced during profuse vomiting) has been implicated in outbreaks involving viral pathogens.

Foodborne and Waterborne Illness: Diagnosis

Clinical History

  • A detailed history to assess changes in the patient’s bowel pattern.
  • Acute diarrhea diagnosis in the clinical setting is based on an increased frequency and looser consistency of stools.
  • Temporal relationships with exposures to food, antibiotics, sick persons, or travel (including hiking and camping) is important.
  • The history may help determine whether the condition is likely to be self limited or requires treatment.
  •  In addition, the history points toward likely causative organisms that may be candidates for testing.
  • For example, a history of blood or mucus in the diarrhea warrants stool examination.

Laboratory examination

  • Stool culture: Stool culture is a test used for the isolation of diarrhea causing organisms from liquid stools. Special nutritional media are used to ensure growth of bacterial pathogens such as Vibrio cholera, Salmonella spp; Shigellaspp.etc.
  • Mass spectrometry based systems are helpful in rapid identification of bacteria.
  • If antibiotic treatment is needed in severe disease, susceptibility testing can be done using disc diffusion and automated microdilution testing.
  • Leukocyte count : Indicate infectious origin especially bacterial diarrhea
  • Fecal occult blood testing: May indicate dysentery (blood in stools) due to certain bacteria such as Shigellaspp, E.coli 157.
  • Screening for ova and parasites: Saline and iodine mounts are done to detect parasitic infections such as Amoebiasis, Hookworm infections.
  • Comprehensive testing for Stool parasites: Includes special stains such as trichrome stain to diagnose parasitic infections.
  • Special stains for opportunistic pathogens: Stains such as Mod.Kinyoun, Mod.Trichrome are used to detect parasitic infections in immunocompromised patients.
  • Stool antigen tests: Stool antigen tests provide rapid, sensitive and reliable diagnosis of parasites such as Giardia, Cryptosporidium. Also useful in viral disease such as Rotavirus, Norovirus and Adenovirus which are being increasingly recognized as leading causes of diarrhea.
  • Serology testing: Serology testing using paired sera is useful for detection of antibodies to various bacteria, virus and parasitic infections, especially in nondiarrhoeal systemic disease.
  • Toxoplasma antibodies, Hepatitis A antibodies, Brucella antibodies can be detected by this test.
  • Blood culture and other sterile site sample cultures: Used to diagnose infections such as Listeriosis, Brucella spp.

Preventive measures

Prevention of the contamination of potable water is very important. Contaminated water should be treated by adequate filtration and disinfection or by boiling.

Vaccines are currently available for cholera and hepatitis A

Outbreak measures

Food and water-borne outbreaks are usually detected following the onset of illness in a group of people who have shared a common meal. The primary objectives of outbreak control are the rapid identification of the causative agent through epidemiological, environmental and laboratory investigations and prevention of further disease by destruction or denaturation of the source.

International measures

International outbreaks are increasingly being recognised, primarily due to the increased trade in food and agricultural products worldwide. Food and water-borne pathogens and contaminants have been identified as potential biological terrorism agents. Cases of rare diseases like botulism should be investigated immediately. Some diseases require notification to the World Health Organization, like cholera.

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heart healthy

Mumbai December 2015:Metropolis Healthcare Ltd, The Pathology Specialist haslaunched ‘The Metropolis Marathon Package’ a comprehensive diagnostic package comprising 20 distinct tests to screen the complete health of a marathoner. The first of its kind diagnostic initiative will be available across Metropolis centers in Mumbai.

The sheer number of Indian runners participating in marathons continues to grow and new half marathons and full marathons are being added every year. Marathon is considered as the ultimate running challenge and marathon enthusiasts train for over a year before the grand finale. Training for a marathon can be just as strenuous as running a marathon. It is important to understand that running for 42kms (full marathon) or 21kms (half-marathon) needs a different conditioning for the body and muscles.

‘The Metropolis Marathon Package’ is a comprehensive health package comprising a group of tests to screen the complete health of individuals taking part in the marathon which includes an in-depth cardiac risk analysis and an overall assessment of kidney and liver function. Whether you are a novice or a seasoned marathon runner, it is important to know your physical limits and capabilities. Prolong running may cause difficulties to heart in refilling chambers and abnormalities in pumping blood from the right side of the heart to the lungs.

Health checks every runner must undergo

  • Are you fit enough to run a Marathon?
  • Do you have a family history of Diabetes/Blood pressure/Heart Attack?
  • Need for medical clearance before a marathon?
  • What are the risks associated with a Marathon?
  • General Body Check
    Test Name: CBC- To check anaemia, infection and measure cell count of various blood components.
    Result: Good haemoglobin levels are very important for marathon runners.
  • Diabetes Check 
    Test Name: HBA1c, Glucose Fasting, D3 HydroxyButarate.
    Result: Endurance training lowers blood sugar. May lead to diabetic ketoacidosis which is life-threatening. The above tests will help diabetics plan their insulin doses and also screen general mass of diabetes.
  • Cardiac Check 
    • Test Name: Lipid Profile Mini, CPK-Total, Stress test, ECG, Blood Pressure.
      Result: High levels of HDL cholesterol are generally observed in endurance / marathon trainers. HDL facilitates fibrinolysis and prevents the occurrence of coronary heart disease. Abnormally high levels of LDL may require further testing before the run.
    • Test Name: CPK
      Result:High CPK suggests muscle / heart / brain injury which may be aggravated because of endurance training. Hence it becomes important to monitor CPK.
    • Test Name:ECG/Stress Test
      Result: Important test to monitor the functioning of heart in order to prevent sudden heart failure post marathon.
  • Bone Health Check 
    Test Name: Calcium / Vit D
    Result: People with low calcium and Vit D are more prone to ligament / muscular/ bone injuries. Such deficiencies prolong the process of healing of injuries.
  • Kidney Health Check 
    Test Name: Kidney Function Test
    Result: Kidneys help regulate blood pressure and plays a vital role in the production of RBCs. Normal kidneys is required for high level endurance training.
  • Liver Health Check 
    Test Name: Liver function Test
    Result: Liver plays a vital role in digestion, metabolism and detoxification. Hence it is important to monitor this organ before a marathon as during the run large toxins are produced in the body.

Speaking on the launch, Dr Nilesh Shah, Group President & SBU Head, West India, Metropolis Healthcare said, “We have seen and heard of instances where athletes collapse during marathon due to sudden cardiac arrest or shooting up of blood pressure etc. The body undergoes various changes with the age and one must not take it for granted; a thorough check-up should be carried out before undertaking any such activity under the supervision of a qualified physician and one should also understand one’s physical limitation. Nothing is more precious than life. Also patients suffering from asthma, lung or kidney issues, diabetes should be extremely cautious before undertaking the marathon.”

With the huge growing popularity of marathon running, it’s important to make sure that the body is up for the challenge.Getting acquainted of personal health records, heart rate and blood sugar level, is the best way to safeguard long-term health issues by classifying troublesome concerns at the earliest.

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1 in 5 women affected by PCOS: Metropolis Study
  • Women between the age group of 15 and 30 are at high risk of PCOS
  • East India leads the chart with 1 in 4 women suffering from PCOS

Metropolis Healthcare Ltd, a multinational chain of pathology laboratories; conducted an inclusive study on Polycystic Ovarian Syndrome (PCOS) to observe the trends in PCOS cases in young women in India. Polycystic Ovarian Syndrome commonly known as PCOS, is a very prevalent reproductive disorder in women and the leading cause of fertility among women today.

Metropolis conducted a comprehensive pan India study on 27411 samples of testosterone over a period of 18 months. Out of 27411 samples, around 4824, (17.60%) of the females face hormonal associated risk with polycystic ovarian syndrome.

The increasing trend of PCOS is predominantly seen in the age group 15 to 30 years. Among the samples tested East India shows alarming levels of 25.88% women affected by PCOS, followed by 18.62% in North India, which can be largely attributed to lack of awareness among young women and ignorance.

Commenting on the study Dr.SonaliKolte, General Manager – Medico Marketing, Metropolis Healthcare Ltd said, “Undiagnosed PCOS can lead to infertility and in long term can cause several health complications; which can be attributed to other factors as well. Early diagnosis and treatment can help control the symptoms and prevent health related problems. Today a lot of young women are aware of the condition and seek medical help”

What is PCOS? It is a common misconception that PCOS is all about cysts but it is in fact a characteristic amalgamation of cosmetic, gynecological and metabolic symptoms. Cosmetic symptoms include facial hair, thinning of the scalp and acne. Gynecological symptoms include irregular or scanty periods which are usually the first red flag in adolescents. Infertility and recurrent pregnancy loss affects the women in the reproductive age. PCOS in older women could even lead to cancer of the uterus, cardiac disease and type 2 diabetes. Hence it is important to manage the symptom along with proper diet and exercise. Awareness and accurate diagnosis is the first step in managing PCOS in a way that it improves quality of life of the patient. Women with PCOS may have enlarged ovaries that contain small collection of fluids called cyst. The cysts are not harmful, but can lead to hormonal imbalances.

Diagnosis: Testosterone test along with a host of other tests (blood sugar, insulin, FSH, LH, 17OHP, DHEAS) are carried out to ascertain PCOS in women. Testosterone plays an important role in both men and women, as it affects the brain, bone, muscle, fat distribution, sexual functions etc. Women have much lower amount of testosterone in the body compared to men.

The below tables has been segregated zone wise to give an overall picture of PCOS in India

ZoneAbnormal Profiles (in %)
North India18.62
East India25.88
West India19.88
South India18

(Reference range: Testosterone Total: 15 – 70 ng/dl, Testosterone Free: 0.29 – 3.18 pg/ml, DHEAS: 45 – 270 ug/dl)

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Top Heart Healthy Foods for you
Heart Healthy FoodsNutritional Value
Ground FlaxseedOmega 3 Fatty Acids, Fibre, phytoestrogens
Almonds & WalnutsOmega 3 Fatty Acids, Vitamin E, Magnesium, Mono and Polyunsaturated fats, phytosterols
Black or Kidney BeansB Complex Vitamins, Niacin, Folate, Magnesium, Omega 3 Fatty Acids, Calcium, Soluble Fibre
OatmealOmega 3 Fatty Acids, Magnesium, Pottasium, Folate, Niacin, Calcium, Soluble Fibre
Brown RiceB Complex Vitamins, Fiber, Niacin, Magnesium
BroccoliBeta Carotene, Vitamin C & E, Pottasium, Folate, Calcium, Fibre
Sweet PotatoBeta Carotene, Vitamin A, C & E, Fibre
OrangesBeta Cryptoxanthin, Beta and Alpha Carotene, Lutein and Flavones, Vitamin C, Pottasium, Folate, Fibre
SpinachLutein, B Complex Vitamins, Magnesium, Potassium, Calcium, Fibre
TomatoesBeta and Alpha Carotene, Lycopene, Lutein, Vitamin C, Pottasium, Folate, Fibre
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