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GENERAL PRACTITIONER'S SECTION
ROLE OF BLOOD ENZYMES IN COMMON FEVERS
OP Kapoor
Enzymology, which was not popular in the past, has become very popular in the diagnosis of even common fevers. The following are the examples:
1. In malaria, the rise of LDH (Lactic Dehydrogenase) is very useful in the diagnosis because it indicates haemolysis of RBCs which
occurs only in this fever.
2. Marked rise of S. Alkaline phosphatase or Gama GT even without hepatic pain, should make you look out for an Amoebic liver abscess and sonography should be asked for.
3. Finding raised CPK (Creatine Phospho Kinase) in a very sick patient having severe aches in the muscles, will go in favour of the diagnosis of Leptospirosis.
4. A very high reading of SGPT (more than 3-5 times the normal) in a fever patient will suggest the diagnosis of viral hepatitis.
5. A very high reading of SGOT and Gama GT will suggest the diagnosis of alcoholic hepatitis. Finally, the demonstration of adeno-de-aminase enzyme in pleural fluid of patients having pyrexia should go very much in favour of tuberculous pleurisy.
SCREENING MAMMOGRAPHY
‘Our findings show that screening with mammography contributes to the reduction in breastcancer mortality rates’
The long-term effect of mammographic service screening is yet to be established. In two studies, investigators have assessed the effects of mammographic screening on deaths from breast cancer in two Swedish counties and the Netherlands, respectively. Laszio Tabar and colleagues compared deaths from breast cancer in the 20 years before screening with the rate of breast-cancer deaths in the 20 years after the introduction of screening in two Swedish countries. Suzie Otto and colleagues analysed data for more than 23000 women who died of breast cancer between age 55 and 74 years of investigate time trends in breast-cancer mortality and the effect of screening. Results from both studies suggest that routine mammography screening can be effective in reducing the number of deaths from breast cancer in the population.
BMJ, 2003; 1405, 1411
