Accuracy of automated urine dipstick test as a screening tool for proteinuria in hypertensive disorders of pregnancy

Background: Progressive proteinuria implies worsening of the condition in hypertensive disorders of pregnancy and hence its quantification guides clinician in making decision and planning treatment. The gold standard is 24 hour urine protein estimation. Urine sediment cytology, also known as ‘liquid renal biopsy’ identifies and analyses the extent of renal damage.Methods: Objectives of the study were to compare the efficacy of urine dipstick test to 24 hour urine protein estimation in detecting proteinuria in pre-eclampsic patients and to describe the findings in urine sediment examination in assessing proteinuria in above patients. Urine dipstick test and sediment cytology were performed on the urinary samples of 242 pregnant women with high BP recordings (BP>140/90 mm Hg) which were collected and tested in Department of Pathology, Government Medical College, Kottayam during the study period of 18 months. This was compared with 24 hour urine protein values (gold standard).Results: About 154 patients (63.63%) had significant proteinuria of more than 300mg/24hr. Dipstick method showed 78.57% sensitivity and 81.82% specificity for prediction of significant proteinuria. Positive predictive value and negative predictive value of urine dipstick test were 88.32% and 68.57% respectively. Urine sediment examination revealed the presence of casts only in 11.98% of study population. Conclusions: Diagnostic accuracy of automated urine dipstick test in assessing proteinuria was 79.75%. For grade 1 proteinuria, diagnostic accuracy was 79.81%, for Grade 2 it increased to 93.14% and for grade 3 & 4, accuracy was 98.68%. Urine sediment examination didn’t correlate with proteinuria and hence the extent of renal damage in pre-eclampsia.

Resultados de urocultivos en adultos realizados por el laboratorio de microbiología del Hospital de Clínicas - San Lorenzo de enero del 2015 a agosto de 2016 y métodos de estudio de las infecciones urinarias disponibles en la institución / Results of urine culture in adults carried out by the microbiology laboratory of the Clinics Hospital - San Lorenzo from january 2015 to august 2016 and methods of study of urinary infections available in the institution

Introducción: Los objetivos de este trabajo son: presentar los métodos de estudio de las infecciones urinarias actualmente disponibles en el Laboratorio de Microbiología del Hospital de Clínicas y mostrar los datos de los urocultivos evaluados en forma retrospectiva. Materiales y Métodos: Para estudiar los métodos de estudio de los urocultivos disponibles en el Laboratorio hemos recurrido al archivo del Laboratorio cuyos datos fueron consecutivamente cargados en una planilla de procesamiento de datos Excel de Microsoft Office ®. Los resultados de los urocultivos fueron evaluados de enero de 2015 a agosto de 2016, en forma retrospectiva, observacional, en corte transverso, de los adultos de ambos sexos. Las muestras para urocultivo son recibidas y procesadas en el laboratorio, siguiendo pasos preestablecidos. Resultados: El microorganismo preponderante de los urocultivos fue Escherichia coli (60% de las mujeres y 32% de los varones) seguido por Klebsiella pneumoniae (19% de los varones, 14% de las mujeres). Otros microorganismos aislados fueron Candida sp., Enterococcus faecalis, Enterobacter cloacae, Pseudomona aeruginosa, Proteus mirabilis, Staphylococcus aureus, Acinetobacter baumanii. La resistencia de Escherichia Coli a nitrofurantoína fue del 6% en los varones y 1% en las mujeres. La resistencia de E.Coli a meropenen fue también escasa. En cuanto a Klebsiella pneumoniae en las mujeres, la resistencia fue del 3%. En los hombres, los antibióticos testados para Klebsiella pneumoniae mostraron una resistencia superior al 30%, con excepción del meropenem. Uropatógenos productores de betalactamas de espectro extentido (BLEE) y de carbapenemasas fueron detectados en el presente estudio. Discusión: La toma de la orina para el urocultivo se efectúa siguiendo pautas claras, emanadas del laboratorio. Con la utilización de medios actualmente disponibles en el laboratorio, es posible tipificar el género y la especie tanto de bacterias Gram negativas y positivas como de hongos. Conclusión: La estructura del Laboratorio de Microbiología ha tenido avances que permiten la identificación precisa de los gérmenes de los urocultivos, así como la prevalencia y la resistencia que presentan a ciertos antibióticos. Estos aportes son particularmente útiles para los casos de Escherichia coli y Klebsiella pneumoniae debido a su alta prevalencia. También fue factible constatar la emergencia de gérmenes productores de betalactamasas de espectro extendido (BLEE) y carbapenemasas.

Introduction: The objectives of this work are: to present the methods of study of urinary infections currently available in the Laboratory of Microbiology of the Hospital de Clínicas and to show the data of the urine cultures evaluated retrospectively. Material and method: in order to study the available methods in urine cultures in the Laboratory, we have used the laboratory file whose data were consecutively loaded in an Excel data processing form of Microsoft Office ®. The results of the urine cultures were evaluated from January 2015 to August 2016, in a retrospective, observational, cross-sectional study of adults of both sexes. Samples for urine culture are received and processed in the laboratory, following pre-established steps. Results: The predominant microorganisms were Escherichia coli in 60% of women and 32%of men, Klebsiella pneumonia 19% of men and 14% of women. Other isolated organisms were Candida sp., Enterococcus faecalis, Enterobacter cloacae, Pseudomonas aeruginosa, Proteus mirabilis, Staphylococcus aureus, and Acinetobacter baumanii. Escherichia coli resistance to nitrofurantoin was seen in 6% of men and 1% of women and meropenem resistance to E. coli was also low. As for Klebsiella pneumoniae in women, resistance to meropenem was seen in 3% of cases. In men, the antibiotics tested for Klebsiella pneumoniae showed resistance greater than 30% except for meropenem. Uropathogens producing Extended-Spectrum -lactamase (ESBL ) and Carbapenemase were found. Discussion: Urine collection for urine culture is done following clear guidelines emanating from the laboratory. With the use of media currently available in the laboratory, it is possible to typify the genus and species of both Gram negative and positive bacteria as well as fungi. Conclusion: The structure of the Laboratory of Microbiology has had advances that allow the precise identification of the germs of the urine cultures, as well as the prevalence and resistance to certain antibiotics. These contributions are particularly useful for the cases of Escherichia coli and Klebsiella pneumoniae due to their high prevalence. It was also possible to verify the emergence of spread spectrum beta-lactamases (ESBL) and carbapenemases.

Evaluation of a rapid dipstick test for identifying cholera cases during the outbreak.

Background & objectives: Intermittent cholera outbreaks are major problem in many of the states of India. It is essential to identify cholera at the earliest for timely mobilization of public health responses and to abort the outbreaks. The present study was a part of a diarrhoeal outbreak investigation in Secunderabad, India, during May 2009 where the usefulness of Crystal VC rapid dipstick kit was assessed for detecting the aetiologic agent of the outbreak. Methods: Stool specimens were collected from 15 hospitalized patients with acute watery diarrhoea and analyzed for detection of cholera vibrios using Crystal VC rapid dipstick kit and the usefulness of the kit was determined by comparative analysis of the same set of specimens using both microbiological and real-time PCR (RT-PCR) based assays. Results: Detection of Vibrio cholerae O1 from 10 of 15 specimens was recorded using dipstick assay. Microbiological methods detected V. cholerae O1 positivity among 11 specimens. However, RT-PCR based assay showed all 15 specimens positive for the presence of V. cholerae O1. In addition, the same assay showed that the pathogen load in the dipstick as well as RT-PCR positive specimens ranged from 106 colony forming units (cfu)/ml or more. Interpretation & conclusions: Crystal VC kit had the potential to identify cholera cases in 10 min in field conditions without having good laboratory support. Therefore, dipstick kit may be considered as cholera detecting tool in diarrhoeal outbreak investigations. Specimens from clinically typical cholera cases, if negative by dipstick, should be reanalyzed by culture based methods.

Visceral Leishmaniasis Eradication is a Reality: Data from a Community-based Active Surveillance in Bangladesh

More than 20 million people in Bangladesh are considered at risk of developing visceral leishmaniasis (VL). A community-based active surveillance was conducted in eight randomly selected villages in a highly endemic area of Bangladesh from 2006 to 2008. A total of 6,761 individuals living in 1,550 mud-walled houses were included in the active surveillance. Rapid rK39 dipstick tests were conducted throughout the study period to facilitate the case diagnosis. Individuals with previous or current clinical leishmaniasis were identified on the basis of the case definition of the VL elimination program. Untreated cases of suspected VL were referred to the hospital for treatment. Socioeconomic and environmental information including bed net use was also collected. In 2006, the annual incidence of clinical leishmaniasis in the study area was 141.9 cases per 10,000 population, which was significantly increased by the following year owing to community-based active surveillance for case detection and reporting. However, early case detection and early referral for treatment led to a significant decrease in incidence in 2008. This study suggests that community-based active surveillance using a simple diagnostic tool might play a role in achieving the goal of the VL elimination program.

Usefulness of Urinary Trypsinogen-2 Dipstick Test for Diagnosis of Acute Pancreatitis / 대한소화기학회지

BACKGROUND/AIMS: The clinical usefulness of urinary trypsinogen-2 dipstick test is still in controversy. We evaluated the usefulness of urinary trypsinogen-2 dipstick test in patients with acute pancreatitis. METHODS: Urinary trypsinogen-2 dipstick test was prospectively performed in 50 patients with acute pancreatitis, 50 patients with non-pancreatic abdominal pain, and 50 healthy controls. RESULTS: On admission, urinary trypsinogen-2 dipstick test was positive in 36 of 50 patients with acute pancreatitis (sensitivity, 72%) and in 4 of 50 patients with non-pancreatic abdominal pain (specificity, 92%). On the other hand, it was all negative in controls. The sensitivity and specificity of serum lipase were 78% and 94%, respectively. At 24 hours after admission, the positive rate of urinary trypsinogen-2 dipstick test rose from 72% to 94% (p=0.02). The results of urinary trypsinogen-2 dipstick test was positive in 14 of 15 patients with severe pancreatitis and 22 of 35 patients with mild pancreatitis according to the criteria by Atlanta International Symposium, 1992. CONCLUSIONS: Urinary trypsinogen-2 dipstick test is comparable to serum lipase in diagnosing acute pancreatitis. Delayed measurement and severe pancreatitis are more likely to yield positive results with urinary trypsinogen-2 dipstick test. Thus, we suggest that the cut-off value of urinary trypsinogen-2 dipstick test should be lowered to increase its sensitivity.

The Performance Evaluation of Yeongdong URiSCAN GEN 10SGL Urine Dipstick Strip Using Other Quantitative, Microscopic, and Culture Methods / 대한임상병리학회지

BACKGROUND: The previous performance tests of URiSCAN GEN 10SGL dipstick reagent strip (Yeongdong pharmaceutical Co., Seoul, Korea) were mainly done by comparison with the approved urine strips. However, adequate comparison was inavailable because the grading systems were different among the manufacturers. We evaluated the correlation of new generation URiSCAN GEN 10SGL urine strip with known quantitative, microscopic, and culture methods. METHODS: We used urine specimens which were collected for the urinalysis and culture from November 2000 to Mars 2001. We evaluated the correlation between the results of URiSCAN GEN 10SGL and the quantitative methods by comparing the mean of change of reflectance rate (change %R) with the result of the corresponding quantitative method for protein, glucose, bilirubin, urobilinogen, pH, and specific gravity. To calculate the sensitivity and specificity, we used microscopic examination for leukocytes and erythrocytes, and used urine culture for nitrite test. RESULTS: The correlation coefficients between the change %R of URiSCAN GEN 10SGL and the corresponding quantitative method exceeded 0.81, except bilirubin and specific gravity (P<0.01; respectively). The agreements of identical or neighboring concentration block were more than 90%, except urobilinogen and specific gravy. The sensitivity and specificity of URiSCAN GEN 10SGL were 63.6% and 94.2% for leukocytes; 92.8% and 74.1% for erythrocytes; 74.4% and 85.0% for nitrite producing organisms. CONCLUSTIONS: URiSCAN GEN 10SGL had acceptable accuracy and agreement compared with the corresponding quantitative methods and culture result. Also, it had improved sensitivity and specificity of leukocytes and erythrocytes detection compared with previous URiSCAN urine dipstick strip.

Significance of urine dipstick in the evaluation of hematuria in patient with renal trauma / 대한비뇨기과학회지

Hematuria has been the most reliable sign of injury to the urinary system. Thus. the rapid and accurate detection of hematuria in the emergency room is essential. In 149 patients with renal trauma in whom radiographic studies defined the severity of injury, we compared the degree of microscopic hematuria determined by dipstick and microscopic urinalysis. Falge positive dipstick occurred in 5(3.6%) patients and false negative dipstick in 4(3.3% ) patients. The dipstick method had greater than 96.4 percent sensitivity and specificity for detection of microscopic hematuria. The correlation between the 2 methods was low (Person`s coefficient 0.4114). However. 85.5 percent or the urine sample with more than 20 red blood cells per high power field corresponded to a dipstick results of 3+ (Regression Y = 0.0129x + 2.93, F = 28.12. p < 0.005). Although microscopic hematuria may be quantified more accurately by microscopic analysis, the urine dipstick is a rapid and reliable screening test with high degree of sensitivity and specificity for the microscopic hematuria in patients with renal trauma.