Diagnosis

HC may be suspected on the basis of elevated liver function tests or because of risk factors (blood transfusions before 1990, history of injection drug use, etc). A second or third generation enzyme-linked immunosorbent assay (ELISA) is the usual screening test, unless an acute infection is suspected. In acute exposure, HCV RNA will be positive early on in the vast majority of patients who have not seroconverted to HCV antibodies. However, a small proportion of patients with acute HC may be missed on the basis of serologic and RNA testing, and therefore should be observed with repeated testing for at least 6 months. Recombinant immunoblot assay testing may be done to confirm an ELISA result, if one suspects false positive antibodies to HCV.

HCV RNA quantitation is a key assay for managing treatment, and may be influenced by sample preparation and different assay methods. The dynamic ranges of these tests vary significantly and one assay cannot be reliably compared with another. Several commercial assays are now available, and the extremely sensitive transcription mediated amplification assay for HCV RNA appears to reliably detect patients who have achieved sustained virologic response versus patients with low level viremia who may later relapse (eg, Heptimax [Quest Diagnostics], Quantasure [Labcorp]). Staging underlying fibrosis by liver biopsy provides useful prognostic information that may influence the urgency of initiating treatment.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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