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All
medical practitioners should know the role played by enzymes in private
practice. This knowledge is available in many books written on this
subject. I quote a few examples where they can be helpful in arriving
at an early diagnosis. |
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1.
Common Fevers |
a.
In malaria, especially falciparum, LDH will rise, before haemoglobin
falls. Therefore, raised LDH early will be suggestive of malaria.
b. In a case of fever with bodyache and muscle pain, raised CPK level
will favour the diagnosis of leptospirosis (and not dengue).
c. Raised SGPT is non-specific, (most of the times) in common fevers,
but if raised 3-5 times, it will help to diagnose viral hepatitis.
d. In a case of malaria, if G6PD deficiency is found, it is advisable
not to prescribe Primaquine. |
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2.
Bone Diseases |
Osteoporosis
is diagnosed by reduced Bone Marrow Density. Added to it, if serum alkaline
phosphatase is increased, it denotes osteomalacia, which is easily treatable
with large doses of Vit D and calcium. |
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3.
Muscle Diseases |
Normally,
CPK would be raised in diseases like myopathy or polymyositis or if
drugs like statins are being taken. Normally, muscles are rich in CPK.
But if a normal, healthy person visits the gymnasium to exercise and
then goes to the lab to give blood for examination, his CPK will be
raised. |
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4.
Cancer |
In
differential diagnosis of wide spread cancer and tuberculosis, LDH level
can help in the diagnosis. It is always raised in the former condition.
Also, remember that in a patient of blood cancer, an estimation of LAP
(Leucocyte alkaline phosphatase) is very useful. |
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5.
Tuberculosis |
During
a general examination, if a patient with `no symptoms' shows signs of
chest tuberculosis and an X-ray chest is also suggestive of it, it may
be necessary to exclude sarcoidosis, where Serum ACE (Angiotensin Converting
Enzyme) level will be raised. |
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6.
Anaemia |
If
an anaemic patient has MCV level more than 120, and if the LDH level
is raised, the diagnosis of anaemia due to deficiency of Folic acid
or B12, should be made. |
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7.
Heart diseases |
Nowadays,
diagnosis of myocardial infarction is made by ‘any’ ECG
changes (ST elevation or Q wave are not a must), together with elevated
Blood Troponin levels (T or I or both) or raised CPK MB enzyme in the
blood. Vice versa, if these blood tests are normal, even after 12 hours
of appearance of symptoms, diagnosis of myocardial infarction can be
excluded. |
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8.
Lung Ailments |
Although,
D-Dimer is not an enzyme, it is included here for practical purposes.
So important is the value of D-Dimer in the diagnosis of pulmonary embolism,
that this condition can be excluded if the D-Dimer levels are normal.
Unfortunately, D-Dimer also rises if a patient develops DVT without
pulmonary embolism. Therefore, deep vein thrombosis, in private practice
can now be accurately diagnosed if the D-Dimer levels in blood are raised.
Costly procedures like Doppler or Duplex ultrasound studies and Isotope
nuclear scans need not be done. |
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9.
Liver Diseases
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Very
high levels of SGOT favour diagnosis of alcoholic hepatitis. SGPT rises
to very high levels in early viral hepatitis. Isolated raised Gama GT
level is suggestive of an alcoholic liver. High fever and markedly raised
ESR, along with markedly raised Gama GT only, is suggestive of tuberculosis
of the liver. In a patient with fever, raised alkaline phosphatase should
make you look for Amoebic Liver Abscess. |
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10.
Pancreatitis
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Acute
pancreatitis is always diagnosed by markedly raised S. Amylase in the
first 24 hours. After 24 hours, testing urinary amylase with creatinine
ratio will help. Besides, Serum Lipase also rises after 24 hours. |
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11.
Gall Bladder Disease |
In
acute cholecystitis, slightly raised S. Alkaline Phosphatase level may
occur.
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12.
Intestinal Disorders |
In a patient with an irritable colon or small intestinal disease, there
is a deficiency of enzyme lactase. Such patients cannot tolerate milk,
which causes a lot of flatus and loose stools. |
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13.
Kidney Disease |
Raised
alkaline phosphatase in CRF patient means that the patient needs calcium
and Vit. D in the form of Calcitriol. |
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TENNIS
ELBOW IS HELPED BY NSAIDs IN THE SHORT TERM
In an excerpt from Concise Clinical Evidence, Assendelft and
colleagues review the evidence for treatments for tennis elbow
(also known as lateral epicondylitis). Topical non-steroidal
anti-inflammatory drugs (NSAIDs) are safe and effective for
pain relief in the short term, and there is some evidence of
benefit from oral NSAIDs. The treatments for which effectiveness
is still unknown include acupuncture, exercise, extracorporeal
shock wave therapy, surgery, braces, and NSAIDs in the long
term. In an accompanying commentary, Mellor cautions against
seeing this review as definitive: many trials have been short
term, during which tennis elbow often spontaneously resolves;
more research is needed on treating chronic tennis elbow.
BMJ 2003; 327 : 329-30 |
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