Sonographic correlations between intravesical prostatic protrusion and bladder outlet obstruction in patients with symptomatic benign prostatic hyperplasia in Ibadan, Nigeria

Evaluating bladder outlet obstruction (BOO) in patients with prostatic enlargement may reflect the severity of the disease and aid in predicting the treatment outcome. Objectives: To determine the sonological correlation between intravesical prostatic protrusion and bladder outlet obstruction in patients with symptomatic benign prostatic enlargement. Methods: This prospective study was conducted over one year at the Department of Radiology, University College Hospital, Ibadan. A transabdominal ultrasound scan of the urinary bladder and prostate gland was carried out on patients with prostatic enlargement and BOO. The intravesical prostatic protrusion, pre-and post-void urine volumes, prostate volume and bladder wall thickness were measured. Results: A total of 132 men aged 43 to 90 years (mean age: 63.8±8.64 years) were studied. The median size of the intravesical prostatic protrusion (IPP) was 7.25 mm (IQR: 0.00 mm; 14.9 mm). The mean prostate volume was 63.3ml±36.0ml. Most subjects (55; 41.7%) had a prostate volume above 60ml, and most patients (101, 77.2%) had bladder wall thickness less than 5mm. The mean bladder wall thickness was 4.26mm±1.54mm. There was a statistically significant correlation between IPP and pre-void urine volume and prostate volume (p = 0.002 and <0.001, respectively). Patients over 70 years had increasing IPP and post-void urine, which lacked statistical significance (p =0.15). Conclusion: The severity of bladder outlet obstruction was reflected in the pre-void urine volume, which correlated with the size of IPP

The risk prediction value of paraquat poisoning dose, urine protein and myocardial enzymes / 中华劳动卫生职业病杂志

Objective: To explore the value of paraquat (PQ) intake, urine protein and myocardial enzyme indexes in judging the prognosis of patients with acute PQ poisoning. Methods: From September to December 2021, all 201 patients with acute PQ poisoning admitted to Guangzhou Twelfth People's Hospital from January 2010 to December 2019 were selected as the research objects. Based on follow-up results 60 days after poisoning, the research objects were divided into survival group (n=78) and death group (n=123) . The differences in information about poisoning, treatment plan, PQ intake, urine protein, creatine kinase, creatine kinase isoenzyme, lactate dehydrogenase, and α-hydroxybutyrate dehydrogenase between the two groups of patients were compared and analyzed. Logistic regression and Cox regression were used to analyze the correlation between poisoning outcome and PQ intake, urine protein and myocardial enzymes. ROC curve and principal component analysis were used to explore high-efficiency indicators for predicting the outcome of acute PQ poisoning. Results: The PQ intake[50 (20, 100) ml], urine protein (total rank 15570.50) , creatine kinase[ (336.36±261.96) U/L], creatine kinase isoenzyme[ (43.91±43.74) U/L], lactate dehydrogenase [ (346.01±196.50) U/L], α-hydroxybutyrate dehydrogenase content[ (271.23±11.92) U/L] of patients in the death group were all higher than the survival group[15 (10, 20) ml, 4730.50, (187.78±178.06) U/L, (18.88±15.50) U/L, (190.92±60.50) U/L, (152.60±48.34) U/L, respectively] (P<0.05) . The outcome of acute PQ poisoning was positively correlated with PQ intake, urine protein, creatine kinase, creatine kinase isoenzyme, lactate dehydrogenase, and α-hydroxybutyrate dehydrogenase (P<0.05) . Multivariate logistic regression and multivariate Cox regression analysis showed that creatine kinase, creatine kinase isoenzyme, lactate dehydrogenase and α-hydroxybutyrate dehydrogenase was positively correlated with the prognosis of patients with acute PQ poisoning (P<0.05) . ROC curve analysis and principal component analysis showed that the combined indexes of PQ intake, urine protein and myocardial enzymes had the highest efficacy and weight in judging the prognosis of patients (AUC=0.91, weight coefficient=0.19, sensitivity=0.76, specificity=0.89) . When the combined score was ≥4, the probability of accurately predicting the death of patients was as high as 91% (positive predictive value=0.91) . Conclusion: PQ intake, urine protein combined with creatine kinase, creatine kinase isoenzyme, lactate dehydrogenase, and α-hydroxybutyrate dehydrogenase has high value in predicting the prognosis of patients with acute PQ poisoning.

Metabolic study of trimetazidine using ultra-high performance liquid chromatography-tandem mass spectrometry

Abstract In the present study, the application of ultra-high performance liquid chromatography-tandem mass spectrometry allowed us to study of known-as well as hitherto unknown-trimetazidine (TMZ) metabolites in human urine and to propose their renal excretion profiles. Urine samples from a healthy volunteer were analyzed at baseline and at 0-4 h, 4-8 h, 8-12 h, and 12-24 h after a single dose of TMZ. A dilute-and-shoot procedure was used as sample treatment before separation. Full-scan spectra of possible metabolites were acquired. Additionally, product ion scan spectra of precursor ions of interest were also acquired at two collision energies. Intact TMZ was a major excretion product, with a maximum concentration at 4-8 h after administration. Moreover, five minor metabolites were observed, namely trimetazidine-N-oxide (M1), N-formyl trimetazidine (M2), desmethyl-trimetazidine O-sulfate (M3), desmethyl-trimetazidine O-glucuronide (M4), and desmethyl-trimetazidine-N-oxide-O-glucuronide (M5). Metabolite M5 has not previously been reported. Excretion curves were constructed based on the chromatographic peak areas of specific mass transitions (precursor ion > product ion) related to each of the detected metabolites

Fluid intake, hydration status and body mass changes in U-15 judo athletes during a training day

Despite numerous studies related to dehydration there is still a lack of scientific literature presenting hydration status and fluid intake of judo athletes during different periods. Therefore, the aim of this study was to investigate, fluid intake, hydration status and body weight changes of young judo athletes during a typical day of training in preparation period. Twenty-two young judo athletes (age: 12 ± 0.7 y, experience: 3.5 ± 1.1) voluntarily participated in this study. Hydration status and weight were examined in the morning, before and immediately after the training. All athletes trained 90 min and they consumed fluids ad libitum during the exercise. According to morning urine specific gravity (USG) values, 81.2% of the athletes were dehydrated while only 18.8% of the athletes were euhydrated. Pre-training urine measurements showed that 63.64% of the athletes presented dehydration and 77.27% of the athletes completed the training in dehydrated condition despite fluid availability during the training. Mean body weight loss during training was -0.64 ± 0.66%. It can be concluded that young judo athletes presented high prevalence of dehydration as indicated by USG values. Most of the athletes were dehydrated during a typical training day and completed the training in more dehydrated conditions compared to pre training values despite ad libitum fluid intake. It is of great importance to evaluate hydration status of the athletes before training to refrain from common practice of fluid restriction for weight loss and adverse effects of a persistent state of fluid deficit on physical and health related state.

Estudo de estabilidade de anfetaminas e produtos de biotransformação de cocaína e tetraidrocanabinol em amostras de urina seca em papel (dried urine spots) / Stability study of amphetamines, biotransformation products of cocaine and tetrahydrocannabinol in dried urine spots

O número de pessoas utilizando substâncias ilícitas de forma recreativa aumenta a cada ano, chamando a atenção de estudiosos de diversas áreas do conhecimento. Com isso, a demanda de exames toxicológicos exigida para trabalhadores, vítimas de crimes e esportistas também tem crescido. A amostra biológica mais utilizada para análises toxicológicas continua sendo a urina, visto que sua obtenção é menos invasiva, possibilita coletar grande volume de amostra e pode-se detectar substâncias até dias após ter ocorrido a exposição ou consumo. Entretanto, estas amostras necessitam de um grande volume físico para serem armazenadas e transportadas aos laboratórios, devendo ser mantidas em temperatura baixa e controlada para conservação. Outro ponto a se considerar é a quantidade de amostra insuficientemente coletada, ou extravasamento do conteúdo, contaminando outras amostras e muitas vezes, inviabilizando a análise. Uma alternativa recente para tais problemas é utilizar a técnica chamada de dried urine spots (DUS), onde poucos microlitros de urina são colocados em um papel absorvente e secos sob temperatura ambiente, preservando de agentes degradantes os componentes presentes na urina. Assim, o objetivo deste trabalho é avaliar a estabilidade das substâncias do presente estudo em alta temperatura, temperatura ambiente e em temperaturas de 4°C e -20°C. Para este fim, foi necessário desenvolver, validar e aplicar métodos de extração e determinação de anfetaminas e produtos de biotransformação de cocaína e tetraidrocanabinol carboxílico (THCCOOH) em amostras dried urine spot, utilizando cromatografia líquida acoplada à espectrometria de massas. Os picos foram identificados por UPLC-ESI-MS/MS, com tempo total de 5 mins utilizando fase A- água, formiato de amônio e 0,1% ácido fórmico, e B- metanol: acetonitrila (6:4) + 0,1% de ácido fórmico. A extração foi feita utilizando acetonitrila: metanol: acetona (1:1:1) +ácido fórmico 0,1%. Não foi possível iniciar a validação de THCCOOH, visto uma possível complexação do analito com o papel. Para as outras substâncias, o método cromatográfico desenvolvido se mostrou eficiente e seletivo, com LOD e LOQ de 10 ng/mL para todos os analitos, sendo linear até 1000 ng/mL, atendeu as especificações de precisão e exatidão e carryover. As amostras permaneceram estáveis ao longo de 32 dias nas temperaturas estudadas, demonstrando a segurança em se utilizar a técnica de DUS para armazenamento e transporte de amostras biológicas dentro da faixa de temperatura do estudo até 32 dias

The number of people using illegal substances in a recreational way increases each year, drawing the attention of scholars from different areas of knowledge. As a result, the demand for workplaces drug tests, toxicological tests for victims of crimes and dopping has also grown. The biological sample most used for toxicological tests remains urine, since obtaining it is less invasive, it is possible to collect a large volume of sample and it is possible to detect substances up to days after exposure or consumption has occurred. However, these samples require a large physical volume to be stored and transported to the laboratories, and must be kept at a low temperature for conservation. Another point to consider is the amount of sample insufficiently collected, or leakage of the content, causing contamination of other samples and often making the analysis unfeasible. A recent alternative to such problems is to use "dried urine spots" (DUS), where few microliters of urine are placed on absorbent paper and dried at room temperature, preserving the components present in the urine from degrading agents. Thus, the objective of this work is to evaluate the stability of the substances in this study at high temperature, room temperature and at temperatures of 4°C and -20°C. For this purpose, it was necessary to develop, validate and apply methods of extraction and determination of amphetamines and biotransformation products of cocaine and carboxylic tetrahydrocannabinol (THCCOOH) in dried urine spot samples, using liquid chromatography coupled to mass spectrometry (LC-MS). The peaks were identified liquid chromatography coupled to a mass spectrometer (UPLC-ESI-MS/MS), with a total time of 5 mins using phase A- water, ammonium formate and 0.1% formic acid, and B- methanol: acetonitrile (6:4) + 0.1% formic acid. Extraction was done using acetonitrile: methanol: acetone (1:1:1) + 0.1% formic acid. It was not possible to perform the validation of THCCOOH, given a possible complexation of the analyte with the paper. To the others substances, the chromatographic method developed proved to be efficient and selective, with LOD and LOQ of 10 ng/mL for all analytes, being linear up to 1000 ng/mL, meeting the specifications of precision and accuracy and carryover. The samples remained stable for 32 days at the temperatures studied, demonstrating the safety of using the DUS technique for storage and transport of biological samples until 32 days on temperature range studied

Implementation of a customised antimicrobial resistance laboratory scorecard in Cameroon, Ethiopia and Keny

Background: In low-resource settings, antimicrobial resistance (AMR) is detected by traditional culture-based methods and ensuring the quality of such services is a challenge. The AMR Scorecard provides laboratories with a technical assessment tool for strengthening the quality of bacterial culture, identification, and antimicrobial testing procedures. Objective: To evaluate the performance of the AMR Scorecard in 11 pilot laboratory evaluations in three countries also assessed with the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist.Methods: Pilot laboratory evaluations were conducted in Cameroon, Ethiopia and Kenya between February 2019 and March 2019. Assessors with previous SLIPTA and microbiology experience were trained. Assessors performed the laboratory assessments using the SLIPTA and AMR Scorecard tools.Results: Weaknesses in technical procedures and the quality management systems were identified in all areas and all laboratories. Safety had the highest mean performance score (SLIPTA: 68%; AMR Scorecard: 73%) while management review had the lowest (SLIPTA: 32%; AMR Scorecard: 8%) across all laboratories. The AMR Scorecard scores were generally consistent with SLIPTA scores. The AMR Scorecard identified technical weaknesses in AMR testing, and SLIPTA identified weaknesses in the quality management systems in the laboratories.Conclusion: Since the AMR Scorecard identified important gaps in AMR testing not detected by SLIPTA, it is recommended that microbiology laboratories use SLIPTA and the AMR Scorecard in parallel when preparing for accreditation. Expanding the use of the AMR Scorecard is a priority to address the need for quality clinical microbiology laboratory services in support of optimal patient care and AMR surveillance.

Desenvolvimento de teste diagnóstico não invasivo capaz de detectar anticorpos anti-SARS-CoV-2 em urina / Development of a non-invasive diagnostic test capable of detecting anti-SARS-CoV-2 antibodies in urine

A plataforma de ELISA (ensaio de imunoabsorção por ligação enzimática) tem sido amplamente utilizada para detectar anticorpos anti-SARS-CoV-2 gerados após a exposição ao vírus ou à vacinação. A amostra comumente utilizada para a realização do teste é o soro. Até o momento, nenhum estudo havia investigado a urina do paciente como amostra para detectar anticorpos específicos para o vírus SARS-CoV-2. A urina é um espécime biológico que traz vantagens significativas inerentes ao tipo de amostra, que compreende coleta não invasiva, de fácil manuseio e armazenamento. Neste trabalho, propomos um ELISA indireto in house baseado no uso de urina e proteínas recombinantes do Nucleocapsídeo (N) ou da Spike (S) do vírus SARS-CoV-2. As proteínas recombinantes (r) de SARS-CoV-2, N e as subunidades da proteína S (S-Glic, S1-NGlic e RBD-NGlic), foram avaliadas usando um painel composto por aproximadamente 200 amostras de urina e de soro. A presença de anticorpos anti-SARS-CoV-2 na urina foi detectada com sensibilidade e especificidade similares ou superiores ao soro, nas quais foram obtidos valores de sensibilidade de 94,0%, 75,0%, 81,38% e 89,66%, e especificidade de 100%, 96,0%, 96,77% e 96,77%, frente às proteínas rSARS-CoV-2 N, S-Glic, S1-NGlic e RBDNGlic, respectivamente. Dessa forma, os dados apresentados sugerem que a urina poderia ser considerada como uma potencial amostra biológica para aplicação em plataformas de imunodiagnóstico para a infecção por SARS-CoV-2, trazendo benefícios tanto no contexto individual quanto populacional.

The Enzyme-linked immunosorbent assay (ELISA) method has been widely used to detect anti-SARS-CoV-2 antibodies generated after exposure to the virus or vaccination. The sample usually used to perform the test is the serum. Thus far, no study has investigated the urine of patients as biological sample to detect specific SARS-CoV-2 antibodies. Urine is a biological specimen with significant advantages inherent to the type of sample, which comprises non-invasive collection, easy handling and storage. In this work, we propose an in house urine-based indirect ELISA using recombinant proteins from Nucleocapsid (N) and Spike (S) of the SARSCoV-2 virus. SARS-CoV-2 recombinant N and S protein subunits (Gly-S, NonGly-S1 and NonGly-RBD) were evaluated in an ELISA platform with a panel composed about 200 urine and serum samples. The presence of anti-SARS-CoV-2 antibodies in urine was detected with similar or superior sensitivity and specificity to serum, in which sensitivity values of 94.0%, 75.0%, 81.38% and 89.66% were obtained, while specificity values were of 100.0%, 96.0%, 96.77% and 96.77%, respectively, against rSARS-CoV-2 N, S-Glic, S1-NGlic and RBD-NGlic proteins. In conclusion, the data presented suggest that urine could be considered as a potential biological sample for application in immunodiagnostic platforms for SARS-CoV-2 infection, with benefits to the individual and population context.

Estudo de estabilidade de anfetaminas e produtos de biotransformação de cocaína e tetraidrocanabinol em amostras de urina seca em papel (dried urine spots) / Stability study of amphetamines, biotransformation products of cocaine and tetrahydrocannabinol in dried urine spots

O número de pessoas utilizando substâncias ilícitas de forma recreativa aumenta a cada ano, chamando a atenção de estudiosos de diversas áreas do conhecimento. Com isso, a demanda de exames toxicológicos exigida para trabalhadores, vítimas de crimes e esportistas também tem crescido. A amostra biológica mais utilizada para análises toxicológicas continua sendo a urina, visto que sua obtenção é menos invasiva, possibilita coletar grande volume de amostra e pode-se detectar substâncias até dias após ter ocorrido a exposição ou consumo. Entretanto, estas amostras necessitam de um grande volume físico para serem armazenadas e transportadas aos laboratórios, devendo ser mantidas em temperatura baixa e controlada para conservação. Outro ponto a se considerar é a quantidade de amostra insuficientemente coletada, ou extravasamento do conteúdo, contaminando outras amostras e muitas vezes, inviabilizando a análise. Uma alternativa recente para tais problemas é utilizar a técnica chamada de dried urine spots (DUS), onde poucos microlitros de urina são colocados em um papel absorvente e secos sob temperatura ambiente, preservando de agentes degradantes os componentes presentes na urina. Assim, o objetivo deste trabalho é avaliar a estabilidade das substâncias do presente estudo em alta temperatura, temperatura ambiente e em temperaturas de 4°C e -20°C. Para este fim, foi necessário desenvolver, validar e aplicar métodos de extração e determinação de anfetaminas e produtos de biotransformação de cocaína e tetraidrocanabinol carboxílico (THCCOOH) em amostras dried urine spot, utilizando cromatografia líquida acoplada à espectrometria de massas. Os picos foram identificados por UPLC-ESI-MS/MS, com tempo total de 5 mins utilizando fase A- água, formiato de amônio e 0,1% ácido fórmico, e B- metanol: acetonitrila (6:4) + 0,1% de ácido fórmico. A extração foi feita utilizando acetonitrila: metanol: acetona (1:1:1) +ácido fórmico 0,1%. Não foi possível iniciar a validação de THCCOOH, visto uma possível complexação do analito com o papel. Para as outras substâncias, o método cromatográfico desenvolvido se mostrou eficiente e seletivo, com LOD e LOQ de 10 ng/mL para todos os analitos, sendo linear até 1000 ng/mL, atendeu as especificações de precisão e exatidão e carryover. As amostras permaneceram estáveis ao longo de 32 dias nas temperaturas estudadas, demonstrando a segurança em se utilizar a técnica de DUS para armazenamento e transporte de amostras biológicas dentro da faixa de temperatura do estudo até 32 dias

The number of people using illegal substances in a recreational way increases each year, drawing the attention of scholars from different areas of knowledge. As a result, the demand for workplaces drug tests, toxicological tests for victims of crimes and dopping has also grown. The biological sample most used for toxicological tests remains urine, since obtaining it is less invasive, it is possible to collect a large volume of sample and it is possible to detect substances up to days after exposure or consumption has occurred. However, these samples require a large physical volume to be stored and transported to the laboratories, and must be kept at a low temperature for conservation. Another point to consider is the amount of sample insufficiently collected, or leakage of the content, causing contamination of other samples and often making the analysis unfeasible. A recent alternative to such problems is to use "dried urine spots" (DUS), where few microliters of urine are placed on absorbent paper and dried at room temperature, preserving the components present in the urine from degrading agents. Thus, the objective of this work is to evaluate the stability of the substances in this study at high temperature, room temperature and at temperatures of 4°C and -20°C. For this purpose, it was necessary to develop, validate and apply methods of extraction and determination of amphetamines and biotransformation products of cocaine and carboxylic tetrahydrocannabinol (THCCOOH) in dried urine spot samples, using liquid chromatography coupled to mass spectrometry (LC-MS). The peaks were identified liquid chromatography coupled to a mass spectrometer (UPLC-ESI-MS/MS), with a total time of 5 mins using phase A- water, ammonium formate and 0.1% formic acid, and B- methanol: acetonitrile (6:4) + 0.1% formic acid. Extraction was done using acetonitrile: methanol: acetone (1:1:1) + 0.1% formic acid. It was not possible to perform the validation of THCCOOH, given a possible complexation of the analyte with the paper. To the others substances, the chromatographic method developed proved to be efficient and selective, with LOD and LOQ of 10 ng/mL for all analytes, being linear up to 1000 ng/mL, meeting the specifications of precision and accuracy and carryover. The samples remained stable for 32 days at the temperatures studied, demonstrating the safety of using the DUS technique for storage and transport of biological samples until 32 days on temperature range studied

Síndrome de la Bolsa de Orina Púrpura. Reporte de caso y revisión de la literatura / Purple Urine Bag Syndrome. Case report and literature review

RESUMEN El síndrome de la bolsa de orina púrpura es una entidad poco frecuente, con una prevalencia hasta de un 8% en pacientes con catéteres permanentes crónicos por más de 2 años. Esta condición se presenta en portadores de sonda vesical, siendo su principal signo clínico la aparición de orina de color púrpura, debida a la producción de sulfatasas y fosfatasas por enterobacterias. Se presenta un caso de una mujer de 63 años con diagnóstico de vejiga neurogénica, antecedente de enfermedad cerebrovascular y secuelas motoras debidas a neoplasia cerebral, quien consultó por presentar el color característico, con síntomas de infección del tracto urinario inferior. Se trató con nitrofurantoína y tuvo normalización del color urinario al quinto día de tratamiento. El diagnóstico de este síndrome implica un reto para el médico, y deben detectarse los factores de riesgo para proveer un adecuado manejo antimicrobiano y evitar el uso de recursos diagnósticos innecesarios. MÉD.UIS.2021;34(2): 83-8.

ABSTRACT Purple urine bag syndrome is a rare entity, with a prevalence of up to 8% in patients with chronic indwelling catheters for more than 2 years. This condition occurs in bladder catheter carriers, being the main clinical sign the appearance of purple urine, due to the production of sulphatases and phosphatases by Enterobacteriaceae. We present a clinical case of a 63-year-old woman with a diagnosis of neurogenic bladder and a history of cerebrovascular disease and motor sequelae due to brain neoplasia, who consulted for presenting that urine characteristic color, with symptoms of lower urinary tract infection. She was treated with nitrofurantoin and she had normalization of urinary color on the fifth day of treatment. The diagnosis of this syndrome implies a challenge for the physician, and risk factors must be detected to provide adequate antimicrobial management and avoid the use of unnecessary diagnostic resources. MÉD.UIS.2021;34(2): 83-8.

Uso de ayudas diagnósticas en el paciente intoxicado en el servicio de urgencias / Use of diagnostic aids in the poisoned patient in the emergency department / Uso de ajudas diagnósticas em paciente intoxicado no atendimento de emergência

Objetivo: La incidencia de intoxicaciones en el servicio de urgencias viene en aumento en Colombia. En el abordaje inicial se solicitan paraclínicos de rutina, en ocasiones sin una correlación entre el xenobiótico, la fisiopatología y el riesgo clínico. El objetivo de esta investigación es describir el uso de las ayudas diagnósticas en el paciente intoxicado en el servicio de urgencias de un hospital de alta complejidad. Metodología: Estudio descriptivo transversal con disponibilidad de datos para el periodo 2014-2016. Se recopiló información de los registros de las historias clínica de los pacientes que acudieron al servicio de urgencias con diagnósticos relacionados con intoxicaciones. Resultados: El 55.4% de la población fue de sexo femenino, el 54.5% eran menores de 25 años y la mayoría pertenencia al área urbana (77.7%). La intencionalidad en el 68.9% fue suicida. Se reportó el toxídrome en el 17.6% de los casos, donde el sedante fue el más común (9.2%). Las sustancias más usadas fueron los psicofármacos (22.8%), siendo los antidepresivos tricíclicos más comunes con un 10.9%; seguidos de los plaguicidas (19.1%), donde los organofosforados fueron los más comunes (8.8%). Las ayudas diagnósticas más solicitadas fueron el hemograma en un 94.3% de los casos, seguido de la creatinina en un 90.2%. El electrocardiograma se realizó en el 49.7% de los casos y los tóxicos en orina en el 7.8%. Conclusión: Se evidencia un uso rutinario de ayudas diagnósticas en el servicio de urgencias; se requieren estudios adicionales que evalúen la pertinencia de ayudas diagnósticas en este escenario.

Objective: The incidence of poisoning in the emergency department is increasing in Colombia. In the initial approach, paraclinical routines are requested, sometimes without a correlation between xenobiotic, pathophysiology and clinical risk. The objective of this research is to describe the use of diagnostic aids in poisoned patients in the emergency department of a high-complexity hospital. Methodology: Descriptive cross-sectional study with retrospective data availability for the 2014-2016 period. Information was collected from the medical records of patients who came to the emergency department with diagnoses related to poisoning. Results: 55.4 % of the population was female, 54.5 % were under the age of 25, the majority belonging to the urban area (77%). The intentionality in 68.9% of them was suicidal. Toxidrome was reported in 17.6% of cases, the sedative being the most common (9.2%). Psychotropic drugs were the most commonly used substances (22.8%), the tricyclic anti-depressant being the most used with 10.9%, followed by pesticides with 19.1%, among which organophosphates were the most common (8.8%). The most requested diagnostic aids were the hemogram in 94.3% of the cases, followed by creatinine in 90.2%. The electrocardiogram was performed in 49.7% of the cases and the toxic in urine in 7.8%. Conclusions: A routine use of diagnostic aids is evidenced in the emergency department. Therefore, additional studies are required to evaluate the relevance of diagnostic aids in this setting.

Objetivo: A incidência de intoxicações no setor de emergência está aumentando na Colômbia. Na abordagem inicial, são solicitadas paraclínicas de rotina, às vezes sem correlação entre o xenobiótico, a fisiopatologia e o risco clínico. O objetivo desta pesquisa é descrever a utilização de meios auxiliares de diagnóstico em pacientes intoxicados no pronto-socorro de um hospital de alta complexidade. Metodologia: Estudo transversal descritivo com disponibilidade de dados para o período 2014-2016. As informações foram coletadas nos prontuários dos pacientes que compareceram ao pronto-socorro com diagnóstico de intoxicação. Resultados: 55,4% da população era do sexo feminino, 54,5% tinham menos de 25 anos e a maioria pertencia à zona urbana (77,7%). A intencionalidade em 68,9% foi suicida. Toxidromia foi relatada em 17,6% dos casos, sendo o sedativo o mais comum (9,2%). As substâncias mais utilizadas foram os psicotrópicos (22,8%), sendo os antidepressivos tricíclicos mais comuns com 10,9%; seguido por agrotóxicos (19,1%), onde os organo-fosforados foram os mais comuns (8,8%). Os meios diagnósticos mais solicitados foram o hemograma em 94,3% dos casos, seguido da creatinina em 90,2%. O eletrocardiograma foi realizado em 49,7% dos casos e a urina tóxica em 7,8%. Conclusão: Evidencia-se o uso rotineiro de meios auxiliares de diagnóstico no pronto-socorro; Estudos adicionais são necessários para avaliar a relevância dos auxiliares de diagnóstico neste cenário.

Estimación de prevalencia de infección congénita por Citomegalovirus y seroprevalencia materna en Tucumán / Estimation of the prevalence of congenital cytomegalovirus infection and maternal seroprevalence in Tucumán

INTRODUCCIÓN: Citomegalovirus (CMV) es agente causal de infección congénita en todo el mundo con gran impacto socioeconómico, dado que produce pérdida de audición en la niñez y retraso del neurodesarrollo. No existen aún tratamientos con eficacia comprobada para todos los grupos de pacientes, ni se ha licenciado una vacuna segura y eficaz; tampoco se ha logrado consenso respecto al screening universal. Los objetivos de este trabajo fueron estimar la prevalencia de infección congénita por CMV y seroprevalencia materna en Tucumán y comparar si existen diferencias en las variables estudiadas según un índice de carencias y tipo de institución (pública o privada). MÉTODOS: Se realizó un estudio observacional de corte transversal. Se reclutaron 201 binomios recién nacido (RN)/madre de 8 maternidades del subsector público y privado. Se obtuvieron muestras de suero de la madre y orina del RN y se completó una Ficha de Recolección de Datos. Se utilizó PCR en tiempo real para la detección de genoma viral en muestras de orina de los RN y se realizó detección de IgG anti-CMV en el suero de las madres. RESULTADOS: Se obtuvo una prevalencia estimada de infección congénita por CMV de 0,5% y una seroprevalencia materna de 96,9%. Se encontraron diferencias según índice de carencias y tipo de institución. DISCUSIÓN: La frecuencia de infección congénita fue baja, comparada con la seroprevalencia materna. Algunas de las variables estudiadas evidencian mayor vulnerabilidad en el sector público

Características de las concentraciones elevadas de yoduria en escolares y adolescentes de Colombia / Characteristics of the high ioduria concentrations in schoolchildren and adolescents in Colombia

RESUMEN Objetivos: Determinar las características de las concentraciones elevadas de yoduria en escolares y adolescentes de Colombia. Materiales y métodos: Análisis secundario de la Encuesta Nacional de la Situación Nutricional en Colombia del 2015 en participantes de 5 a 17 años que incluyó la medición de yoduria. Los criterios para medir el estado nutricional del yodo se basaron en la mediana de la concentración de yodo urinario en µg/L definido por la Organización Mundial de la Salud (OMS), donde valores <100 son considerados como deficientes, entre 100-199 adecuada, 200-299 arriba de los requerimientos y >300 excesiva. Se realizaron además mediciones de razón de probabilidades a través de un análisis de regresión logística. Resultados: La mediana de yoduria nacional para escolares y adolescentes fue 406,8 µg/L y 410,8 μg/L respectivamente, mayor en el área urbana (410,5 µg/L); en la región Atlántica se encontró el mayor nivel para escolares (423,7 µg/L) y en la central para adolescentes (427,7 µg/L). El 4,4% de escolares y el 2,2% de adolescentes presentaron deficiencia y en más del 75% de la población, hubo ingesta excesiva de yodo. Los factores asociados a la ingesta excesiva de yodo en escolares fueron edad, etnia, región e índice de riqueza; y para adolescentes el sexo y área geográfica. Conclusiones: Las concentraciones de yoduria en escolares y adolescentes colombianos es superior al adecuado según OMS, la deficiencia es muy baja y se presenta un grave problema de salud pública por ingesta excesiva de yodo en tres cuartas partes de la población.

ABSTRACT Objetives: To determine the characteristics of high ioduria concentrations in schoolchildren and adolescents in Colombia. Materials and methods: Secondary analysis of the 2015 National Survey of the Nutritional Situation in Colombia in participants aged 5 to 17 years, which included the measurement of ioduria. The criteria to measure the nutritional status of iodine were based on the median urinary iodine concentration in µg / L defined by the World Health Organization (WHO), where values ​​<100 are considered deficient, between 100-199 adequate, 200-299 above the requirements and> 300 excessive. Odds ratio measurements were also performed through logistic regression analysis. Results: The national median iodine for schoolchildren and adolescents was 406.8 µg / L and 410.8 µg / L respectively, higher in the urban area (410.5 µg / L), in the Atlantic region the highest level was found for schoolchildren (423.7 µg / L) and in the central for adolescents (427.7 µg / L). 4.4% of schoolchildren and 2.2% of adolescents presented deficiency and in more than 75% of the population, there was excessive intake of iodine. The factors associated with excessive iodine intake in schoolchildren were age, ethnicity, region and wealth index, and for adolescents gender and geographic area. Conclusions: The iodine concentrations in Colombian schoolchildren and adolescents are higher than adequate according to WHO, the deficiency is very low and a serious public health problem occurs due to excessive iodine intake in three-quarters of the population.

Desempenho de diferentes marcas de tiras reagentes relativo à densidade e à análise química da urina de cães e gatos / Performance of different brands of reagent strips for density and chemical analysis of dog and cat urine

Objetivou-se verificar a compatibilidade entre diferentes marcas de tiras reagentes para urinálise, tanto de uso veterinário, como de uso humano, e confrontar os parâmetros semiquantitativos desse instrumento com métodos quantitativos. Para isso, foram analisadas 77 amostras frescas de urina de cães e gatos e testados 04 modelos de tiras reagentes. Quanto à densidade urinária, houve correlação razoável entre os métodos quantitativo e semiquantitativo naquelas amostras com pH ácido, mas não naquelas com pH neutro ou alcalino. Quanto à concentração proteica, houve similaridade de 53,3% a 83,3% entre as marcas testadas e quando comparadas com a análise fotométrica houve uma correlação razoável (rs = 0,69752 a 0,75074). Em ponto de corte de 15mg/dL de proteína, a sensibilidade da tira reagente foi 82,5% e 100% para urina canina e felina, respectivamente. No tocante à hematúria, houve divergência razoável entre a sedimentoscopia e as diferentes marcas de tiras reativas. Quanto à piúria, há uma baixa sensibilidade das tiras em relação às amostras caninas com muitos resultados falso-negativos (33% a 75%), enquanto em amostras felinas a sensibilidade foi de 100%. Assim, independente da marca, as tiras reagentes devem servir apenas como teste rápido de triagem, sendo mais apropriado o uso de métodos quantitativos na avaliação clínica do paciente a partir da urinálise.

The aim was to verify the compatibility between different brands of urinary dipsticks, for both human and veterinary use, and to compare the semiquantitative parameters of this instrument with quantitative methods. For this, 77 fresh samples of urine from dogs and cats were analyzed e and 04 models of reagent strips were tested. Regarding urinary density, a reasonable correlation was observed between the quantitative and semiquantitative methods in those samples with acidic pH, which did not occur in those with neutral or alkaline pH. Regarding the protein concentration, there was similarity from 53.3% to 83.3% between the brands and in the comparative analysis between the control strip and the photometric analysis, there was a reasonable correlation (rs = 0.69752 to 0.75074). In cut-off point of 15mg/dL protein, the sensitivity of the reagent strip was 82.5% and 100% for canine and feline urine, respectively. Regarding hematuria, there was a reasonable divergence of results between sedimentation and tested dipsticks. As for pyuria, there is a low sensitivity of the strips in relation to canine samples with many false negative results (33% to 75%), while in feline samples the sensitivity was 100%. Thus, regardless of the brands, the reagent strips should serve only as a rapid screening test, while the use of quantitative methods in the clinical evaluation of the patient from urinalysis is more appropriate.

Demanda de culturas microbiológicas e prevalência de microrganismos em um hospital universitário de Pernambuco / Demand for microbiological cultures and prevalence of microorganisms in a university hospital of Pernambuco / Demanda de culturas microbiológicas y prevalencia de microrganismos en un hospital universitario de Pernambuco

Objetivo: verificar a demanda de hemoculturas, aspirados traqueais e uroculturas realizadas no HU-UNIVASF/ EBSERH e a prevalência dos microrganismos identificados no período de janeiro a junho de 2016. Métodos: estudo retrospectivo documental com abordagem quantitativa. Resultados: o setor de microbiologia realizou 488 hemoculturas, 427 uroculturas e 197 aspirados traqueais. A positividade de hemoculturas mostrou-se entre 10,9 à 25,7%, e o percentual de contaminações variou de 6,8 à 14,0%. Os microrganismos mais prevalência nas hemoculturas foram Staphylococcus epidermidis (23,7%), Staphylococcus aureus (19,3%) e Klebisiella pneumoniae (9,6%). Nas uroculturas foram Klebisiella pneumoniae (23,1%), Candida sp. (13,5%) e Escherichia coli (12,5%). Nos aspirados traqueais foram Acinetobacter baumannii (29,2%), Pseudomonas aeruginosa (26,6%) e Staphylococcus aureus (16,2%). Conclusão: a cultura mais solicitada foi hemocultura. A bactéria mais prevalente nas hemoculturas foi Staphylococcus epidermidis, nos aspirados traqueais Acinetobacter baumannii e nas uroculturas Klebisiella pneumoniae

Objective: the study's purpose has been to verify the demand for blood cultures, tracheal aspirates and urine cultures performed at a University Hospital from the Universidade Federal do Vale do São Francisco (HU-UNIVASF/EBSERH), as well as the predominance of microorganisms identified over the period from January to June 2016. Methods: it is a retrospective documentary study with a quantitative approach. Results: the microbiology sector carried out 488 blood cultures, 427 urine cultures and 197 tracheal aspirates. The positivity of blood cultures was between 10.9 and 25.7%, and the percentage of contaminations ranged from 6.8 to 14.0%. The most prevalent microorganisms in blood cultures were Staphylococcus epidermidis (23.7%), Staphylococcus aureus (19.3%) and Klebsiella pneumoniae (9.6%). In urine cultures were Klebsiella pneumoniae (23.1%), Candida sp. (13.5%) and Escherichia coli (12.5%). In tracheal aspirates were Acinetobacter baumannii (29.2%), Pseudomonas aeruginosa (26.6%) and Staphylococcus aureus (16.2%). Conclusion: the most requested culture was blood culture. The most prevalent bacterium in blood cultures was Staphylococcus epidermidis, in tracheal aspirates was Acinetobacter baumannii, and in urine cultures was Klebsiella pneumoniae

Objetivo: el propósito del trabajo es verificar la demanda de hemocultivos, aspirados traqueales y urocultivos realizados en el Hospital Universitário de la Universidade Federal do Vale do São Francisco (HU-UNIVASF/ EBSERH) y la prevalencia de los microorganismos identificados en el período de enero a junio de 2016. Métodos: este trabajo es un estudio retrospectivo documental con abordaje cuantitativo. Resultados: el sector de microbiología realizó 488 hemocultivos, 427 urocultivos y 197 aspirados traqueales. La positividad de hemocultivos se mostró entre el 10,9 al 25,7%, y el porcentaje de contaminaciones varía de 6,8 a 14,0%. Los microorganismos más prevalentes en los hemocultivos fueron Staphylococcus epidermidis (23,7%), Staphylococcus aureus (19,3%) y Klebsiella pneumoniae (9,6%). En los urocultivos fueron Klebisiella pneumoniae (23,1%), Candida sp. (13,5%) y Escherichia coli (12,5%). En los aspirados traqueales fueron Acinetobacter baumannii (29,2%), Pseudomonas aeruginosa (26,6%) y Staphylococcus aureus (16,2%). Conclusión: la cultura más solicitada fue hemocultivo. La bacteria más prevalente en los hemocultivos fue Staphylococcus epidermidis, en los aspirados traqueales, Acinetobacter baumannii y en los urocultivos, Klebisiella pneumoniae

Urolithiasis and sleeve gastrectomy: a prospective assessment of urinary biochemical variables / Urolitíase e gastrectomia vertical: uma avaliação prospectiva das variáveis bioquímicas urinárias

ABSTRACT Introduction: to evaluate urinary biochemical alterations related to urolithogenesis processes after sleeve gastrectomy (SG). Materials and methods : prospective study with 32 individuals without previous diagnosis of urolithiasis who underwent SG. A 24-h urine test was collected seven days prior to surgery and at 6-month follow-up. The studied variables were urine volume, urinary pH, oxalate, calcium, citrate, and magnesium and calcium oxalate super saturation (CaOx SS). Results: patients were mainly women (81.2%), with mean age of 40.6 years. Mean pre- and postoperative BMI were 47.1 ± 8.3 Kg/m2 and 35.5 ± 6.1 Kg/m2, respectively (p<0.001). Urine volume was significantly lower at the postoperative evaluation in absolute values (2,242.50 ± 798.26 mL x 1,240.94 ± 352.39 mL, p<0.001) and adjusted to body weight (18.58 ± 6.92 mL/kg x 13.92 ± 4.65 mL/kg, p<0.001). CaOx SS increased significantly after SG (0.11 ± 0.10 x 0.24 ± 0.18, p<0.001). Moreover, uric acid levels were significantly lower at the postoperative evaluation (482.34 ± 195.80 mg x 434.75 ± 158.38 mg, p=0.027). Urinary pH, oxalate, calcium, citrate, and magnesium did not present significant variations between the pre- and postoperative periods. Conclusion: SG may lead to important alterations in the urinary profile. However, it occurs in a much milder way than that of RYGB.

RESUMO Introdução: avaliar as alterações bioquímicas urinárias relacionadas aos processos de litíase urinária após gastrectomia vertical (GV). Método: estudo prospectivo, com 32 indivíduos submetidos a GV, sem diagnóstico prévio de urolitíase. Foi coletada urina de 24 horas, sete dias antes da operação e no retorno de 6 meses. As variáveis estudadas foram volume de urina, pH urinário, oxalato, cálcio, citrato e super saturação de oxalato e cálcio (SS CaOx). Resultados: os pacientes foram em sua maioria mulheres (81,2%), com idade média de 40,6 anos. O IMC médio pré e pós-operatório foi 47,1 ± 8,3 Kg/m2 e 35,5 ± 6,1 Kg/m2, respectivamente (p<0,001). O volume de urina foi significativamente baixo na avaliação pós-operatória em valores absolutos (2.242,50 ± 798,26 mL versus 1.240,94 ± 352,39 mL, p<0,001) e ajustado ao peso corporal (18,58 ± 6,92 mL/kg versus 13,92 ± 4,65 mL/kg, p<0,001). A SS CaOx aumentou significativamente após a GV (0,11 ± 0,10 versus 0,24 ± 0,18, p<0,001). Além disso, os níveis de ácido úrico apresentaram-se significativamente baixos na avaliação pós-operatória (482,34 ± 195,80 mg versus 434,75 ± 158,38 mg, p=0,027). PH urinário, oxalato, cálcio, citrato e magnésio não apresentaram variações significativas entre os períodos pré e pós-operatório. Conclusão: a GV pode levar a alterações importantes no perfil urinário. Entretanto, essas ocorrem de forma muito mais leve que na derivação gástrica em Y de Roux.

Enterobacterales productores de betalactamasas de espectro extendido portadores del gen mcr-1 en Lima, Perú / Extended-spectrum beta-lactamase-producing enterobacterales carrying the mcr-1 gene in Lima, Peru

RESUMEN Se analizó la presencia del gen mcr-1 en 165 enterobacterales productores de betalactamasas de espectro extendido (EP-BLEE) recuperados en 2017 de sangre (40), orina (57), secreciones respiratorias bajas (12) e hisopados rectales (56) de pacientes hospitalizados en el Instituto Nacional de Enfermedades Neoplásicas (Perú). La identificación y la susceptibilidad antimicrobiana se determinaron por el sistema automatizado Phoenix M50; la resistencia a colistina por Colistin Agar-Spot (CAS); la detección de mrc-1 por el método fenotípico de predifusión de colistina e inhibición con EDTA (CPD-E) y por reacción en cadena de la polimerasa (PCR, por sus siglas en inglés). De los 165 EP-BLEE 25 fueron positivos para mcr-1 por el método CPD-E y se confirmó por PCR. Por el método CAS, 20/165 fueron resistentes a colistina. Además, mostraron resistencia a las fluoroquinolonas y a la gentamicina, y permanecieron sensibles a la amikacina; dos aislamientos presentaron metalocarbapenemasas. La obtención de datos sobre la resistencia a antimicrobianos considerados de última línea (colistina) es crucial para establecer medidas para su control.

ABSTRACT We analyzed the presence of the mcr-1 gene in 165 extended-spectrum beta-lactamase-producing enterobacterales (ESBL-PE) obtained during 2017, from blood (40), urine (57), lower respiratory secretions (12) and rectal swabs (56) of patients hospitalized in the Instituto Nacional de Enfermedades Neoplásicas (Peru). Antimicrobial identification and susceptibility were determined by the Phoenix M50 automated system; colistin resistance by Colistin Agar-Spot (CAS); mrc-1 detection by colistin pre-diffusion and inhibition with EDTA test (CPD-E) and by polymerase chain reaction (PCR). We found that from the 165 ESBL-PE, 25 were positive for mcr-1 by the CPD-E method and confirmed by PCR. Colistin resistance was found in 20/165 by using the CAS method. Additionally, they showed resistance to fluoroquinolones and gentamicin, while remaining sensitive to amikacin; two isolates presented metallo-carbapenemases. Obtaining data on resistance to last-line antimicrobials (colistin) is crucial to establish measures for its control.

Mejora de las variaciones en la ecografía vesical Evaluación del volumen de orina residual posmiccional en obstrucción moderada de la salida de la vejiga / Improving Variations in Bladder Ultrasound Assessment of Post-Void Residual Urine Volume in Moderate Bladder Outlet Obstruction

Objectives: This study aimed to assess the accuracy of post-void residual (PVR) urine volume measurements in patients with moderate bladder outlet obstruction. Materials and Methods: This prospective observational study was conducted between January and December 2019. The inclusion criteria were male patients with symptoms of moderate bladder outlet obstruction. On the other hand, patients with a history of diabetes, symptoms of urinary tract infection, and positive urine for pyuria, as well as patients using medications, such as diuretics, alpha-blockers, and anticholinergic drugs, were excluded. The patients were asked to drink 1000 mL of water one to two hours before the initial ultrasound scan. Pre-void bladder capacity was measured, followed by a post-void ultrasound for residual urine volume measurement at three intervals: immediately after voiding, 15-20 minutes after the first void, and one week later with an empty bladder. Assessment of per-void capacity was carried out, based on the patient's subjective sensation of bladder fullness (a strong desire to void). Results: A total of 78 male patients, with the mean age of 60 years, were included in this study (27 cases in group I; 37 cases in group II; and 14 cases in group III). The mean PVR volume was 92 mL in the first measurement, 62 mL in the second measurement, and 60 mL in the third measurement. Significant differences were found between the first and second PVR measurements and between the first and third PVR measurements (P<0.05). However, no significant difference was found between the second and third PVR measurements (P=0.107). On the other hand, significant differences were found between groups I and II and between groups I and III (P<0.05) in the three PVR measurements. Nevertheless, there was no significant difference between groups II and III in the three PVR measurements (P=0.204, 0.56, and 0.487 for the first, second, and third PVR measurements, respectively). Conclusion: A bladder ultrasound must be performed and interpreted carefully to avoid further unnecessary medications, investigations, or procedures. We recommend a second PVR measurement in patients with bladder outlet obstruction. Also, it is suggested to conduct similar studies in different conditions to confirm our findings.

Perfil de resistência aos antimicrobianos de Escherichia coli isoladas de amostras de urina de pacientes de uma Unidade de Terapia Intensiva / Antimicrobial resistance profile of Escherichia coli isolated from urine specimens of an Intensive Care Unit patients

Objective: To assess the susceptibility profile of Escherichia coli isolated from urine samples from patients admitted in the adult ICU of a teaching hospital in the city of Juiz de Fora, MG. Methods: The study is retrospective and transversal, whose urine sample data were collected through electronic records from Hospital Infection Control Service, referring to the period from January to December of 2018. In these studies, cultures of urine with growth for E. coli that had colony counts ³ 100.000 CFU/mL were considered positive. Results: A total of 769 urine samples were submitted to culture, out of these, 240 (31,2%) presented microbial growth, being 37 (4,81%) positive for Escherichia coli. In relation to antimicrobial susceptibility profile, 3,24% of the strains were resistant to ciprofloxacin, 40,54% to norfloxacin, 35,13 to ampicillin, 32,43 to nitrofurantoin, 29,72% to cephalothin, ceftriaxone, ceftazidime and cefepime, 18,91% to sulfamethoxazole trimethoprim, 5,04% to amikacin and gentamicin. All the strains were sensitive to carbapenems. Nine (24,82%) strains productors of Extended Spectrum Beta Lactamase (ESBL) were isolated. Conclusion: The Escherichia coli is an important pathogen related to UTI and presents increasing resistance to the antimicrobials used in medicine practice, such as the quinolones and the beta-lactams.

Objetivo: Avaliar o perfil de suscetibilidade de Escherichia coli isoladas de uroculturas de pacientes internados na UTI adulto de um hospital de ensino na cidade de Juiz de Fora, MG. Métodos: Trata-se de um estudo retrospectivo e transversal, cujos dados de urocultura foram coletados por meio dos registros eletrônicos do Serviço de Controle de Infecção Hospitalar, referentes ao período de janeiro a dezembro de 2018. Foram consideradas as culturas com crescimento positivo para E. coli com contagem de colônias ≥ 100.000 UFC/mL. Resultados: Foram submetidas à urocultura 769 amostras de urina, e, destas, 240 (31,2%) apresentaram crescimento microbiano, sendo 37 (4,81%) positivas para Escherichia coli. Em relação ao perfil de suscetibilidade aos antimicrobianos, 43,24% das cepas foram resistentes ao ciprofloxacino, 40,54% ao norfloxacino, 35,13 à ampicilina, 32,43 à nitrofurantoína, 29,72% a cefalotina, ceftriaxona, ceftazidima e cefepime,18,91% ao sulfazotrim, 5,04% a amicacina e gentamicina. Todas as cepas foram sensíveis aos carbapenêmicos. Foram isoladas nove (24,82%) cepas produtoras de Beta-Lactamase de Espectro Estendido (ESBL). Conclusão: A Escherichia coli é um importante patógeno relacionado a infecção do trato urinário ( ITU) e, ainda, apresenta resistência crescente aos antimicrobianos utilizados na prática médica, tais como quinolonas e beta-lactâmico