Adrales Amin Antonio Azul Balda Batallones Urgel

Bacteriologic Studies

Antibiotic Sensitivity Test

Determines which antibiotic will kill a particular organism Done in the laboratory Antibiotic test:
Disk Tube dilution

Directions for collecting a specimen: 1. Use of regulation tubes or bottles (sterile) 2. Use regulation plugs to stopper tubes 3. Use only one applicator per tube 4. Collect the specimen on a sterile cotton swab 5. Place the swab in a sterile test tube 6. Seat the plug firmly in place 7. Send the specimen into the laboratory without delay

Caries Activity Test

An estimation of the number of lactobacilli in the saliva in determining the degree of caries actively present in cariessusceptible persons Measure of speed of progression of a carious lesion

LACTOBACILLUS COUNT
*low caries activity 1,000-10,000 lactobacilli per milliliter of saliva *high caries activity 50,000 lactobacilli per milliliter of saliva

SNYDER TEST - measures the ability of the salivary microorganims to form organic acid from a carbohydrate medium -utilizes the an acid medium contaning bromcresol green *bromcresol green- indicates the degree of acid production when inoculated with saliva

Change in color of the medium: Within 24 hrs- high caries rate

48 hrs to 3 days- less caries activity

No color change within 4 days- no caries activity

FOSDICK TEST - a test for determining dental caries activity based on a solution of powdered human enamel in a saliva-glucose-enamel mixture.

BLOOD STUDIES

BLOOD STUDIES
PRINCIPLES OF HEMATOLOGIC DIAGNOSIS ASSOCIATED WITH:
1. 2. 3. 4. 5. Anemia and polycythemia Bleeding Infections Lymph node enlargement Leukemia

BLOOD STUDIES
Common S/S:
Pallor Anemia Bleeding Lymphadenopathy Cardinal signs of inflammation

Anemia and Polycythemia

Subjective symptoms Head ache, vertigo, faintness, cold sensitivity, tinnitus, weakness and irritability Objective symptoms
Pallor, smooth tongue, Plummer-Vinson syndrome and abnormal tongue sensation

Anemia and Polycythemia

Normal RBC adult range
Male : 5.4 0.8 x 106/ mm3 Female : 4.8 0.6 x 106/ mm3

Normal Hemoglobin adult range

Male : 16 2g/100ml of blood Female : 14 2g/100ml of blood

Bleeding
Screening examination includes:
1. 2. 3. 4. 5. Bleeding time Coagulation time and clotting time Clot retraction time Tourniquet test Prothrombin test

Bleeding time
Time required for hemostasis to occur Methods
1. Duke Method
Patient is pricked, about 34 mm deep, with a special needle or lancet, after having been swabbed with alcohol. The patient then wipes the blood every 30 seconds with a filter paper. The test ceases when bleeding ceases. The usual time is about 25 minutes.

Bleeding time
2. Ivy method
Blood pressure cuff is placed on the upper arm and inflated to 40 mmHg. A lancet or scalpel blade is used to make a shallow incision that is 1 millimeter deep on the underside of the forearm. The time from when the incision is made until all bleeding has stopped

Coagulation time and clotting time

Screening test to determine plasma coagulation defects and anticoagulation activity
Lee-White Method

Clot retraction time

Used to assess the ability of a clot to retract and close a wound adequately in a given time Normally 1 hr Affected by platelet deficiency, decreased fibrinogen, anemia, polycythemia and hyperglobulinemia

Tourniquet test
Determines capillary fragility Method includes placement of tourniquet or cuff for 5 mins placed above the elbow
Normal : Few scattered petechial spots Abnormal: Numerous petechial spots Does not indicate a specific diagnosis. May be positive in scurvy, severe prim or secondary thrombocytopenia and several other systemic

Hematologic diagnosis associated with chemotherapy

-for patients with neoplastic diseases -drugs: nitrogen mustard, urethan, cyclophosphamide
Depressant effect on bone marrow
Px develops agranulocytosis
Mucosa becomes smoothand shiny with intensification of color Superficial ulcers in vestibular mucosa Gingival ulcerations (palatal of CI)

Serologic test
*presence of syphilis detected by finding Treponema Pallidum in discharge from the lesion primary syphilitic infection
Early syphilitic lesion Demonstration of spirochetal organisms -BY DARK FIELD EXAMINATION OR DRY SMEAR

secondARY syphilitic infection

-BY COMPLEMENT FIXATION OR PRECIPITATION TEST PRIMARY CHANCERS OF SHORT DURATION RARELY GIVES (+) RESULT

TERTIARY syphilitic infection

(+) SEROLOGIC TEST

Serologic test
Nontreponemal test
(VDRL) flocculation test used for screening
-greater sensitivity

treponemal test
Fta-abs
-most sensitive and specific - Treponemal because it uses Nichols strain of T. pallidum

Serologic test
Alkaline phosphatase
Alkaline phosphatase- bone matrix formed Diseases of liver and biliary system prevents excretion of bile Normal in adults: 1.5-4 Bodansky units Normal in children: 5-14 bodansky units

Inorganic phosphorus
Normal in adult: 3-4.5 mg/100ml influenced by functional state of kidneys by parathyroid and GH and vit d. Renal disease retention of phosphate Parathormone inc. excretion of phosphorus and mobilizes calcium and phosphorus from bone

Serologic test
Calcium
Change in concentration may be caused by rise in
protein-bound or ionized calcium

Normal : 9-11.5 mg/100ml

Pagets disease
Inc. serum protein level
Multiple myeloma Sarcoidosis

Diffuse radiographic pictures Systemic disease

Urine Studies
Urinalysis is not a routine part of the examination of a patient. Frequently used by the dentist if there is a suspicion of diabetes mellitus. Unfortunately presence of melituria alone cannot be a dependent indicator of diabetes mellitus *melituria - sugar in urine - also occurs with lowered renal threshold ( in normal persons, pregnant women, px with chronic renal disease )

 Persistent melituria is most often found to be a glycosuria

*Glycosuria - glucose in urine - occurs frequently w/o diabetes in persons under stress or after ingestion of a high carbohydrate meal.

Glucose test - urine

Urine sample is needed. It should be a clean catch urine specimen. Usually the health care provider checks for glucose in the urine sample using a dipstick made with a color sensitive pad. Urine test strip or dipstick a basic diagnostic tool used to determine pathological changes in a patients urine in standard urinalysis.

 The test strips consist of a ribbon made of plastic or paper of about 5 mm wide, plastic strips have pads impregnated with chemicals that react with the compounds present in the urine producing a characteristic colour.
Normal glucose range in urine: 0 0.8mmol/l(0-15 mg/dl)

 Diagnosis of diabetes mellitus can be made only after a high fasting blood sugar ( 150 mg/ 100ml or more) or impaired glucose tolerance has been demonstrated Determine blood glucose level on a single sample of blood taken 3 hours after ingestion of a breakfast containing 100g of carbohydrate.
If the value is within normal limits (70 to 110mg/100ml of blood) diabetes mellitus is excluded.

If positive, refer the patient to a physician for additional tests and evaluation.

Hematologic concerns

Complete blood count

RBC 4.5-5.5 million/mm3
+ erythrocytosis - high red blood cell count CAUSE: Polycythemia - a bone marrow disease that leads to an abnormal increase in the number of blood cells - Erythropenia - deficiency in the number of erythrocytes

CAUSES:
Anemia Bone marrow failure Excessive bleeding Hemolysis (red blood cell destruction) due to transfusions Blood vessel injury Nutritional deficiencies: iron, copper, folate, vitamins B6 and B12 Pregnancy.

Anemia
Sickle cell anemia Red blood cells become crescent-shaped because of a genetic defect. They break down rapidly, so oxygen does not get to the body's organs, causing anemia. The crescent-shaped red blood cells also get stuck in tiny blood vessels, causing pain. Iron-deficiency anemia occurs because of a lack of the mineral iron in the body. Vitamin-deficiency anemia may occur when vitamin B12 and folate are deficient. These two vitamins are needed to make red blood cells

 WBC
5000-10000 million/mm3 + leukocytosis - elevated number of white cells in the blood ie. leukemia - Leucopenia - shortage of white blood cells in the system
- CAUSE:
- anemia - menorrhagia - abnormally heavy menstrual period

o Normal ranges of :
Neutrophils 54-62% Monocytes 5% Lymphocytes 25-32% Eosinophils 1-3% Basophils 0-3%

 Platelets 150,000 450,000 mm3

parts of the blood that help blood to clot.

+ thrombocytosis - disorder in which your body produces too many platelets (thrombocytes), important role in blood clotting
CAUSE:
blood disease and bone marrow disease- autonomous, primary or essential thrombocytosis or essential thrombocythemia.

- Thrombocytopenia - abnormally low amount of platelets

- This condition is sometimes associated with abnormal bleeding.

Blood Chemistry

A. B. C. D. E. F. G. H. I.

FBS = 70-110 mg/dl BUN = 9-20 mg/dl Serum Protein = 6-7.8 g/dl Albumin = 3.2-4.5 g/dl Globulin = 2.3-3.5 g/dl Serum Calcium = 9-11 mg/dl or 4.5-5.5 mEq/L Serum Uric Acid = 3-8mg/dl Serum Inorganic Phosphorous = 3-4.5 mg/dl Serum Alkaline Phosphatase = 0.5-2 Bodansky units J. Serum Creatinine = 0.7-1.4mg/dl K. Cholesterol (CHOL) = 150 to 250 mg/100ml L. Serum Glutamic Oxaloacetic Transaminase (SGOT)

FBS = 70-110 mg/dl

High value:

diabetes mellitus Cushingss Disease Pheochromocytoma glucagon-producing tumor in patients taking corticosteroids in thiazide diuretic therapy.
insulin secreting tumors extensive liver disease pituitary hypofunction Addisons disease in malabsorption of monosaccharides

Low value:

BUN = 9-20 mg/dl

High BUN readings:
Acute or chronic renal failure Congestive heart failure Urinary tract obstruction

Serum Protein = 6-7.8 g/dl

High total protein:

Lupus erythematosus Rheumatoid arthritis Other collagen diseases Acute liver disease Multiple myeloma
Liver disease Malabsorption Anemia Diarrhea Burns nephrosis

Low total protein values

Albumin = 3.2-4.5 g/dl

High albumin values are rare but may be seen in dehydration and shock Low albumin values are caused by the same processes as the low protein values

Globulin = 2.3-3.5 g/dl

High globulin values:
Multiple myeloma Nephrosis Chrobic ifnectoins Collagen disease Liver disease

Low level
Burns Severe malnutrition

Abnormal A/G ratio is seen in malabsorption, severe liver disease, multiple myeloma, and hodgkins disease

Serum Calcium = 9-11 mg/dl or 4.5-5.5 mEq/L

High levels of calcium

Hyperparathyroidism malignant metastasis to bone multiple myeloma hypervitaminosis D. sarcoidosis Milk-allkali syndrome Pagets disease of bone.
Hypoparathyroidim Vitamin D deficiency (rickets, osteomalacia) diseases that decrease intestinal calcium absorption renal insufficiency.

Low levels occur in

Serum Uric Acid = 2-8mg/dl

Abnormally high Values of uric acid are seen in
Gout Renal failure Leukemia Lymphoma Thiazide diuretic use Starvation Lead poisoning Cancer cchemotherapy

Low levels are rare.

Serum Inorganic Phosphorous = 34.5 mg/dl

When Calcium levels increase, inorganic phosphate levels decrease. Phosphorous levels are regulated by parathyroid hormone, which acts on kidney tubules to inhibit re-absorption, Vitamin D controls intestinal absorption of phosphorous. Phosphorous acts in carbohydrate metabolism, in the production of adenosine triphosphate, in the mineralization of bone and teeth and in the synthesis of nucleic acids. High Values of Phosphorous
Chronic Renal Disease healing bone fractures hypoparathyroidism hypervitaminosis D elevated levels of growth hormone. Hyperparathyroidism Rickets Osteomalacia with the ingestion of antacid drugs.

Low values of Phosphorous

Serum Alkaline Phosphatase = 1.5-4.5(adult) 5-14(children) Bodansky units

High alkaline phosphatase values:
Obstructive liver disease Metastatic carcinoma involving bones Hyperparathyroidism Pagets disease of bone Osteomalacia Rickets Acute or chronic liver disease

Low values:
Hypophosphatasia Hypothyroidism Scurvy

Serum Creatinine = 0.7-1.4mg/dl

High values:
Kidney dsease Acromegaly Large muscle mass

Cholesterol (CHOL) = 150 to 250 mg/100ml

High level are seen in:

Cardiovascular disease Biliary obstruction Hypothyroidism Nephrosis Chronic hepatitis Uncontrolled diabetes mellitus
Acute infections Acute hepatitis Anemia Hemolytic jaundice Malnutrition Occasionall hyperthyroidism

Low level:

Serum Glutamic Oxaloacetic Transaminase (SGOT)

High values:
Acute hepatitis Acute myocardial infarction Cirrhosis Skeletal muscle disease Generalized infections Congestive heart failure

Types of Anemia
1. Factor Deficiency Anemias
Iron, Folic Acid, Vit B12 Deficiency Pernocious Anemia due to lack of intrinsic factor

Types of Anemia
2. Production Defect
Hyperplastic bone marrow (aplastic anemia) Chronic renal, hepatic, neoplastic. Infectious and autoimmune Disorder

Types of Anemia
3. Depletion Anemia
Hemolytic Anemia- caused by genetic defect such as sickle cell anemia and thalassenia (cooleys Anemia) Hemorrhage caused byacute and chronic blood loss such as GIT bleeding

Wintrobe Indices
Estimates the erythrocyte size and hemoglobin content Consists of
1. Mean corpuscular volume (MCV) 2. Mean Corpuscular Hemoglobin(MCH) 3. Mean Corpuscular Hemoglobin Cincentration(MCHC

Wintrobe Indices
Index MCV Calculation Hct x 10 RBC count Normal range 82-1003 Clinical significant macrocytic anemia microcytic

MCH

Hgb x10 RBC count

26-34 pg

hyperchromic (rare)
hypochromic

MCHC

Hgb x 10 Hct

31%-27%

hyperchromic (rare)
hypochromic

Differential WBC count

Granulocytes Neutrophils Basophils Eosinophils Agranulocytes Lymphocytes B-cells make antibodies that bind to pathogens to enable their destruction T-cells coordinates the immune system Killer T-cells kills cells that infected by a virus Monocytes Bacterial infection Bacterial infection Allergic reaction Parasitic Infection

Serologic Test
Test that rely on immunologic mechanisms to demonstrate the presence of either antibodies or antigens associated with specific infection and autoimmune disease. Designed either to identify current infection or to demonstrate antibodies stimulated by past exposure to an organism and the current immunity to the disease.

 Serologic tests are usually quantitated by serial dilutions of the patientss serum called titers. The titer reflects the effectiveness of the patientss immun respone to a current infection and/or the severity of the infection

Syphilis
Viral disease caused by a spirochete (treponema pallidum) transmitted by unproctected sexual contact. Stages:
1. Primary Chancre 2. Secondary Mucous patches 3. Tertiary gummatous necrosis and neurosyphilis

Serologic tests for syphilis

Relies on the detection of a nonspecific antibacterial antibody caled Reagin
1. Rapid Plasma Reagin (RPR) card test 2. Veneral Disease Research Laboratory (VDRL)
For 1 & 2, false positive are common so the need for a more definitive and highly specific test which are as follows:

3. Treponema pallidum Hemagglutinaton Test 4. Fluorescent Treponemal Antibody with absorbed serum (FTA-ABS)

Infectious Nucleosis
Infection that results from initial contact with EB virus The serologic hallmark is the formation of a heterophil or Paul-Bunnel antibody, an antibody that appears shortly after the initial symptoms develop

Acquired Immunodeficienct Syndrome (AIDS)

An autoimmune disease caused by a retrovirus, human immunodeficiency virus (HIV) transmitted usually by unprotected sexual contact

Serologic test for AIDS

1. ELISA (Enzyme-Linked Immunoabsorbent Assay)
Test for the presence of HIV antibodies and antigenic viral components Confirmatory test for HIV/AIDS

2. Western Blot test

Viral Hepatitis
Refers to the inflammation of the liver parenchyma caused by hepatitis viruses (A, B, C, D, E) Transmission of HAV and HEV: Fecal-Oral contamination Transmission of HBV, HCV (Non-A Non-B) and Delta Hepatitis: Unprotedted sex, infected needle sharing, blood transfusion, bodily secretions (sweat, etc.)

Serologic Markers
Hepa A: presence of Hepa A antigen or antibody Hepa B: (preicteric/icteric phase) presence of HBsAg meaning to say, the blood is currently infectious Hepa B: hepatitis B surface antibody (AntiHBs) indicates immune response and is used for testing long term immunity A positive test for Anti-HBs excludes the possibility of the carrier state

 Hepatitis C (non-A, non B hepatitis) clinical features as well as serologic testing are similar in most respects to hepatitis B.
Delta Hepatitis can only develop simultaneousy witg hepattis B infection because replication of the delta virus relies on the HBV genetic codes.