Crp
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C-reactive protein (CRP) is a plasma protein that rises during inflammation. A positive CRP test indicates inflammation somewhere in the body, which can be caused by conditions like cancer, heart disease, infection, or autoimmune diseases. Factors like smoking, obesity, diabetes, sedentary lifestyle, and high cholesterol can elevate CRP levels. CRP levels can be reduced through non-pharmacological methods like exercise, smoking cessation, and diet changes, or through drug therapy using statins which can lower CRP levels by 13-50%.
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Lecture 7-c-reactive protein
C-reactive protein (CRP) is a marker for inflammation that is produced by the liver and measured via a blood test. CRP levels rise in response to inflammation and can help diagnose bacterial infections. A rapid latex agglutination test is commonly used to measure CRP levels qualitatively, involving mixing patient serum with antibody-coated latex particles. If CRP is present, the particles will agglutinate, indicating a positive result. Precise reaction timing and controls are needed to get an accurate reading.
C reactive protein
This document discusses C-reactive protein (CRP) and its clinical importance. It begins by defining acute phase proteins (APPs) as proteins whose plasma concentration increases or decreases in response to inflammation. CRP is an example of a positive APP whose levels rise with inflammation. It is produced primarily in the liver in response to cytokines like IL-6 and IL-1. Elevated CRP levels can indicate conditions like infections, osteoarthritis, and coronary events. High-sensitivity CRP (hs-CRP) is an even more sensitive marker useful for cardiovascular risk assessment and determining risk of future cardiovascular diseases and events.
Lecture 9-rheumatoid factor
Rheumatoid factor is an antibody that is associated with rheumatoid arthritis. A test called the rapid latex agglutination test can detect rheumatoid factor in a patient's serum. This test works by mixing the patient's serum with latex particles coated with human IgG - if rheumatoid factors are present, the latex particles will agglutinate or clump together visibly. Controls and following the correct procedure are important to ensure accurate results. While rheumatoid factor can indicate rheumatoid arthritis, some patients may not have it present and it may be detected in other diseases as well.
VDRL Test for Syphilis
The VDRL (Venereal Disease Research Laboratory) test is a screening test for syphilis that detects antibodies produced against antigens released by damaged host cells in patients infected with Treponema pallidum, the bacterium that causes syphilis. It is a non-treponemal test that detects IgM and IgG antibodies. To perform the test, serum is heated to inactivate inhibitors and then mixed with cardiolipin antigen on a slide. Under a microscope, clumping or agglutination indicates a reactive or positive result, while a homogeneous suspension indicates a non-reactive or negative result. The VDRL test is useful for syphilis screening but must be confirmed with a treponemal-
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Camp test
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Pleural fluid examination
Pleural fluid is the fluid found between the membranes lining the thoracic cavity. An excess amount is called a pleural effusion, which can be caused by conditions like heart failure, pneumonia, or rheumatoid arthritis. A sample of pleural fluid is removed through thoracentesis and analyzed to determine if it is a transudate or exudate and diagnose the cause. A transudate is caused by pressure imbalances while an exudate results from inflammation or injury, requiring additional testing to identify conditions like infection, bleeding disorders, or cancer. Test results provide information on the fluid's characteristics, protein levels, and microscopic examination of cells to diagnose the pleural effusion's underlying cause.
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Lecture 7-c-reactive protein
C-reactive protein (CRP) is a marker for inflammation that is produced by the liver and measured via a blood test. CRP levels rise in response to inflammation and can help diagnose bacterial infections. A rapid latex agglutination test is commonly used to measure CRP levels qualitatively, involving mixing patient serum with antibody-coated latex particles. If CRP is present, the particles will agglutinate, indicating a positive result. Precise reaction timing and controls are needed to get an accurate reading.
C reactive protein
This document discusses C-reactive protein (CRP) and its clinical importance. It begins by defining acute phase proteins (APPs) as proteins whose plasma concentration increases or decreases in response to inflammation. CRP is an example of a positive APP whose levels rise with inflammation. It is produced primarily in the liver in response to cytokines like IL-6 and IL-1. Elevated CRP levels can indicate conditions like infections, osteoarthritis, and coronary events. High-sensitivity CRP (hs-CRP) is an even more sensitive marker useful for cardiovascular risk assessment and determining risk of future cardiovascular diseases and events.
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Rheumatoid factor is an antibody that is associated with rheumatoid arthritis. A test called the rapid latex agglutination test can detect rheumatoid factor in a patient's serum. This test works by mixing the patient's serum with latex particles coated with human IgG - if rheumatoid factors are present, the latex particles will agglutinate or clump together visibly. Controls and following the correct procedure are important to ensure accurate results. While rheumatoid factor can indicate rheumatoid arthritis, some patients may not have it present and it may be detected in other diseases as well.
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The VDRL (Venereal Disease Research Laboratory) test is a screening test for syphilis that detects antibodies produced against antigens released by damaged host cells in patients infected with Treponema pallidum, the bacterium that causes syphilis. It is a non-treponemal test that detects IgM and IgG antibodies. To perform the test, serum is heated to inactivate inhibitors and then mixed with cardiolipin antigen on a slide. Under a microscope, clumping or agglutination indicates a reactive or positive result, while a homogeneous suspension indicates a non-reactive or negative result. The VDRL test is useful for syphilis screening but must be confirmed with a treponemal-
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The document discusses biochemical analysis of cerebrospinal fluid (CSF) in medical laboratories. Routinely tested parameters in CSF include glucose, protein, electrolytes, lactate, and enzymes. Proper handling and centrifugation of CSF samples is important to avoid contamination. Abnormal levels of glucose, protein, lactate and enzymes can indicate conditions like meningitis or tumors. The Pandy's test and Biuret method are described for measuring CSF protein levels, along with normal ranges. Spectrophotometry is used to analyze results from colorimetric assays.
Camp test
The CAMP test identifies Streptococcus agalactiae (Group B Strep) and Listeria species by their production of a substance called the CAMP factor. The CAMP factor acts synergistically with Staphylococcus aureus to induce enhanced hemolysis, appearing as an arrowhead shape. Discovered in 1944 by Christie, Atkins, Munch, and Petersen, the CAMP test remains an important method for identifying S. agalactiae and Listeria monocytogenes.
Coomb's test
Coomb's test: Introduction, principle, application, clinical significance, requirements, procedure, interpretation and result.
Pleural fluid examination
Pleural fluid is the fluid found between the membranes lining the thoracic cavity. An excess amount is called a pleural effusion, which can be caused by conditions like heart failure, pneumonia, or rheumatoid arthritis. A sample of pleural fluid is removed through thoracentesis and analyzed to determine if it is a transudate or exudate and diagnose the cause. A transudate is caused by pressure imbalances while an exudate results from inflammation or injury, requiring additional testing to identify conditions like infection, bleeding disorders, or cancer. Test results provide information on the fluid's characteristics, protein levels, and microscopic examination of cells to diagnose the pleural effusion's underlying cause.
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Pleural fluid
It is fluid which is present in the pleural cavity of
lungs b/w parietal pleura n visceral pleura.
The pleural cavity is a potential space lined by
mesothelium of the visceral n parietal pleura.
Lecture 8-streptolysin o
This document discusses Streptolysin O, an exotoxin produced by Streptococcus pyogenes bacteria, and the Antistreptolysin O (ASO) antibody produced in response. It describes how the ASO latex agglutination test is used to detect ASO antibodies as a way to diagnose post-streptococcal conditions like rheumatic fever when live bacteria cannot be cultured. The test works by detecting if patient serum causes agglutination of latex particles coated with Streptolysin O antigen, indicating the presence of ASO antibodies. The procedure, interpretation of positive and negative results, and limitations are provided.
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CRP is an acute-phase protein of hepatic origin that increases following interleukin-6 secretion by macrophages and T cells.
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Antibodies directed against the Fc fragment of immunoglobulin G (IgG) are called rheumatoid factors (RFs). They are heterogenous and usually composed of immunoglobulin M (IgM)
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ASO test.ppt
This document discusses agglutination tests, which cause antigens and antibodies to clump together when mixed. It focuses on agglutination tests using latex particles or other carriers coated with antigens. These qualitative or quantitative tests can identify bacteria, diagnose infections like typhoid, and detect antibodies. For example, the ASO latex slide agglutination test detects antibodies to streptolysin O, an exotoxin from streptococci bacteria that causes sore throats and other diseases. The test involves mixing serum samples with latex particles coated in streptolysin O, and observing for agglutination which indicates the presence of antibodies.
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NOTE - THIS IS AN ACCESSORY MATERIAL TO THIS VIDEO - https://youtu.be/C1RS39B6XbE
Please watch the video too, to enhance the topic.
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The document discusses different methods of blood collection including capillary, venous, and arterial blood. It describes various anticoagulants used in blood collection tubes and their purposes, such as EDTA for cell counts and citrate for coagulation studies. The document also outlines the proper order for drawing blood into collection tubes and the use of blood banks for storing blood components.
Csf in clinico laboratory diagnoses
The document summarizes cerebrospinal fluid (CSF) physiology, composition, and analysis. It describes how CSF is produced in the choroid plexus and circulates through the ventricles and subarachnoid space. Normal CSF contains low levels of protein, glucose equal to 60% of plasma, and electrolyte concentrations different than plasma. Analysis of CSF protein, glucose, white blood cells, and other components can help diagnose conditions like meningitis, tumors, and neurological disorders. Increased opening of the blood-brain barrier and local immune responses can be evaluated through analysis of CSF albumin and immunoglobulin levels.
CRP Presentation
World Vision Pakistan implements several disaster risk reduction and early warning projects in Muzaffargarh, including the Community Resilience Project from 2013-2014. This project aimed to increase community resilience through mainstreaming DRR across development programs, forming disaster management committees in 10 villages, conducting hazard assessments, installing early warning systems, and training volunteers and children. Challenges included limited funding, staffing issues, and the complex security situation. Lessons indicated a need for longer-term strategies, mainstreaming DRR into other sectors, and strengthening coordination between organizations and the government.
CRP and inflammatory response (2)
A sufficient decrease in C-reactive protein (CRP) levels after elective colorectal surgery can predict an uneventful recovery. The study found that patients who developed early complications had higher CRP levels on the second postoperative day compared to uncomplicated patients. A decrease in CRP levels between the second and fifth postoperative days of less than 36% for open surgery and 48% for laparoscopic surgery indicated a risk of developing late complications. Monitoring CRP levels in the early postoperative period can help identify patients at risk of septic complications and guide safe discharge from the hospital.
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This presentation is focused on diagnostic utility of Red blood cell indices which will be very useful for undergraduate and postgraduate of medical field.
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This document summarizes the various methods used to diagnose HIV infection in a laboratory setting. It discusses screening tests like ELISA and rapid tests that detect HIV antibodies, supplemental tests like Western Blot for antibody confirmation, and confirmatory tests including viral RNA detection by PCR and p24 antigen detection. It also mentions nonspecific immunological markers and stresses the importance of pre-test and post-test counseling.
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The document discusses medical technology and medical technologists, who analyze complex tests on blood and body fluids to diagnose diseases. It then explains that proteins are the body's primary building blocks and play many roles, and medical technologists perform several protein tests, including C-Reactive Protein, Bence-Jones Protein from urine, and Serum Protein Electrophoresis from blood, to detect inflammation and diseases.
Pleural fluid
It is fluid which is present in the pleural cavity of
lungs b/w parietal pleura n visceral pleura.
The pleural cavity is a potential space lined by
mesothelium of the visceral n parietal pleura.
Lecture 8-streptolysin o
This document discusses Streptolysin O, an exotoxin produced by Streptococcus pyogenes bacteria, and the Antistreptolysin O (ASO) antibody produced in response. It describes how the ASO latex agglutination test is used to detect ASO antibodies as a way to diagnose post-streptococcal conditions like rheumatic fever when live bacteria cannot be cultured. The test works by detecting if patient serum causes agglutination of latex particles coated with Streptolysin O antigen, indicating the presence of ASO antibodies. The procedure, interpretation of positive and negative results, and limitations are provided.
ANTINUCLEAR ANTIBODY
This document discusses antinuclear antibodies (ANAs), which are autoantibodies that bind to contents of the cell nucleus. There are many subtypes of ANAs that bind to different nuclear proteins. Indirect immunofluorescence is the reference method for detecting ANAs using three tissues and viewing under fluorescence microscopy, where positive samples show apple-green fluorescence in distinctive patterns associated with particular antigens and diseases. ANA testing is important for diagnosing and managing autoimmune conditions but can also be present in normal individuals so results need accurate interpretation.
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CRP is an acute-phase protein of hepatic origin that increases following interleukin-6 secretion by macrophages and T cells.
Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints.
Antibodies directed against the Fc fragment of immunoglobulin G (IgG) are called rheumatoid factors (RFs). They are heterogenous and usually composed of immunoglobulin M (IgM)
Widal Test
The Widal test is a serological test developed in 1896 by Farnand Widal to diagnose enteric fever. It detects antibodies against Salmonella typhi and paratyphi in patient serum. There are two types of Widal tests: the slide test which is rapid and qualitative, and the tube test which is quantitative. The tube test involves serially diluting patient serum and mixing it with antigens before incubating and examining for agglutination, allowing a titre value to be determined. Elevated or rising titres of certain antibodies can indicate active or past enteric fever infection.
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This document discusses agglutination tests, which cause antigens and antibodies to clump together when mixed. It focuses on agglutination tests using latex particles or other carriers coated with antigens. These qualitative or quantitative tests can identify bacteria, diagnose infections like typhoid, and detect antibodies. For example, the ASO latex slide agglutination test detects antibodies to streptolysin O, an exotoxin from streptococci bacteria that causes sore throats and other diseases. The test involves mixing serum samples with latex particles coated in streptolysin O, and observing for agglutination which indicates the presence of antibodies.
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PANCREATIC FUNCTION TESTS
Amylase and lipase are enzymes that help digest starch, glycogen, and fats. Amylase levels rise within hours of acute pancreatitis and return to normal within 3-5 days, making it useful for diagnosis. Lipase levels are more sensitive than amylase for detecting acute pancreatitis, as they remain elevated for 7-14 days. Both enzymes can also be elevated in conditions like burns, renal failure, and malignancy.
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NOTE - THIS IS AN ACCESSORY MATERIAL TO THIS VIDEO - https://youtu.be/C1RS39B6XbE
Please watch the video too, to enhance the topic.
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CSF Examination
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The document discusses macrovascular complications in diabetes. It notes that atherosclerosis is an inflammatory disease and lists some theories of atherogenesis. It also discusses C-peptide and its potential role in atherosclerosis. Finally, it provides definitions of the metabolic syndrome from various organizations like WHO, ATP III, and IDF and notes unresolved questions regarding the metabolic syndrome.
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An important non-communicable disease and a risk factor for cerebro-vascular(CVA), cardio-vascular(CAD), end stage renal disease(ESRD)
CVD-Report-V1.pdf
The document provides a cardiovascular disease risk report for a 60-year-old male client. It includes information on risk factors such as total cholesterol, blood pressure, family history of CVD, and diabetes. It finds the client has a high 34% 10-year risk of CVD based on risk factors. It also finds moderately elevated troponin levels, indicating possible heart injury, and a moderate genetic predisposition to CVD based on analysis of 17 genetic markers. It recommends the client increase physical activity, consult a cardiologist due to the elevated risks, and inform the cardiologist of any planned medications due to results of a CVD pharmacogenetics test.
2. prof. bambang irawan cv assessment in met s and t2dm [compatibility mode]
This document summarizes guidelines from several organizations on cardiovascular assessment and management of risk factors for patients with metabolic syndrome and diabetes. The guidelines address:
1) Definitions of metabolic syndrome from organizations like WHO, NCEP ATP III, IDF which include criteria like waist circumference, blood pressure, lipids, and glucose.
2) Cardiovascular risk assessment recommendations including considering patients with diabetes as high risk and using risk scores.
3) Management strategies focusing on lifestyle changes and treating multiple risk factors like dyslipidemia, hypertension, and hyperglycemia to reduce cardiovascular risk.
Metabolic_Syndrome(0).ppt
Metabolic syndrome is a cluster of conditions that increases the risk of heart disease, diabetes and stroke. It includes increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. Having more of these conditions increases health risks significantly. The syndrome is related to insulin resistance and affects nearly 25% of American adults. Lifestyle changes including diet, exercise and weight loss are important for prevention and treatment.
lipid guidelines.pptx
This document provides guidelines for the treatment of dyslipidemia to reduce cardiovascular risk. It defines dyslipidemia as abnormal lipid levels measured in a blood sample. The guidelines classify risk based on LDL cholesterol, total cholesterol, and HDL cholesterol levels. They recommend screening adults over certain ages for lipid levels and cardiovascular risk. Risk is assessed using tools like the Framingham Risk Score. Treatment involves starting statin therapy, with the intensity based on a patient's risk category. Lifestyle changes and other medications may also be used. The guidelines aim to identify those who will benefit most from treatment to lower lipid levels and cardiovascular risk.
Dyslipidemia.docx
The document discusses cholesterol and lipoproteins. It states that cholesterol is essential for cell membrane structure and steroid hormone production. Cholesterol is transported through the body bound to lipoproteins including chylomicrons, VLDLs, IDLs, LDLs, and HDLs. Chylomicrons carry dietary cholesterol from the intestines through the lymphatic system before breaking down into chylomicron remnants that are taken up by the liver. The liver produces VLDLs that circulate and break down into LDLs, which are the major cholesterol carriers. High LDL levels increase risk of cardiovascular disease. HDLs aid in reverse cholesterol transport and have a protective effect against cardiovascular disease.
NPCDCS BY DR.R.MOHAN
The document discusses the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS) in India. It notes that non-communicable diseases are emerging as a leading cause of death in India. The NPCDCS was initiated in 2010 to prevent and control common NCDs through lifestyle changes, early diagnosis, treatment, and capacity building. The program aims to reduce mortality from heart disease, stroke, cancer and other NCDs. It operates in 100 districts across 21 states using strategies like health promotion, screening, affordable diagnosis and treatment, and monitoring/evaluation.
Pfizer Talk Final
1) A 43-year-old male presented with chest pain and was diagnosed with an acute inferior STEMI while in normal sinus rhythm. His medical history included atherosclerosis.
2) Atherosclerosis is caused by plaque buildup in arteries and accounts for over 70% of cardiovascular deaths in the US. Elevated LDL cholesterol increases the risk of atherosclerosis and heart disease.
3) Therapeutic lifestyle changes like diet and exercise can modestly lower LDL cholesterol by about 5% on average but response varies between individuals. High fat, low carb diets may improve glycemic control in diabetes without worsening lipids.
metabolic syndrome by dr amber.pptx
This presentation will show the diagnosttic criteria of metabolic syndrome and life style modification to cope up with this common disease .
also shows some quiz for medical students
Care of the bariatric patient for the OR Nurse
This document discusses care considerations for bariatric or obese patients. It defines bariatric as relating to weight and discusses classifications of obesity using body mass index. Morbid obesity is defined as a BMI of 40 or higher and is associated with numerous health risks and comorbidities. Providing care for obese patients requires awareness of physiological changes, risks of procedures, appropriate drug dosing, and mobilization to prevent complications like blood clots.
Managing the Myths in Lipid Management
Early Diabetes and Dyslipidaemia Treatment Optimisation.
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Cardiologist, Electrophysiologist
Asian Heart & Vascular Centre
www.ahvc.com.sg
Diabetic dyslipidemia
This document provides an overview of diabetic dyslipidemia and lipid management recommendations for patients with diabetes. It discusses that excess fat contributes to atherosclerosis and mortality in diabetes. It outlines traditional and non-traditional risk factors for cardiovascular disease. The spectrum of diabetic dyslipidemia includes quantitative changes like high triglycerides and qualitative changes in lipoprotein composition. Lifestyle modifications and statin therapy are recommended to improve lipid profiles and reduce cardiovascular risk according to guidelines. The appropriate screening, interpretation of results, and intensity of statin therapy depends on individual patient risk factors and characteristics.
Exercise as a prescriptive medicine in Non Communicable Diseases
Exercise is a prescriptive medicine. Physiotherapists use it as a potent tool to combat several NCD's also referred to as diseases of civilisation. Thanks to all references who made their work publicly available.
Dyslpidemia Cme Com 25 May09
This presentation was presented by me in one of the CME programs, held in Comilla, Bangladesh on the 25th. May 2009.
Obesity And Its Hazards
Obesity is a medical condition where excess body fat has accumulated to the extent that it may negatively impact health. It is generally defined as a body mass index over 30 kg/m2. Obesity increases the risk of heart disease, diabetes, sleep apnea, certain cancers, and osteoarthritis. It results from an imbalance between caloric intake and utilization, and can be caused by genetic susceptibility, excessive food intake, lack of physical activity, or underlying diseases. Treatment involves dietary changes, exercise, medication, and in severe cases, weight-loss surgery.
9. metabolic syndrome
This document discusses metabolic syndrome, which is a combination of medical disorders that increase the risk of cardiovascular disease and diabetes when occurring together. It affects about 20% of the Malaysian population. The core components include hypertension, high triglycerides, low HDL cholesterol, obesity, and impaired glucose tolerance. There are different criteria for diagnosing metabolic syndrome, but central to all definitions is insulin resistance. If left untreated, metabolic syndrome can increase the risk of serious health conditions such as heart disease, stroke, and type 2 diabetes.
Cardiometabolic Syndrome-Nabil Sulaiman(1).ppt
This document discusses cardiometabolic syndrome, also known as metabolic syndrome. It provides a brief history of metabolic syndrome and defines it as a clustering of risk factors that increase the risk of cardiovascular disease and diabetes. These risk factors include abdominal obesity, high blood pressure, insulin resistance, dyslipidemia, and elevated fasting glucose. The document then discusses the global prevalence of cardiometabolic risks like abdominal obesity and how targeting individual risk factors through lifestyle modifications and medical treatment can help reduce overall cardiometabolic risk.
PPT CVD OKE.pptx
This document outlines a medical school lecture on nutrition and cardiovascular disease. It discusses several nutritional risk factors that contribute to cardiovascular disease risk, including dyslipidemia, hypertension, and type 2 diabetes. Lifestyle factors such as diet, exercise, smoking and alcohol consumption are described as influencing these risk factors. The document provides statistics on cardiovascular disease prevalence in Australia and worldwide, and recommends dietary approaches to reduce cardiovascular disease risk at both the individual and population levels.
Metabolic consequences of obesity
This document discusses metabolic consequences of obesity and the metabolic syndrome. It defines appetite, hormones that regulate hunger and satiety, and how excess calories are stored as fat. Factors secreted by fat cells like leptin, resistin, and adiponectin are described. Obesity is defined as BMI over 30 kg/m2 and methods for assessing obesity are provided. Genetic and environmental factors that can lead to obesity are listed, along with complications of obesity such as diabetes and heart disease. The metabolic syndrome is characterized as a clustering of risk factors including abdominal obesity, insulin resistance, dyslipidemia, and hypertension.
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Crp
- 1. CRP
- 2. At the end …. You will be able to identify: Whey this test is performing? When its increase and what's the causes/ risk factors, how to reduce it.
- 3. So what's the meaning of CRP and what is it?? C-reactive protein: A plasma protein that rises in the blood with the inflammation from certain conditions.
- 4. When isn't rise!! What are the causes !? what an-abnormal result mean??
- 5. But keep in mind Small changes can occur after psychological stress and in sever psychiatric illnesses, also during the last half of pregnancy or with the use of birth control pills (oral contraceptives).
- 6. A positive test means you have inflammation in the body.
- 7. Cancer Connective tissue disease Heart attack Infection Inflammatory bowel disease (IBD) Lupus Pneumococcal pneumonia Rheumatoid arthritis Rheumatic fever Tuberculosis Heart disease. Coronary heart disease (CHD) Cardiovascular disease
- 8. Risk factors can elevate CRP: Smoking Obesity Diabetic Sedentary lifestyle Increased cholesterol Hypertension and metabolic syndrome.
- 9. 1) Non-pharmacological methods 2) Drug therapy
- 10. Non-pharmacological methods 1- Aerobic exercise 2- Smoking cessation 3- Weight loss and diet.
- 11. One study showed if healthy person eats standard low saturated fat diet or diet plus plant sterols, soy protein, and nuts. In severely obese patients decrees CRP achieved with either a fat restricted or carbohydrate restricted diet.
- 12. Drug therapy: Stations reduce CRP levels (13 to 50 %,). Lipitor (atorvastatin), Mevacor (lovastatin), Pravachol (pravastatin) and Zocor (simvastatin) .
- 13. The American Heart Association and US Centers for Disease Control and Prevention have defined risk groups as follows: Low risk: less than 1.0 mg/L Average risk: 1.0 to 3.0 mg/L High risk: above 3.0 mg/L