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STUDENT DIGITAL NEWSLETTER ALAGAPPA INSTITUTIONS |
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S. Munir Alam, PhD
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Culture of expectorated sputum is used by some for the evaluation of pneumonia treatments yeast infections pregnant discount 100 mg trazodone overnight delivery, although controversy exists regarding this practice; both sensitivity and specificity of sputum cultures are generally regarded as poor (<50%) medicine zocor purchase trazodone 100mg otc. Specificity is improved by collecting expectorated purulent matter from the lower respiratory tract and avoiding mouth and oropharyngeal matter treatment medical abbreviation trazodone 100 mg sale, thereby reducing contamination medicine jobs 100 mg trazodone overnight delivery. Prior to culture, the specimen should be examined for the presence of white blood cells (evidence of purulent matter) and a paucity of squamous cells (evidence of minimal contamination by oral matter). Blood cultures should be performed to establish the definitive etiology of an associated pneumonia. Useful For: Aiding in the diagnosis of lower respiratory bacterial infections including pneumonia Interpretation: A negative test result is no growth of bacteria or growth of only usual flora. Antimicrobial susceptibility testing should be performed on pure culture isolates of pathogenic (or potentially pathogenic in special situations) bacteria grown from specimens that have been appropriately collected so as not to confuse clinically significant isolates with normal flora. Useful For: Aiding the diagnosis of lower respiratory bacterial infections, including pneumonia Determining the in vitro antimicrobial susceptibility of potentially pathogenic aerobic bacteria, if appropriate this test is not intended for medicolegal use. Interpretation: A negative test result is no growth of bacteria or growth of only usual flora. Cystic fibrosis patients may be colonized or chronically infected by some organisms over a long period of time, therefore, positive results must be interpreted in conjunction with previous findings and the clinical picture to appropriately evaluate results. A susceptible category result and a low minimal inhibitory concentration value indicate in vitro susceptibility of the organism to the antimicrobial tested. Note: An isolate that is interpreted as nonsusceptible does not necessarily mean that the isolate has a resistance mechanism. Isolation of 2 or more organisms above 10,000 cfu/mL may suggest specimen contamination. Wound, Abscess, Exudates: Skin and soft tissue infections can occur as a result of a break in the skin surface, as complications of surgery, from trauma; human, animal, or insect bites, or from diseases that interrupt a mucosal or skin surface. For most open lesions and abscesses, remove the superficial flora by decontaminating the skin before collecting a specimen from the advancing margin or base. The specific anatomic site is required to establish possible contaminating flora in the area of specimen collection for appropriate reporting of culture results. Interpretation: When no resident flora is present, any microorganism found is considered significant and is reported. For specimens contaminated with normal bacterial flora, bacteria that are potentially pathogenic are identified. Isolation of 2 or more organisms with more than 10,000 cfu/mL may suggest specimen contamination. For specimens contaminated with the usual bacterial flora, bacteria that are potentially pathogenic are identified. A "susceptible" category result and a low minimum inhibitory concentration value indicate in vitro susceptibility of the organism to the antimicrobial tested. Refer to the Reference Values section for interpretation of various antimicrobial susceptibility interpretive categories (ie, susceptible, susceptible-dose dependent, intermediate, nonsusceptible, resistant, or epidemiological cutoff value. This category also includes a buffer zone, which should prevent small, uncontrolled, technical factors from causing major discrepancies in interpretations, especially for drugs with narrow pharmacotoxicity margins. R - Resistant: A microorganism is categorized as "Resistant" when there is a high likelihood of therapeutic failure even when there is increased exposure. Anaerobes colonize the skin, oral cavity, and genitourinary and lower gastrointestinal tracts, and generally do not cause infection. Their presence is important for vitamin and other nutrient absorption and in preventing infection with pathogenic bacteria. They also can develop resistance to antimicrobials by producing beta-lactamase and other modifying enzymes, and by alterations in membrane permeability and structure of penicillin-binding proteins. Ertapenem, metronidazole, and clindamycin are generally effective agents although resistance to clindamycin, and occasionally ertapenem, is increasing. Useful For: Diagnosing anaerobic bacterial infections Directing antimicrobial therapy for anaerobic infections Interpretation: Isolation of anaerobes in significant numbers from specimens collected under sterile conditions including blood, other normally sterile body fluids, or closed collections of purulent fluid indicates infection with those organisms. A susceptible category result and a low minimum inhibitory concentration value indicate in vitro susceptibility of the organism to the antimicrobial tested. In some instances, an interpretive category cannot be provided based on available data and the following comment will be included: "There are no established interpretive guidelines for agents reported without interpretations. When usual skin and mucosal barriers are penetrated as well as in an anaerobic environment, these bacteria can behave as pathogens. Typical anaerobic infections include periodontitis, abdominal or pelvic abscesses, endometritis, pelvic inflammatory disease, aspiration pneumonia, empyema and lung abscesses, sinusitis, brain abscesses, gas gangrene, and other soft tissue infections. Anaerobes grow aggressively in the body under anaerobic conditions and may possess a variety of virulence factors including capsules and extracellular enzymes. They also can develop resistance to antimicrobials by producing beta-lactamase and other modifying enzymes as well as by alterations in membrane permeability and structure of penicillin-binding proteins. Because anaerobic bacteria are a significant cause of human infection and are often resistant to commonly used antimicrobials, susceptibility testing results are useful to clinicians. Useful For: Diagnosing anaerobic bacterial infections Interpretation: Isolation of anaerobes in significant numbers from well-collected specimens including blood, other normally sterile body fluids, or closed collections of purulent fluid, indicates infection with the identified organisms. Appropriate treatment for the causative organism can reduce morbidity and mortality. These include Pseudomonas aeruginosa (mucoid and nonmucoid), Staphylococcus aureus, Burkholderia cepacia complex, Stenotrophomonas maltophilia, other non-fermenting Gram-negative rods, Haemophilus influenzae, and Streptococcus pneumoniae. Useful For: Detection of aerobic bacterial pathogens in specimens from patients with cystic fibrosis Determining the in vitro antimicrobial susceptibility of potentially pathogenic aerobic bacteria, if appropriate Interpretation: A negative test result is no growth of bacteria or growth of only usual flora. Patients with cystic fibrosis may be colonized or chronically infected by some organisms over a long period of time, therefore, positive results must be interpreted in conjunction with previous findings and the clinical picture to appropriately evaluate results. For interpretation of various antimicrobial susceptibility interpretive categories (ie, susceptible, susceptible-dose dependent, intermediate, nonsusceptible, resistant, or epidemiological cutoff value), see Reference Values. These include Pseudomonas aeruginosa (mucoid and nonmucoid), Staphylococcus aureus, Burkholderia cepacia complex, Stenotrophomonas maltophilia, other non-fermenting gram-negative rods, Haemophilus influenzae, and Streptococcus pneumoniae. Useful For: Detection of aerobic bacterial pathogens in specimens from patients with cystic fibrosis Interpretation: A negative test result is no growth of bacteria or growth of only usual flora. A negative result does not rule out all causes of infectious lung disease (see Cautions). Reference Values: No growth or usual flora Identification of probable pathogens Clinical References: 1. Typing may allow discrimination of 2 or more isolates of the same species, which can inform recognition of an outbreak, nosocomial transmission, or identify a potential source of infection in an individual patient. Useful For: Aiding in the investigation of a potential outbreak by a single bacterial species May assist in identification of recurrent infection in an individual patient Interpretation: the genomic sequence of individual isolates will be determined and compared to the genomic sequences of the other cosubmitted isolates. A link to the interpretive report will be sent to the registered email address provided by the client. Reference Values: Reported as isolates are "related", "possibly related", or "unrelated". Useful For: Establishing a diagnosis of an allergy to Bahia grass Defining the allergen responsible for eliciting signs and symptoms Identifying allergens: -Responsible for allergic disease and/or anaphylactic episode -To confirm sensitization prior to beginning immunotherapy -To investigate the specificity of allergic reactions to insect venom allergens, drugs, or chemical allergens Interpretation: Detection of IgE antibodies in serum (Class 1 or greater) indicates an increased likelihood of allergic disease as opposed to other etiologies and defines the allergens that may be responsible for eliciting signs and symptoms. The allergens chosen for testing often depend upon the age of the patient, history of allergen exposure, season of the year, and clinical manifestations. Useful For: Establishing the diagnosis of an allergy to bald cypress Defining the allergen responsible for eliciting signs and symptoms Identifying allergens: - Responsible for allergic disease and/or anaphylactic episode - To confirm sensitization prior to beginning immunotherapy - To investigate the specificity of allergic reactions to insect venom allergens, drugs, or chemical allergens Testing for IgE antibodies is not useful in patients previously treated with immunotherapy to determine if residual clinical sensitivity exists, or in patients in whom the medical management does not depend upon identification of allergen specificity. Useful For: Establishing a diagnosis of an allergy to bamboo shoots Defining the allergen responsible for eliciting signs and symptoms Identifying allergens: -Responsible for allergic disease and/or anaphylactic episode -To confirm sensitization prior to beginning immunotherapy -To investigate the specificity of allergic reactions to insect venom allergens, drugs, or chemical allergens Interpretation: Detection of IgE antibodies in serum (Class 1 or greater) indicates an increased likelihood of allergic disease as opposed to other etiologies and defines the allergens that may be responsible for eliciting signs and symptoms. Useful For: Establishing a diagnosis of an allergy to bananas Defining the allergen responsible for eliciting signs and symptoms Identifying allergens: -Responsible for allergic disease and/or anaphylactic episode -To confirm sensitization prior to beginning immunotherapy -To investigate the specificity of allergic reactions to insect venom allergens, drugs, or chemical allergens Interpretation: Detection of IgE antibodies in serum (Class 1 or greater) indicates an increased likelihood of allergic disease as opposed to other etiologies and defines the allergens that may be responsible for eliciting signs and symptoms. Useful For: As part of a panel of immunostains where loss of staining can be used as a marker of various neoplasms Interpretation: this test includes only technical performance of the stain (no pathologist interpretation is performed). Mephobarbital and phenobarbital are frequently used to control major motor (grand mal) seizures. Useful For: Detecting drug abuse involving barbiturates such as amobarbital, butalbital, pentobarbital, phenobarbital, and secobarbital Chain of custody is required whenever the results of testing could be used in a court of law. Interpretation: the presence of a barbiturate in urine indicates use of one of these drugs.
This assay is specific for tacrolimus; it does not cross-react with cyclosporine treatment h pylori best 100mg trazodone, cyclosporine metabolites medications i can take while pregnant generic 100 mg trazodone mastercard, sirolimus treatment 4 hiv trazodone 100mg amex, sirolimus metabolites medications that interact with grapefruit order 100 mg trazodone visa, or tacrolimus metabolites. Results should be interpreted in conjunction with this clinical information and any physical signs or symptoms of rejection or toxicity. Tapentadol acts as an opiate agonist through its binding to mu-opioid receptors and through the inhibition of norepinephrine reuptake. Tapentadol and its metabolites (N-desmethyltapentadol and hydroxyl-tapentadol) are excreted almost exclusively via the kidneys and approximately 70% of the drug is excreted in urine in the conjugated form. Opioid analgesics have high abuse potential and the regular use of tapentadol may result in physical dependence and tolerance. Useful For: Monitoring of compliance utilizing tapentadol Detection and confirmation of the illicit use of tapentadol this test is not intended for use in employment-related testing Interpretation: the presence of tapentadol or N-desmethyltapentadol levels of 25 ng/mL or higher is a strong indicator that the patient has used tapentadol. Reference Values: Cutoff: 25 ng/mL Note: Tapentadol concentrations will be reported quantitatively and N-desmethyltapentadol will be reported qualitatively (Present or Negative). With a high risk for abuse/diversion, professional practice guidelines recommend compliance monitoring for these medications using urine drug tests. Useful For: Qualitatively (present vs not detected) identifying 27 benzodiazepine compounds (parent drug and metabolites) in urine to help determine compliance or identify illicit benzodiazepine drug use this test is not intended for employment-related testing. Interpretation: If a benzodiazepine or its corresponding metabolites is identified (present), it indicates that the patient has used the respective benzodiazepine in the recent past. With a high risk for abuse and diversion, professional practice guidelines recommend compliance monitoring for these medications using urine drug tests. However, traditional benzodiazepine immunoassays suffer from a lack of cross-reactivity with all the benzodiazepines, so many compliant patients taking clonazepam (Klonopin) or lorazepam (Ativan) may screen negative by immunoassay but are positive when confirmatory testing is done. Useful For: Determining compliance or identifying illicit benzodiazepine drug use this test is not intended for employment-related testing. The absence of expected benzodiazepines or their metabolites may indicate noncompliance, inappropriate timing of specimen collection relative to drug administration, poor drug absorption, diluted or adulterated urine, or limitations of testing. If a specific drug concentration is required, the laboratory must be contacted within 2 weeks of specimen collection/testing to request quantification by a second analytical technique at an additional charge. Reference Values: Not Detected Cutoff concentrations: Alprazolam: 10 ng/mL Alpha-hydroxyalprazolam: 10 ng/mL Alpha-hydroxyalprazolam glucuronide: 50 ng/mL Chlordiazepoxide: 10 ng/mL Clobazam: 10 ng/mL N-desmethylclobazam: 200 ng/mL Clonazepam: 10 ng/mL 7-Aminoclonazepam: 10 ng/mL Diazepam: 10 ng/mL Nordiazepam: 10 ng/mL Flunitrazepam: 10 ng/mL 7-Aminoflunitrazepam: 10 ng/mL Flurazepam: 10 ng/mL 2-Hydroxy ethyl flurazepam: 10 ng/mL Lorazepam: 10 ng/mL Lorazepam glucuronide: 50 ng/mL Midazolam: 10 ng/mL Alpha-hydroxy midazolam: 10 ng/mL Oxazepam: 10 ng/mL Oxazepam glucuronide: 50 ng/mL Prazepam: 10 ng/mL Temazepam: 10 ng/mL Temazepam glucuronide: 50 ng/mL Triazolam: 10 ng/mL Alpha-hydroxy triazolam: 10 ng/mL Zolpidem: 10 ng/mL Zolpidem phenyl-4-carboxylic acid: 10 ng/mL Clinical References: 1. Useful For: Qualitatively (present vs not detected) identifying 33 opioid compounds (parent drug and metabolites) in urine to help determine compliance or identify illicit opioid drug use this test is not intended for use in employment-related testing. Interpretation: If an opioid or its corresponding metabolites is identified (present), it indicates that the patient has used the respective opioid in the recent past. The absence of expected opioids or their metabolites may indicate noncompliance, inappropriate timing of specimen collection relative to drug administration, poor drug absorption, diluted or adulterated urine, or limitations of testing. These medications can also produce physical and psychological dependence and have a high risk for abuse and diversion, which is one of the main reasons many professional practice guidelines recommend compliance testing in patients prescribed these medications. Useful For: Determining compliance or identifying illicit opioid drug use using urine specimens this test is not intended for employment-related testing. Chronic Pain in America: Roadblocks to Relief, survey conducted for the American Pain Society, the American Academy of the Pain Medicine and Janssen. Useful For: Aiding in the determination of compliance or identify illicit stimulant drug use this test is not intended for use in employment-related testing. Interpretation: If a stimulant or its corresponding metabolite is identified (present), it indicates that the patient has used the respective stimulant in the recent past (typically 1-3 days). The absence of the expected stimulant or its metabolites may indicate noncompliance, inappropriate timing of specimen collection relative to drug administration, poor drug absorption, diluted or adulterated urine, or limitations of testing. The concentration of the drug must be greater than or equal to the cutoff to be reported as present. Chronic Pain in America: Roadblocks to Relief, survey conducted for the American Pain Society, the American Academy of the Pain Medicine and Janssen Pharmaceutical; 1999 9. Useful For: Determining compliance or identifying illicit stimulant drug use this test is not intended for employment-related testing. Caution should be used since other types of lymphoma can also be positive, such as marginal zone lymphoma, but usually their staining is less intense. Useful For: Classification of leukemias and lymphomas Interpretation: this test includes only technical performance of the stain (no pathologist interpretation is performed). Useful For: Diagnosis of neurodegenerative disorders Interpretation: this test includes only technical performance of the stain (no pathologist interpretation is performed). Tau has become important in the analysis of a wide variety of neurodegenerative disorders, including Alzheimer disease, Pick disease, corticobasal degeneration, supranuclear palsy, multisystem atrophy, as well as a recently recognized category of disorders known as tauopathies. Useful For: Analysis of neurodegenerative disorders Interpretation: this test includes only technical performance of the stain (no pathologist interpretation is performed). The carrier frequency for this disease in individuals of Ashkenazi Jewish ancestry is 1 in 31. In non-Ashkenazi Jewish individuals, the detection rate for the common mutations is significantly decreased. When performed in conjunction with hexosaminidase A biochemical testing, the variant detection rate using this assay is approximately 99%. A common cause of false-positive carrier screening by enzyme analysis, particularly among individuals of nonAshkenazi Jewish descent, is due to the presence of a pseudodeficiency allele, either R247W or R249W. These sequence variations are not associated with disease but result in the production of a hexosaminidase A enzyme with decreased activity towards the artificial substrate used in the enzyme assay. Useful For: Carrier testing of individuals of Ashkenazi Jewish ancestry or who have a family history of Tay-Sachs disease Determining Tay-Sachs disease carrier status for individuals with enzyme activity within the carrier or equivocal ranges Prenatal diagnosis of Tay-Sachs disease for at-risk families Confirmation of suspected clinical diagnosis of Tay-Sachs disease in individuals of Ashkenazi Jewish ancestry Interpretation: An interpretive report will be provided. A minority ofcells express other T-cell receptors made of different polypeptide chains, gamma and delta. Eachcell has approximately 30,000 identical antigen receptors on its cell surface. The beta chain locus rearranges before the alpha chain and a functional beta chain has to be produced in order for thecell to form a pre-T-cell receptor. A key concept in understanding the immune response is that there is enormous diversity in the immune system to enable protection against a huge array of pathogens. Since the germline genome is limited in size, diversity is achieved not only by the process of V(D)J recombination but also by junctional (junctions between V-D and D-J segments) deletion of nucleotides and addition of pseudo-random, nontemplated nucleotides. Useful For: Assessment of T-cell receptor diversity in various clinical contexts including primary immunodeficiencies, monitoring immune reconstitution posthematopoietic cell transplantation, and temporal assessment of repertoire changes in autoimmune diseases and viral infections Interpretation: An interpretive report will be provided with adult and pediatric reference values for the relative contribution of each family to the total repertoire (% diversity ratio). Information on the distribution of peaks, eg, Gaussian vs non-Gaussian, will also be included in the report, where appropriate. Internal analytical and quality controls will be assessed to determine the suitability of reporting a patient result. Correlation with the clinical context will be made when possible, based on clinical history provided in the patient information sheet (which should be provided with the patient sample). Pirovano S, Mazzolari E, Pasic S, et al: Impaired thymic output and restricted T-cell repertoire in two infants with immunodeficiency and early-onset generalized dermatitis. Useful For: Establishing the diagnosis of an allergy to tea Defining the allergen responsible for eliciting signs and symptoms Identifying allergens: - Responsible for allergic disease and/or anaphylactic episode - To confirm sensitization prior to beginning immunotherapy - To investigate the specificity of allergic reactions to insect venom allergens, drugs, or chemical allergens Testing for IgE antibodies is not useful in patients previously treated with immunotherapy to determine if residual clinical sensitivity exists, or in patients in whom the medical management does not depend upon identification of allergen specificity. Telomerase is an enzyme complex that can extend the length of the telomere, thus helping to slow the shortening process. Telomerase is most active in highly proliferative tissues such as lymphocytes, skin, intestine, and bone marrow. Variants in genes involved with telomere repair and maintenance may cause telomeres to shorten more quickly than normal. The severity of these syndromes is variable, and they may present in children or adults. In addition to bone marrow failure, other symptoms of telomere biology disorders include pulmonary fibrosis, liver disease, gastrointestinal disease, and mucocutaneous abnormalities. Telomere biology disorders can be inherited in a variety of patterns, including X-linked recessive, autosomal dominant, and autosomal recessive. See Table for a summary of the genes included in this panel, associated diseases, and the mode of inheritance. Alternatively, some patients may have 1 of these 3 features along with a hypocellular bone marrow. These patients all have very short telomeres (<1% percentile of age) in leukocytes.
Furuya S symptoms 3 dpo generic trazodone 100mg fast delivery, Masurmori N treatment 4 syphilis purchase trazodone 100 mg online, Furuya R medicine to stop period purchase 100mg trazodone free shipping, et al: Characterization of localized seminal vesicle amyloidosis causing hemospermia: An analysis using immunohistochemistry and magnetic resonance imaging medications prescribed for pain are termed discount trazodone 100 mg visa. Kebbel A, Rocken C: Immunohistochemical classification of amyloid in surgical pathology revisited. Tuccari G, Barresi G: Lactoferrin in human tumours: immunohistochemical investigations during more than 25 years. Useful For: Establishing a diagnosis of an allergy to lamb Defining the allergen responsible for eliciting signs and symptoms Identifying allergens: -Responsible for allergic disease and/or anaphylactic episode -To confirm sensitization prior to beginning immunotherapy -To investigate the specificity of allergic reactions to insect venom allergens, drugs, or chemical allergens Interpretation: Detection of IgE antibodies in serum (Class 1 or greater) indicates an increased likelihood of allergic disease as opposed to other etiologies and defines the allergens that may be responsible for eliciting signs and symptoms. Because individual B cells or plasma cells synthesize immunoglobulin containing either kappa or lambda light chains, but not both, immunoperoxidase stains for light chains can be applied to lymphocyte and plasma cell populations as a marker of clonality and B-cell lineage. Useful For: A marker of B-cell and plasma cell clonality and B-cell lineage Interpretation: this test does not include pathologist interpretation, only technical performance of the stain. Surfactant is packaged into lamellar bodies and is excreted into the alveolar space where it unravels and forms a monolayer on alveolar surfaces. Lamellar bodies can also pass into the amniotic cavity and, hence, are found in amniotic fluid. The surfactant functions to reduce the surface tension in the alveoli, preventing atelectasis. When surfactant is deficient, the small alveoli collapse and the large alveoli become overinflated and stiff, which has been associated with increased risk of developing respiratory distress. Lamellar bodies are similar in size to platelets and can be quantified on a hematology analyzer utilizing the platelet channel and used to estimate fetal lung maturity. Haymond S, Luzzi V, Parvin C, Gronowski A: A direct comparison between lamellar body counts and fluorescent polarization methods for predicting respiratory distress syndrome. Szallasi A, Gronowski A, Eby C: Lamellar body count in amniotic fluid: a comparative study of four different hematology analyzers. Its many off-label uses include treatment of migraine, trigeminal neuralgia, and treatment-refractory depression. The half-life is 25 to 33 hours in adults but decreases with concurrent use of phenytoin or carbamazepine (13-14 hours) and increases with concomitant valproic acid therapy (59-70 hours), renal dysfunction, or hepatic impairment. Common adverse effects are dizziness, ataxia, blurred or double vision, nausea, or vomiting. While most patients show response to the drug when the trough concentration is in the range of 2. Langerin is expressed in both normal and neoplastic Langerhans cells, and is specifically associated with the assembly of Birbeck granules in these cells. Useful For: Visualization of normal and neoplastic Langerhans cells Interpretation: this test includes only technical performance of the stain (no pathologist interpretation is performed). In individuals predisposed to develop allergic disease, the sequence of sensitization and clinical manifestations proceed as follows: eczema and respiratory disease (rhinitis and bronchospasm) in infants and children <5 years due to food sensitivity (milk, egg, soy, and wheat proteins) followed by respiratory disease (rhinitis and asthma) in older children and adults due to sensitivity to inhalant allergens (dust mite, mold, and pollen inhalants). Useful For: Distinguishing T-cell subsets and helping to classify T-cell lymphomas Interpretation: this test includes only technical performance of the stain (no pathologist interpretation is performed). Useful For: Establishing a diagnosis of an allergy to latex Defining the allergen responsible for eliciting signs and symptoms Identifying allergens: -Responsible for allergic disease and/or anaphylactic episode -To confirm sensitization prior to beginning immunotherapy -To investigate the specificity of allergic reactions to insect venom allergens, drugs, or chemical allergens Interpretation: Detection of IgE antibodies in serum (Class 1 or greater) indicates an increased likelihood of allergic disease as opposed to other etiologies and defines the allergens that may be responsible for eliciting signs and symptoms. Useful For: Detecting clinically significant lead exposure due to occupational exposure in random urine specimens this test is not a substitute for blood lead screening. Interpretation: Urinary excretion of less than 4 mcg/g creatinine is not associated with any significant lead exposure. Urinary excretion of more than 4 mcg/g creatinine is usually associated with pallor, anemia, and other evidence of lead toxicity. Increased urine lead concentration per gram of creatinine indicates significant lead exposure. Measurement of urine lead concentration per gram of creatinine before and after chelation therapy has been used as an indicator of significant lead exposure. Useful For: Detecting clinically significant lead exposure due to occupational exposure this test is not a substitute for blood lead screening. Interpretation: Measurements of urinary lead levels have been used to assess lead exposure. However, like lead blood, urinary lead excretion mainly reflects recent exposure and thus shares many of the same limitations for assessing lead body burden or long-term exposure. Measurement of urine lead excretion rate before and after chelation therapy has been used as an indicator of lead exposure. Useful For: Detecting clinically significant lead exposure in 24-hour specimens this test is not a substitute for blood lead screening. Interpretation: Measurements of urinary lead (Pb) levels have been used to assess lead exposure. Lead can enter the environment through releases from mining lead and other metals, and from factories that make or use lead, lead alloys, or lead compounds. Before the use of leaded gasoline in motor vehicles was banned (January 1, 1996), most of the lead released into the United States environment came from vehicle exhaust. People may be exposed to lead by eating food or drinking water that contains lead. Drinking (tap) water in houses containing lead pipes may contain lead, especially if the water is acidic or "soft". The majority of the daily intake is excreted in the stool after direct passage through the gastrointestinal tract. While a significant fraction of the absorbed lead is incorporated into bone (approximately 94% adults; approximately 73% children) and erythrocytes, lead ultimately distributes among all tissues, with lipid-dense tissues such as the central nervous system being particularly sensitive to organic forms of lead. Lead expresses its toxicity by several mechanisms: 1) It avidly inhibits aminolevulinic acid dehydratase and ferrochelatase, 2 of the enzymes involved in the synthesis of heme. However, chelation therapy is available to treat severe disease and may be necessary especially in children if the blood lead is higher than 25 mcg/dL. Useful For: Detecting lead toxicity with capillary collections Interpretation: No safe blood lead level in children has been identified. If a worker is medically removed, a new blood lead level must be measured monthly during the removal period. Jusko-MACROS-, Henderson C, Lanphear B, et al: Blood lead concentrations <10 mcg/dL and child intelligence at 6 years of age. If the hair is collected and segmented in a time sequence (based on length from root), the approximate time of exposure can be assessed. Useful For: Detecting lead exposure using hair specimens Interpretation: Normal hair lead content is below 4. Ultimately, the hair lead content needs to be interpreted in addition to the overall clinical scenario including symptoms, physical findings, and other diagnostic results when determining further actions. Barbosa F, Tanus-Santos J, Gerlach R, Parsons P: A Critical review of biomarkers used for monitoring human exposure to lead: advantages, limitations, and future needs. Sanna E, Liguori A, Palmes L, et al: Blood and hair lead levels in boys and girls living in two Sardinian towns at different risks of lead pollution. Useful For: Detecting lead exposure using nail specimens Interpretation: Normally, the nail lead content is below 4. Ultimately, the nail lead content needs to be interpreted in addition to the overall clinical scenario including symptoms, physical findings, and other diagnostic results when determining further actions. Barbosa F, Tanus-Santos J, Gerlach R, Parsons P: A critical review of biomarkers used for monitoring human exposure to lead: advantages, limitations, and future needs. Lead was banned from household paints in 1978 but is still found in paint produced for nondomestic use and in artistic pigments. Lead is commonly found in soil especially near roadways, older houses, old orchards, mining areas, industrial sites, near power plants, incinerators, landfills, and hazardous waste sites. Recent data has also shown that inexpensive cosmetic jewelry pieces sold to the general public may contain high levels of lead, which can be transferred to the skin through routine handling. Drinking (taps) water in houses containing lead pipes may contain lead, especially if the water is acidic or "soft". Leafy fresh vegetables grown in lead-containing soils may have lead-containing dust on them. Lead may also enter foods if they are put into improperly glazed pottery or ceramic dishes and from leaded-crystal glassware. However, since lead solder is no longer used in cans, very little lead is typically found in food. The typical diet in the United States contributes 1 to 3 mcg of lead per day, of which 1% to 10% is absorbed; children may absorb as much as 50% of the dietary intake, and the fraction of lead absorbed is enhanced by nutritional deficiency.
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