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PRE- MEDICAL DIVISION

IMMUNITY AND DISEASE


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IMMUNITY AND DISEASE


4 IMMUNE SYSTEM

System which protect the body from disease is called immune system.

(Immune = Letin term Exempt or Freedom)

 Some terms related to immunity :


 Immunity : Resistance of the body against a pathogen or disease.

 Antigen or Agglutinogen : Proteinous substance which stimulates the production of antibodies is


called antigen.

 Antibody or Agglutinin : It is a complex glycoprotein secreted by B-lymphocytes in response to


an antigen. it is also called Agglutinin.

 Antiserum : Serum of any animal which contains the antibody for a specific antigen is called
antiserum.

 Venom (poison) : Toxic substances secrete by snake and some insect.

 Agglutination : Antigen antibody reaction is called agglutination and study of antigen-antibody reaction
is called serology.

 Toxoid : A bacterial exotoxin which is detoxicated by special procedures to allow its safe use in
immunization against the disease.

 Interleukin : It is a protein substances which stimulate the growth and activate certain kind of W.B.C.
that are involved in Immune response, also act as a secondary messanger that activates the immune
system. EX. IL-1, IL-2, IL-3, IL-4, IL-5

 Immunity (Two Types) :


 Congenital immunity or innate Immunity or Non-specific immunity.

 Acquired immunity or Adaptive or specific immunity


IMMUNITY

Acquired (specific) Innate (Natural)

Active Passive

Natural : Artificial : Natural : Artificial :


Follows clinical or Induced by Transplacental passage Injection of preformed
subclinical infection vaccination of maternal IgG antibody antibody (e.g. ATS)
which protects child for derived from serum
first 6 months of life of human or animals

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 Congenital Immunity :
It is present by birth and in most of animal. It is first line of defence of body. It is made up of following
barriers.

 Anatomical Barrier : It is made up of two parts :-


 Skin : Outermost layer of skin is dead (str. corneum). So the bacteria does not grow or enter into it.
pH of skin destroy the bacteria, sebum of skin also have anti bacterial action.

 Mucosal surface : Food and air passage lined by mucosa. Mucosa contain mucosal cells and cilia.
Mucosa entraps the micro-organism and cilia propell the microbes.

 Physiologocal Barriers : Many physiological functions of body make the unfavourable environment for the
growth of microbes.

 Fever : High temp. of body, inhibit the growth of microbes.

 pH of body : Acidic pH of various part of body like oral cavity, stomach and Vagina inhibit the growth
of microbes.

 Secretions : Secretions of body like Eyes, sebum contain lysozyme enzyme. This enzyme destroys
the microbes.

 Interferon : Anti-viral protein made up to 270 amino acids secreated by virus infected cells and
sitmulates the adjacent cells to produce the Translation inhibiting Protein (T.I.P.)

By this mechanism interferon limits the infection of virus.

Interferons make cells resistant to viral infection by synthesis of antiviral proteins in that cell.

Vertebrate cells when infected with a virus respond by releasing a small amount of a class of glycoprotein
called interferons.

Interferons are species specific i.e. interferons produced by one species can protect only cells of
same species against viral infection.

Types of interferons :

 - produced by Leucocytes. (B-lymphocytes)

 - produced by Fibroblasts.

 - produced by Lymphocytes. (T-lymphocytes)

Interferons can be used for prophylaxis and treatment of viral infections.

 Phagocytic Barrier :- In response to pathogenic infection, the total count of WBC in body increases.
Phagocytosis is exhibited by some types of WBC’s such WBC’s are called phagocytes.

Most important phagocytes are Macrophages and Neutrophils. Monocytes are liberated at the site of
infection these later converted into macrophages.

Macrophages are large irregular shaped cells that engulf microbes, virus, cellular debris etc in response
to an infection.

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Steps of Phagocytosis -

 Vasodilation (Blood stasis)

 Adhesion

 Migration or diapedesis

 Chemotaxis (Neutrophils or Monocytes)

 Phagocytosis
Blood cells
Blood vessels
1
3
4
Bacteria
2

5
Phagocytic cell

Steps of Phagocytosis -

 Vasodilation : At site of entry - Increased diameter of blood vessels.

 Adhesion : Accumulation of leucocytes at periphery of blood vessels due to decreased blood flow.

 Diapedesis : Now the leucocytes (neutrophils or Monocytes) migrates from the blood vessel by Active
movements (Amoeboid movement) into the E.C.F. This kind of active movement of cell, is called
diapedesis.

 Chemotaxis : Now this leucocyte cells move towards the pathogen by chemotactic movement
(Active).

 Phagocytosis :
Attachment
Bacteria
Ingestion

Lysosome
with diagestive
enzymes
Phagosome

Formation of
Macrophage phagolysosome Destruction of
ingested microbes

Phagocytosis

G Attachment (adherence) : The infective agent gets attracted to the membrane of the phagocyte.
G Ingestion : Phagocyte engulfs the particular material into a vacuole (Phagosome). The membrane
of which fuses with a lysosome forming a phagolysosome. Lysosome contains hydrolytic enzymes
and other bactericidal substances.
G Intracellular killing of bacterium : Most bacteria are slaughtered in the phagolysosome by the
hydrolytic enzymes within a few minutes of phagocytosis.

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 Inflammatory Barrier :
 Inflammation : Local response of living mammalian tissue to injury due to any agent. It is the body
defence reaction in order to eleminate or limit the spread of infectious agent.
Inflammation is manifested as pain, swelling, redness and increased temperature in the local area.
 Inflammatory response occurs due to : Release of histamines and prostaglandins from damaged mast
cells. At the site of entry of pathogen, there is redness (due to vasodilation) and swelling of skin due to
accumulation of fluids and High temp. (due to  B.M.R.) and pain (due to secretion of allergic substances
like histamine and prostagladin (PGs) from the damaged cells and PGs stimulate the pain receptors.
 NK-Cell : It is a large granular lymphocyte cell.
During this process apart from the phagocytes, another type of cells called Natural killer cells kill
virus infected cells and tumour cells of body by creating perforin lined pores in the plasma membrane
of target cells (i.e. infected cells). Water enters through these pores causing swelling and bursting of
the diseased cells.

 Complementary system :
It is formed by complementary component of C-component and they are inactive but when agglutination
occurs in our body they become active and show inflammation, cell lysis and promote phagocytosis.
Complement system takes part in both innate and acquired immunity.

Inrushing fluids

Complement
Proteins Pore

Plasma
membrane

Cytoplasm

Fig. Complement proteins creating


a hole in the plasma membrane

 Acquired Immunity :
It is the resistance that an individual acquires during life. This is generated in response to an exposure to
the micro-organism in question.
 This type of immunity is founds only in vertebrates.
 It is also called Adaptive or specific immunity.
This immunity is accquired after birth by experience.
This immunity recognise and selectively eleminate the pathogen.

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 Features of Acquired immunity :

G Specificity : Acquired immunity is specific for specific micro-organisms.

G Diversity : This system have capability to recognise vast variety of micro-organisms.

G Discrimination between self and non-self. It can recognise self (body or tissue) and non self
(Foreign tissue) and respond according to them.

G Memory : When a pathogen enter inside the body, body takes longer times to recognise and
respond to it this is called primary immune response but the memory of this encounter remain
in immune system.

When this pathogen enters second time inside the body, body immune system rapidly recognise
this pathogen and respond quickly to it. This is called secondary immune response. This is
based on memory of immune system.
Blood antibody concentration

st 2nd antigen
I antigen exposure
exposure
Secondary
Primary response (more
response rapid and intense)

0 30 0 60 0 0 90
Time period (in days)

 Types of Acquired Immunity :


Natural
Active
Artificial
Types
Natural
Passive
Artificial

 Active acquired immunity : Resistance developed by an individual as a result an antigenic stimulus.

G Natural : Results from a clinical or inapparents infection by a micro-organism.

G Artificial : Resistances induced by vaccine

Vaccines : Prepaairation of live or killed micro-organism or their products used for immunisation.

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 Passive Immunity : It is received passively by host without participation or contribution from host’s
immune system. Immunological memory is absent here and the readymade antibodies are given in
immuno suppressive individual this is called passive immunity.

Natural
Passive
Artificial

G Natural : Resistance pasively transferred from mother to baby. Mother milk gives passive immunity
to the new born child by colostrum (first mother milk) – IgA type of antibody.

G Artificial : Resistance passively transferred to a recepient by administration of antibodies.

Examples : human immunological administration.

Anti - tetanus serum (ATS)

Anti - rabies serum (ARS)

Anti - diptheria serum (ADS)

 Difference between active and passive immuntiy :

Active immunity Passive immunity


1 Produced actively by the immune system of host 1 Received passively by the host and the host's
immune system does not participate.

2 Induced by infection or by contacts with 2 Conferred by introduction of ready-made


immunogen, e.g. vaccines. antibodies.

3 Immunity develops only after a lag period 3 Immune response-short lived and less effective.

4 Immune response-durable and effective 4 Immunity effective immediately.


5 Immunological memory present. Subsequent 5 No immunological memory. Subsequent
challenge with booster dose more effective. administration of antibody less effective due
to "immune elimination"

6 Serves no purpose in immunodeficient host 6 Applicable in immunodeficient host

7 Used for prophylaxis to increase body resistance 7 Used for treatment of acute infection.

 Active Immunity :
 This immunity develop after infection or vaccination.

 Active immunity is formed by lymphocytes, lymphocytes are produce in bone marrow


(Haematopoisis). After production some of lymphocytes migrates from bone marrow to thymus cells
and mature as T-cells (Thymus cell).

 Lymphocyte which remain in bone marrow mature as B-cells (Bone marrow cells) so, bone marrow
and thymus gland are primary lymphoid organ.

 After maturation some lymphocytes migrate from bone marrow & thymus gland to the spleen & lymph
nodes like tonsils, and proliferate ( number). Here, so spleen and lymph nodes are called secondary
lymphoid organ.

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TM
(Thymus)
T TC Cellular immunity

Bone Marrow 
TH IgG
 IgA
B Plasma-cells IgM Humoral immunity
(Bone Marrow) IgD
BM
IgE
IMMUNE SYSTEM
Based on these two type of lymphocytes there are two types of active immune system.

 C.M.I.S.  Cell mediated immune system or Cellular immunity


This immune system is based on T-cells, (60-70%)

There are 4 type of T-cell

G Helper T-cell

G Killer T-cell or cytotoxic T-cell

G Memory T-cell

G Suppressive T-cell

When pathogens enter inside the body first macrophage interact with them and activates T H-cell by
releasing cytokines or interleukin or Monokines.

 Helper T-cell : This activated helper cell stimulates the killer T-cell and B-cell and these killer T-cell
& B-cell start dividing and produce clone (group of similar cells) this phenomenon is called clonal
selection.

They produce lymphokines (messenger molecules) which cause accumulating of WBCs to the affected
site. T H-cells also stimulate B-cells to produce antibodies and facillitate the action of other T-cells.

 Killer T-cell : These cell or clone of these cell destroy the infected cells or target cell and kill the
pathogen and virus infected cell by secreting Lymphotoxic substances and secret lymphokinin which
attracts phagocytes. These are responsible for cell-mediated immunity. They also destroy transplanted
and other foreign cells.

 Suppressor Cells (TS) : These cell supress the functions of T C and TH cells. B-cells and plasma cells
are also affected by T S cells by secreting suppressor factors to suppress the entire immune system
for attacking the own body.

 Memory T-cell : They don’t kill the pathogen or don’t form the antibodies but these cell retain the
memory or every encounter.

They convertes into effector cells (T C) on later encounter with specific antigen even after several years.

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 Antigen Presenting Cells : In immune mechanism every antigen molecule is processed by antigen
presenting cells like macrophages, B-lymphocyts etc. This processed antigen is presented on the
surface of these cells. When a T-helper lymphocyte passes closely by the side of the antigen presenting
cell bearing the antigen on its surface. It recognise the antigen and become activated. Now T-helper
cells activate the B-cells and T-killer cells. These cells in turn develop clones by frequent divisions in
themselves.

 A.M.I.S. (Antibody mediated immune system or humoral immunity)

 This immune system is based on B-lymphocyte (10-20%) and these B-lymphocyte secret the antibody.

 Antibody or Immunoglobulin : These are complex glycoprotein molecule made up of 4 polypeptide


chains two light and two heavy chains.

 These two chain held together by disulphide bond in shape of Y molecule.

 Two top tips of this molecule bind with antigen [large and complex foreign molecules mainly proteins
that activate the specific immunity] like lock and key fashion and make antigen-antibody complex.

 Function of antibodies :

G Agglutination : Antibody attach with the antigen which is present on the surface of pathogen and
destroy the pathogen by cell lysis.

G Opsonisation : Coating of bacteria (Ag) with opsonin Antibody (IgG and IgM) facilates the phagocyte
cells and these antibodies promote phagocytosis by combination as opsonin.

G Neutralization : Antibodies neutralise the toxin of bacteria by attaching with them.

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 Type of Antibodies –
S. Group of Total Main Characters Functions
No. Antibodies Quantity (%) and occurrence

1 IgG 75-80 Most aboundantly antibodies main Stimulate complementary


(Gamma) immunoglobulin of blood and system, provide immune power
interstitial fluid which has capacity to to human embryo and specific
pass through placenta, M.W. linkage with phagocytic cells for
1,46,000 (lightest) phagocytosis.

2 IgA 10 The primary antibodies present in Protection of mucous


(Alpha) colostrum, M.W. 1,70,000 : present membranes and outer surface of
in saliva, mucus and other body and protection from inhaled
secretions. ingested pathogens.

3 IgM 5-10 Oldest and first antibody generated in First antibody generated at the
(Mu) response to antigens, present in time of defence, strongest
blood plasma (80%) and interstitial agglutination
fluids and largest immunoglobulin
with pentameric form, M.W. 9,60,000
(heaviest)

4 IgD 1-3 Present in trace amount on the Activation of B-lymphhocytes and


(Delta) surface of lymphocytes in blood, development and maturation of
M.W. 1,85,000 immune reactions.

5 IgE 0.05 Present in very small quantities, Stimulation of mast cells, related
(Epsilon) show specific linkage with mast cells to allergic reactions and
and basophils, M.W. 1,88,000 protection from parasites.

 Mostly intravascular

IgG – Protects body fluids.

IgA – Protects body surfaces.

IgM – Protects body blood stream.

IgE – Mediates regional hypersensitivity.

First line of Defence : Skin, Mucous membrane

Second line of Defence : Neutrophils, Monocytes, Macrophage, interferon, fever.

Third line of Defence : Specific immunity by T- and B-lymphocytes

4 VACCINE

Vaccine is suspension of inactivated pathogens or antigenic protein of pathogen which is taken orally
or injected to provide immunity for that pathogen.

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 History :

 Edward janner (1796) noticed that milkmaid did not suffer from small pox but they had scabs of cow
pox. He transport the material from sore of milkmaid who was suffering from cow pox to the young boy
of 8 year old. After sometime he injected live small pox material into that boy. But symptoms of disease
did not appear. he tried this procedure on other person and get success. He gave the term vaccination
for this process. (Vacca = Cow)

 Louis pasture : He discovered the process of inactivating the pathogen given the concept of
vaccination and prepared vaccines for Anthrax, Chicken cholera, Rabies.

 Von behring : He discovered the process of passive immunization and prepared the antidiptherial
serum by injecting diptheria antigen into sheep.

Von behring is known as ‘Father of passive immunization’.

 Principle of vaccination :

 It is based on memory of immune system. When a antigenic material is injected in a healthy person,
it generate antibodies and memory cell as a primary immune respone. When this active pathogen
enter second time inside this body of vaccinated person memory cells rapidly recognise and respond
with massive production of lymphocytes and antibodoes. So it destroys pathogen rapidly and disease
does not appear. Person become resistant for that disease after vaccination.

 Types :

 First generation vaccines : These vaccines are prepared by inactivating the whole pathogen but
they have side effects. e.g. oral polio vaccine (OPV), DPT

 Second generation vaccines : Antigenic polypeptides of pathogens are produced with recombinant
DNA technology in transgenic organisms.

These are made by multiplication of surface antigen by genetic engineering. They have no side effect
e.g. Hepatitis B vaccine produced from trangenic yeast.

 Third generation vaccines : These are highly potent, synthetic in nature & prepared by genes they
are also called DNA vaccine.

 Live attenuated (OPV, BCG, Small pox, Influenza etc.)

 Killed (Typhoid, Salk polio, Cholera, Rabies, Plague etc.)

 Toxoid (Diphtheria, Tetanus)

 Combination (DTP, MMR)

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 HLA System :

 Human leucocyte antigens (HLA) were first discovered on leucocytes. Genes for histocompatibility
antigens, are located on a portion of chromosome-6. This is called MHC or Major Histo Compatibility
complex or HLA complex. The recepients immune system can recognise the histocompatibility antigens
on the donar organ and accordingly acceptor reject it.

 The array of HLA alleles on a homologue of our chromosome 6 is known as a haplotype. An individual
inherits one HLA haplotype from each parent.

 Only identical twins can have identical haplotype.

 The best HLA matching can be observed within the same family.

 Tissue Typing : The procedure carried out to match HLA proteins of donar and recepient.

 Preference order of transplants : Identical twins > Sibling > Parent > Unrelated donar.

4 IMMUNE SYSTEM DISORDER

Improper functioning of immune system may cause discomfort (Allergy), disease (AIDS) or even death
(anaphylactic shock). Improper functioning divided into 3 classes.

 Hyper sensitive disorder or Allergy :


 When a person show hyperresponse or hyper sensitiveness for a common antigen or agent then it is
called allergy.

 The agents which cause allergy are called allergen. Common allergens can be pollen grains, food (egg,
fish), medicines (penicilline), cold, heat, sunlight, fibres etc.

 Physiology of Allergy : Secretion of histamine from mast cell & production IgE antibodies in
response to a common antigen or allergen.

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 Manifestations : (Effects) –
G Bronchial Asthma : It is common menifestation of allergy on (allergy of lungs) when an allergen
enters inside the body by inhalation. It comes in contact with respiratory tube. This is characterised
by the spasm of the smooth muscles present in the walls of the bronchiole. It is generally caused
due to the hypersensitivity of the bronchiole to the foreign substances present in the air passing
through it. The mucous memebranes on the wall of air passage start secreting excess amount of
mucous, which may close the bronchi, as well as bronchiole.
Symptoms : coughing and difficulty in breathing mainly during expiration. (Wheezing)
Prevention and cure :
• Avoiding exposure to the foreign substance or allergens is the best preventive measure.
• Hyposensitisation (by exposing small doses of the specific allergen) is the other preventive meausre.
• Antibiotic therapy for removing the infection, and use of bronchodilator drugs, as well as inhalers
for symptomatic relief.
 Hay Fever : Mucosa of eyes and upper respiratory passage become hyper secretory in response to
allergen (pollen grain).
 Urticaria - Multiple, Circumscribed raised pinkish itchy blisters of skin
 Eczema (Dermatitis) - Raddening of skin, Vesicle formation then rupture, scales formation.
 Anaphylactic shock : This is generalized and severe form of allergy. When a allergen (penicillin)
enter into blood, it stimulates the secretion of histamine from the mast cell of whole body, this causes
the vasodilation and increase permeablity of blood vessel. So large amount of fluid is leaked out
form blood vessel into extra cellular space and decrease in blood volume cause fall in blood
pressure that may leads to death.
 Auto immune disorder : When the immune system does not discriminates between self and non-self
antigen, antibodies are formed against the self antigen these antibodies destroy the self antigen and
also the self tissue of the body.
So, the antibody formation against self antigen is called Auto immunity
Example –
G Myasthenia gravis : Antibodies are formed against acetylcholine receptors so these receptors
are destroyed and decreases. It causes depressed or less effective nerve conduction at myoneuronal
junction and  movements of muscles. Muscle become degenerate after some time.
G Pernicious (Destructive) anemia : Antibodies are formed against castle intrinsic factor (Stomach)
so the vitamin B12 is not absorbed in intestine and blood formation is decreased. This deficiency
of blood is called pernicious anemia.
G Hashimoto disease : Antibodies are formed against the thyroid gland. These antibodies destroy
the thyroid gland thyroglobulin and deficiency of thyroid hormone is called Hypothyroidism.
G Rheumatoid arthritis : It is due to presence of rheumatoid factor (a type of immunoglobulin IgM).
Primary symptom of inflammation of synovial membrane. If it is left untreated, then the membrane
thickness and synovial fluid increases, exerting pressure that causes pain. The membrane then
starts secreting abnormal granules, called pannus, which after accumulating on the surface of the
cartilage, cause its erosion. As a result, the fibrous tissues are attached with the bones and
become ossified, making the joints, stiff and immovable.
Treatment : pain and inflammation by heat treatment and physiotherapy. Joint replacement surgery
is done in extreme cases.

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G I.D.D.M. : Insulin dependent diabetes mellitus.

Antibodies are formed against the B cell of pancreas that cause the deficiency of insulin in body
and this called I.D.D.M. Symptoms are hyperglycaemia, glycosuria, polyuria, polydipsia (excessive
thirst), polyphagia (increase food intake)

G Multiple sclerosis : Antibodies are formed against the myline sheath of nerve cells. Destruction
of myline sheath causes neurological dysfunction.

 Immuno deficiency disorder : May be due to gene mutation, gene deficiency, infection, nutritional
deficiency & accidents.

G De-George’s syndrome or Thymic aplasia - Deficiency of T-cells or cell mediated immunity due
to inactive thymus gland.

G Bruton’s agammaglobulinemia - Deficiency of gamma antibodies or Antibody mediated immunity


due to deficient fromation of B-cells.

G S.C.I.D. : Severe combined immuno deficiency : This disorder is due to gene mutation or-gene
deficency of enzyme adenosin deaminase. This enzyme involved in formation of T and B
lymphocytes. SCID is characterized by very low number of circulating functional thymocytes affected
individual die at an early age.

Treatment – Gene therapy

G A.I.D.S. (Acquired immuno deficiency syndrome) : HIV attaches on T-helper cells. This
cause the decrease count of T-helper cell from normal 950/mm 3 to less than 200/mm 3.

 Immunotherapy :
 Immunotherapy is a treatment procedure that involves suppression or augmentation of immune responses,
to achieve therapeutic effects. Manipulation of the immune response can be carried out by modulating
various components involved in it. Cytokines are natural immunomodulators secreted by one type of
immune cell that elicits response in another type of immune cell these include interleukins, interferons
and tumour necrosis factors.

 Immunomodulators : Drugs that modulate the activity of a patient’s immune response. Either up or
down, until a desired level of therapeutic effect is reached. There are two general clinical approaches
of immunomodulation.

G Immunopotentiation therapies : This includes administration of immunopotentiating agents like


preformed antibodies, or immunopotentiating drugs. This strategy augments the immune response.

Example – Levamisole, interleukin, interferon, antiserum.

G Immunosuppressive therapies : When the patients immune system becomes activated against
his or her own body, in situations such as, autoimmune diseases, the response is suppressed by
using specific therapies. These include inhibitors of cell division, cytokine production,

Example – Corticosteriode, cyclosporine.

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4 CANCER
Uncontroled, Abnormal and excessive mitotic division of cells is called cancer (Crab = cancer)
Study of cancer is called oncology
This abnormal and undifferentiated cells are called cancerous cells.
 Tumour or neoplasm (new growth) :
Types of Tumours -
 Benign Tumour : Capsulated, localised to the site of origin & does not spread to another parts of
body, it is non-metastatic, non-malignant, non-cancerous, Non invasive.
Example -
G Bone tumour - Osteoma
G Muscle tumour - Myoma
 Malignant Tumour (Malignant = Harmful) : Some of the cancerous cells detach from their origin
place and spread to other parts of body by blood and lymph. Then cancerous cells form fresh colonies
there. This is called metastasis or sec. growth. This type of tumour is called metastatic or cancerous
tumour. It is invasive tumour.
Example -
G All malignant tumour are called cancers.

 CANCER IS DIVIDED INTO 3 CLASSES ON BASIS OR ORIGIN :


 Carcinoma : This tumour originate from the skin and epithelial tissue
Example -
G Brain carcinoma G Oral carcinoma
G Gastric carcinoma G Colon carcinoma
G Lung carcinoma G Cervical carcinoma
G Adeno carcinoma (gland tumour) G Breast carcinoma

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Carcinoma is most common type of tumour (85%)

Breast Cancer in female and prostate cancer in males are common incidence in world. Lung cancer
accounts for 31.1% of all cancer death in men and 25% in women.

Cervical (Uterine Cervix) cancer in female and oral cancer in males are common in India.

Melanoma - It is type of carcinomas. These are cancerous growths of melanocytes (a type of skin
cells).

 Sarcoma : This is tumour of mesodermal tissue.

Example -

G Bone cancer - Osteosarcoderma

G Muscle cancer - Myosarcoma

G Lymph node cancer - Lymphosarcoma

 Leukaemia (Leucocyte = W.B.C.) or Blood Cancer : This is cancer of white blood cells (WBC).

G Chronic myelogenous Leukaemia (CML) : This fatel cancer occurs mainly due to reciprocal
translocation between chromosome-22 (Philadelphia chromosome) and chromosome 9.

G Burkitt’s Lymphoma (Denis parsons Burkitt, 1956 Africa) : This is type of leukaemia which is
produced due to reciprocal translocation between chromosome-8 and chromosome-14.

 Normal mechanism of body growth -


Normal cell division regulation by proto-oncogens and it is suppressed by tumour surppressor gene.

1. Proto-oncogen


Normal cells

2. Tumor-suppressor gene
3. Gene related to programe cell death

 Causes of cancer -
Chemical or physical agents that can cause cancer are known as carcinogen. Depending on their mode
of action, carcinogens fall into the following main categories :

 Agents that can cause alterations in the genetic material (DNA), resulting in oncogenic trasformation.

 Agents that promote the proliferation of cells, which have already undergoes genetic alteration responsible
for oncogenic transformation. These agents are called tumour promoter e.g. some growth factors and
hormones.

 Cancer causing DNA and RNA viruses (tumour viruses) have been shown to be associated with
oncogenic transformation.

Transformation of a normal cell into cancer cell if the regulation is upset.

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Proto-oncogene
oncogenic transformation
Oncogene

Abnormal or tumour cells

Tumor-suppressor gene
(No effect)

 Carcinogen :
Causative agent cancer - Carcinogen

 Chemical factor : Tobacco and betal chewing cause oral cancer. Heavy smoking (N-Nitrosodimethylene)
causes oral cancer, cancer of larynx and lungs. Combustion product of coal and pesticides, artificial
flavour, sweetners, synthetic food, add flavour, hormonal inbalance in body cause cancer.

Hormonal imbalance or estrogen excess causes breast cancer.

Urinary bladder cancer is common in dye workers.

 Important carcinogens and the organs affected :


S.No. Ca rcinoge ns Affe cte d Orga ns
i Soot Skin and lungs

ii Cigarrete smoke (N-nitrosodimethylene) Lungs


iii Coaltar (3, 4-benzopyrine) Skin and lungs

iv Aflatoxin (metabolic product of fungi) Liver

v Cadmium oxide Prostate gland

vi Mustard gas (b) Lungs

vii Asbestos Lungs


viii Nickel and Chromium compounds Lungs, Larynx

ix Vinyl chloride Liver

x Diethyl stebesterol (DES) Vagina

xi Benzene Blood, Bone marrow


xii Arsenic Liver, Lungs, Skin

 Physical factors : Sharp teeth cause Tongue cancer

Kashmiri people keep ‘Kangri’ close to skin that cause skin cancer & this skin cancer is called Kangri
cancer.

 Radiation factors : Cosmic rays, X-rays and U.V. rays cause cancer. There are 5 times more
incidence of leukemia in Hiroshima & Nagasaki due to radiation effect of nuclear bombing.

 Biological factor : Oncogenes (cancer producing genes) and oncovirus cause cancer (HIV in AIDS.)

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 Investigation -
 Blood examination : Detection of the abnormal cells or cancerous cell in blood. Detection of the
tumour marker like -feto protein in blood by blood examination.
 Biopsy : Cancerous tissue examination is called biopsy (Karyoplasmic index high)
 F.N.A.C. (Fine needle aspiration cytology)
 C-T scan, M.R.I., X-rays.
X-ray of breast is called Mamography.
 Pap smear : It is used cervical carcinoma and detects cytological character of cancer.
 Modern techniques detect the molecular changes that occur in cancer cells; this enables an early
diagnosis of cancer. Monoclonal antibodies against cancer-specific antigens are coupled to appropriate
radioisotopes. These antibodies are then used for detection of cencer. (Most common radioisotope for
diagnosis of cancer is technetium - 99)

 Treatment :
 Surgery : By removing the entire cancerous tissue and infected lymph nodes.
 Radiation : Cobalt therapy (Co-60), X-ray radiations are given. These radiations destroy the rapidly
dividing cells.
 Chemotherapy : Many anti-cancerous drugs like
Drug mechanism :
G Vincristine (weed - cantharanthus roseus = Vinca rosea)
G Vinblastin (weed - cantharanthus roseus = Vinca rosea)
G Cyclophosphamide
 inhibit the DNA synthesis in cell cycle of cancerous cell but this has side effects.

 Immuno therapy - Monoclonal antibodies, vaccine and -interferon are given in it


One of the recent approaches of cancer treatment involves augmentation of natural anti-cancer immunological
defence mechanisms. Monoclonal antibodies have been used in various ways, e.g., radioimmunotherapy,
etc., for treatment of cancer. Research is in progress to develop cancer vaccines.
Most of cancer are treated by combination theraphy of surgery, radiation and anti cancerous drug.

DRUG ADDICTION & MENTAL HEALTH


4 DRUG DEPENDENCE
Meaning : Certain drugs are prescribed physicians for the prevention or treatment of diseases or for increasing
the physical and mental performance and are withdrawn as soon as the desired effect is achieved. Repeated
use of certain drugs on a periodic or continuous make the body dependent on them. This is called drug
dependence. The term. “drug-dependence” is now a-days preferred to ‘drug-addiction or drug habituation’
(WHO, 1964). Some people start taking drugs without medical advice due to one reason or the other and
become drug dependent.

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Types : Drug dependence in of two types Psychological and Psysical or physiological.

 Psychological dependence : If refer to the person’s belief that the normal state of well being can be
attained only with the drug’s action.

 Physical (Physiological) Dependence : It refers to the person’s state when intake of a drug becomes
essential to maintain physiological equilibrium. In such a case, the nervous system functions normally in
the presence of the drug only. The physical dependence is, therefore, also called neuroadaptation.

Types of Habituating Drugs : The habituating drugs are gouped into two main categories. Psychotropic
drugs and psychodelic drugs

4 ADDICTIVE DISORDERS
If the body needs continuous presence of psychoactive substance within it, it is called addition. Psychoactive
drugs have the ability to alter the activity of nervous system. Different psychoactive drugs along with their category
and effects are given below.
Major categories of psychoactive drugs (i) Psychotropic drug (ii) Psychedelic drug, their effects and
clinical uses

Type of drug Examples Effects Clinical uses


(i) Psychotropic drug
Sedatives and Barbiturates depress brain activity Hypnotic,
tranquillisers Benzodiazepines and produce feelings of antianxiety
(depressants) (e.g.) Valium calmness relaxation, drowsiness
and deep sleep (high doses)

Opiate narcotics Opium, morphine, Suppress brain function, relieve Analgesic


heroin, pethidine, intense pain (physical and
methadone mental), produce temporary
euphoria

Stimulants Caffeine (Very mild), Stimulate the nervous system Weight control
amphetamines make a person more wakeful, neurotic
(including increase alertness and activity, depressive
dexamplhetamine), produce excitement disorder.
cocaine and its
drivative Novacaine

(ii) Psychedelic drug


Hallucinogens LSD, mescaline, Alter thoughts, fellings and None
psilocybin, charas, perceptions, hallucinations
hashish, marijuana
(bhang)

A person who is habitual user if abstains from a drug (abstinence), his body reacts i.e., ceases to function
normally. It is called physical dependence. The symptoms appearing in the body are withdrawal symptoms and
range from mild tremors to convulsions, abdominal pain, diarrhoea, muscle cramps, anxiety, nausea, insomnia
are called withdrawal symptoms. In many cases the withdrawal symptoms may be life threatening and needs
medical supervision.

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4 PSYCHOTROPIC DRUGS

Type of drug Examples Effects Clinical Uses


Sedatives and Barbiturates Depress brain activity and produce Hypnotic,
tranquilizers Benzodiazepines feelings of calmness, relaxation, Antianxiety
(depressent) (e.g., Valium) drowsiness and deep sleep (high
doses)
Opiate narcotics Opium, morphine, Suppress brain function, relieve intense Analgesic
heroin, pethidine, pain (physical and mental), produce
methadone temporary euphoria

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Type of drug Examples Effects Clinical Uses


Stimulants Caffeine (very mild), stimulate the nervous system; make a Weight control
amphetamines person more wakeful, increase alertness Neurotic
(including and activity, produce excitement. (Depressive)
dexamphetamine), disorder
cocaine and its
derivative Novacaine

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PSYCHEDELIC (= Hallucinogenic) DRUGS

Type of drug Examples Effects Clinical Uses


Hallucinogens LSD, mescaline, Alter thought, feelings and perception; None
psilocybin, charas, hallucinations
hashish, marijuana
(bhang)

 Cannabinoid receptors present principally in the brain


 Cannabinoid generally taken by inhalation and oral ingestion, these mainly affect cardiovascular system
of body.

 Atropa belladona and Datura also have hallucinogenic properties.

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4 ADOLESCENCE AND THEIR PROBLEMS

The transition period between 8–18 years for girls and 7–19 years for boys is called the adolescence. It is
poised between–childhood and adulthood which is characterised by rapid growth, and physical and mental
dvelopment. This period is marked by attainment of sexual maturity (puberty) and increased production of
hormones, including sex hormones. This results in frequent shifts of moods and emotional turbulence. The
most common problems of all adolescents of both sexes are.

 Acne : Most common problem of adolesence due to increased production of sex hormone androgen.

 Hypochondria : Most of them are concerned about their health. The eating disorders are abnormal
patterns of handling food for fear of obesity and disfigurement of body. These disorders predominantly
affect women. They resort to voluntary food restrictions or dieting and try to loose body weight. This
disorder is known as anorexia nervosa which may start other types of body complications due to heavy
loss of weight.

 Neurasthenia : It is characterised by the inability to concentrate or enjoy things, and may lead to irritability,
fatique, insomnia depression and headache.

 Post traumatic stress disorder : It occurs due to rape, robbery or premarital sexual intercourse which
results in unwanted pregnancies. Pregnant girls often visit illegal abortion clinics to hide their action and
put their life in a great risk.

 Addiction : Addiction to alcohol, drugs tobacco smoking and chewing is also common. Advertisements,
curiosity, peer–pressure, frustration and depression, feeling of independence, etc may be some of the
reasons for such addictions.

 Phobias : These are intense fear of things or creatures like snakes or situations like vast open places.
closed small chamber, crowded places fear of needles (Belonephobia).

Adolescent is a period (12 to 20 years) of rapid physical and psychological changes and they should seek
all sorts of help from their parents. The parents specially mothers should take complete care of their sons
and daughters. The approach of parents towards their growing up children should be more friendly and
they should be able to discuss most of the issues which come in the life of every young individual.

 Combinations of drugs :
Some addicts use mixtures of drugs to have immediate ‘kick’ or ‘charge’. Simultaneous use of drug (hemp
derivatives, barbiturates, aspirin or antihistamines) and alcohol may produce dangerous effects, including
death. When barbiturates and alcohol are taken together, each doubles the effect of the other. A mixture of
cocaine and heroin, called speed ball, gives spontaneous kick of cocaine and prolonged pleasure of heroin.

Interaction of Alcohol and other substances of Abuse with Some common Drugs

Drugs Effects
Alcohol and other depressants e.g. Dramatically increased depressant effect
barbiturates
Alcohol + Antihistamines Marked drowsiness (normally little or no sedative
effect)
Alcohol + Benzodiazepines (sleeping pills) Repid increase in sedative effect often dramatic
Alcohol + Marijuana or Hashish Decreased coordination, increased reaction time,
impaired judgement
Alcohol + Aspirin Increased risk of damage to gastric mucosa

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ALCOHOLISM
Alcoholism is a dependency of a person on regular consumption of alcohol either in low concentration (wine, bear
etc) or in high concentration (rum, vodka etc)

 Effect of Alcohol on an individual


 Effects on liver : Absorbed alcohol is carried directly to the liver, where it becomes metabolised. Use of
moderate amounts of alcohol does not case liver damage, provided adequate nutrition is maintained. However,
chronic alcoholism causes the following diseased.

G Alcoholic fatty. The liver becomes enlarged, yellow, greasy and firm. Hepatocytes (cells of liver) are
distended by large fat globules which push the hepatocyte nucleus against the cell membrane. There is
increase in the fat synthesis in the liver

G Alcoholic hepatitis. It is characterised by degeneration of hepatocytes. The damaged (degenerated)


hepatocytes are surrounded by polymorphonuclear lecucocytes. These hepatocytes may be pale and
swollen and some contain dense masses called Mallory’s body.

G Alcoholic cirrhosis. With continued alcohol intake, there is destruction of hepatocytes and fibroblasts
(cells which form fibres) and stimulation of collagen protein formation.

G Cholestasis (Gr. Chole-bile, stasis-a standing still). It is stoppage in the flow of bile. It is characterised by
jaundice, abdominal pain and hepatomegaly (enlargement of liver).

 Effect on nervous system : These are characterised as

G Will power, judgement power and self control become reduced.

G Control on emotion becomes reduced.

G Moral sense becomes reduced.

G Cerebellum becomes affected which results the loss of musle co-ordination so affected person shows
staggering gait and incoherent speech.

G Inflammation of axons of neurons leads to neuritis.

 Effects on stomach : High doses of alcohol cause ill effect on gastric glands of stomach, these glands
secrete gestric juice in excess which cause the inflammation to gastric mucosa. This condition is known as
gastritis. It may also result gastric cacinoma, peptic ulcer, Dilute alcohol (optimum 10 %) stimulates gastric
secretion (specially acid). Acute alcoholic intake can result in inflammation of the oesophagus (esophagitis)
and stomach (gastritis). Chronic heavy drinking, if associated with violet vomiting, can produce a longitudinal
tear in the mucosa at the gastrointestinal junction- a Mallory- Weiss syndrome (also called mallory- weiss
Lesion).

 Effect on heart : Due to deposition of alcoholic fat on the wall of blood vessels, the lumen of blood vessels
becomes reduced, this increases the blood pressure and hence, the activity of heart.

 Effect on kidneys : Alcohol reduces the release of hormone ADH (Antidiuretic hormone) due to which the
excess amount of water is released from the body. So, alcoholism greatly causes dehydration condition.

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 Heavy drinking can cause an acute alcoholic myopathy characterized by painful and swollen muscless and
high levels of serum creatine phosphokinase (CK).

 Alcohol increases RBC size causing a milk anaemia. Chronic heavy drinking can also decrease production
of white blood cells (WBCs). Alcohol may decrease platelet aggregation.

 Effects on the skeletal system include alternations in calcium metabolism with an increased risk for fracture
and osteonecrosis (death of bone mass) of the head of femur.

 Hormonal changes include an increase in cortisol levels, inhibition of vasopressin, reversible decrease in
serum thyroxine and a more marked decrease in serum triiodothyronine (T3).

 Heavy drinking during pregnancy results in serious consequences for foetal development. The foetal alcohol
syndrome (FAS) includes facial changes, poorly formed concha (cavity of pinna), small teeth with faulty
enamel, defects in atria and ventricles of heart.

 Regular intake of small to moderate amounts has been found to raise HDL-high density lipoproteins (good
cholesterol) and lower LDL-low density lipoproteins (bad cholesterol) levels in the blood plasma. This may be
responsible for lower incidence of coronary artery disease in such persons. Alcohol also reduces blood sugar
level which is harmful to the functioning of brain.

 Effect on immunity : Alcoholims losses resistance to infection. The alcoholics in most cases, are victims of
malnutrition and are easily susceptible to diseases like pneumonia.

 Effect on family : The habit of drinking not only create problems to the drinker but directly or indirectly
affects the family and community life. Most drinkers do not think regarding needs of their children and other
members of the family.

 Effect on society : Alcoholism is invariably associated with social crimes and dissolution of moral and
cultural inhibitions. Violence and other corrupt practices in the community are often directly or indirectly due
to the drinking of alcohol.

 Metabolism of Alcohol
 In body the alcohol passes to the stomach. Some amount of it also passes to proximal part of intestine.
Thus, stomach and proximal part of intestine absorb this alcohol and then transfer to blood and from blood to
liver. In liver, alcohol is converted to acetaldehyde with the help of enzyme alcohol dehydrogenase.

 Acetaldehyde is oxidized by the enzyme acetaldehyde dehydrogenase. It liberates the heat. This heat is
utilized in the synthesis of fat. The excess of fat reduce the formation of glycogen, enzymes and structural
proteins. This condition is known as cirrhosis.

4 TOBACCO ADDICTION

 Tobacco can be obtained from dried and cured leaves of young branches of two species of tobacco plant,
Nicotiana tobaccum and N. rustica. Tobacco plant belongs to angiospermic family Solanaceae.

 The use of tobacco was started in America where Red Indians were started use it. It spreads to Europe and
other countries in early 1700s.

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Table : Toxic substances of tobacco and their effects

S. No. Particulate Effect Gaseous Constituent Effect


1 Tar Carcinogenic, CO Imkpairs
immobilisation of cilia haemoglobin
functioning
2 Polynuclear, aromatic Carcinogenic Nitrosamines, hydrazine Carinogens
hydrocarbons vinyl chloride

3 phenol cresol Carcinogenic, irratants HCN, acrolein, Ciliotoxins and


Formaldhyde, nitrogen irraitants
oxides, acetaldehyde
4 Benzopyrene, trace Carcinogen, carcinogens Alter thoughts, fellings and None
metals (e.g. Polynium perceptions, hallucinations
210, nickel, aresenic)

5 b Nakphthylamine Carcinogenic
6 N-nitrosononicotine Carcinogenic
7 Nicotine Ganglionic stimulant and
depressant,
cocarcinogenic

 Tobacco smoking and diseases


 Cancer : About 90% of victims of lung cancers are associated with smoking. Another cancer is mouth
cancer due to chewing of tabacco.

 Immunity becomes weak due to regular use of tobacco

 Use of tabacco increases the male infertility.

 Adrenaline release becomes increase which also increase blood pressure and rate of beart heat. It may
lead cardiovascular diseases.

 Nicotine alkaloid causes reduced foetal growth and development in pregnant women.

 Carbon monoxide present in smoke combines with haemoglobin present in blood and forms
carboxyhaemoglobin. It greatly reduces the oxygen carrying capacity of blood.

 Premature wrinkling may be possible.

 It is also known to cause pulmonary tuberculosis.

 Smoking causes inflammation of lung alveoli which decreases surface area for gaseous exchange and cause
emphysema.

 Smoking causes irritation and inflammation of mucosa of throat and bronchi which causes coughing and
bronchitis.

 Smoking accelerates the secretion gastric juices which causes gastric and duodenal ulcers.

Drugs of abuse are frequently taken with alcohol or other common medicine e.g. aspirin, insulin. Such
combination can lead to increased sedation or reduces the effect or medicine or complication like hypertension.

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Table Interaction of alcohol and other substances of abuse with some common drugs

Drugs Effects
Alcohol and other depressants, Dramatically increased depressant effect
e.g. barbiturates

Alcohol + Antihistamines Marked drowsiness


(normally little or no sedative effect)

Alcohol + Benxodiazepines Rapid increase in sedative effect, often dramatic

Alcohol + Marjuana or Hashish Decreased coordination, increased reaction time, impaired


judgement

Alcohol + Aspirin Increased risk of damage to gastric mucosa

Benxodiazophines + Barbiturates Increased sedation

Amphetamine + insulin Decreased insulin effect

Nicotine + Cocaine Increase cardiovascular effects

Cocaine + Antidepressants Hypertension

Drug abuse is found only with those who live a stressful life, unsatisfied with themselves, feel insecure. As the
problems and stress are becoming a part of modern life, these a person must lean to face the problems as
stresses. One must discuss the problems with family members/friends and attempt to sort them out, rather
than to drug/alcohol use.

4 BLOOD BANK

Due to certain factors when blood flows out of the body of any person, then blood is required for performing the
vital activities.
It is essential to provide the blood to this person. This phenomenon is known as blood transfusion. For different
persons the blood of matching blood group is required for this purpose the storage of blood is essential.
The storage of blood of different blood groups in protected places are known as ‘Blood-bank’
 Blood is mixed with adenine-supplemented citrate-phophate dextose and it is stored at 4°C (39°F)
(1 unit = 350 ml)
 Citrate and oxalate binds with Free Ca+ ion present in blood and prevent the coagulation of blood.
 In this method blood can be stored up to 1 month.

DISEASE
 Disease :- Any change from the normal state that causes discomfort or disability or impairs the
health is called disease.
 Health :- Health is a state of complete physical, mental and social well being. and not merely an
absence of disease or infirmity (W.H.O. - 1948)
 Prophylaxis or preventive measures :- Preventive measure for a disease is called prophylaxis.
 Epidemiology :- The study of causes and spread of disease is called Epidemiology.
(epi = among, demos = Human, logy = study)

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 Etiology :- Study the internal cause of disease is called Etiology.

 Incubation period :- Time interval between the entry of pathogen and appearance of symptoms is
called incubation period.

Window period :- Period between infection to the time when it can be laboratrically detected.

 Chemotherapy : Treatment with chemicals (Medicine)


 Antibiotics : Substances which are secreted by micro-organism that inhibit the growth or destroy the
other micro-organism are called antibiotics. This term was given by Walksman (Streptomycin-first
bacterial antibiotic obtained from bacteria-streptomycin griseus).

Example- Bacteriostatic-Tetracycllin, Chloramphenicol,

Bacteriolytic or Bacteriocidal-Streptomycin, Ciprofloxacin, Ampicillin.

 Analgesics : Substance that relieves pain.

Example - Opioid analgesics- Morphine, Codeine, Diclofenac sodium, Nimesulide.

 Antipyretics (Antifebrile) : (Pyrexia - Fever) Substance that reduces temperature or fever of body.

Example - Aspirin (Acetyl salicylic acid)- (It produces gastric ulcer so not extensively recommanded
as a analgesic), Ibuprofen, Paracetamol, Nimesulide.

 Antihistaminic drug : These drugs give relief from allergies by neutralizing histamines that is released
from the ruptured mast cell. e.g. cetrizine.

 Tranquillisers and Hypnotics and Sedative drug :

Example - Diazepam, Alprazolum)

G Tranquilliser drug : A drug that act to reduce mental tension and anxiety without interfering with
normal mental activity.

G Sedative drug : A drug that calms the subject without inducing sleep.

G Hypnotic drug : A drug that induces sleep.

 Antiseptic and Disinfectant : Agent that inhibit or kill microbes on contact. Conventionally agents
used on living surfaces are called antiseptics while those used for inanimate objects are called
disinfectants.

Disinfection : In this process, kill only vegetative form of bacteria.

Sterlisation : In this process, kill all form of pathogens including spores.

4 MEDICAL TERMS

 Arthro - Joint (Arthritis)

 Aesthesia - Sensation (Anaesthesia means lack of sensation)

 Bracy - Short (Bracydactyly)

 Brady - Slow (Bradycardia)

 Coronary or Cardia - Heart

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 Dropsy - Due to Argimone maxicana’s seeds. These seeds mix

with mustard oil and produce poisoning.

 Encephalon - Brain

 Enteron - Intestine

 .......emia - Blood (Anemia, protenemia, Hyperglycemia)

 Gastric - Stomach

 Hepatic - Liver

 .......itis - Infection or inflammation

 Myo - Muscles

 Metastasis - Cancer cells or tissue spread from one part to another part of body.

 Nephric/Renal - Kidney

 Pulmonary - Lungs

 Patho - Disease

 .......Penia - Decrease (Neutropenia, Leucopenia)

 .......Philia or Cytosis - Increase (Neutrophilia, Lymphocytosis)

 Phobia - Acrophobia, Hydrophobia, Agoraphobia

 Plegia - Paralysis, (Hemiplegia, Paraplegia, Quadriplegia)

 Phrenic - Diaphargm

 Rhine - Nose

 Tachy - Fast (Tachycardia-fast heart rate)

 .......uria - Urine (Haematuria)

 SCIENTISTS :
 Father of Medicine : Hippocrates – He gave scientific explaination of disease first time.

 Father of Surgery : Susruta – He used non-poisonous leeches as an anti coagulant during surgery.

 Father of Ayurveda : Charaka (Ayu – Life, Veda – Knowledge)

He first gave concept of digestive, metabolism and immunity

 Father of Modern Pathology : Rudolf virchow.

 Father of Immunity : Edward Jenner (Small pox vaccine)

 Father of Blood grouping : C. Landstainer.

 Father of Modern Bacteriology : Robert Koch (Anthrax, T.B., Cholera)

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 Got nobel prize :


 In 2004 for odourent receptor (olfaction) is given to Richard Axel and Linda B Buck.

 In 2005 = Marshal and Warren for Helicobactor pylori bacterium

 In 2006 = Fire and Melo for RNA interference.

 In 2009 = V.Ramkrishan for antibiotic and ribosome relationship.

 26 June : International day against drug abuse and Illicit trafficking.

 IMPORTANT DAYS :
 30 January - Leprosy Day

 24 March - Tuberculosis Day

 07 April - World Health Day

 01 July - Doctor’s Day

 11 July - World Population Day

 01 December - AIDS Day

DISEASE

Congenital or genetic disorder Acquired disorder

CONGENITAL OR GENETIC DISORDER

Due to gene mutation Due to chromosomal Due to gene incompatibility


mutation eg. Rh compatibility
ABO compatibility

 Gene mutational disorder/Biochemical disorder :


 Autosomal Recessive gene mutation disorder :

Phenyl pyruvic
Liver acid (Brain)
Phenylalanine amino acid
Phenylalanine Phenyl ketone
Hydroxylase (Urine)

Homogentisic acid (Alkaptone)


Homogentisic
Acid oxidase

Tyrosine amino acid

Tyrosinase

Melanin pigment

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 Phenyl ketonuria : (12th chromosome) due to deficiency of phenyl alanine hydroxylase,


phenylalanine increase in blood & it convert into phynyl pyruvic acid and phenyl ketone in liver this
phenyl pyruvic acid accumulates in brain & destroy the brain cells. This causes mental retardation
these individuals are called phenyl pyruvic idiots.

 Alkaptonouria (16 Chromosomal) (Black urine disease) –

This disorder is due to deficiency of enzyme homogentisic acid oxidase. So, homogentisic acid
does not metabolised into tyrosine.  concentration of alkaptone or homogentisic acid in blood and
tissue like joints, ligament, tendon, cartilage and also excreate in urine so it is called alkaptonuria.
When this urine comes in contact with air, it turn black due to oxidation of homogentisic acid so it
is also called black urine disease.

 Albinism (11 Chromosome) : This disorder is due to deficiency of enzyme tyrosinase therfore the body
parts like skin, iris of eye etc., they become melanin deficient. Melanin provide protection against U.V. rays.

 Tay-sach’s disease or Infantile amourotic (Greek term – darkning – visionloss) 15 Chromosomal


: This disease is first reported by tay and sac. This genetic disorder is due to deficiency of enzyme
-N acetyl hexose aminidase, this enzyme is involved in fat metabolism. So, the fat (conjugate
lipid) accumulate in brain (ganglioside cell) and spinal cord and damage these cells. This cause mental
retradation and paralysis of a normal born child and so child does not survive more than 3-4 years.
There is no treatment of Tay-sach’s disease.

 Thalassemia (Thalassa - sea) (Thomas Cooley – 1925) : (Mediterranean anemia or cooley’s anemia)
This disorder was, first found in population of mediterranean region. Frame shift mutation causes
the deficiency of  and  genes present on 11 th & 16 th chromosomes respectively. So
decrease synthesis of  and  polypetide chain of hemoglobin, (Mainly –chain is affected)
abnormal type or decreased hemoglobin is formed in R.B.C. This deform the R.B.C. become hemolytic
in nature.

So hemolytic anemia appear in this disorder.

Treatment : Blood transfusion or bone marrow transplantation

 Sickle cell anemia (11th chromosome) : Glutamic acid is replaced by valine at the 6th position of
 chain of hemoglobin. This abnormal Hb change the shape of RBC from spherical to sickle shape and
these RBC’s become hemolytic in nature

and produce haemolytic anemia. Sickle cell anemic patients are resistant against malaria (Falciparum
malaria)
Normal Hb

HbA HbA2 HbF


(22) (22) (22)
97% 2-3% < 1%

 X-Linked recessive disorders :


 G-6-Phosphate dehydrogenase deficiency syndrome – G-6-PD enzyme present in RBC. This enzyme
stabilize the membrane of R.B.C. Deficiency of this enzyme cause rupture of R.B.C. when it comes
in contact with sulfa drug, chloroquine, Fava (Favism) bean legumes.

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 Duchenne’s muscular dystrophy – Dystrophin protein is absent in muscles, this protein helps in
conduction of Ca++ ion. Due to deficiency of dystrophin protein, muscles contraction do not occur
properly.

 Autosomal dominant gene mutational disorder


 Polydactyly (7th chromosome) : Presence of extra fingers and toes

 Brachydactyly : presence of abnormal short fingers & toes.

 Huntington chorea : In this disorder dominant mutation occur on 4th chromosomes so the mental
and muscle degeneration occurs in the patients. This causes abnormal movement of limbs and
defective speech. This disease appears at the age of 25-55 yrs. (late onset) Nerve degeneration causing
involuntary shaking of legs, arms and head).

 Achondroplasia (4th Chromosome) : Defective formation of cartilagenous bones causing dwarfism.

 Marfan syndrome (15th chromosome) : Long & thin body, Myopia, long Arachnodactyly (spide like)
fingers. Mitral valve prolapes. Connective tissue disorder effect the skeleton, eye and cardiovascular
system.

4 CHROMOSOMAL MUTATIONAL DISORDER

 Autosomal Aneuploidy : (Change in no.)


 Down’s Syndrome : (Mongolism or Mangolion Idiocy) 21 trisomy. This disorder first reported by
Langdon down. It is first chromosomal mutational disorder to be discovered. It is most common
cause of trisomy & mental retardation in children.

Its frequency or incidence is 1 in 700 children. This abnormality or disorder is formed mostly by fusion
of normal sperm with abnormal egg. This abnormal egg contains the extra chromosome on 21th
position.

Women around the age of 45 are more likely to produce the children having down syndrome This
disorder is due to chromosomal non disjunction.

Symptoms : Short stature, rounded face, extra folds in eye lids (epicanthus), broad forehead, retracted
tongue and lower lips, flatened nasal bridge, open mount, short nack, flat hands, stubby fingers,
undeveloped genital & gonads, mental retardation (I.Q. = 25 – 50).

Amniocentesis is done to detect this syndrome in embryonic stage.

 Edward’s syndrome (trisomy 18) (Incidence 1 in 8000 birth)

In this disorder defective formation of ears and nervous system. They are mentally retarded small
eyes– micropthalmia, micrognatha (small jaw).

 Patauo’s syndrome (trisomy 13) (Incidence 1 in 15,000 birth)

Cleft plate, polydactyly, small hands, tiny eyes, mentaly retarded.

 Cat cry syndrome (Cri-du-cat)

This disorder is due to partial deletion of short arm of Chromosome 5. Patients are mentally retarded
and exhibit characteristic cat cry.

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 Sex chromosomal (Aneuploidy)

 Klinefelter’s syndrome (44 + xxy) or (44 + xxxy) (Incidence 1 in 850 live male birth)

G A + XX + A + Y

G A + X + A + XY

This disorder is due to fusion of abnormal female gamete (A + XX) with normal sperm (A + Y) or normal
egg (A + X) with abnormal sperm (A + XY).

So these patients have 47 chromosome (extra sex chromosome) instead of 46. (Trisomic disorder).

Symptoms : These are sterile male, abnormal development of genitals and gonads, mentally retarded
and female like characters like Gynecomastia (Female like breast), Barr body present. Most common
cause of Hypogonadism in male.

 Turner’s Syndrome (44 + XO) (Incidence 1 in 3000 female birth)

G A + X × A + O

G A + O × A + X

This syndrome is formed by fusion of normal egg with abnormal sperm or abnormal egg with normal
sperm. So, pateint have 45 chromosome. It is a monosomic disorder.

Symptoms : Sterile female, primary amenorrhoea, undeveloped ovaries (rudimentary ovary), small uterus,
shielded chest, webbed neck, mentally retarded, short statured Mently retarted, Most common cause of
death is cardiovascular abnormalty (coarctation of aorta– compression of the wall of vessel).

 Jacob’s Syndrome or super males or criminal syndrome (44 + XYY) (Incidence 1 in 1000 live born
males).

These patients have extra y chromosome. So the  production of testosterone in these patients.These
individual have abnormal height, aggressive behaviour, mentally retarded and criminal bent of mind.

 Super females or Multi-x females (44 + xxx) (Incidence 1 in 1200 females)

Mental retardation is proportional to the No. of X-chromosomes, fertile female.

ACQUIRED DISORDER

Communicable Non-communicable
or Contagious or non-infectious
or Infectious disease disease

(Bacterial) (Viral) (Protozoal) (Helminthic) Degenerative Deficiency Cancer


(Due to
ageing)

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Common Human Diseases

Disease (s) Pathogens Symptoms

(A) Bacterial diseases


1. Tuberculosis Mycobacterium tuberculosis Chronic cough, fever, weakness,
Mode of injection - bloody sputum, breathlessness
Droplet injection treatment - DOTS (Direct
observation treatment short course)
Investigation - Mantoux test

2. Diphtheria Corynebacterium High grade fever, difficulty in


diphtheriae breathing (Investigation - Schick
test)

3. Whooping cough Bordetella pertussis Presistent large bouts of cough


(Pertussis)
(100 days cough)

4. Cholera Vibrio cholerae Diarrhoea, dehydration, vomiting

5. Pneumonia Streptococcus pneumoniae Infection in lungs, difficulty in


(Earlier Diplococcus pneumoniae) breathing, high fever

6. Tetanus (Lock jaw) Clostridium tetani Sustained contraction of body


muscles, spasm, lock jaw,
unconsciousness, opisthotonus,
Risus Sardonicus - Streching of
facial muscles

7. Leprosy or Hanson's Mycobacterium leprae Patches on skin, ulcer and nodules


disease formation in skin and nerves,
deformities, ulceration and wasting of
fingers and toes

8. Typhoid fever Salmonella typhi High Fever, loss of appetite,


intestinal ulcers, bradycardia and
perforation Detect by widal test

9. Plague Yersinia pestis High fever, headache, enlargement of


(Black death) (Earlier name-Pasteurella pestis) axillary lymph nodes,
unconsciousness

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(B) Viral diseases


1. Polio or poliomyelitis Polio virus (Group-Picorna virus) Fever, headache, paralysis

2. Influenza Orthomyxovirus Sudden fever after headache, nasal


discharge

3. Measles Paramyxovirus High grade fever, white-brown


patches on body and blisters

4. Chicken pox Pox virus Rashes on body with fever


(Varicella-herpes virus) (Dew drop like appearance of vesicle)

5. Mumps Para myxovirus Painful swelling in parotid glad

6. Dengue fever or (Arbovirus (Flavi)) Fever, pain in muscles and joints


Break bone fever Vector-Aedes agypti haemorrhagic condition in body
(Torniquet test)

7. Chikun gunya Togavirus (Flavi) Fever, joint pain, arthritis

8. Rabies Rabdo virus or Affect CNS - Madness, hydrophobia


(hydrophobia) street virus due to laryngeal spasm and 100%
death after symptoms.
(Vector-Rabbit, dog, cat and For prevention - Human diploid cell
wild animals) culture vaccine.

(C) Protozoan diseases


1. Malaria Plasmodium sps. High fever with chill of intermittent
periodicity, pain in joints

2. Amoebiasis Entamoeba histolytica Intestinal spasm, dysentry

3. Diarrhoea Giardia intestinalis Vomiting, loose motions

4. African sleeping Trypanosoma gambiens Patient feels sleepy, nervous system


sickness impairment

5. Kala azar Leishmania donovani High fever associated with


enlargement of spleen and liver

(D) Helminth diseases


1. Ascariasis Ascaris lumbricoides Abdominal spasm, insomnia,
vomiting, loose motions,
restlessness

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Hepatitis types • HAV (Entero virus Contaminated food Fever, vomiting,


(A, B, C, D, E affect type-72) – SS RNA and water through Hepatomegaly
liver) 2 – 6 weaks foecooral route or jaundice (increase)
intestinal route. billirubin in blood due to
Hepatitis A liver infection. Liver
(epidemic jaundice or does not change
infectious hepatitis) billirubin. This billirubin
(Most common Hexagonal accumulates in various
body
cause of Jaundice) body parts so body
Single
strand become yellowish and
R.N.A. also excrete billirubin in
urine.
Dark urine, whitish
stool
P -hepatitis.
A vaccine
T/t – Bed rest less
protein & more
carbohydrate diet
 –globulin,
interferon

Hepatitis B HBV – Double • Sexual contact, blood Fever, vomiting,


Serum hepatitis stranded circular DNA contact, mother to jaundice, dark urine
(STD) size = 42 nm child by placenta whitish stool
2 to 6 months called vertical transmis- Investigation– Serum
sion (Liver.) billirubin
Outer protein coat (More infectious than SGPT (Serum glutamic
(Surface envelop) AIDS) pyruvic transminase
(Australian D.S.circular test)
DNA
antigin 5 – 40 I.U.
HBsAg) Inner
protein coat ELISA test
HBcAg.
Hexagonal HBeAg
core DNA
polymerase

Hepatitis – C HCV By Blood


(Non–A, Non–B SS R.N.A. Transfusion (90%)
hepatitis Post Blood
transfusion Hepatitis)

Hepatitis – E HEV (R.N.A.) Water born


Similar to disease
Hepatitis A

Hepatitis – D Hepatitis B Prophylaxis –


or Delta Hepatitis (Carrier state) Hepatitis B Vaccine
SS RNA (0, 1, 6 months)
Engerix – B
Shenvac – B
Enivac – B

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Some STDs, their Pathogens and Symptoms

Disease (s) Pathogens Symptoms

(A) Bacterial
1. Syphilis or French pox Treponema pallidum Round elevated ulcers on genital organs
(Inclubation Period) – Investigation - VDRL test (Veneral disease
Aprox 21 days research laboratory test)

2. Gonorrhoea Neisseria gonorrhoeae Infection of urethra in male, discharge of


(2 to 5 days) white thick fluid from urethra, pain during
urination
In females– Infection in cervix, pain and
burning during micturition

3. Vaginitis Gardnerella vaginalis Grayish–white discharge from vagina

4. Chancroid Haemophilus ducreyi Foul smelling discharge and ulcers

5. Chlamydiasis Chlamydia trachomatis Recurrent pain and infection in urinary tract

(B) Viral
1. Herpes genitalis HSV-2(DNA) Virus In males–Painful rashes on prepuce, glans
and penis In females–Rashes on vulva and upper part
of vagina

2. Condyloma acuminatum Papova DNA Virus Itching and fever

3. Molluscum contagiosum Pox DNA Virus Pain

4. AIDS Human Immuno- Immune system failure, fever, diarrhoea etc.


deficiency Virus (HIV)

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4 AIDS (Aquired Immuno Deficiency Syndrome)


 Also caled slim disease.
 First detected in homosexual males in USA (1981) at Disease control centre Atlanta.
 In India first AIDS case was reported in 1986 from chennai.
 Virus was named variously HCLV-III = Humen cell Leukemia Virus-III
HTLV-III = Human T-lymphotrophic Virus-III
LAV = Lymphoadenophathy associated virus
HIV-I = Most common in India (90 - 120 nm) and widly distributed throughout the world.
HIV-II = Most common in West Africa (90 - 120 nm)
 Transmission :
 Sexual route : due to multiple sex partners, prostetuters, homosexuality, artificial insemination (Probability < 1%)
 Parenteral route : through blood contact due to unsecreened blood transfusion, tattoeing, infected,
poorly sterlised dentral instruments.
 Trasplacentral route = from mother to fetus = Vertical transmission, by placenta (33%)
= from mother to infants = perinatal transmission, by colostrum.
 Misconceptions :
 AIDS so not spread through more touch, physical contact, hugging, kissing, sharing meals, shaking
hands, mosquito bites, coughing, sheezing looking after AIDS pateints.
 HIV spreads only through body fluids.
 Pathogenicity :

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 Structure :
 Retro virus (Lenti virus family)
 Core has 2 identicle molecules of SSRNAs, enzymes (reverse transcriptase, protease)
Core also has
- Inner protein coat (P-24)
- Outer protein coat (P-18)
 Core is covered by lipoproteins (GP-120 and GP-41)
 GP-120 has complementry sequence to CD-4 receptors present on Macrophages (HIV factory), helper
T-cell etc.

 Symptoms :
 Asymptomatic phase 2 - 10 yrs, There is no anitbody, protection in 1st (2 - 12 weaks) so infctivity
of patients or activeness of virus is maximum is this period. This period is called window period (No
specific symptom appear in this phase so ELISA test is negative in window period)
 AIDS related complex (ARC) = mild form of HIV
= Swollen lymph nodes, bouts of fever, repeated episodes of
diarrhoea, weight loss prolonged cough.
= Patient become fully immune deficient in this period.
T-lymphocytes or CD4 count < 200 × 106 / litre (normal CD4
count > 900 × 106 per/litre) and now this condition is called full
blown AIDS.
 Full blown AIDS = Tuberculosis by Mycobacterium avium.
= Candidiasis of mouth and oesophagus by Candida albicans.
= Pneumonia by fungus Pnemocystis carinii
= Sores by Herpes simplex virus-II
= Cancer of skin and lymphnodes (Kaposi’ sarcoma), HIV acts as an
oncovius.
= Dysentery by cryptosporidium
= AIDS dementia (memory loss) by Herpes Zoster Virus.
= Encephalitis by Toxoplasma gondii.
 Most of infections are due to oppurtunistic infections, appear when immunity become weak.

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 Investigation :
 Screening test : (ELISA) Enzyme linked immuno sorbent assay.

 Confirmatory tests : Western blot test which detects antibodies, in patient’s serum.

 Treatment :
 Reverse transcriptase inhibitor = Zidovudin (previously called AZT), Stavudin, Trizivir, DDI (Didexymidine),
Foscarnet, etc.

 Protease inhibitor = Ritonavir, Nelfinavir, Sequinavir etc.

 HAART (Highly Active Ant Retroviral Therapy) includes both reverse transcriptase inhibitor and protease
inhibitor drugs.

Dr. David Ho. - Cocktal treatment of AIDS in 1993 and research in USA 1995, man of the year.

- Treatment is only partially effective, only prolong the life of the patients but cant prevent death, which
is inevitable.

 Prevention :
 Education : NACO (National AIDS control Organisation) has been set up under health family welfare
ministry.

(NGOs / Non government organisation also playing their important role)

 Screening of blood.

 Ban on prostetution, Safer sex and awareness about to use of condoms.

 Use of disposables.

 Sterlization of Ragors, blades and dentral equipments.

 AIDS patients need help and sympathy instead of being shunned by society.

4 BIOCHEMICAL INVESTIGATION

 Haemoglobin Estimation -
Methods of Haemoglobin Estimation :

Haemoglobin is a chromoprotein consisting of the colourless globin molecule attached to four red coloured
haem molecules. The globin molecules consist of two alpha-polypeptide chains and two beta-polypeptide
chains. Haem is a metal complex containing an iron atom in the centre of porphyrin structure. Haemoglobin
is formed in developing erythrocytes (normoblasts) in the marrow.

The biosynthesis of haemoglobin involves the tried of manufacture of haem, manufacture of globin and iron
metabolism. Methods of estimation of haemoglobin are as follows :

Sahli’s acid haematin method :

Principle :

Hb is converted into acid haematin by hydrochloric acid. The brown colour of the compound is matched
against a brown glass standard in a comparator.

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Fig. haemoglobinometer

Normal range of Hb

Adult 15.5  2.5 g / dl

 One of the common method employed to determine Hb is Sahli method using as Haemoglobinometer
(Brown complex - acid Haematin is formed).

 Some indicators of disorders are :

Low Hb - Anemia and leukemia.

High Hb - Dehydration and polycythemia or erythrocytosis

 Erythrocyte Sedimentation Rate (ESR)

It is the rate at which the erythrocytes or RBC sediment. when they are allowed to settle out from plasma.
ESR is measured in terms of milimeter per hour. It is useful in diagnosis of many diseases or non specific
infection, though it is not specific for any particular disease.

Fig. Westergren Method

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Normal value of ESR is various methods are as follows

Method Normal values


Man (mm/hr) Woman (mm/hr)
Wintrobe 0 to 15 0 to 20
Westergren 0 to 15 0 to 20

 Estimation of blood groups -


Blood groups detection is termed as typing of blood and is generally carried out by “Slide Technique”
using antisera A and B. Climbing of cell due to serum indicate the blood groups as given below :

RBC (Groups) Seram


Anti-A Anti-B
O - -
A + -
B - +
AB + +

 Lipid Profile : Blood Cholesterol Tests measure the levels of lipids (fatty acids). cholestrerol and
triglycerides in the blood. Elevated lipid levels indicate heart disease or stroke overweight or
diabetes mellitus.
 Two important cholestrol types are HDL (high-density lipoprotein) and LDL (low-density lipoprotein) HDL
have a protective effect against atherosclerosis where as high blood level of LDL is a risk factor
HDL is good cholesterol and LDL is bed cholesterol.
Normal cholesterol level in blood = 150 mg – 240 mg/dl.
200 > low risk / 200 – 250 moderate risk
> 250 – high risk
 ELISA TEST (Enzyme linked Immunosorbent Assay Test or diagnostic kit)
It is a technique which can detect and even quantitate extremely small amount of a protein, antibody
or antigen with the help of enzyme. The reaction is allowed to proceed in specialised ELISA plate or
tray. The commonly used enzymes are peroxidase, alkaline phosphatase and -galactosidose
ELISA for HIV antibody in serum:

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 Microsassay plate coated with HIV antigen. The sample suspected to contain the Ag immobilised on the
surface of an ELISA plate.

 Test serum is added and incubated. HIV antibody if present in the serum will attach to HIV antigen.

 After washing, add goat antithuman immunoglobulin antibody conjugated with horse serum peroxidase
enzyme. The conjugate will attach to HIV antibody in a positive test.

 After washing, add substrate OPD (orthophenyl diamine HCI/paranitropheny phosphate). or


(H2O2 + 4-chloronapthol)

 A colour develops in the positive test, while there will be no colour in a negative test. ELISA is very quick
diagnostic technique for detection of a wide variety of pathogens, disorders, allergens and hormones,
Like–

G Pregnancy test throught presence of human chorionic gonadotropin (HCG) in urine or blood.

G AIDS or HIV infection

G Hepatitis

G STD or sexually transmitted disease

G Rubella virus

G Thyroid disorder

 Autoanalyser

It is a automatic, computerised instrument which can analyse qualitatively and quantitatively various
biochemicals present in body fluids like urea, uric acid, ketones, cholesterol, glucose proteins, enzymes,
etc. in batch type autoanalyser (more common) only one type of analysis is carried out at a time while in
multichannel autoanalyser a number of biochemicals are tested from the same sample.

 Tissue Grafting

This is based on HLA (Human leucocyte antigen) or MHC (Major Histocompatibility Complex). It is present
on the surface of leucocyte tissue typing is done before tissue grafting.

Gene of this antigen is present on sixth chromosomes. Cyclosporin drug is used as a immunosuppressent
drug during tissue grafting.

 Type of Tissue Grafting


 Autograft : (most successful) Transplantation of tissue from one body part into another body part of an
individual.

 Isograft : Transplantation of tissue in between the individual of same genetic constitution. Ex. - Graft
between identical twins.

 Homo or allograft : Tissue grafting in between the genetically dissimilar individual of the same species.
e.g. Family members or intra species gaft.

 Hetero or Xenograft : Tissue grafting inbetween organism of different species.

Successful graft order : Self > Identical twins > Siblings > Parents > Unrelated donar

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 Polygraphy
 It is popularly but quite incorrectly called ‘The lie detector’ Polygraph is a simple, compact and portable
machine that records qualitative changes in physiological parameters rather than measuring them
accurately. These parameters include vital traces such as cardiac variables (ECG). Heart pulse rate (HR)
relative blood pressure (BP), the rate and depth of breathing and the resistance of skin to the conduction
of electricity.

 A modern computerised version of this multi channel device is used to record neuro physiological parameters
such as E.E.G, EMG (Electromyograph). and EOG (Electrooculograph).

 Uses of polygraphy

G Lie detecting

G Monitoring of stages of sleep

G Electrophysiological behaviour of brain and its functions

 Laser
 Laser (LASER) or light amplified by stimulated emission of radiation is a beam of very high energy
particles. Depending upon the source of generation, it is called argon laser, carbon dioxide laser or neon
laser Medical lasers used for therapeutic purposes. They can be targeted on any tissue or organ inside the
body.

G Breaking of kidney stones and gall bladder stones into fine powder for removal through natural excretory
processes instead of surgery.

G Treatment of cancerous and other tumours by selective burning of cells.

G Treatment of opacity of eye lens.

 Laser Microsurgery
In microsurgery type, use and effect of laser on tissue depends on its wavelength.

type of laser used in microsurgery

 Carbondioxide laser : This laser has a short wavelength (10.6 m) it is absorbed by water in target cells
and its energy is quickly converted into heat. As a result the effect of laser is highly localised. used in
Neurosurgery to remove the unoperable brain tumours.

 Visible Argon-ion laser : It is used in eye surgery has an intermediate effect on tissue.

 Lasik laser

 Cryosurgery
Cryosurgery as the name implies, uses freezing temperatures to destroy. Liquid nitrogen, which has a
temperature of –196°C, is sprayed onto the tissue either directly, as in the treatment of warts, or via a hollow
probe that is inserted into the tissue. Cancerous tumours can also be destroyed in this way.

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4 DEVICES

There are three types of devices

G Implants

G External Prosthesis

G Disposables

 Implants -
Implants are devices fitted in various body parts to overcome disorder, e.g., heart valves, joints, vascular grafts,
cosmetic surgery. The material used in implants is nontoxic and biocompatible. Two common types of implants
are artificial heart valves and vascular grafts.

 Artificial Heart Valves : Heart valves (Semilunar, bicuspid, tricuspid) are working round the clock, they
may become damaged due to wear and tear, rheumatic fever and other diseases. Such valves require
replacement with artificial ones as defective heart valves can lead to heart failure. Artificial valves are of two
types.

G Mechanical or Metalic Valves : They are made of special biocompatible plastics, metal alloys or
ceramics, Mechanical or Metalic valves develop tendency of blood coagulation. Hence, blood
anticoagulants are required.

G Tissue Valves : They are obtained directly from pigs, cadavers or made from pericardium of
animals. The valves have the tendecy to calcify with time, especially in young.

 Vascular Grafts or Artificial Arteries : Parts of blood vessels, especially arteries may become defective
due to blockage, atherosclerosis, disease or aneurysm (dilation like a balloon with changes of rupturing
and consequent death) requiring replacement. Artificial arteries or vascular grafts are pliable tubes generally
made of fibrous plastic of dacron (terylene) or teflon (poly tetra fluoro ethylen) - Saphenous vein or
internal mammary artery.

 P.T.C.A. (Percutaneous transluminal coronary angioplasty)

It is a technique for unblocking coronary arteries that have atherosclerotic plaque. A balloon catheter is
inserted into an artery of the arm or thigh and gently guided through the arterial system under X-ray
observation artery. Then, while dye is being released, angiograms are taken to localise the plaques. Next,
the catheter is advanced to the point of obstruction and a balloon-like device is inflated with air to squash
the plaques against the blood vessel wall, there by clearing the channel for the blood even in cases where
it had previously been partially blocked.

 External Prosthesis
 It is a device which can be attached to body for overcoming a person who has undergon amputation e.g.
artificial hand/arm, foot leg, denture (artificial teech), etc P.K. Sethi of jaipur has developed a highly
sophisticated light weight solid rubber wood aluminium foot which can be rotated and bent just like a
natural foot. It is popularly known as Jaipur foot. Artificial arms are equally successful. A myoelectric
arm has also been developed which can move prosthetic wrist and fingers to hold objects.

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 Disposable devices

 Oxygenators or Heart lung machine (Bubble oxygenators most common)

Heart lung bypass is resorted to during open heart or lung surgery. Function of heart is performed by
roller pump while that of lung is taken over by oxygenator. Oxygenator is a disposable device or
artificial lung for oxygenation for blood.

Fig. Heart lung machine

 Blood Dialyser / Haemodialyser or Artificial Kidney :

The blood urea level rises abnormally (uremia) in patients suffering from renal failures. An artificial
kidney is used for removing excess urea form the blood of the patient by a process called hemodialysis.
Blood is taken out form an artery of the patient, mixed with an anticoagulant, such as heparin, and then
pumped into the apparatus called the artificial kidney. In this apparatus, blood flows through channels or
tubes bounded by cellophane membrane. The membrane is impermeable to macromolecules, such as
plasma proteins, but permeable to small solutes, such as urea, uric acid, creatinine and mineral ions. The
membrane separated the blood flowing inside the channels or tubes from a dialysing fluid flowing outside
the membrane.

The dialysing fluid contains some small solutes and mineral ions, but does not contain nitrogenous waste
products, such as urea, uric acid and creatinine. So, these wastes diffuse from the blood to the dialysing
fluid across the cellophane membrane, following the concentration gradient. Thus, the blood is considerable
cleared of nitrogenous waste products without losing plasma proteins.

Such a process of separating small solutes from macromolecular colloids with the help of a selectively
permeable membrane is called dialysis. The blood coming out of the artificial kidney is warmed to body
temperature, mixed with an antiheparin to restore its normal coagulability, and returend to a vein of the
patient. Hamodialysis saves and prolongs the life of many uremic patients.

If the kidney failure cannot be treated, by drug of dialysis, the patients are advised for kidney transplantation.

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 Defibrillator -

Fibrillation is abnormal and asynchronous contraction of the heart muscles so that the effectiveness of
heart pumping is reduced or completely lost. Atrial fibrillation may occur in myocardial infarction, and in
rheumatic heart disease. A strong electrical current passed across the chest for the short period of
time can stop ventricular fibrillation; this is called defibrillation. It is achieved by a defibrillator that gives
the electric shock through large-paddle shaped electrodes pressed against the skin of the chest. Now
battery operated implantable devices are available for patients suffering from arhythmic disorder.

 Endoscopy (Endo = Within, Scope = View) -

The endo-scope constist of long flexible tube attached to a handset. The tube is inserted through an
opening into the body. This tube have many channel.

G One channel for electric cable the electric signal from the camera (tip of tube) is sent up the tube
along this electric cable and feed into a videomonitor where a magnified image is seen.

G One channel for transmit light to the tip contain bundles of optical fibres inside the endoscope.

G One channel in the endoscope carries air and water making it possible to wash the surgical site.

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G One channel is for miniature surgical instruments such as forceps at the tip that are controlled by a
cable running through a parallel channel. Can also be taken to the site where surgery is needed. A
wide variety of instrument can be fitted to the endoscope; toothed biopsy forceps allow samples of
tissue to be removed for analysis :

Metal snares cary high frequency elecric current that can coagulate blood vessels.

 Types of Endoscopes :

(Named after the part of the body they are desined to view)

G Gastroscope : This is used to examine the stomach for gastric ulcer.

G Laproscope : (Lapro = abdomen) This is used to examine the cyst or infections of the uterus, fallopian
tube and ovaries.

BIOMEDICAL TECHNOLOGIES
DIAGNOSTIC IMAGES

4 X-RAY IMAGING

Introduction – It is one of the oldest method of imaging which start with the accidental discovery of X-
ray by Wilhelim Konred Roentgen, a German physicist, in 1895.

The branch of science that deals with the study of X-ray for detection and treatment of diseases is called
radiology.

Principle : High dose X-ray

Uses :

 X-ray imaging is usually applied in detecting bone fractures and dislocations. This technique is also
advantageous in detecting the diseases of heart and lung. (Barium is used as radio opaque dye)

Advantage : Cheap and easy procedure.

Disadvantage : Harmful to our body (Act as carcinogens).

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 Digital Subtraction Anaiography (DSA) :


DSA is an imaging technique that produces clear views of flowing blood in vessels and indicates the
presence of blockages, if any. An angiograph (angeion : vessel, graghein : to record) is taken of the organ,
for example. heart and its major blood vessels and stored in a computer. A second angiograph is taken
after a contact agent containing iodine (I132). Which is opaque to X-rays, has been injected into the blood
stream. The first image is digitally subtracted from the second, leaving behind a clear outline of the blood
flow to heart, brain or kidneys.

Fig. X-ray of chest

4 C.T. (COMPUTERIZED TOMOGRAPHY) SCAN

Computerized tomography (CT) is also known as computerized axial tomography (CAT). This technique was
invented by English physicist Geoffrey N.Hounsfield in 1972 (Tomo is a greek term ‘cut’ or ‘slice’).
Hounsefield is also called father of modern radiology.

The theoretical basis of this technique was provided by the work of the Indian biophysicist, Gopalsamudram
N. Ramachandran.

Principal : Low dose X-rays.

Fig. CT scan of brain

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Advantages :

 Improved contrast resolution between tissue not previosly on plain radiography, eg. liver v/s gall-bladder, etc.

 Ability to display cross-sectional images in the axial plane.

Uses :

CT scans are generally performed of the head and the abdomen. CT is valuable technique commonly
used to investigate the brain following a stroke or if a brain tumour is suspected.

Disadvantages :

 Expensive

 Ionising radiation (X-ray) involved.

4 M.R.I. (MAGNETIC RESONACE IMAGING)

(Dr. Raymond Damadian, Felix bloch, Edward M.Purcell (Nobel Prize))

The technique is based on magnetic resonance generated by the nuclei of hydrogen atom subjected to
an external magneticfield (upto 7-Tesla). It is based on NMR (Nuclear Magnetic Resonance) because
our body cell is having H atom in the form of H2O molecule therefore our body act as miniature magnet
and generated magnetic field.

Fig. CT scan of brain

Advantages :

 No ionising radiation is used.

 Images can be taken in any plane and obtain 3D image in picture.

 The inherent contrast between various tissues is better than with other modalities.

MRI detects water because it focuses on the behaviour of hydrogen atoms in water molecules. This allows
MRI to distinguish between water-poor and water-rich tissues. Teeth and bones which contain little
water, do not appear in MRI. Therefore, tissue surrounded by bones, such as spinal cord, are readily
observable in MRI. It is used to examine brain and spinal tissue, joint injuries and slipped disk in the
spinal column. MRI can also visualise minute cancerous tumours, since radio frequency absorbed by the
hydrogen atoms in such tissues for the same field is different from that for normal tissues.

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Fig. CT scan of brain

 MRI is superior to CT and PET. because :


 CT-scan can obtain only cross-sectional images whereas MRI can obtain images in any plane.

 MRI is applicable is diagnosing tumours, infarctions (muscle cell death), haemorrhage, abnormalitties
related to spine, myocardial infarction (heart attack), myocardial ischaemia coronary artery disease,
etc. A related technique, called Magnetic Resonance Angiography (MRA), can be used to monitor the
flow of blood.

 Nuclear magnetic resonance (NMR) or magnetic resonance imaging (MRI) is a new noninvasive
method of mapping the internal structure of the body.

Disadvantages :

 Expensive

 Patients with various metallic implants may not be able to undergo MRI exams.

 Claustrophobia can lead to inability to examine patients.

4 POSITRON EMISSION TOMOGRAPHIC SCANNING (PET)

 PET is also a computer based imaging technique but differs from CT scanning. It provides information
on the metabolic and physiological processes of the tissues and organs. The CT scanning, on the
other hand, gives only the ‘static’ anatomical images.

 This technique involves the use of positron emitting short life radio isotopes (like 11C, 13N, 15O and 18F).

These atoms are first incorporated into biomolecules (such as glucose, aminoacids, carbon dioxide
and amonia) and then injected in very small amounts into or inhaled by the experimental animal or
human.

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As the radioactive atom decays, it emits a subatomic particle, called positron. Almost immedietely, the
emitted positron colloids with it antiparticle, i.e., an electron. This collision releases a burst of
electromagnetic energy in the form of pair of -radiation. This double emission is the key to the PET
scan. These radiations emerge simultaneously in the opposite directions and they strike crystals in a
ring of detectors around the patient’s head, causing the crystals to light up.

 A computer records the location of each flash and spots the source of radiation, translating that data
into a 3D-image.

A metabolically active tissue will receive a greater blood supply than a relatively inactive tissue.
Therefore, it will also get a greater supply of radioactive glucose and would appear as a brighter
area in the PET image. For example, the darkened area on the of brain indicates damage from
a stroke. Bright colours in the rest of the brain show normal blood flow. Thus, by tracing the radioactive
glucose, a physician can pin point the area of greater brain activity, e.g., the regions of brain involved
in a particular function.

This versatile technique is used to study epilepsy schizophrenia, Parkinson’s disease and drug addiction.

 Recently, the scientists in U.K. have located the colour processing centres in the human vision cortex
with the help of PET-imaging technique.

 PET is useful in measuring :

 Metabolic rates.

 Regional blood volume and blood flow

 Areas of abnormalities like disease and defects.

 Identifiation of specific centres in brain like colour processing in visual cortex of humans.

4 SONOGRAPHY / ULTRASOUND IMAGING

(Olaf von Ramm; Donald, 1958)

It is a noninvasive technique which uses ultrasound for producing images of internal body parts. Ultrasound
is ‘sound’ beyond human hearing power, that is, above 20000 Hz or 20 kHz. Diagnostic ultrasound used
in sonography has a frequency of 1-15 MHz (MHz = magahertz = 1 million oscillations / sec.). Ultrasound
is produced through piezoelectric effect. Here, electric potential is applied to crystals of lead zirconate
in a transducer. The crystals vibrate and produced ultrasound. Ultrasound is partly relfected as it
passes from one layer to another. The reflected waves are picked up by lead zirconate crystals and
changed to electrical signals. The latter produce a visual image which is observed over compoutrer screen.
Sonography provides images to all those organs or regions which are different or become different in density
from surrounding tissues.

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Monitor

Transducer

Operator
Transducer

skin Aorta
Heart

Narrow ultrasound beam rapidly TV Display


oscillated through 60º or 90º

Fig. Ultrasound imaging (Sonography)

Sonography is also called Echography. For clinical examination, a sonographer places a scan head or
transducer in contact with the area to be scanned. A layer of aqueous gel is applied between the skin
and scan head to ensure that the sound has an air-free path to the object of interest, e.g., a foetus.

Sonography, safer than radiography, is comfortable and inexpensive.

Fig. Ultrasound imaging (Sonography)

Uses of USG :
 It is used to assess foetal growth and to pick up a wide range of abnormalities, such as spinal bifida,
and conditions liable to cause difficulty in labour.
 Ultrasound imaging is used to investigate the internal organs such as liver, gall bladder, kidney,
stomach, uterus, heart, etc.
 A related technique, called Doppler Ultrasound Scanning is used to investigate the flow of blood
in vessels and for detecting blood clots (Incoming blood - red, out going blood - blue.)
Sonography is also used to image the adult body. It even provides pictures of blood flow through the
beating heart, based on a phenomenon konwn as Doppler effect.
 Echocardiography is sonographic (ultrasound) imaging of heart, great vessels, heart valves, heart
walls, etc. to know abnormality. It is also used to record blood flow velocity and blood turbulence.

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Advantages :

There is no exposure to radiation. Ultrasound imaging is non-invasive and painless. there is no harmful
effects in man. It is less expensive. The images can be obtained in any plane.

Disadvantages :

Ultrasound imaging does not penetrate bones and air filled spaces so it is not useful in diagnotic abnormalities
in the skull, lungs or intestine, Resolution power of ultrasound imaging is inferior to CT Scan and MRI

4 EEG (ELECTRO-ENCEPHALOGRAPH) OR BERGER WAVES

Hens Berger (1929) obtained electrical activity when a galvanometer was connected to human scalp. It
gave birth to electroencephalography. Electro-encephalo graph is an electricity operated instrument having
16-30 elctrodes which when attached to scalp given information about the electric waves originating from
different parts of the brain. It is a noninvasive technique.

There are four types waves-alpha, beta, theta and delta.

Fig. EEG of brain

 -waves : An awake but resting person produces rhythmic alpha waves with a range of 8-13 Hz
Alpha waves originate from occipital region.

 -waves : An alert wide awake person shows unsynchronised high frequency ECG. During intense
mental activity, beta waves originate from frontal and parietal regions. Frequency is 14-30 Hz.

 -waves : Theta waves occur in children as well as adults under stress and drowsy Frequencyis
4-7 Hz.

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 -waves : Higher amplitude and slower frequency waves called delta waves, originate when a person
is in deep sleep. Frequency is below 1-3 Hz.

 Deviation indicate brain disorders and changes in physiological state of brain. Electro-encephalogram
is the recording of electrical potentials, originating from different parts of the brain in the forms of waves.
EEG can diagnose epilepsy, brain tumour, subdural haematoma, brain injury, sleep disorrders,
metabolic and drug effects on brain.

 MET (Magneto encephalography) -


 It is magnetoencephalographic technique which empolys SQID for picking up weak magnetic waves
emanating from brain. The tchnique gives information about the health of various parts of the brain.

 SQID (Super Conducting Quantum Interference Device) -


 It is super-conducting quantum inerference device, e.g., magnetoencephalograph. The device has a
superconducting ring where a change the magnetic flux into the voltage in amplified form.

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