Dr. Candido Otero, M.D.

Anemia is a serious disease in children and adults. A complete evaluation is needed. It is a sever low hemoglobin level. Please, contact your pediatrician for complete evaluation. The normal hemoglobin level for your 3-year-old child is 9.5 – 14 g/dL The cause of the anemia needs to be evaluated. Thank you.

A low A/G ratio have been associated with many etiologies (causes) and ilinesses which may be related to inflammation, or certain cancer such as myelomas. Can also be decreased in tissue trauma, infection, chronic inflammatory conditions, and nutritional problems. Please contact your healthcare provider for a complete evaluation. Thank you.

A persistent cough could have many etiologic factors to take in consideration. Most common at that age is asthma, allergies, or a chronic infection in the sinuses or airways can cause chronic cough. A protracted bacterial bronchitis, a prolonged infection in the bronchial tree. Could also be an irritation in the throat or inhalation of foreign object as well. Please check with you doctor’s child. Thank you.

The test is a culture of the cotton swab from your nostrils. A mucus sample is sent to the laboratory where it is examined for fungi. Most fungal infections result from mold or yeast. Consult your healthcare provider to order the test. Thank you.

For Example: Your Doctor could ask if you or in your family have had an intraocular tumor like retinoblastoma, uveal melanoma, glaucoma, conjunctival pigmented lesions, vitreous large cell lymphoma, and sebaceous cell carcinoma. An ophthalmic evaluation involves gross dissection and microscopic examination and diagnosis of eyes and ocular adnexal tissue that have been surgically removed. It highly specialized branch of the medical laboratory and the specialty is called Ophthalmic Pathology. Also, retinal pathology questions such as congenital anomalies, degenerations, dystrophies, toxicities, inflammation, trauma, detachments, neoplasm, and any involvement of systemic diseases. Thank you.

A blood test is used to check diabetes. Hemoglobin A1c is the test used besides measuring your blood sugar level on empty stomach. Thank you.

Blood test can detect signs of hepatitis B virus in you body and tell your provider whether is acute or chronic. Detection of Hepatitis B surface antigen (HBsAg), or core antigen (HBcAg) in liver tissue by immunohistochemical staining and of HBV DNA by Southern Hybridization, in situ. HBV was originally called serum hepatitis. Hepatitis B virus plays an important role in hepatocellular carcinoma. HBsAg is a marker that appears before symptoms and is a marker of active infection. IgM anti-HBc is usually the first antibody to appear. HBeAg, HBV DNA appear soon after HBsAg and it may indicate persistence or progression. Consult your healthcare provider. Thank you.

There are two types of cerebral spinal fluid (CFS) leaks with different symptoms, different causes, and different treatments. These are spinal leaks and cranial leaks. Spinal leaks occur anywhere in the spinal column. A cranial leak occurs in the skull. The most common symptoms on the spinal CSF leak are a headache, while cranial CSF leak causes symptoms such as clear fluid leaking from the nose and ear. The most common symptoms of CSF leak are pain in the back of the head, pian improve when lying down, however it worsens when standing. Also, may worsen on exertion (coughing or straining). It rarely starts suddenly, and other symptoms are shoulder pain, ringing or ears (tinnitus), change in hearing, dizziness, change in vision, and change in behavior. Some cranial leaks improve with conservative methods such as bed rest, elevating the head of the bed, and taking stool softeners to prevent straining. Treatment for spinal leaks may include an epidural patch (involve taking a sample of your own blood, in this case your son’s blood, then injecting it into the spinal canal. It will form a clot and creates a patch that covers where the CSF is leaking), Sealant (special sealant use along with blood and used the same way as previously).and Surgery (only performed when all other options has failed). Trans-venous embolization is a new minimally invasive procedure, a catheter-based treatment for CSF-venous fistulas only that involves gluing shut the fistula from inside the culprit vein. Check with your son’s doctor for treatment as necessary. Follow conservative measure first to alleviate the symptoms in the meantime. Thank you.

Gonorrhea can be diagnosed by testing the urine, urethral (men), or endocervical and vaginal (for women) specimens using nucleic acid amplification testing (NAAT). Also is diagnosed using gonorrhea culture which requires endocervical or urethral swab specimen. Thank you.

Is diagnose in blood by measuring TSH, T4, T3, Free T4, Free T3 and clinically by your healthcare provider. Thank you.

Gonorrhea can be diagnosed by testing the urine, urethral (men), or endocervical and vaginal (for women) specimens using nucleic acid amplification testing (NAAT). Also is diagnosed using gonorrhea culture which requires endocervical or urethral swab specimen. Thank you.

The blood test can measure the hormone level in the blood and are more accurate than a home test. The best thing to do is to do another test. Incorrect test usage, previous abortions and miscarriages, and some medication can give false-positive pregnancy test result. Thank you.

A blood test is used to check diabetes. Hemoglobin A1c is the test used besides measuring your blood sugar level on empty stomach. Thank you.

It is common to feel a lump after hernia operation due to the inflammation. This swelling or bulge can go away in up to six month or above. Anyway, ask your surgeon about the bulge, he can explain it to you but it is common. Thank you.

TB is a chronic communicable disease caused by Mycobacterium Tuberculosis. The lesion is characterized by a necrotizing granulomatosis (Caseating necrosis) in tissue where the organism is seeded. Transmission of TB is by inhalation of infected droplets from coughing or sneezing of infected individuals. The cell wall of lipids and carbohydrates of Mycobacterium Tuberculosis appear to enhance virulence by interfering with phagolysosomal fusion. This interference allows the intracellular survival of mycobacteria. Once the sensitization appears in patients during the infection, the nonspecific inflammatory response become granulomatous (granuloma), and abundant epithelioid histiocytes, occasional giant cells, peripheral mononuclear cells among others. There is often a central, caseous necrosis of the granuloma. Therefore, an increase resistant inhibiting intracellular replication of the bacilli. There are several forms of TB. Primary Pulmonary Tuberculosis – these are individual lacking previous contact with the bacilli. Secondary TB – means that the patient has an active infection in a previously infected individual. Miliary TB – present with myriad of minute foci of infection in many organs, preferentially liver, bone marrow, spleen, and kidneys. Isolated organ tuberculosis – when disseminated organism become established in only one or two organs or female genital tract (salpingitis, endometritis). Tuberculosis is caused by the aerobic, non-spore forming, non-motile bacillus M. tuberculosis, which has a waxy coat that stain red with acid-fast stain. The mycobacteria may block vacuolar acidification by nonactivated macrophages. The CD4+ helper T cells secretes tissue necrosis factor gamma (TNFγ), which activates macrophages to kill intracellular mycobacterium via reactive nitrogen intermediates and to form epithelioid granulomas. CD8+ suppresser T cell kill macrophages that are infected with mycobacteria, resulting in the formation of caseating (cheeselike) granulomas (delayed type of hypersensitivity reaction). The residual lesion is a calcified scar in the lung parenchyma and in the hilar lymph node (Ghon Complex). Thank you.

TB is a chronic communicable disease caused by Mycobacterium Tuberculosis. The lesion is characterized by a necrotizing granulomatosis (Caseating necrosis) in tissue where the organism is seeded. Transmission of TB is by inhalation of infected droplets from coughing or sneezing of infected individuals. The cell wall of lipids and carbohydrates of Mycobacterium Tuberculosis appear to enhance virulence by interfering with phagolysosomal fusion. This interference allows the intracellular survival of mycobacteria. Once the sensitization appears in patients during the infection, the nonspecific inflammatory response become granulomatous (granuloma), and abundant epithelioid histiocytes, occasional giant cells, peripheral mononuclear cells among others. There is often a central, caseous necrosis of the granuloma. Therefore, an increase resistant inhibiting intracellular replication of the bacilli. There are several forms of TB. Primary Pulmonary Tuberculosis – these are individual lacking previous contact with the bacilli. Secondary TB – means that the patient has an active infection in a previously infected individual. Miliary TB – present with myriad of minute foci of infection in many organs, preferentially liver, bone marrow, spleen, and kidneys. Isolated organ tuberculosis – when disseminated organism become established in only one or two organs or female genital tract (salpingitis, endometritis). Tuberculosis is caused by the aerobic, non-spore forming, non-motile bacillus M. tuberculosis, which has a waxy coat that stain red with acid-fast stain. The mycobacteria may block vacuolar acidification by nonactivated macrophages. The CD4+ helper T cells secretes tissue necrosis factor gamma (TNFγ), which activates macrophages to kill intracellular mycobacterium via reactive nitrogen intermediates and to form epithelioid granulomas. CD8+ suppresser T cell kill macrophages that are infected with mycobacteria, resulting in the formation of caseating (cheeselike) granulomas (delayed type of hypersensitivity reaction). The residual lesion is a calcified scar in the lung parenchyma and in the hilar lymph node (Ghon Complex). Thank you.

Typically, there is a steady gripping or gnawing pain in the upper right abdomen near the rib. The fastest way is by putting warm compresses in the affected area. Also, peppermint tea can soothe the pain and magnesium supplement to help empty your gallbladder. Thank you.

Tinea capiti is usually treated with prescription antifungal medication taken by mouth for 1 to 3 months. Thank you.

A compound melanocytic nevus can be found in association with melanoma. Since this is a pigmented lesion that could be turned into a melanoma, the pathologist asks for a second opinion to ascertain that the cells he or she are looking at are not malignant. Also, depending on how many atypical (distorted) cells are seen in the sample, additional consideration by another pathology should be attained to rich the final diagnosis. If melanocytic nevi are not diagnosed, the prognosis could be poor. So, it is prudent to wait, and the more eyes sees your biopsy, the more accurate diagnosis you will have at the end. Large congenital melanocytic nevi are associated with an increased risk of developing cutaneous melanomas, leptomeningeal melanomas, neurocutaneous melanocytosis, malformation of the brain, and, rarely, rhabdomyosarcoma and liposarcoma. The treatment is excision. Thank you.

vYes, there are: Allergy skin testing, blood tests, spirometry (lung function tests), Food challenges, medication (drug) challenge, aspirin desensitization, patch testing as well. A full allergy test consists of placing a small amount of substance (allergens) that may be causing your symptoms on the skin, most often in your forearm, upper arm or back. Skin Prick Test (SPT) is the most popular and is a quick test that gives results within 15 – 20 minutes. A doctor may test from few substances or as many as 40 at a time. Thank you.