Kidney stones in renal transplant recipients: A systematic review.

INTRODUCTION: Lithiasis in renal graft recipients might be a dangerous condition with a potential risk of organ function impairment. EVIDENCE ACQUISITION: A systematic literature search was conducted through February 2023. The primary objective was to assess the incidence of lithiasis in kidney transplant (KT) recipients. The secondary objective was to assess the timing of stone formation, localization and composition of stones, possible treatment options, and the incidence of graft loss. EVIDENCE SYNTHESIS: A total of 41 non-randomized studies comprising 699 patients met our inclusion criteria. The age at lithiasis diagnosis ranged between 29-53 years. Incidence of urolithiasis ranged from 0.1-6.3%, usually diagnosed after 12 months from KT. Most of the stones were diagnosed in the calyces or in the pelvis. Calcium oxalate composition was the most frequent. Different treatment strategies were considered, namely active surveillance, ureteroscopy, percutaneous/combined approach, or open surgery. 15.73% of patients were submitted to extracorporeal shock wave lithotripsy (ESWL), while 26.75% underwent endoscopic lithotripsy or stone extraction. 18.03% of patients underwent percutaneous nephrolithotomy whilst 3.14% to a combined approach. Surgical lithotomy was performed in 5.01% of the cases. Global stone-free rate was around 80%. CONCLUSIONS: Lithiasis in kidney transplant is a rare condition usually diagnosed after one year after surgery and mostly located in the calyces and renal pelvis, more frequently of calcium oxalate composition. Each of the active treatments is associated with good results in terms of stone-free rate, thus the surgical technique should be chosen according to the patient's characteristics and surgeon preferences.

Patient with adrenal insufficiency due to a de novo mutation in the NR0B1 gene.

Objectives: Congenital X-linked adrenal hypoplasia is a rare disease with a known genetic basis characterized by adrenal insufficiency, hypogonadotropic hypogonadism, and a wide variety of clinical manifestations. Case presentation: We present the case of a 26-day old male newborn with symptoms consistent with adrenal insufficiency, hyponatremia, and hyperkalemia. Following NaCl and fludrocortisone supplementation, the patient remained clinically stable. 17-OH-progesterone testing excluded congenital adrenal hyperplasia. The rest of hormones were within normal limits, except for adrenocorticotropic hormone (ACTH), which was significantly elevated, and aldosterone, which was below the reference value. Further testing included very long chain fatty acids to exclude adrenoleukodystrophy, the CYP11B2 gene (aldosterone synthase), and an MRI to screen for other morphological abnormalities. All tests yielded normal results. Finally, after cortisol deficiency was detected, expanded genetic testing revealed a mutation in the NR0B1 gene, which led to a diagnosis of congenital adrenal hypoplasia. Conclusions: Diagnosis of congenital adrenal hypoplasia is challenging due to the heterogeneity of both clinical manifestations and laboratory abnormalities. As a result, diagnosis requires close monitoring and genetic testing.

Recurrent reactive infectious mucocutaneous eruption (RIME) secondary to Chlamydophila pneumoniae infection in an adult.

The terminology surrounding the clinical syndrome characterized by acute mucositis with minimal skin involvement has been a subject of debate over time. In recent years, terms such as mycoplasma-induced rash and mucositis and reactive infectious mucocutaneous eruption (RIME) have been introduced to encompass milder mucocutaneous diseases associated with respiratory infections, with implications for management and prognosis. We report the first case of recurrent RIME associated with Chlamydophila pneumoniae infection in an adult patient. RIME is likely underreported due to misclassification and a lack of testing for potential pathogens. Early recognition of recurrent RIME is of particular interest from the patient's perspective to reduce the frequency and duration of hospital admissions.

A MHz X-ray diffraction set-up for dynamic compression experiments in the diamond anvil cell.

An experimental platform for dynamic diamond anvil cell (dDAC) research has been developed at the High Energy Density (HED) Instrument at the European X-ray Free Electron Laser (European XFEL). Advantage was taken of the high repetition rate of the European XFEL (up to 4.5 MHz) to collect pulse-resolved MHz X-ray diffraction data from samples as they are dynamically compressed at intermediate strain rates (≤103 s-1), where up to 352 diffraction images can be collected from a single pulse train. The set-up employs piezo-driven dDACs capable of compressing samples in ≥340 µs, compatible with the maximum length of the pulse train (550 µs). Results from rapid compression experiments on a wide range of sample systems with different X-ray scattering powers are presented. A maximum compression rate of 87 TPa s-1 was observed during the fast compression of Au, while a strain rate of ∼1100 s-1 was achieved during the rapid compression of N2 at 23 TPa s-1.

Structural and functional properties and digital image texture analysis of gelatin, pectin, and carrageenan gels with honey addition.

Gels combined with honey might generate new possibilities of textures in food development. This work explores the structural and functional properties of gelatin (5 g/100 g), pectin (1 g/100 g), and carrageenan (1 g/100 g) gels with different content of honey (0-50 g/100 g). Honey decreased the transparency of gels and made them more yellow-greenish; all of them were firm and uniform, especially at the highest honey content. The water holding capacity increased (63.30-97.90 g/100 g) and moisture content, water activity (0.987-0.884) and syneresis (36.03-1.30 g/100 g) decreased with the addition of honey. This ingredient modified mainly the textural parameters of gelatin (Hardness: 0.82-1.35 N) and carrageenan gels (Hardness: 2.46-2.81 N), whereas only the adhesiveness and the liquid like-behavior were increased in the pectin gels. Honey increased the solid behavior of gelatin gels (G': 54.64-173.37 Pa) but did not modify the rheological parameters of the carrageenan ones. Honey also had a smoothing effect on the microstructure of gels as observed in the scanning electron microscopy micrographs. This effect was also confirmed by the results of the gray level co-occurrence matrix and fractal model's analysis (fractal dimension: 1.797-1.527; lacunarity: 1.687-0.322). The principal component and cluster analysis classified samples by the hydrocolloid used, except the gelatin gel with the highest content of honey, which was differentiated as a separate group. Honey modified the texture, rheology, and microstructure of gels indicating that it is possible to generate new products to be used in other food matrices as texturizers.

Association between the body mass index, waist circumference, and body fat percentage with erosive esophagitis in adults with obesity after sleeve gastrectomy.

Background: High anthropometric indexes before sleeve gastrectomy (SG) are associated with an increased risk of erosive esophagitis (EE) in bariatric surgery candidates. Reasons that explain how these indexes influence the development of esophageal pathology after surgery remains unclear. Objectives: To assess the association between the body mass index (BMI), waist circumference (WC), and body fat percentage (BFP) with the development of EE in adults with obesity three months after SG. Setting: Clínica Avendaño, Lima, Peru. Methods: Retrospective cohort using a database including adults with obesity who underwent SG during 2017-2020. All the patients included had an endoscopy before and after the surgery. Sociodemographic, clinical and laboratory characteristics were compared according to BMI, WC and BFP, as well as by the development of de novo esophagitis. The association was evaluated by crude and adjusted generalized linear models with the log-Poisson family. Results: From a total of 106 patients, 23 (21.7%) developed EE. We did not find significant differences in sociodemographic, clinical and laboratory characteristics between patients with de novo EE compared to those who did not develop EE. After adjustment, BMI (aRR = 0.59, 95% CI = 0.18-1.40), BFP (aRR = 0.41, 95% CI = 0.15-1.19) and WC (aRR = 0.91, 95% CI = 0.69-1.16) were not associated with the development of EE three months post SG. Conclusions: We found no association between preoperative anthropometric indexes and the development of de novo EE; therefore, morbid obesity should not be a criterion to exclude the patients to undergo SG as primary surgery because of the risk of developing EE.

Calidad de sueño en personas adultas mayores con diabetes mellitus tipo II / Sleep quality in older adults with type II diabetes mellitus

Introducción: el dormir mal podría ser la causa de diabetes mellitus tipo II y otras enfermedades crónicas no transmisibles. Objetivo: conocer la calidad de sueño de las personas con diabetes mellitus tipo II. Material y métodos: se realizó un estudio descriptivo, la muestra 44 adultos con diabetes mellitus. Se aplicó el cuestionario de Índice de Calidad de Sueño de Pittsburgh, 19 reactivos que contiene siete componentes con una escala de 0 a 3. La suma de estos da el índice. Resultados: se evaluó la calidad de sueño en 44 personas con diabetes mellitus tipo II, de abril a agosto 2021. El promedio de edad 67 años, 73 % del sexo femenino. El 39 % tiene una mala calidad de sueño, 27 % tarda en dormir entre 30 y 60 minutos, 18 % duerme <5 horas, 79.5 % no tiene una eficiencia de sueño normal, 48% reporto tener alteraciones del sueño una o dos veces a la semana, 11 % usa medicamentos para dormir menos de una vez a la semana y 11 % tiene una disfunción diurna. En cuanto al índice de calidad de sueño 85 % tiene un índice > 5. Conclusión: las personas diabéticas tienen una mala calidad de sueño lo cual puede afectar su metabolismo, en consecuencia es necesario realizar una intervención para mejorar su calidad de sueño.

Introduction: poor sleep could be the cause of type II diabetes mellitus and other chronic non-communicable diseases. Objective: to know the quality of sleep of people with type II diabetes mellitus. Material and methods: a descriptive study was carried out, the sample consisted of 44 adults with diabetes mellitus. The 19-item Pittsburgh Sleep Quality Index questionnaire was applied, containing seven components with a scale from 0 to 3. The sum of these gives the index. Results: the quality of sleep was evaluated in 44 people with type II diabetes mellitus, from April to August 2021. The average age was 67 years old, 73% are female. 39% have a poor quality of sleep, 27% take between 30 to 60 minutes to sleep, 18% sleep <5 hours, 79.5% do not have a normal sleep efficiency, 48% reported having sleep disturbances one or twice a week, 11% use sleep medications less than once a week and 11% have a daytime dysfunction. Regarding the sleep quality index, 85% have an index> 5 Conclusion: diabetic people have a poor quality of sleep which can affect their metabolism, so it is necessary to carry out an intervention to improve their quality of sleep.

Copper(II) invigorated EHU-30 for continuous electroreduction of CO2 into value-added chemicals.

The doping of zirconium based EHU-30 and EHU-30-NH2 metal-organic frameworks with copper(II) yielded a homogeneous distribution of the dopant with a copper/zirconium ratio of 0.04-0.05. The doping mechanism is analysed by chemical analysis, microstructural analysis and pair distribution function (PDF) analysis of synchrotron total scattering data in order to get deeper insight into the local structure. According to these data, the Cu(II) atoms are assembled within the secondary building unit by a transmetalation reaction, contrarily to UiO-66 series in which the post-synthetic metalation of the MOF takes place through chemical anchorage. The resulting materials doubled the overall performance of the parent compounds for the CO2 electroreduction, while retained stable the performance during continuous transformation reaction.

Breast cancer and physical activity: A bibliometric analysis.

Breast cancer is a pathology suffered by millions of women worldwide, affecting the mental health, quality of life (QoL), physical functioning, cognitive functioning, and social and work life of surviving patients. Moreover, breast cancer is associated with weight gain, muscle atrophy, and weakness. Physical exercise appears to be an effective non-pharmacological treatment to improve short-term self-esteem, QoL, fatigue, and psychological factors such as depression, anxiety, happiness, and body image. The practice of physical activity is also associated with a reduction in the side effects of treatment. This bibliometric analysis analyzed the trend followed by publications on breast cancer and physical activity. The Web of Science database was used, and bibliometric laws were applied to identify the most prolific authors, the journals most involved in the field, and the countries, institutions, and keywords most used by the authors. Breast cancer and physical activity have an exponential trend in the number of publications, with Psycho-Oncology being the journal with the highest number of publications.

Recent Advances in the Discovery and Function of Antimicrobial Molecules in Platelets.

The conventional function described for platelets is maintaining vascular integrity. Nevertheless, increasing evidence reveals that platelets can additionally play a crucial role in responding against microorganisms. Activated platelets release molecules with antimicrobial activity. This ability was first demonstrated in rabbit serum after coagulation and later in rabbit platelets stimulated with thrombin. Currently, multiple discoveries have allowed the identification and characterization of PMPs (platelet microbicidal proteins) and opened the way to identify kinocidins and CHDPs (cationic host defense peptides) in human platelets. These molecules are endowed with microbicidal activity through different mechanisms that broaden the platelet participation in normal and pathologic conditions. Therefore, this review aims to integrate the currently described platelet molecules with antimicrobial properties by summarizing the pathways towards their identification, characterization, and functional evaluation that have promoted new avenues for studying platelets based on kinocidins and CHDPs secretion.

Effect of flaxseed (Linum usitatissimum L.) flour and yerba mate (Ilex paraguariensis) extract on physicochemical and sensory properties of a gluten free corn-based snack.

Flaxseed (Linum usitatissimum L.) and yerba mate (Ilex paraguariensis) are particularly interesting as functional ingredients due to their high content of essential omega 3-fatty acids and antioxidant properties, respectively. The objective of this work was to formulate a corn snack enriched with flaxseed flour and yerba mate extract and evaluate its physicochemical and sensory properties. Flaxseed flour, added at three levels 1, 3 and 5%, increased the water activity, moisture content and cohesiveness, and decreased the hardness and plastic deformation of the samples. The flour also changed the superficial colour and made the microstructure more compact. On the contrary, yerba mate extract (1 and 3%) decreased the water activity, moisture content and cohesiveness, counteracting the effect of flaxseed flour. Yerba mate increased the plastic deformation and the antioxidant activity of the snacks. The colour was not modified and the microstructure was more fragmented in the presence of yerba mate. Sensory evaluation suggested that flaxseed flour and yerba mate affected the flavour but did not modify the colour and crunchiness of the product.

Compression-rate dependence of pressure-induced phase transitions in Bi.

It is qualitatively well known that kinetics related to nucleation and growth can shift apparent phase boundaries from their equilibrium value. In this work, we have measured this effect in Bi using time-resolved X-ray diffraction with unprecedented 0.25 ms time resolution, accurately determining phase transition pressures at compression rates spanning five orders of magnitude (10-2-103 GPa/s) using the dynamic diamond anvil cell. An over-pressurization of the Bi-III/Bi-V phase boundary is observed at fast compression rates for different sample types and stress states, and the largest over-pressurization that is observed is ΔP = 2.5 GPa. The work presented here paves the way for future studies of transition kinetics at previously inaccessible compression rates.

Incidence of enterovirus in patients with acute gastroenteritis.

Enteroviruses (EV) have been linked to lymphocytic meningitis and exanthems, but they may also be involved in acute gastroenteritis (AGE), a condition whose aetiological agent often remains unidentified. In this work 1214 samples from individuals with AGE were studied with the aim of establishing the incidence of EV. The samples were collected between September and December in three different years and subjected to real-time genomic amplification in order to determine the viral load (VL). Of the 1214 samples studied, infection by a single virus was found in 328 cases (27%) and coinfection in 69 (5.7%). While adenoviruses (AdV) were the most frequent (14.8% of total), EV were present in 126 (10.4%) of the individuals tested. Of the 126 EV-positive samples, this virus was found as a single infection and coinfection in 76 (6.3%) and 50 (4.1%) cases, respectively. VL for EV was 5.58±1.51 log copies/ml (range 3.73-9.69) in the former and 6.27±1.75 (range 3.73-10.5) (p=0.02) in the latter. EV were identified in 97 children under 5 (16.9%) and in 29 (4.5%) patients over 5. Patients less than 5 years showed a higher VL that those more than 5 years age [6.08±1.57 (range 3.82-9.69) vs. 5.07±1.53 (range 3.73-10.58); (p=0.002)]. There was a high incidence of EV in AGE patients, and they were more frequent in those under 5, where they were found to replicate more efficiently. These results therefore indicate that testing for EV should be included in the diagnosis of AGE.

A novel single nucleotide polymorphism assay for the detection of N501Y SARS-CoV-2 variants.

The N501Y mutation in SARS-CoV-2 variants found in several strains from the UK, South Africa and Brazil has been linked to increased transmission. In order to discriminate N501Y variants quickly, a single nucleotide polymorphism (SNP) discrimination assay was designed and validated. It was then deployed prospectively in 757 nasopharyngeal swabs. Validation of the novel variant discrimination assay corroborated the results in all validation panel samples (n = 63) through sequencing. This novel variant discrimination assay was then deployed prospectively in 757 clinical nasopharyngeal swabs during the last week of January 2021. N501Y was found in 206 (27.4 %) of the samples: 94 (28.2 %) men and 112 (26.85 %) women (p = 0.73). The patients in whom it was identified had a mean age of 47.8 ± 25.8 (0-96) years, similar to that of patients without this variant: 51.7 ± 25.9 (0-104) years (p = 0.06). 501Y variant was confirmed in 34 samples by sequence method and 501 N wild type was confirmed in 67. This method is sensitive, specific, and simple to apply in any microbiology lab.

Peripheral Blood Mitochondrial DNA Levels Were Modulated by SARS-CoV-2 Infection Severity and Its Lessening Was Associated With Mortality Among Hospitalized Patients With COVID-19.

Introduction: During severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the virus hijacks the mitochondria causing damage of its membrane and release of mt-DNA into the circulation which can trigger innate immunity and generate an inflammatory state. In this study, we explored the importance of peripheral blood mt-DNA as an early predictor of evolution in patients with COVID-19 and to evaluate the association between the concentration of mt-DNA and the severity of the disease and the patient's outcome. Methods: A total 102 patients (51 COVID-19 cases and 51 controls) were included in the study. mt-DNA obtained from peripheral blood was quantified by qRT-PCR using the NADH mitochondrial gene. Results: There were differences in peripheral blood mt-DNA between patients with COVID-19 (4.25 ng/µl ± 0.30) and controls (3.3 ng/µl ± 0.16) (p = 0.007). Lower mt-DNA concentrations were observed in patients with severe COVID-19 when compared with mild (p= 0.005) and moderate (p= 0.011) cases of COVID-19. In comparison with patients with severe COVID-19 who survived (3.74 ± 0.26 ng/µl) decreased levels of mt-DNA in patients with severe COVID-19 who died (2.4 ± 0.65 ng/µl) were also observed (p = 0.037). Conclusion: High levels of mt-DNA were associated with COVID-19 and its decrease could be used as a potential biomarker to establish a prognosis of severity and mortality of patients with COVID-19.

Completeness of TB notification in Portugal, 2015: an inventory and capture-recapture study.

BACKGROUND: Despite the steady decline in the last few decades, Portugal remains the Western European country with the highest TB notification rates. The aim of this study was to estimate the completeness of notification to the National Tuberculosis Programme (NTP) Surveillance System (SVIG-TB) in 2015.METHODS: We implemented an inventory study and a three-source log-linear capture-recapture analysis using two additional data sources that were deterministic and probabilistically linked: the national notifiable diseases surveillance system (Sistema Nacional de Vigilância Epidemiológica SINAVE) and the national hospital discharge database (Grupos de Diagnósticos Homogéneos GDH).RESULTS: We identified 2328 unique probable/confirmed TB cases across the three data sources. We found a positive dependency between SVIG-TB and SINAVE (incidence rate ratio IRR 8.9, 95%CI 6.6-12.0) and between GDH and SINAVE (IRR 2.6, 95%CI 2.0-3.4). After adjusting for these dependencies, we estimated that 266 cases (95%CI 198-358) were not reported, indicating a notification (to SVIG-TB) completeness rate of 77.0%.CONCLUSION: True incidence rate of TB in Portugal in 2015 could have been as high as 26.1 per 100 000. This could be an overestimation because of false-positive cases recorded in both SINAVE and GDH or on a smaller scale, false non-matches. Studies aimed at validating potentially false-positive cases should be implemented to address these limitations.

A comparative study of texture and rheology of Argentinian honeys from two regions.

The rheological and textural properties of 26 eastern Argentinian honeys from two different regions (North and Central) were investigated. The viscosity curves of the samples were obtained using a rotational rheometer over a temperature range of 10 to 50C. The viscosity decreased with temperature and all honeys showed a Newtonian behavior. The temperature dependence of viscosity was described using the Arrhenius, Williams-Landel-Ferry, Vogel-Taumman-Fulcher, and Power Law models. The glass transition temperatures of honeys were measured with differential scanning calorimetry and values ranged from -42.63 to -47.71C. The glass transition temperature was also predicted with the Williams-Landel-Ferry model and no significant differences were observed with the experimental results. Rheological parameters were obtained by small amplitude oscillation experiments. Results indicated that the viscous modulus was higher than the storage modulus within all the frequency ranges assayed and honeys from the North region were more viscous. Results of the back extrusion test showed that honeys from the Central region are harder and both groups of honeys (North and Central) exhibited the same consistency and adhesivity. PRACTICAL APPLICATIONS: The honey chain production starts with the extraction of the product from the combs, pumping it through pipes and finishes at the packaging of the product. During all these stages, honey viscosity is a key parameter to ensure proper processing and quality control, preventing the waste of economic resources. Determining honey viscosity is of great importance for the industry to select the equipment such as pumps, mixers, filters, centrifuges, heat exchangers, and optimization of industrial processes. The rheological and textural properties of honey are very important in terms of applications related to quality control and authenticity of honeys. Honey authenticity increases the trust of consumers to certified food products. Argentina is one of the leading honey producers and exporters in the world, but information on the rheological, thermal, and textural characteristics of Argentinian honey is very poor in the scientific literature.

Obtention and characterization of dried gels prepared with whey proteins, honey and hydrocolloids mixture.

BACKGROUND: Large amounts of honey and liquid whey derived from the dairy industry are produced in Argentina. Honey is exported in bulk and whey is transformed into whey protein concentrates and isolates. The objective of this work was to investigate the effect of pH, composition and storage time on the properties of dried gels with honey, whey proteins and hydrocolloids. RESULTS: Color properties varied according to pH and composition. The fracture stress of dried gels prepared with corn starch was higher than that of gels prepared with guar gum in all conditions assayed. Young's modulus was higher at pH 7 for both compositions and increased with storage time. Rubbery characteristics were found in dried gels with guar gum, while both corn starch and guar gum made the microstructure rougher. Multivariate analysis showed that samples could be grouped by pH. Panelists preferred pH 7 products over acidic ones, and no significant differences in sensory properties were found using either corn starch or guar gum in the formulation. CONCLUSION: The results demonstrated that it is possible to generate a new product, which may open new applications for honey and whey in food formulations. © 2017 Society of Chemical Industry.

Monitoring the response of patients with cutaneous leishmaniasis to treatment with pentamidine isethionate by quantitative real-time PCR, and identification of Leishmania parasites not responding to therapy.

BACKGROUND: Leishmania (Viannia) guyanensis is believed to be the principal cause of cutaneous leishmaniasis (CL) in Suriname. This disease is treated with pentamidine isethionate (PI), but treatment failure has increasingly been reported. AIM: To evaluate PI for its clinical efficacy, to compare parasite load, and to assess the possibility of treatment failure due to other infecting Leishmania species. METHODS: Parasite load of patients with CL was determined in skin biopsies using real-time quantitative PCR before treatment and 6 and 12 weeks after treatment. Clinical responses were evaluated at week 12 and compared with parasite load. In parallel, molecular species differentiation was performed. RESULTS: L. (V.) guyanensis was the main infecting species in 129 of 143 patients (about 90%). PI treatment led to a significant decrease (P < 0.001) in parasite counts, and cured about 75% of these patients. Treatment failure was attributable to infections with Leishmania (Viannia) braziliensis, Leishmania (Leishmania) amazonensis and L. (V.) guyanensis (1/92, 1/92 and 22/92 evaluable cases, respectively). There was substantial agreement beyond chance between the parasite load at week 6 and the clinical outcome at week 12, as indicated by the κ value of 0.61. CONCLUSIONS: L. (V.) guyanensis is the main infecting species of CL in Suriname, followed by L. (V.) braziliensis and L. (L.) amazonensis. Furthermore, patient response to PI can be better anticipated based on the parasite load 6 weeks after the treatment rather than on parasite load before treatment.

Point-of-care management of urogenital Chlamydia trachomatis via Gram-stained smear analysis in male high-risk patients. Diagnostic accuracy and cost-effectiveness before and after changing the screening indication at the STI Clinic in Amsterdam.

OBJECTIVES: To measure the effect of changing the point-of-care (POC) testing algorithm of urogenital chlamydia for all male high-risk patients to those with only symptoms with respect to: diagnostic accuracy, loss to follow-up, correctly managed consultations and costs. METHODS: Retrospective comparison of the diagnostic accuracy and cost-effectiveness of Gram-stained urethral smear analysis for the POC management of urogenital Chlamydia trachomatis infections. Between 2008 and 2009 Gram-stained urethral smear analysis was offered to all men irrespective of symptoms; between 2010 and 2011 only to those with symptoms. The Aptima CT assay was the reference diagnostic test. RESULTS: The number of examined Gram-stained smears in the two periods was respectively 7185 (2008-2009 period) and 18,852 (2010-2011 period). The sensitivity of the Gram stain analysis was respectively 83.8% (95% CI 81.2% to 86.1%) and 91.0% (95% CI 89.5% to 92.3%) (p<0.001). The specificity was respectively 74.1% (95% CI 73.0% to 75.2%) and 53.1% (95% CI 51.8% to 54.4%) (p<0.001). The positive predictive value was low in both periods, respectively 31.7% (95% CI 29.8% to 33.6%) and 35.6% (95% CI 34.1% to 37.1%) (p=0.002), whereas the negative predictive value was high, respectively 97.0% (95% CI 96.4% to 97.4%) and 95.4% (95% CI 94.6% to 96.1%) (p=0.002). The loss to follow-up rate between 2008-2009 and 2010-2011 was, respectively, 1.8% (95% CI 1.0% to 2.9%) vs 2.3% (95% CI 1.7% to 3.0%) (p=0.36). There was a small difference in overtreatment, 68.0% (95% CI 66.0% to 69.8%) vs 64.1% (95% CI 62.6% to 65.5%) (p=0.001). The cost per correctly managed consultation was 14.3% lower in the 2010-2011 period (€94.31 vs €80.82). The percentage of delayed treated infections was significantly lower in the 2008-2009 period (10.5%) compared with the 2010-2011 period (22.8%) (p<0.001). CONCLUSIONS: With a high sensitivity in male high-risk patients, the Gram-stained urethral smear is a useful POC test to detect urogenital C. trachomatis. When offered only to men with urogenital symptoms the specificity decreases but the cost per correctly managed consultation is reduced with 14.3% without a significant difference in loss to follow-up but with a significantly higher rate of delayed treatment.