FAQs ON MATERNAL MARKERS AND PlGF TESTING

Why is a Dual Marker not done when one foetus is aborted in case of twin pregnancies?

If one foetus is aborted, we need to look for the foetal pole. If the foetal pole is present in the demised twin, the dual test is not possible as there will be production of substances (PAPP-A & Free βhCG) from the demised twin and the resulting interpretation will be erroneous. Foetal pole needs 8-9 weeks to close in cases where one foetus in aborted. If there is no foetal pole we can take the pregnancy as a singleton and the dual test can be processed.

Why do we report single risk in monochorionic twins although the CRL (Crown-rump Length) and NT (Nuchal Translucency) values are different?

Monochorionic twins originate from the same embryo, so they are assumed to be genetically identical although there is the difference in biometry.

What is the benefit of NT value measured using FMF (Fetal Medicine Foundation) guideline?

FMF guidelines provide a standardized methodology for NT measurement. This is paramount in maintaining the sensitivity of the combined screening as it contributes significantly (about 70% to the 91%) detection rate in the dual test.

What is Corrected MoMs?

Corrected MoMs are MoMs with weight corrections.

  • Weight correction should be applied to all analytes in Down’s syndrome screening
  • Evidence shows that weight correction improves the detection rate
  • Multiple median values can be significantly affected by weight correction
What is the importance of the sample collected on the DBS card over serum?

Free βhCG is more stable and intact on the DBS card. Also dissociation from free βhCG occurs slow on the DBS card.

Why is maternal screening not done between 14 and 15 week of gestation?

One of the most discriminating markers for NTD is AFP which is best accessed from the 15th week for the quadruple test. Hence, the window of the 14 to 15 week is not ideal for dual or quadruple test.

Why do we not report Patau syndrome (T13) in 2nd trimester screening?

Sensitivity of patau syndrome is very low in the 2nd trimester as pregnancies diagnosed with T13th end in miscarriages between 12 to 15 week of gestation.

What is the difference between LifeCycle software, ssdw, Austria and Prisca?

LifeCycle risk calculation engine is a comprehensive informatics package for maternal health monitoring and risk assessment. An accessible patient data management system is coupled with a flexible risk calculation engine, which can be configured to meet local variations. Because the system has been fully validated and all calculation methods, algorithms and values are supported by the current published literature, LifeCycle gives full confidence in a maternal risk assessment program.

Are there any insights on Pre-eclampsia (PIGF- PLACENTAL GROWTH FACTOR)?

Pre-eclampsia is a sudden increase in blood pressure and protein in the urine after the 20th week of pregnancy. Pre-eclampsia can lead to eclampsia, or convulsions, posing serious health implications for the mother and the baby. Symptoms of pre-eclampsia may include:

  • High blood pressure (≥140/90 mmHg)
  • Swelling in the face and hands (and feet, although swollen feet are common during pregnancy)
  • Weight gain of more than 2 kgs in a week
  • Other problems such as headache, blurred vision, abdominal pain and nausea
What is MAP & uAD and what is their relevance in PlGF test?
  • Mean Arterial Pressure (MAP) – Accurate measurement of blood pressure in pregnant women is particularly important when attempting to identify early signs of pre-eclampsia. As a means of prediction, it has been suggested that the MAP, whether measured in the first or second trimester, is better than systolic blood pressure, diastolic blood pressure, or an increase of blood pressure. In clinical practice MAP measurement in the first trimester may not make a clinical impact in isolation but could be suitable for use with other markers, including maternal serum markers, to improve the accuracy for estimating the risk of pre-eclampsia.
  • Uterine Artery Doppler (uAD) – The uterine artery Doppler can be evaluated by direct visualization, i.e. examining the characteristics of the waveform to determine if nothing is present or absent, or by quantifying the waveform by measuring the blood flow velocity at peak systole (maximal contraction of the heart) and peak diastole (maximal relaxation of the heart). These values are then computed to derive a ratio. The most common approach is to measure the Resistance Index (RI) in which the peak of systole is divided by the sum of systole and diastole.
  • RI= systole/ (systole + diastole)
  • In early pregnancy, the peak flow at diastole is less than later in pregnancy. Therefore, as the duration of pregnancy increases, the amount of blood flowing in the umbilical artery increases during diastole.
Test Code Test Name Sample Comment/ Description
SGO61 Dual Marker Test: (11 – 13.6 weeks) PAPP-A, Free ßhCG 2 ml serum / DBS Card NT by USG report (NT & CRL values) and brief clinical history required
SGO62 Triple Marker Test: (15 – 21.6 weeks) AFP, ßhCG, uE3 2 ml serum USG report and brief clinical history required
SGO63 Quadruple Marker Test: (15 – 21.6 weeks) AFP, ßhCG, uE3, Inhibin – A 2 ml serum USG report and brief clinical history required
PRF2400 Integrated Test: Dual Marker (First Trimester Screening) & Quadruple Marker (Second Trimester Screening) 2 ml serum NT by USG report in 1 trimester & USG report in nd 2 trimester and brief clinical history required

Sequential Test: (Combined risk evaluation even if Dual Marker is done seperately)

Test Code Test Name Sample Comment/ Description
SDO61 Dual Marker Test: (11 – 13.6 weeks) PAPP-A, Free ßhCG 2 ml serum NT by USG report and brief clinical history required
SDO63 Quadruple Marker Test: (15 – 21.6 weeks) AFP, ßhCG, uE3, Inhibin A 2 ml serum USG report and brief clinical history required, (Patient needs to carry Dual Marker report)
SDO63 Prenatal BoBs (Aneuploidies + Microdeletion) 3 ml Amniotic Fluid / Chorionic Villi Brief clinical history required
SDO65 KaryoLite BoBs Placental biopsy without blood clot in normal special container provided by Lab Brief clinical history required

Premarital Screening

A premarital test is a test that offers a crucial health assessment of soon-to-be married couples in which they are tested for genetic, infectious and transmissible diseases to prevent any risk of transmitting any disease to each other and their children.

Marriage is considered a remarkable event in a couple’s life, as they plan to start a family, and through which they usher in a new stage in terms of building emotional, social, familial and healthy relationships.

Premarital testing programs should educate couples, providing accurate and unbiased information. Family background, hereditary factors, age, diet, exercise, weight management and addictions all contribute to the bigger picture.

For couples considering marriage, pre-marital screening helps identify potential health problems and risks for themselves and also their offspring. It is vital for couples to be screened in order to aid them to understand their genetics and help them take the necessary precautions or treatments.

    Importance of Pre-marital Screening:

  • Gauge the positive health status of prospective bride and groom
  • Detect infectious diseases – Hepatitis B infection, HIV, HCV and other sexually transmitted diseases
  • Identify carriers of genetic disorders, in order to assess the risk of having children with a severe form of disease. The couple can then choose whether or not to have an affected child. e.g. Thalassemia, Haemophilia and Sickle Cell Disease

Tests that constitute Pre-marital Screening:

  • Routine Investigations – Complete Blood Count (CBC), Complete Urine Analysis and Peripheral Blood Smears to check for normal and abnormal cells. Blood group testing (ABO-RH) is important to screen out the Rh-negative women and counsel them about the risks in pregnancy
  • Infectious Diseases
    • VDRL for Syphilis Testing
    • HIV – I and II
    • Hepatitis-B Screening
    • Hepatitis-C Virus
  • Genetic Tests
    • Doctors usually go for culture based genetic screening. Depending on your family history and ancestry, different tests are designed for different disorders like thalassemia
    • The tests are especially referred in ‘consanguineous marriages’ or relationships by blood or common ancestry, in which the chances of offspring inheriting a recessive allele for a disease are increased. The closer the relationship, the greater the risk
    • Genetic tests are done by analyzing small samples of blood or body tissues

Thalassemia

Thalassemia is an inherited blood disorder (passed from parents to children through genes). Anaemia is a disorder in which your body doesn’t have enough normal, healthy Red Blood Cells (RBC).

Overall estimate of ß-Thalassemia carriers is 35-45 million among India’s population of over a billion people. Estimated number of births of affected babies annually would be 10,000-12,000. Causing a Social, Psychological and Financial Burden


When thalassemia is called “alpha” or “beta,” it refers to the part of haemoglobin that isn’t being made. If either the alpha or beta part is not made, there aren’t enough building blocks to make normal amounts of haemoglobin. Low alpha is called alpha thalassemia. Low beta is called beta thalassemia.

When the words “trait,” “minor,” “intermedia,” or “major” are used, these words describe how severe the thalassemia is. A person who has thalassemia trait may not have any symptoms at all or may have only mild anaemia, while a person with thalassemia major may have severe symptoms and may need regular blood transfusions.

What is Thalassemia Minor?

People with a thalassemia mutation only in one gene are known as carriers or are said to have thalassemia minor. Thalassemia minor results in no anaemia or very slight anaemia. People who are carriers do not require blood transfusion or iron therapy, unless proven to be iron deficient.

What is Thalassemia Major?

Children born with thalassemia major usually develop the symptoms of severe anaemia within the first year of life. Lacking the ability to produce normal adult haemoglobin, children with thalassemia major:

  • Are chronically fatigued
  • Fail to thrive
  • Do not grow normally

If both parents carry thalassemia minor, their children may have thalassemia minor, or they may have completely normal blood, or they may have thalassemia major. In each pregnancy there is a one in four (25%) chance that their child will have normal blood, a two in four (50%) chance that the child will have thalassemia minor or a one in four (25%) chance that the child will have thalassemia major

How is Thalassemia diagnosed?

Thalassemia is diagnosed by the following tests:

  • Complete Blood Count (CBC with blood smear)
  • Iron studies
  • Haemoglobinopathesis (Hb) Evaluation: This test measures the type and relative amounts of haemoglobin present in the red blood cells. Haemoglobin A, composed of both alpha and beta globin, is the normal type of hemoglobin found in adults. A greater percentage of Hb A2 and/or F is usually seen in beta thalassemia trait. Hb H may be seen in alpha thalassemia due to Hb H disease. Other Haemoglobinopathesis – HbD, HbE, HbS
  • DNA Analysis: This test is used to investigate deletions and mutations in the alpha and beta globin producing genes. DNA testing is not routinely done but can be used to help diagnose thalassemia and to determine carrier status

HOW IS THALASSEMIA TREATED?

The treatment for thalassemia depends on the type and severity of disease involved. Your doctor will give you a course of treatment that is customized to your particular case.

INFECTIOUS DISEASES

Infectious diseases like HIV, Hepatitis B Virus (HCV), Hepatitis B Virus (HBV), Syphilis and Sexually Transmitted Disease (STD).

Among the blood-borne viruses transmissible through the parenteral route, by blood transfusion, as well as, by sexual intercourse, Human Immunodeficiency Viruses (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) are important and have several implications.

Pre-marital Screening also helps rule out carrier status of potentially life-threatening infectious diseases like the HIV and HBV. The World Health Organization (WHO) notes that HBV is 50 – 100 times more infectious than HIV. HBV can be passed from mother to baby during birth. Therefore, it is imperative to safeguard yourself from these potentially life-threatening diseases with simple screening.

Not only do they establish asymptomatic persistent infections, but they also cause significant morbidity and mortality when transmitted through transfusion of blood and blood products.

Failure to diagnose and treat STDs at an early stage results in serious complications and sequelae, including infertility, fetal wastage, ectopic pregnancy, cancer and death.

Tests to remember

  • CBC
  • Hb Electrophoresis
  • Iron Studies
  • Ferritin
  • Transferrin
  • TIBC
  • Alpha Thalassemia
  • Beta Thalassemia
  • Pre-Marital Screening Package: CBC, Blood Group, VDRL, HIV, HbsAg, Hb Electrophoresis, HCV

Do not let your allergies control you

What is Allergy?

Allergy occurs when a person’s immune system reacts to substances in the environment that are harmless for most people. These substances are known as allergens and are found in house dust mites, pets, pollen, insects, moulds, foods and some medicines. Atopy is the genetic (inherited) tendency to develop allergic diseases. People with atopy are said to be atopic.

What happens when you have an allergic reaction?

When a person who is allergic to a particular allergen comes into contact with it, an allergic reaction occurs. This begins when the allergen (for example, pollen) enters the body, triggering an antibody response. The antibodies attach themselves to special cells, called mast cells. When the pollen comes into contact with the antibodies, the mast cells respond by releasing certain substances, one of which is called histamine. When the release of histamine is due to an allergen, the resulting swelling and inflammation is extremely irritating and uncomfortable.

Which areas of the body may be affected?

Depending on the allergen and where it enters your body, you may experience different symptoms. For example, pollen, when breathed in through the nose, usually causes symptoms in the nose, eyes, sinuses and throat (allergic rhinitis).

Allergy to foods usually causes stomach or bowel problems, and may cause hives (urticaria).

Allergic reactions can also involve several parts of the body at the same time.

This can then cause symptoms in the:

  • Nose and/or Eyes – Hay Fever (Allergic rhinitis/conjunctivitis) Skin – Eczema, Hives (Urticaria) Lungs – Asthma
  • Skin – Eczema, Hives (Urticaria)
  • Lungs – Asthma
Common Allergy Symptoms
Fatigue Frequent Headaches
Sneezing Postnasal Drainage
Itching of the Nose Frequent “Colds”
Recurrent Ear Infections Recurrent Cough or Bronchitis
Chronic Sinus Infections Dizziness
Dark Circles Under the Eyes
Itching, Watering, Redness or Swelling of the Eyes
Tightness in the Chest, Wheezing or Asthma
Eczema, Skin Rashes, Itching, or Hives

Types of Allergies

Allergies exist in many different forms:

  • Food Allergies and Food Intolerance
    • Food allergies or food intolerance affect nearly everyone at some point. People often have an unpleasant reaction to something they ate and wonder if they have a food allergy.
  • Seasonal Allergies
    • Winter and Spring Allergies: Spring is the time of year that we normally think of when it comes to seasonal allergies. As the trees start to bloom and the pollen gets airborne, allergy sufferers begin their annual ritual of sniffling and sneezing
    • Summer Allergies: Although spring most readily comes to mind when we think of allergies, many of the same allergic triggers that can make us miserable in the spring persist into summer
    • Fall Allergies: The allergy triggers might be slightly different, but they can be just as misery-inducing as the flower pollen that fills the air in the spring and summer
  • Pet Allergies
    • Dog and Cat Allergy: For a person with dog allergies, life in a dog-loving country isn’t easy. Dog and cat dander gets everywhere, including places where dogs have never set a paw
  • Other Allergies
    • Hay Fever: Hay fever is an immune disorder characterized by an allergic response to pollen grains and other substances. Also known as allergic rhinitis, there are two types: seasonal, which occurs only during the time of year in which certain plants pollinate, and perennial, which occurs all year round
    • Allergic Conjunctivitis (Pink Eye): Pink eye caused by bacteria, viruses, or STDs can spread easily from person to person but is not a serious health risk if diagnosed promptly; allergic conjunctivitis is not contagious
    • Hives (Urticaria): Hives, also known as urticaria, are an outbreak of swollen, pale red bumps, patches, or welts on the skin that appear suddenly – either as a result of allergies, or for other reasons
    • Mold Allergy: People with mold allergies, however, may have a reaction if exposed to too much of the fungus
    • Pollen Allergies: For most people, a change of seasons signals the beginning of long, lazy days or cool, crisp evenings
    • Dust Allergy: Life with dust allergies — whether they’re yours or a family member’s — comes with a load of questions. For instance, might a dust allergy explain your child’s never-ending cold symptoms
    • Cosmetic Allergy: Although cosmetics can help us feel more beautiful, they can cause skin irritation or allergic reactions. Certain ingredients used in cosmetics, such as fragrances and preservatives, can act as allergens, substances that trigger an allergic reaction
    • Drug Allergy: Many drugs can cause adverse side effects, and certain medicines can trigger allergic reactions. In an allergic reaction, the immune system mistakenly responds to a drug by creating an immune response against it

Allergies and Anaphylaxis

Anaphylaxis is a serious, potentially life-threatening allergic response that is marked by swelling, hives, lowered blood pressure, and dilated blood vessels. In severe cases, a person will go into shock. If anaphylactic shock isn’t treated immediately, it can be fatal.

Allergy Testing

Finding out what you are allergic to is an important first step to effective allergy treatment. Today allergy tests are more convenient and accurate than ever before. When combined with a detailed medical history, allergy testing can identify the specific things that trigger your allergic reactions.

Types of Allergy Blood Tests

Allergy blood tests detect and measure the amount of allergen-specific antibodies in your blood. When you come into contact with an allergy trigger, known as an allergen, your body makes antibodies against it. Allergy blood tests usually screen for at least 10 of the most common allergy triggers, including dust, pet dander, trees, grasses, weeds, and molds related to where you live. They are also particularly helpful in diagnosing food allergies.

Allergy blood testing is recommended if you:

  • Are using a medicine known to interfere with test results and cannot stop taking it for a few days. This would include antihistamines, steroids, and certain antidepressants
  • Cannot tolerate the many needle scratches required for skin testing
  • Have an unstable heart condition
  • Have poorly controlled asthma
  • Have severe eczema, dermatitis, psoriasis, or another severe skin condition
  • Might have an extreme reaction during skin testing or have a history of life-threatening allergic reaction called anaphylaxis

Allergy blood tests may be referred to as immunoassay tests and include:

Immunoglobulin E (IgE): IgE antibodies appear in human serum and plasma as a result of sensitization to a specific allergen. Measuring circulating IgE antibodies provides an objective assessment of sensitization to an allergen. Immunoglobulin E (IgE) is an antibody that’s strongly linked to the body’s allergy response. Elevated concentrations of IgE are generally thought of in the context of allergic disease.

Enzyme-linked immunosorbent assay (ELISA, or EIA)- ImmunoCAP Specific IgE(PhadiaTop):

ImmunoCAP Phadiatop is a blood test designed to differentiate atopic from non-atopic patients. Quantifying IgE antibodies with ImmunoCAP Specific IgE accurately evaluates allergy patients. Using ImmunoCAP Complete Allergens or ImmunoCAP Allergen Components to determine the presence of IgE antibodies offers a broad range of allergens or allergen components to aid the reliable diagnosis of patients with suspected allergy.

ImmunoCAP Phadiatop/Phadiatop Infant

In younger children aged 0-3, allergic sensitization is mostly related to food allergens (such as egg, milk, fish, soybean and peanut) rather than inhalant allergens. However, antibodies to inhalant allergens such as house dust mites and pets can still appear early in life. With this in mind, a combination of Phadiatop and the most common food allergens is recommended when testing children for atopy.

Clinical value

Phadiatop and Phadiatop Infant are assays for the graded determination of atopy with semiquantitative or qualitative results.

Accuracy of ImmunoCAP Specific IgE allergen test (Phadiatop)

  • Sensitivity 93%
  • Specificity 89%

Living and Managing

If something irritates you, avoid it. That’s the motto that allergy sufferers must adopt. By tuning into your allergy triggers, you can rein in your reactions

Tests to remember

  • Allergy Phadiatop (Pediatrics)
  • Allergy Comprehensive Food Panel (Veg/Non Veg)
  • Allergy Pediatrics Panel (1 / 2)
  • Allergy Food Panel Vegetarian (Mini/Maxi)
  • Allergy Eczema Panel (Mini/Maxi-1/Maxi-2)
  • Allergy Rhinitis Panel (Mini/Maxi)

A closer look at Infertility

Infertility is a disorder of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.

Nearly 30 million couples in India suffer from infertility.

Top causes of Infertility in men

  • A history of having mumps
  • Testicular injury
  • Exposure to chemicals or toxins
  • Acute illness or prolonged fever
  • Drugs (marijuana, opiods, cimetidine, corticosteroids, methotrexate, antineoplastics drugs) or alcohol use
  • Use of anabolic steroids
  • Undescended testis
  • Hormonal imbalance
  • Klinefelter Syndrome

Top causes of Infertility in Women

  • Blocked fallopian tubes due to sexually transmitted diseases
  • Polycystic Ovarian Syndrome (PCOS), which can interfere with ova release
  • Uterine fibroids
  • Endometriosis
  • Autoimmune disorders, which produce antibodies against foetal tissues
  • Diabetes
  • Hypothyroidism
  • Fluctuating or diminished hormone levels
  • Eating disorders
  • Obesity – increased Body Mass Index (BMI) has been associated with infertility and morbidity during pregnancy
  • Gluten intolerance (celiac disease)

Other leading factors of infertility that are common for both men and women

  • Stress
  • multiple partners
  • toxicity in food
  • drug use
  • excessive alcohol drinking
  • smoking and delayed marriages

Couples should undergo fertility testing as 30% of the times males are the sole cause of fertility problems.

What are Infertility tests?

Infertility tests are done to help find out why a woman cannot become pregnant. The tests help find whether the problem is with the man, the woman, or both. Tests are usually include a physical exam, semen analysis, blood tests, and special procedures.

Fertility tests for women

  • Pelvic Ultrasound to discover abnormalities with the uterus, fallopian tubes and/or ovaries. Sonography can show evidence of pelvic scarring
  • PAP Smear Test
  • Rubella Antibody Test
  • Test for Chlamydia trachomatis
  • Test for Chlamydia trachomatis
  • Blood test includes day 3
    • FHS, LH, Prolactin
    • Progesterone
    • Testosterone (Free and Total)
    • Estradiol
    • Anti-Mulerian Hormone
    • Free T3, free T4, and TSH
    • DHEA-S
  • Hysterosalpingogram (HSG) that evaluates the condition of the uterus and fallopian tubes.
  • Further specialised tests like:
    • TORCH 8
    • TB Culture
    • GeneXpert TB test
    • Genetic testing (Chromosomal Karyotype)
    • Procedures such as endometrial biopsy, laparoscopy and hysteroscopy

Fertility tests for men

  • Semen analysis to check for abnormalities in the number of sperms (concentration), motility (movement) and morphology (shape).
  • Test for Chlamydia trachomatis which, in addition to being a known cause of infertility in women, can also affect sperm function.
  • Blood Tests include:
    • Follicle stimulating Hormone (FHS)
    • Luteinizing Hormone (LH)
    • Prolactin
    • Testosterone (Free and Total)
    • Estradiol and SHBG
    • Transrectal and Scrotal Ultrasound is done to look for evidence of conditions such as retrograde ejaculation and ejaculatory duct obstruction
    • Depending on your history and test results, further specialised tests are recommended in certain cases like GeneXpert TB test, Genetic testing (Chromosomal Karyotype), AFB culture, Testicular biopsy (to tell if sperms production is normal)

Strategies for preventing Infertility – Advantages of first trimester screening

Increase your chances of getting pregnant by

  • Avoid extreme weight loss or gain
  • Exercise moderately
  • Quit Smoking
  • Limit Caffeine
  • Limit alcohol

Tips to maintain healthy sperm count

  • Quit smoking
  • Limit alcohol
  • Exercise regularly
  • Avoid high temperatures and exposure to industrial or environmental toxins

Reference:

http://www.who.int/reproductivehealth/topics/infertility/definitions/en/

http://www.cdc.gov

http://www.medicinenet.com

http://www.mayoclinic.org

DIABETES AND HEART AILMENTS: WHAT’S THE LINK BETWEEN THE TWO?

Did you know that there is a strong correlation between diabetes and heart diseases? Well, patients with diabetes are at a higher risk of heart-related ailments. However, with a few precautionary measures and lifestyle changes, one can easily overcome such health concerns.

The link between diabetes and heart diseases

It is important to understand the connection between the two concerns. Those with diabetes often run the risk of other problems such as:

  • high blood pressure
  • compromised heart function
  • high levels of bad fats

all of the above can lead to serious heart diseases.

It is imperative to understand that each of these medical problems damage blood vessels, create plaques in blood vessels which lead to blockages and reduce the flexibility and elasticity of the blood vessels; making their walls rigid and hard. This is when the heart functions take a beating as there is a sudden obstruction in the normal flow of blood through major vessels, causing cardiovascular diseases. Moreover, this also blocks blood flow to the brain leading to strokes in many cases.

Are you taking the right precautionary measures?

Often one of the major causes of death in patients with diabetes is heart-related ailments. Precisely why you need to keep your blood sugar, blood pressure and bad cholesterol levels in check at all times. What are the measures one can take to ensure that they don’t fall prey to heart diseases when suffering from diabetes? Your answer lies in taking charge of the ABCs of Diabetes:

A stands for A1c

A1c is the short form for a test for diabetes called hemoglobin A1c and measures your average blood sugar levels over the last three months.

B stands for blood pressure

This is a reminder for patients to keep their blood pressure in control.

C stands for cholesterol

This is a reminder for patients to keep their cholesterol in check. In the absence of such checks, bad cholesterol can build up causing your arteries to clog.

How can you reach your ABC targets?

Make sure you talk to your doctor on the medicines you need to take to reach your targets. Additionally, lifestyle changes such as quitting smoking, changing your diet and exercising will also inch you closer to your ABC targets.

Get yourself tested today

India is the diabetes capital of the world and we are being faced with a diabetes epidemic. Practically, every family, every household has a few diabetics. Hence, it’s imperative that you take a stock of your health and get your diabetes tests done today. Diabetes tests include:

  • HbA1c as described above
  • Fasting blood sugar
  • Post meal blood sugar
  • Random blood sugar
  • Liquid profile (gives an idea of the cholesterol levels)

Additionally, an ECG may also be helpful to understand your heart function.

Why you need to know your Vitamin D levels

About prostate cancer What is prostate cancer? Cancer begins in your body when normal cells start to grow out of control. In prostate cancer, prostate cells grow out of control. They can spread and affect nearby organs. They can also spread to distant parts of the body and cause problems. How common is prostate cancer? Prostate cancer is the most common cancer in men (after skin cancer). The chance of having prostate cancer goes up with age. Are all prostate cancers the same? No, they are not. Many prostate cancers grow slowly. These are not likely to cause any harm. Some prostate cancers grow fast. They spread to other parts of the body where they cause problems and can even cause death.

What causes prostate cancer?

We don’t know what causes this cancer. We do know that certain things cause some men to have a higher chance of having prostate cancer than others. Some of these are age, family history, and race. We call these risk factors because they increase your risk of having prostate cancer.

  • Age: Your age is the strongest risk factor. The chance of having prostate cancer goes up quickly after age 50. About 2 out of 3 prostate cancers occur in men over the age of 65.
  • Family history: Men with a father or brother who had prostate cancer are more likely to get prostate cancer, too. This is even more likely if the father or brother had the cancer before age 65.
  • Race: We don’t know why, but prostate cancer is more common in African American men than in other races
What if I am having prostate symptoms now?

If you have pain when you pass urine, blood in your urine, or trouble passing urine, you should talk with your doctor now. These are often symptoms of other prostate problems, but they can also be caused by prostate cancer. The only way to know what’s wrong is to see your doctor.

You can have prostate cancer and not have any symptoms. But if you have symptoms, please see a doctor right away.

What are my chances of having prostate cancer?

Based on the way prostate cancer testing is done today, about 14 out of 100 of men (14%) will be diagnosed with prostate cancer during their life. About 3 out of 100 men (3%) will someday die of prostate cancer.

As you get older, your chance of having prostate cancer goes up. You might also hear it this way – As you get older, your risk for prostate cancer increases.

Prostate cancer testing

A PSA blood test and rectal exam can tell your doctor about your prostate. Your doctor might do a PSA blood test alone, or he might do both tests. What is a PSA test? This test measures how much PSA is in your blood. PSA stands for prostate-specific antigen – a protein made by the prostate gland.

What is a rectal exam?

With this test, your doctor puts a gloved, lubricated finger into your rectum to feel your prostate gland. A rectal exam can tell if the prostate size, shape, and texture are normal.

Can testing tell me for certain that I have prostate cancer?

No. There is no perfect test to look for prostate cancer.

  • PSA test: There is no PSA level that says for sure that a man has prostate cancer. Your chance of having prostate cancer goes up as your PSA level goes up.

    PSA levels can be high in prostate cancer, but they can also be high with prostate infections and other prostate problems. So, having a high PSA level does NOT always mean that you have prostate cancer.
  • Rectal exam: Most prostate cancers cannot be felt by a rectal exam. But sometimes rectal exams can find cancer even when the PSA level does not suggest cancer.

If your PSA level is high or if your rectal exam is not normal, you will need other tests to find out why.

Can testing tell me for certain that I do not have prostate cancer?

No. If your PSA level is low, you can still have prostate cancer. If your rectal exam does not suggest cancer, you can still have prostate cancer. The rectal exam is not as good as the PSA test for finding prostate cancer, but it might find cancers in some men with low PSA levels.

So, what happens if my PSA or rectal exam suggests prostate cancer?

If your PSA level or your rectal exam suggests cancer, you may need a biopsy to know for sure if you have prostate cancer.

  • A biopsy is done with a needle. The needle is put into the prostate gland.
  • Tiny pieces of the prostate gland are removed with the needle.
  • These tiny pieces are looked at under a microscope to see if cancer cells are present.
  • The biopsy is done as an outpatient and takes only a few minutes.

If the biopsy shows cancer cells, you and your doctor will decide how to treat the cancer, or whether treatment is needed at this time.

Questions If I get tested If I do not get tested
What will happen? You go to your doctor and get a PSA test and maybe a rectal exam You have regular check-ups but no prostate cancer testing.
If your test results are cause for concern, you may have a biopsy. At any time, you can change your mind and be tested.
Possible benefits to you Testing may find an early prostate cancer – while it’s small and before it has spread. You avoid the worry that you might have from getting test results
If it’s found early, there may be a better chance of being treated and not dying from prostate cancer. You avoid being treated for a cancer that might never cause you any problems.
Getting tested may give you peace of mind You avoid the side effects that may occur with treatment. These include problems passing urine, problems with your bowels, and/or problems having sex.
Risks to you Testing may lead to worry about the results. You may be worried that you have prostate cancer and have not been tested.
Testing may lead to more tests, such as a biopsy, even if you don’t have cancer You may have an early prostate cancer, and you won’t know this.
Testing may find a cancer that might never have caused problems or caused death. You may have a prostate cancer that may later cause symptoms or death and not have the chance to find it early.
Testing may lead to treatment, and treatment can cause side effects. These include problems controlling your urine, problems with your bowels, and/or problems having sex.
Testing may not find anything even though cancer is there.
How do I decide if testing is the right choice for me?
Know the facts
  • Know about prostate cancer and other prostate problems.
  • Know what the PSA test and rectal exam can and cannot tell you.
  • Know what other decisions you may need to make if you are tested.
Ask questions, and talk to others.
  • Write down your questions and discuss them with your doctor.
  • Talk about testing with your family and those who care about you.
Use the balance scale at the end of this booklet.
  • Weigh how you feel about testing.
  • Make your decision about testing.
So, what does the American Cancer Society recommend for me?

Starting at age 50, talk to your doctor about the pros and cons of testing. Then decide if testing is the right choice for you.

13 If you are African American or have a father or brother who had prostate cancer before age 65, have this talk with your doctor starting at age 45.

This talk should take place at age 40 for men with 2 or more close relatives who had prostate cancer before age 65.

If you decide to be tested, you should have the PSA blood test with or without a rectal exam. How often you’re tested will depend on your PSA level.

The decision is yours.

A proactively done ECG on a reluctant patient, revealed the need for urgent pacemaker implantation

Patient Details: A 68-year-old male,retired professional,residing in Mumbai.

Medical History: Cardiovascular disorders since last several years and referred to Suburban Diagnostics by his physician for a 2D echo. An ECG done in the recent past was relatively normal with some changes indicating IHD but without any arrhythmias.

Clinical presentation: New onset dyspnoea on exertion NYHA class II/IV.

Tests done: 2D Echo revealed severe LV systolic dysfunction.

Clinical Suspicion: The reporting cardiologist Dr.Ravi strongly suspected a cardiac arrhythmia. Hence, he connected with the patient proactively and requested him to undergo an ECG to better understand the condition. The patient was highly reluctant and refused to get an ECG done as it was not advised by his physician. Therefore, we offered him an ECG free of cost. Hence, the patient agreed to get the ECG done.

Results: The ECG showed AV dissociation.

Diagnosis based on the results: Atrioventricular dissociation suggestive of the need of cardiac pacemaker. Further expert cardiac consultation and clinical correlation was warranted. The referring physician Dr. U G Shirodkar was immediately informed about the condition and the patient was counseled for the need for hospitalisation for pacemaker implantation.

Significance of this case (Take home messages): An ECG performed on a patient who was otherwise unwilling to undergo the tests, ended up revealing that the patient had a life threatening cardiac arrhythmia and needed pacemaker surgery. The Suburban Diagnostics team could help diagnose an urgent clinical need of the patient that would have otherwise gone unnoticed or would have created a medical emergency had it gone missed.

Routine ECG helps uncover a silent disorder in a chronic kidney patient

Routine ECG helps uncover electrolyte an underline clinical problem in a chronic kidney patient.

Patient Details: A 43 -year old female patient residing in Mumbai

Medical History: On dialysis for ongoing renal disease; however patient did not reveal this at the first consultation at Suburban Diagnostics.

Clinical presentation: Patient experienced a typical chest pain in the morning and came for a cardiac consultation at our center the same day on her own.

Tests done: At the center, the patient proactively requested an ECG.

Results: The ECG revealed a very rare abnormality called the long QT syndrome.

Clinical Suspicion: This raised a suspicion of arrhythmia and underlying heart disease. Dr. Ravi Chavan, the cardiologist at Suburban Diagnostics, proactively enquired with the patient. The patient revealed that she had been on dialysis for the last several years for chronic renal disease. On further probing, she also complained of having palpitations. Upon further questioning by Dr. Ravi the patient revealed that though she had been a chronic case of renal disease, she had been neglecting her investigations and had not done her renal function tests since the last several months. Dr. Ravi advised her to get her RFT done immediately to detect electrolyte imbalance which could have been the cause of the then ongoing chest pain she was experiencing.

Diagnosis based on the results: Echocardiographic confirmation of long QT syndrome suggestive of underlying electrolyte imbalance based on clinical correlation and ECG findings. Further metabolic and nephrological consultation was advised.

Significance of this case (Take home messages): At Suburban Diagnostics, we ensure that every case – whether it’s a routine ECG proactively done by a patient or any investigation ordered by a clinician is looked at very keenly, keeping in mind the clinical implications that the findings could have. In this case, the patient and her doctors were completely unaware of the presence of a long QT syndrome. The patient was counselled by our cardiologist and guided regarding the next clinical steps to be taken to address the finding of long QT syndrome.



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