Medical Laboratory

MEDICAL LABORATORY

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Page | 1 BROADWAY MEDICAL LABORATORY

10\10\2009

A clinical medical test laboratory where blood tests, ECG, CT scanning, physiotherapy, etc are performed. MEDICAL TESTS:  Haemotology tests  Biochemical tests  Microbiological tests  Urine tests  Lipid profile tests  Endocrine tests  Motion tests  Liver function tests  Semen analysis FACILITIES AVAILABLE:  Interferential therapy (IFT)  Short Wave Diathermy (SWD)  Electronic Traction  Ultra sound  Wax Bath  T.E.N.S  Cryotherapy

 Stimulator(Muscle/Nerve)

 Manipulation therapy Page | 2

 Neuro Development therapy  Chest Physiotherapy  Sports Physiotherapy  Combination therapy

EQUIPMENTS SEEN:  Electrocardiogram  Stimulator  Traction table  IFT  Ultrasound technology  Shortwave diathermy  Auto analyser

 Incubator ELECTROCARDIOGRAPHY Electrocardiography (ECG or EKG) is a transthoracic interpretation of the electrical activity of the heart over time captured and externally recorded by skin electrodes. It is a noninvasive recording produced by an electrocardiographic device. The etymology of the word is derived from electro, because it is related to electrical activity, cardio, Greek for heart, and graph, a Greek root meaning "to write".

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 Exercise therapy

ECG GRAPH PAPER

One second of ECG graph paper Timed interpretation of an ECG was once incumbent to a stylus and paper speed. Computational Analysis now allows considerable study of Heart Rate Variability. A typical electrocardiograph runs at a paper speed of 25 mm/s, although faster paper speeds are occasionally used. Each small block of ECG paper is 1 mm². At a paper speed of 25 mm/s, one small block of ECG paper translates into 0.04 s (or 40 ms). Five small blocks make up 1 large block, which translates into 0.20 s (or 200 ms). Hence, there are 5 large blocks per second. A diagnostic quality 12 lead ECG is calibrated at 10 mm/mV, so 1 mm translates into 0.1 mV. A

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Electrical impulses in the heart originate in the sinoatrial node and travel through the intimate conducting system to the heart muscle. The impulses stimulate the myocardial muscle fibres to contract and thus induce systole. The electrical waves can be measured at electrodes placed at specific points on the skin. Electrodes on different sides of the heart measure the activity of different parts of the heart muscle. An ECG displays the voltage between pairs of these Page | 3 electrodes, and the muscle activity that they measure, from different directions, also understood as vectors. This display indicates the overall rhythm of the heart and weaknesses in different parts of the heart muscle. It is the best way to measure and diagnose abnormal rhythms of the heart, particularly abnormal rhythms caused by damage to the conductive tissue that carries electrical signals, or abnormal rhythms caused by electrolyte imbalances. In a myocardial infarction (MI), the ECG can identify if the heart muscle has been damaged in specific areas, though not all areas of the heart are covered. The ECG cannot reliably measure the pumping ability of the heart, for which ultrasound-based (echocardiography) or nuclear medicine tests are used.

calibration signal should be included with every record. A standard signal of 1 mV must move the stylus vertically 1 cm, that is two large squares on ECG paper.

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A typical ECG tracing of a normal heartbeat (or cardiac cycle) consists of a P wave, a QRS complex and a T wave . A small U wave is normally visible in 50 to 75% of ECGs. The baseline voltage of the electrocardiogram is known as the isoelectric line. Typically the isoelectric line is measured as the portion of the tracing following the T wave and preceding the next P wave.

The four deflections were originally named ABCDE but renamed PQRST after correction for artifacts introduced by early amplifiers.

A PERSON UNDERGOING ECG:

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WAVES AND INTERVALS

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CT SCAN TECHNOLOGY CT scanning—sometimes called CAT scanning—is a noninvasive medical test that helps physicians diagnose and treat medical conditions. CT scanning combines special x-ray equipment with sophisticated computers to produce multiple images or pictures of the inside of the body. These cross-sectional images of the area being studied can then be examined on a computer monitor or printed. CT scans of internal organs, bone, soft tissue and blood vessels provide greater clarity and reveal more details than regular x-ray exams. Using specialized equipment and expertise to create and interpret CT scans of the body, radiologists can more easily diagnose problems such as cancers, cardiovascular disease, infectious disease, trauma and musculoskeletal disorders. Physicians often use the CT examination to:     

quickly identify injuries to the lungs, heart and vessels, liver, spleen, kidneys, bowel or other internal organs in cases of trauma. guide biopsies and other procedures such as abscess drainages and minimally invasive tumor treatments. plan for and assess the results of surgery, such as organ transplants or gastric bypass. stage, plan and properly administer radiation treatments for tumors as well as monitor response to chemotherapy. measure bone mineral density for the detection of osteoporosis.

DESCRIPTION:

PROCEDURE: CT scanning of the body is usually completed within The technologist begins by positioning you on the CT examination table, usually lying flat on your back or possibly on your side or on your stomach. Straps and pillows may be used to help you maintain the correct position and to hold still during the exam. If contrast material is used, it will be swallowed, injected through an intravenous line (IV) or administered by enema, depending on the type of examination.

Next, the table will move quickly through the scanner to determine the correct starting position for the scans. Then, the table will move slowly through the machine as the actual CT scanning is performed. You may be asked to hold your breath during the scanning. Any motion, whether breathing or body movements, can lead to artifacts on the images. This is similar to the blurring seen on a photograph taken of a moving object. When the examination is completed, you will be asked to wait until the technologist verifies that the images are of high enough quality for accurate interpretation. LIMITATIONS: Soft-tissue details in areas such as the brain, internal pelvic organs, knee or shoulder can be more readily and clearly seen with magnetic resonance imaging (MRI). The exam is not generally indicated for pregnant women.

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The CT scanner is typically a large, box like machine with a hole, or short tunnel, in the center. You will lie on a narrow examination table that slides into and out of this tunnel. Rotating around you, the x-ray tube and electronic x-ray detectors are located opposite each other in a Page | 6 ring, called a gantry. The computer workstation that processes the imaging information is located in a separate room, where the technologist operates the scanner and monitors your examination.

A person who is very large may not fit into the opening of a conventional CT scanner or may be over the weight limit for the moving table 1 Page | 7

BENEFITS:  CT scanning is painless, noninvasive and accurate. 

A major advantage of CT is its ability to image bone, soft tissue and blood vessels all at the same time.

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Unlike conventional x-rays, CT scanning provides very detailed images of many types of tissue as well as the lungs, bones, and blood vessels.

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CT examinations are fast and simple; in emergency cases, they can reveal internal injuries and bleeding quickly enough to help save lives.

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CT has been shown to be a cost-effective imaging tool for a wide range of clinical problems.

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CT is less sensitive to patient movement than MRI.

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CT can be performed if you have an implanted medical device of any kind, unlike MRI.

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CT imaging provides real-time imaging, making it a good tool for guiding minimally invasive procedures such as needle biopsies and needle aspirations of many areas of the body, particularly the lungs, abdomen, pelvis and bones.

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A diagnosis determined by CT scanning may eliminate the need for exploratory surgery and surgical biopsy.

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No radiation remains in a patient's body after a CT examination.

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X-rays used in CT scans usually have no side effects.

RISKS: 

There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.

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The effective radiation dose from this procedure ranges from approximately two to 10 mSv, which is about the same as the average person receives from background radiation in three to five years.

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Women should always inform their physician and x-ray or CT technologist if there is any possibility that they are pregnant.

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CT scanning is, in general, not recommended for pregnant women unless medically necessary because of potential risk to the baby.

Nursing mothers should wait for 24 hours after contrast material injection before resuming breast-feeding.

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The risk of serious allergic reaction to contrast materials that contain iodine is extremely rare, and radiology departments are well-equipped to deal with them.

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Because children are more sensitive to radiation, they should have a CT study only if it is essential for making a diagnosis and should not have repeated CT studies unless absolutely necessary.

PATHOPHYSIOLOGICAL INDICATIONS OF ECG

Shortened QT interval

Hypercalcemia.

Prolonged QT interval

Hypocalcemia.

Flattened or inverted T waves Coronary ischemia. Hyperacute T waves

Possibly the first manifestation of Acute myocardial infarction.

Prominent U waves

Hypokalemia.

SUGGESTIONS:  Can introduce more modern equipments  Larger area for more efficient purposes  More staffs can be employed.

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DAIRY FARMING 24.10.2009

AAVIN DAIRY FARM, MADHAVARAM .

Dairy farming is a class of agricultural, or an animal husbandry, enterprise, for long-term production of milk, usually from dairy cows but also from goats and sheep, which may be either processed on-site or transported to a dairy factory for processing and eventual retail sale. Most dairy farms sell the male calves born by their cows, usually for veal production, or breeding depending on quality of the bull calf, rather than raising non-milk-producing stock. Many dairy farms also grow their own feed, typically including corn, alfalfa, and hay. This is fed directly to the cows, or is stored as silage for use during the winter season. Additional dietary supplements are often added to the feed to increase quality milk production. Dairy farming has been part of agriculture for thousands of years. Historically it has been one part of small, diverse farms. In the last century or so larger farms doing only dairy production have emerged. Large scale dairy farming is only viable where either a large amount of milk is required for production of more durable dairy products such as cheese, or there is a substantial market of people with cash to buy milk, but no cows of their own. HAND MILKING Centralized dairy farming as we understand it primarily developed around villages and cities, where residents were unable to have cows of their own due to a lack of grazing land. Near the town, farmers could make some extra money on the side by having additional animals and selling the milk in town. The dairy farmers would fill barrels with milk in the morning and bring it to market on a wagon. Until the late 1800s, the milking of the cow was done by hand. In the United States, several large dairy operations existed in some northeastern states and in the west, that involved as many as several hundred cows, but an individual milker could not be expected to milk more than a dozen cows a day. Smaller operations predominated.

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MILKING PARLORS Innovation in milking focused on mechanising the milking parlour to maximise throughput of cows per operator which streamlined the milking process to permit cows to be milked as if on an assembly line, and to reduce physical stresses on the farmer by putting the cows on a platform slightly above the person milking the cows to eliminate having to constantly bend over. Many older and smaller farms still have tie-stall or stanchion barns, but worldwide a majority of commercial farms have parlours. The milking parlor allowed a concentration of money into a small area, so that more technical monitoring and measuring equipment could be devoted to each milking station in the parlor. Rather than simply milking into a common pipeline for example, the parlor can be equipped with fixed measurement systems that monitor milk volume and record milking statistics for each animal. Tags on the animals allow the parlor system to automatically identify each animal as it enters the parlor. ROTARY PARLORS In rotary parlors, the cows are loaded one at a time onto the platform as it slowly rotates. The milker stands near the entry to the parlor and puts the cups on the cows as they move past. By the time the platform has completed almost a full rotation, another milker or a machine removes the cups.

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Milking took place indoors in a barn with the cattle tied by the neck with ropes or held in place by stanchions. Feeding could occur simultaneously with milking in the barn, although most dairy cattle were pastured during the day between milkings. Such examples of this method of dairy farming are difficult to locate, but some are preserved as a historic site for a glimpse into the days gone by. One such instance that is open for this is at Point Reyes National Seashore.

MILKING OPERATION

Milk is extracted from the cow's udder by flexible rubber sheaths known as liners or inflations that are surrounded by a rigid air chamber. A pulsating flow of ambient air and vacuum is applied to the inflation's air chamber during the milking process. When ambient air is allowed to enter the chamber, the vacuum inside the inflation causes the inflation to collapse around the cow's teat, squeezing the milk out of teat in a similar fashion as a baby calf's mouth massaging the teat. When the vacuum is reapplied in the chamber the flexible rubber inflation relaxes and opens up, preparing for the next squeezing cycle. It takes the average cow three to five minutes to give her milk. Some cows are faster or slower. Slow-milking cows may take up to fifteen minutes to let down all their milk. Milking speed is only minorly related to the quantity of milk the cow produces — milking speed is a separate factor from milk quantity; milk quantity is not determinative of milking speed. Because most milkers milk cattle in groups, the milker can only process a group of cows at the speed of the slowest-milking cow. For this reason, many farmers will cull slow-milking cows. The extracted milk passes through a strainer and plate heat exchangers before entering the tank, where it can be stored safely for a few days at approximately 3 °C or around 42 °F (6 °C). At pre-arranged times, a milk truck arrives and pumps the milk from the tank for transport to a dairy factory where it will be pasteurized and processed into many products.

PROCESSING OF MILK: 

Raw milk is brought to the dairy plant, it is then graded, weighed, and sampled. The butterfat content determines the price paid the farmer.

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Processing of raw milk starts with clarification or separation, using centrifuges. The clarification process removes impurities like blood cells from the milk that will be sold as whole milk (milk containing all of its butterfat). Separation process removes butterfat as well as impurities from milk. Skim milk is produced when all the butterfat is removed from the raw milk.

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Milking machines are held in place automatically by a vacuum system that draws the ambient air pressure down from 15 to 21 pounds of vacuum. The vacuum is also used to lift milk vertically through small diameter hoses, into the receiving can. A milk lift pump draws the milk Page | 11 from the receiving can through large diameter stainless steel piping, through the plate cooler, then into a refrigerated bulk tank.

Dairy cows are milked 2 or 3 times a day. Most dairy farms use milking machines. The fresh milk is strained through cotton to remove foreign matters, it is then cooled in the milk house and then sold in bulk form to dairy plants. Milk is shipped by truck in 10gallon cans or in refrigerated tank trucks.

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Milk is then pasteurized to kill harmful bacteria.

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Milk with butterfat is then homogenized to prevent the butterfat from separating from the milk.

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 Processed milk is then chilled in a cooler and then placed in sterile containers.  Processed milk is then packed individually in containers, which are usually plastic bottles or paper cartons, are put on moving racks and pass under machine that will automatically fills and seals them.

Homogenization - is the process of breaking up the fat into smaller sizes so that it no longer separates from the milk. Pasteurization - is the process of heating liquid for the purpose of destroying viruses and harmful organism. It is different from sterilization because pasteurization only aims to reduce the number of bacteria so they are unlikely to cause disease. Sterilization is not common in food processing because it can affect the flavor.

MEDICAL CARE During milking dairy farmers and their employees are constantly checking and monitoring their animals. Nutritious diets, comfortable living conditions and solid medical care are all part of taking good care of their animals. This includes regular veternarian check-ups across the entire farm, either monthly, bi-monthly or, on some farms, weekly, to keep an eye on the wellness of the herd. Vaccinations and prompt treatment of illnesses are among the many practices used by dairy farmers to ensure healthy herds. Cows are no different than people in that they sometimes become ill and require medical care. Farmers work with large-animal veterinarians who can diagnose and treat an illness with the proper medication. Any cows who receive medicine to aid in a speedy recovery are removed from the healthy herd and won’t rejoin their herdmates until their milk tests free of antibiotics.

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Milk that tests positive for antibiotics is not permitted in the food supply and is immediately discarded. 1 Page | 13

CLEANING EFFICIENCY:

W-Water quality;soft,hard water hinders the action of detergents may leave behind mineral residue. A-Agitation of the detergent solution should be vigorous, detergent flow velocity should be more than 1.5M/second to provide turbulent flow.

T- Time of detergent solution contact with the soil of surface should be adequate.It depends on nature of deposit , detergent concentration and temperature.

C - Concentration of detergent solution should be optimum,too high concentration might actually hinder the quality. H- Heat or temperature of detergent greatly affects the cleaning efficiency.Higher the temperature, higher the efficiency.Every 100C increase in solution temperature increases its activity two-fold.Optimum temperature-700C.

DAIRY PRODUCTS:

Butter, Cream, Cottage cheese, Yogurt, Yogurt drinks, flavoured milk drinks and Ice-creams.

The world's largest exporter of dairy products is New Zealand,and dairy products are the largest export earner for the country.Fonterra is the fifth-largest dairy company in the world and New Zealand's largest company by turnover, Japan is the world's largest importer of dairy products.

World production RANK COUNTRY

PRODUCTION (109KG/YR)

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India

114.4

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United States

79.3

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Germany

39.4

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Pakistan

35.2

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China

32.5

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Russia

28.5

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India is the largest producer of dairy products in the world. There is a great deal of variation in the pattern of dairy production world-wide. Many countries which are large producers, Page | 14 consume this internally, while others — in particular New Zealand — export a large percentage of their production. Internal consumption is often in the form of liquid milk, while the bulk of international trade is in processed dairy products such as milk powder.

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Brazil

26.2

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France

24.2

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New Zealand

17.3

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United Kingdom 13.9

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Ukraine

12.2

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Poland

12

13

Netherlands

11.5

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Italy

11.0

15

Turkey

10.6

16

Mexico

10.2

17

Australia

9.6

18

Egypt

8.7

19

Argentina

8.5

20

Canada

8.1

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COMPETITION

The milking of cows was traditionally a labor-intensive operation and still is in less developed countries. Small farms need several people to milk and care for only a few dozen cows, though for many farms these employees have traditionally been the children of the farm family, giving rise to the term "family farm". Advances in technology have mostly led to the radical redefinition of "family farms" in industrialized countries such as the United States. With farms of hundreds of cows producing large volumes of milk, the larger and more efficient dairy farms are more able to weather severe changes in milk price and operate profitably, while "traditional" very small farms generally do not have the equity or cash flow to do so. The common public perception of large corporate farms supplanting smaller ones is generally a misconception, as many small family farms expand to take advantage of economies of scale, and incorporate the business to limit the legal liabilities of the owners and simplify such things as tax management. Before large scale mechanization arrived in the 1950s, keeping a dozen milk cows for the sale of milk was profitable. Now most dairies must have more than one hundred cows being milked at a time in order to be profitable, with other cows and heifers waiting to be "freshened" to join the milking herd . In New Zealand the average herd size, depending on the region, is about 350 cows. Herd size in the US varies between 1,200 on the West Coast and Southwest, where large farms are commonplace, to roughly 50 in the Northeast, where land-base is a significant limiting factor to herd size. The average herd size in the U.S. is about one hundred cows per fa P WAVE

During normal atrial depolarization, the main electrical vector is directed from the SA node towards the AV node, and spreads from the right atrium to the left atrium. This turns into the P wave on the ECG.

PR INTERVAL

The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex.

It is usually 120 to 200 ms long.

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Most milk-consuming countries have a local dairy farming industry, and most producing countries maintain significant subsidies and trade barriers to protect domestic producers from foreign competition. In large countries, dairy farming tends to be geographically clustered in regions with abundant natural water supplies (both for feed crops and for cattle) and relatively inexpensive land (even under the most generous subsidy regimes, dairy farms have poor return Page | 16 on capital). New Zealand, the fourth largest dairy producing country, does not apply any subsidies to dairy production.

The ST segment connects the QRS complex and the T wave

T WAVE

The T wave represents the repolarization (or recovery) of the ventricles. The interval from the beginning of the QRS complex to the apex of the T wave is referred to as the absolute refractory period. The last half of the T wave is referred to as the relative refractory period (or vulnerable period).

QT INTERVAL

The QT interval is measured from the beginning of the QRS complex to the end of the T wave.

U WAVE

The U wave is not always seen. It is typically small, and, by definition, follows the T wave.

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It has a duration of 0.08 to 0.12 sec (80 to 120 ms).

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ST SEGMENT