Synovial Fluid Analysis #synovial #fluid #analysis, # #2006 #21st #abnormal #abnormally #activities


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Synovial Fluid Analysis

Synovial fluid analysis is a group of tests that examine joint (synovial) fluid. The tests help diagnose and treat joint-related problems.

Alternative Names

Joint fluid analysis; Joint fluid aspiration

How the test is performed

A sample of synovial fluid is needed for this test. Synovial fluid is normally a thick, straw-colored liquid found in small amounts in joints, bursae, and tendon sheaths.

After the area is cleaned, the health care provider will insert a sterile needle through the skin and into the joint space. Once in the joint, fluid is drawn through the needle into a sterile syringe.

The fluid sample is sent to the laboratory. The laboratory technician will check the sample’s color and clarity, and then place it under a microscope to check it for red and white blood cells, crystals (in the case of gout), and bacteria. In addition, there may be a chemical analysis, and if infection is a concern, a sample will be cultured to see if any bacteria grow.

How to prepare for the test

Normally, no special preparation is necessary, but contact your health care provider before the test to make sure. Tell your doctor if you are taking blood thinners, as they can affect test results.

How the test will feel

Occasionally, the health care provider will first inject local anesthesia with a small needle, which will sting. The aspiration is done with a larger needle and may also cause some pain. The procedure usually lasts less than one minute.

Why the test is performed

The test can help diagnose the cause of pain or swelling in joints. Removing the fluid can also help relieve joint pain.

This test may be used to diagnose:

  • Gout
  • Infection
  • Other inflammatory joint conditions
  • Joint injury
  • Osteoarthritis

What abnormal results mean

Abnormal joint fluid may look cloudy or abnormally thick.

Blood in the joint fluid may be a sign of injury inside the joint or a body-wide bleeding problem. An excess amount of normal synovial fluid can also be a sign of osteoarthritis.

What the risks are

  • Infection of the joint — unusual but more common with repeated aspirations
  • Bleeding into the joint space

Special considerations

Ice or cold packs may be applied to the joint for 24 to 36 hours after the test to reduce the swelling and joint pain. Depending on the exact problem, you can probably resume your normal activities after the procedure. Talk to your health care provider to determine what activity is most appropriate for you.

References

Knight JA, Kjeldsberg CR. Cerebrospinal, synovial, and serous body fluids. In: McPherson RA, Pincus MR, eds. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 21st ed. Philadelphia, Pa: Saunders Elsevier; 2006:chap 28.

Review Date: 7/10/2009

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsements of those other sites. Copyright 2010 A.D.A.M. Inc. as modified by University of California San Francisco. Any duplication or distribution of the information contained herein is strictly prohibited.

Information developed by A.D.A.M. Inc. regarding tests and test results may not directly correspond with information provided by UCSF Medical Center. Please discuss with your doctor any questions or concerns you may have.

Getting Care


A-Plumbing Service and Repair Specialists: Plumbing Company for the South Texas Coastal


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FREE ESTIMATES

Our Guarantee to You:

Complete satisfaction with both our service and our plumbers is 100% guaranteed. Our highly-skilled, licensed and insured plumbing professional team want you to have the best experience possible. You can count on our plumbers to identify, explain and address your plumbing problem. We’ll be there when you need us, 24 hours a day, seven days a week, because we understand emergencies don’t come at convenient times.

Chamber Membership:

We love our Chamber of Commerce and have been a member since 2004! Our membership allows us to network with our community in a way that no other membership can. Participating in events, helping and giving support to our community here in the Texas Coastal Bend is rewarding, but we especially like working with our area youth and are proud donors to Rockport-Fulton High School’s “Project Graduation”!

Customer Loyalty:

We have the most technologically advanced plumbing tools & equipment available. We treat every plumbing project like an emergency and never sacrifice quality. With over 100,000 service calls logged, we pride ourselves on doing the best job possible! We have a 5-Star Rating from Yelp as well and Top-Rated by Angie’s List! We thank you sincerely for your business and trust! Give us a call TODAY: 361-790-9005 or 361-758-3516 today!

Our Green Philosophy:

A-Plumbing offers valuable tips and recommendations to home owners and businesses with regard to Water Conservation. A leaky or dripping faucet or a running toilet can waste many gallons of water per day. We fix leaks and help conserve our precious water. We support the efforts of our local and state agencies who remind us daily. TO THINK GREEN AND CONSERVE WATER!

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Adolescent Acute Residential Treatment (ART) Program #adolescent, #teen, #mclean #hospital, #art, #dual


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Adolescent Acute Residential Treatment (ART) Program

Access to Care Steps to Receiving Treatment

The Adolescent Acute Residential Treatment (ART) Program provides intensive, short-term, and highly focused psychiatric care for teens and young adults through age 19 with emotional and behavioral difficulties. With a length of stay between 10 and 14 days, this insurance-based residential program focuses on stabilizing adolescents in acute crisis.

At our two locations, McLean s main campus in Belmont, Massachusetts, and McLean SouthEast in Middleborough, Massachusetts, the coeducational program operates in unlocked settings, maximizing each individual s responsibility and capacity for self-control. The ART is a voluntary program so residents must be willing to participate in treatment.

For more information or to make a referral. call 617.855.2800 (Belmont) or 774.419.1100 (McLean SouthEast)

We specialize in treating teenagers who are struggling with psychiatric diagnoses such as ADHD, anxiety, depression, and bipolar disorder. We also offer a specialty track for those whose illness is complicated by a co-occurring substance use disorder.

Groups and structured activities involve skills training, team building, preparing meals, and recreational therapy. These pursuits enhance daily living skills, build self-mastery and esteem, and provide a sense of autonomy and membership in a community.

Teens and young adults can be referred to the program from home or any level of care, including inpatient, partial hospital, and outpatient. We offer a full range of services, including assessment and consultation, group therapy, skills training, education, medication evaluation and management, and family therapy. As part of the Division of Child and Adolescent Psychiatry. the program offers access to care and services throughout McLean Hospital.

At McLean SouthEast we also offer day program services, the McLean SouthEast Adolescent Partial Hospital Program, for teens who require intensive, structured treatment but are able to manage living at home.

Our staff is composed of a multidisciplinary group of board-certified psychiatrists, licensed psychologists and clinical social workers, registered nurses, and expressive therapists. The ART staff specializes in making sophisticated assessments, diagnoses, and recommendations in complex situations.


Laboratory Tests and Hepatitis C – Viral Hepatitis #hcv, #laboratory, #test, #hepatitis


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Viral Hepatitis

Contents

Introduction

Laboratory tests for hepatitis C are divided into four general categories:

  • Screening: Screening for hepatitis C virus (HCV) is done with a serologic test for the HCV antibody (Ab).
  • Confirmatory: Diagnosis of chronic hepatitis C requires the presence of HCV RNA, commonly called hepatitis C viral load.
  • Genotype: Once it is determined that HCV RNA is present, the specific genotype and subtype of the virus can be determined with a genotype test.
  • Drug resistance: Mutations of some proteins in HCV can allow the virus to have resistance to direct-acting antivirals (DAAs), commonly referred to as resistance-associated variants (RAVs) or resistance-associated polymorphisms (RAPs).

HCV Serologic Testing (HCV Ab)

Enzyme immunoassays for Detection of Hepatitis C Antibody

The HCV Ab test is used for initial screening for hepatitis C. The test is performed by enzyme immunoassays (EIAs), which detect the presence of hepatitis C antibodies in serum. The result of the test is reported as positive or negative. Third-generation EIAs have a sensitivity/specificity of approximately 99%. However, the presence of HCV Ab does not indicate whether the infection is acute, chronic, or resolved. A positive antibody test result should be followed up with an HCV RNA test to confirm that viremia is present.

False-Negative and False-Positive HCV Ab Results

Despite the extremely high sensitivity and specificity of the EIA test for the antibody, it is still possible to have both false-positive and false-negative results.

False-Negative HCV Ab
  1. A false-negative HCV Ab result may occur if the test is performed during the window period after acute HCV infection but before seroconversion (when the HCV Ab converts from negative to positive). The average time from infection until seroconversion is 8 weeks and is referred to as the “serologic window.” If acute infection is suspected to have taken place within the past 8 weeks, it would be appropriate to order the HCV RNA test. If the HCV Ab test result is negative within the first 8 weeks after infection, it would be appropriate to retest the antibody after 8 weeks to check for seroconversion.
  2. A false-negative HCV Ab result may also occur in immunocompromised individuals such as those infected with HIV, recipients of organ transplants, and patients receiving chronic hemodialysis. If the HCV Ab result is negative in immunocompromised patients, but there is strong suspicion of HCV infection, it would be appropriate to order the HCV RNA test.
False-Positive HCV Ab
  1. A false-positive HCV Ab result may occur because of cross-reactivity with other viral antigens or the presence of immunologic disorders, such as lupus or rheumatoid arthritis.

Time for Processing HCV Ab Test Results

The turnaround time for 3rd-generation EIAs is at least 1 day. Many labs do not perform the tests on site and must send specimens to another lab for processing, which may further increase the turnaround time.

A point-of-care test is also available. The OraQuick HCV Rapid Antibody Test is an FDA-approved test that can be performed with a fingerstick (or venous blood draw). It is also a CLIA-waived test and therefore can be used in clinic offices and outreach facilities. Results are reported as reactive or nonreactive within 20 minutes. Just as for the standard HCV Ab test done in the lab, a positive OraQuick test must be confirmed by an HCV RNA test. The sensitivity and specificity of the test is similar to that of the laboratory-based assays.

Recombinant Immunoblot Assay for Confirmation of HCV Ab

Recombinant immunoblot assay (RIBA) is a highly specific test that in the past was used as a confirmatory test of antibody results. It still required HCV RNA testing for the diagnosis of chronic infection. The RIBA test is no longer in use or available in the United States.

HCV RNA Testing

The presence of HCV RNA is required to confirm chronic HCV infection. Therefore, a positive HCV Ab screening result must be followed by a test for the HCV RNA. The HCV RNA tests can detect virus within 1-2 weeks following exposure.

Appropriate Uses of the HCV RNA Test

There are 4 major reasons that HCV RNA tests are used:

  1. To confirm a positive HCV Ab result and make the diagnosis of current HCV infection
  2. To measure a patient’s baseline viral load prior to starting HCV therapy
  3. To monitor a patient’s response to therapy
  4. To determine whether a patient has achieved a sustained virologic response (SVR)

More rarely, HCV RNA is used when either very acute HCV infection is suspected or a false HCV Ab is suspected.

It would not be appropriate to repeatedly order HCV RNA viral load screening for a patient who is not on or was recently on HCV treatment, or to use the HCV viral load to determine the severity of the patient’s infection or the patient’s risk of developing significant liver disease.

HCV Antibody and HCV RNA Test Result Interpretations

The HCV RNA is detectable but the number of international units is so low that it cannot be quantified accurately. This indicates extremely low level of virus is present.

” 12 IU/mL” or ” 15 IU/mL” or ” 25 IU/mL” All of these are “less than the LLOQ”

HCV RNA is undetectable. No virus is detected at all in the patient’s serum specimen.

HCV Genotype Testing

There are at least six HCV genotypes. These are classified as genotypes 1-6. There are also 30 subtypes of HCV, which are referred to as genotypes 1a, 1b, 2a, etc. Identifying HCV genotypes is essential for selecting treatment regimens and predicting treatment response. Within genotype 1, it is also important to determine whether the patient is subtype 1a or 1b, as this determines treatment duration and the need for ribavirin in the treatment regimen. Patients only need to be genotype tested once in their lifetime, as the genotype remains the same throughout the course of infection. Repeating a genotype test is warranted only if there is suspicion that a patient may have been reinfected with a different genotype after achieving an SVR.

Genotype testing is performed by analyzing the sequences of various regions of the HCV genome. Most genotype assays rely on the amplification of short HCV RNA regions from clinical specimens, followed by a type-specific assay, such as restriction fragment length polymorphism (RFLP) analysis, line probe reverse hybridization, or sequence analysis. Most assays target the 5′ untranslated region (5′ UTR), as it is the most conserved region throughout the HCV genome and is most suitable for reverse transcription polymerase chain reaction (RT-PCR) amplification.

HCV Resistance Testing (RAV testing)

DAAs are drugs that target specific steps in the life cycle of the hepatitis C virus. When these steps are disrupted, replication of HCV is stopped. DAA drug classes include NS5A inhibitors, NS5B polymerase inhibitors, and NS3/4A protease inhibitors. Resistance Associated Variants (RAVs) refer to mutations that occur in the target enzymes that confer resistance to DAAs. RAV testing is done in most patients who have failed a prior DAA-containing regimen before they initiate re-treatment with another DAA regimen. For example, genotype 3 patients are recommended to have RAV testing if they are treatment experienced before starting re-treatment with sofosbuvir/velpatasvir and to determine whether ribavirin is needed. RAV testing is occasionally done in treatment-naive patients if it may change the regimen or the duration of treatment. For example, genotype 1a patients who are treatment naive should be RAV tested before starting treatment with elbasvir/grazoprevir to determine whether ribavirin is needed or whether an extended duration of treatment is needed. Genotyping of the NS5A, NS5B, and NS3/4A genes to identify RAVs can now be accomplished by RT-PCR and population-based sequencing methods at the VA Palo Alto Public Health Reference Laboratory (PHRL) and at commercial laboratories including Monogram Biosciences (LabCorp) and Quest Diagnostics. HCV drug resistance testing should be ordered only by experienced HCV clinicians.

References

  1. Centers for Disease Control and Prevention. Testing for HCV infection: an update of guidance for clinicians and laboratorians. MMWR Morb Mortal Wkly Rep. 2013 May 10;62(18):362-5.
  2. Carrazin C. The importance of resistance to direct acting antiviral drugs in HCV infection in clinical practice. J Hepatol. 2016 Feb;64(2):486-504.

Drug and Alcohol Treatment Centers: Alcohol Rehab Centers, Drug Rehab Programs –


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Drug and Alcohol Treatment Centers

Drug treatment centers are almost as varied as those who need their services. The differences can range from the types of services offered to whether they are publically or privately funded to the principles and tenets on which they base their rehabilitation programs.

Concerning the differences in services, these can include those facilities which offer drug rehab only as well as those which operate strictly as alcohol treatment centers. Others may offer both drug and alcohol rehab. The differences may not end there, however.

Certain facilities may be set up to only accept those people who are considered in-patients; that is, for a specific amount of time (as little as 28 days or as much as six months or longer) they do not leave the facilities. In other words, their lives are put on hold for the duration of time that their status is shown as that of an inpatient.

It is true that under most circumstances, save perhaps for someone who is there because of a court order or other legal edict, entering drug treatment centers is for the most part voluntary, and anyone wishing to do so can choose to leave the program, whether he is there on an in-patient or outpatient basis. For those who are ordered to stay, at least for a minimum number of days or are serious about overcoming their addiction problem, in-patient facilities are available.

Other drug treatment centers act as strict outpatient facilities. Patients enter these after having completed the in-patient phase of drug rehab or alcohol rehab. They do not stay; but rather attend regularly-scheduled counseling sessions or continuing rehabilitation programs during the week and sometimes on weekends.

Even the ways in which these facilities are funded can differ from one to the other. Some drug treatment centers and alcohol treatment centers may be publically funded; that is, they receive money from municipal, county, state, or federal agencies. Other are private; the patients for all the services for as long as they are in rehabilitation.

Publically-funded facilities may be limited to the services they can offer, while private facilities may be able to provide more programs. The differences continue in the way in which the drug rehab or alcohol rehab services are presented. Some may be faith-based; that is, they are supported by and present the programs in such a way that follows the tenets of the religious organization with which they are affiliated. Others may present their programs in a more secular manner. Some places may offer both types of programs.

About the only thing that may be considered about choosing rehabilitation facilities and programs is finding them. Different websites are available which make it possible for a person to search for facilities in his particular state.

Those who live in certain states-Hawaii, for example, and may come into first contact with persons needing drug rehab or alcohol rehab can receive further help from their state. There are handbooks available which provide the names and locations of facilities, the treatment they provide, and whether or not the services are free. Further, the handbooks give information on how to approach those persons needing rehabilitation services, and what to say to make them receptive to the information being offered.

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