Dipstick Research Articles

Proteinuria screening and risk of bone fracture: a retrospective cohort study using a nationwide population-based database.

Proteinuria is associated with an increased risk of kidney function deterioration, cardiovascular disease, or cancer. Previous reports suggesting an association between kidney dysfunction and bone fracture may be confounded by concomitant proteinuria and were inconsistent regarding the association between proteinuria and bone fracture. Therefore, we aimed to evaluate the association using a large administrative claims database in Japan. Using the DeSC database, we retrospectively identified individuals with laboratory data including urine dipstick test between August 2014 and February 2021. We evaluated the association between proteinuria and vertebral or hip fracture using multivariable Cox regression analyses adjusted for various background factors including kidney function. We also performed subgroup analyses stratified by sex and kidney function and sensitivity analyses with Fine & Gray models considering death as a competing risk. We identified 603766 individuals and observed 21195 fractures. With reference to the negative proteinuria group, the hazard ratio for hip or vertebral fracture was 1.10 [95% confidence interval (CI), 1.05-1.14] and 1.16 (95%CI, 1.11-1.22) in the trace and positive proteinuria group, respectively, in the Cox regression analysis. The subgroup analyses showed similar trends. The Fine & Gray model showed a subdistribution hazard ratio of 1.09 (95%CI, 1.05-1.14) in the trace proteinuria group and 1.15 (95% CI, 1.10-1.20) in the positive proteinuria group. Proteinuria was associated with an increased risk of developing hip or vertebral fractures after adjustment for kidney function. Our results highlight the clinical importance of checking proteinuria for predicting bone fractures.

Diagnostic Value of Dipstick Test (Leukocyte Esterase and Nitrite) in Diagnosis of Urinary Tract Infection

Background: The accurate UTI diagnosis is crucial in the laboratory. Objective: The objective was to assess the sensitivity and specificity of the nitrite test, leukocyte esterase, both nitrite and leukocyte esterase, and urine microscopy in UTI diagnosis. Methodology: This was a cross-sectional study in which 100 adult patients, who were suspected to have UTI and did not receive antibiotics for at least 1 week, were included in this study performed in Shahabuddin Medical College and Hospital, Gulshan-2, Dhaka. Urine samples were collected and sent to laboratory for urine analysis and urine culture. Nitrite and leukocyte esterase dipsticks tests were done as well. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were measured for nitrite, leukocyte esterase, both nitrite and leukocyte esterase. Results: According to the results of the urine dipstick test, microscopy, and urine culture, nitrite was positive in 17.0% of the cases, leukocyte esterase was positive in 53.0% of the cases, both nitrite and leukocyte esterase were positive in 17.0% of the cases, urine microscopy was positive in 71.0% of the cases, and urine culture was positive in 41.0% of the cases. In the detection of urinary tract infections, the sensitivity, specificity, PPV, and NPV of leukocyte esterase were 87.8%, 71.2%, 67.9%, and 89.4% respectively, using urine culture as the gold standard test. Based on urine culture as gold standard test, the sensitivity, specificity, PPV, and NPV of both nitrite and leukocyte esterase were 34.1%, 94.9%, 82.4%, and 67.5% respectively, in detecting urinary tract infections. Conclusions: Efficacy of leukocyte esterase was found better in detecting UTI comparing nitrite test. Escherichia coli is the most common isolated organism. Bangladesh Journal of Medical Microbiology, July 2023;17(2):55-59

In house-development of a rapid immunochromatographic test for the detection of Escherichia coli in urine samples

Urinary tract infections (UTIs) are a common health concern. Urine culture is the “gold standard” for UTI diagnosis but takes 48h. Rapid methods like dipstick tests are used as point-of-care tests. However, their sensitivity and specificity are variable. In this work, a rapid immunochromatographic test (IT) for detecting Escherichia coli in urine was developed, and its performance was evaluated in urine samples from patients with suspected UTI. The “universal lateral flow assay kit” was employed using an E. coli capture antibody. One hundred and five (105) urine samples were analyzed using the IT, dipstick test, and urine culture. The sensitivity of the IT was 74.5%, specificity 88.9%, positive predictive value (PPV) 86.3%, and negative predictive value (NPV) 78.7%. The combination of the IT with the dipstick test increases sensitivity to 94.1%, specificity to 66.7%, PPV to 72.7%, and NPV to 92.3%. Using the IT for detecting E. coli in urine could be a valuable technique for UTI screening, showing better specificity and diagnostic precision but lower sensitivity than the dipstick test. Based on these results, we propose that the combined use of both screening techniques would allow a rapid and more precise diagnosis of UTI, rationalizing the indication for empirical antibiotics.

Validation of peritoneal neutrophil gelatinase-associated lipocalin as a biomarker for peritonitis: A comparison between laboratory-base method and rapid stick test

ABSTRACT Background: Neutrophil gelatinase-associated lipocalin (NGAL) is a multifunctional protein with roles beyond biomarker status, influencing critical processes. This study aimed to assess dipstick test for NGAL (NGALds), a novel dipstick test, against the established laboratory-based NGAL (NGALlab) method for early peritonitis detection, focusing on peritoneal fluid analysis to provide a rapid and cost-effective diagnostic tool for peritonitis management. Methods: Conducted at San Bortolo Hospital, Italy, this retrospective study collected samples from suspected or confirmed peritonitis cases between May 1, 2021, and December 31, 2021. Samples included peritoneal dialysate effluents (PDE) and underwent white blood cell counts, NGALds, NGALlab, and effluent culture. Results: The study analyzed 27 peritonitis cases, involving 133 PDE samples from 22 patients. NGALds exhibited a strong correlation (Rs = 0.732, P < 0.05) with NGALlab, particularly for medium to high-risk peritonitis cases, with a 98% accuracy rate. Conclusion: NGALds effectively aligns with NGALlab for peritonitis diagnosis, offering a valuable diagnostic tool, particularly suitable for point-of-care and resource-limited healthcare settings. Further research should investigate its correlation with neutrophil levels in PDE, solidifying NGALds as an accessible and efficient resource for peritonitis management.

Maternal Cardiac Functional and Structural Changes in Preeclampsia: an Echocardiographic Study

Background & objective: Preeclampsia is a pregnancy-induced multi-organ syndrome of acute cardiovascular manifestations with significant short and long-term sequelae. However, there is a relative lack of knowledge with respect to cardiac functional and structural changes in women with preeclampsia Therapeutic interventions used in the management of preeclampsia may cause iatrogenic adverse consequences due to this lack of knowledge. The present study was therefore designed to evaluate the echocardiographic changes in cardiac structural and functional indices in pregnant women with PE. Methods: This cross-sectional study was carried out in the Department of Obstetrics and Gynaecology Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College Hospital (DMCH), and Shaheed Suhrawardy Medical College Hospital (SSMCH) in collaboration with National Institute of Cardiovascular Diseases (NICVD), Dhaka over a period of one year from July 2013 to June 2014. A total of 30 single-tone pregnant women of 20-40 weeks gestation with preeclampsia were taken as cases. An equal number of gestationally-matched healthy pregnant (HP) women of similar age cohorts having no history of preexisting hypertension were included as controls. Preeclampsia was defined as SBP ≥140and/or DBP ≥ 90 mmHg after 20 weeks gestation in a woman with previously normal blood pressure and with proteinuria≥1 + in the dipstick test. Pregnant women with systolic and diastolic blood pressures within the normal range (< 140mmHg and > 90 mmHg respectively), trace or absence of proteinuria by dipstick test were defined as controls. All thesubjects were investigated with ECG, standard two-dimensional, M-mode, and Doppler transthoracic echocardiography. The cardiac functional and structural changes were measured in terms of interventricular septal thickness (IVSTd),posterior wall thickness (PWTd), left ventricular internal diameter at the end of diastole (LVIDd), ejection fraction (EF), transmitral velocity (MV E/A ratio), MV deceleration time (MV DecT). Result: Half of the women with preeclampsia were primigravidae and there was no association between gravidity and the occurrence of preeclampsia. Prepregnancy overweight or obesity (in terms of BMI) was found to be strongly associated with preeclampsia. One in 10 PE women had a previous history of preeclampsia as opposed to none in the HP women. A substantial proportion (56.7%) of PE women had a family history of hypertension in comparison to healthy pregnant women (16.3%). The women with PE had significantly higher SBP, DBP, & MAP than the HP women. Parameters of diastolic dysfunction, like mitral E/A ratio was reduced and deceleration time was prolonged in PE with diastolic dysfunction (mean E/A ratio < 0.73 and mean DceT >178 ms respectively) than those in PE with normal diastolic function (mean E/A ratio 1.2 and mean DceT 192.4 ms respectively) healthy pregnant women (mean E/A ratio 1.3 and mean DecT 186.5 ms respectively). Over one-third (36.7%) of women with PE met the criteria of diastolic dysfunction compared to none in healthy pregnant women. The LVH appears to be a frequent occurrence in pregnancies complicated by preeclampsia (43.3%) as compared to none in healthy pregnant women. In the present study, the systolic function was assessed with the help of EF, which was well-preserved both in PE and HP with no significant intergroup difference. Conclusion: Preeclampsia is associated with left ventricular diastolic dysfunction and hypertrophy preserving the systolic function. These structural and functional changes are primarily adaptive in nature for maintaining cardiac systolic function. Ibrahim Card Med J 2022; 12 (2): 32-39

Neutrophil Gelatinase-Associated Lipocalin in Peritoneal Dialysis-Related Peritonitis: Correlation with White Blood Cells over Time and a Possible Role as the Outcome Predictor

Introduction: The present study aimed to monitor peritoneal neutrophil gelatinase-associated lipocalin (pNGAL) during peritonitis episodes and to enhance its diagnostic value by evaluating pNGAL at scheduled times in parallel with white blood cell (WBC) count. In addition, we investigated possible correlations between pNGAL and the etiology of peritonitis, evaluating it as a possible marker of the clinical outcome. Methods: Twenty-two patients with peritoneal dialysis (PD)-related peritonitis were enrolled. Peritonitis was divided into Gram-positive, Gram-negative, polymicrobial, and sterile. WBC count and neutrophil gelatinase-associated lipocalin (NGAL) in PD effluent were measured at different times (days 0, 1, 5, 10, 15, and/or 20 and 10 days after antibiotic therapy discontinuation). NGAL was measured by standard quantitative laboratory-based immunoassay and by colorimetric NGAL dipstick (NGALds) (dipstick test). Results: We found strong correlations between peritoneal WBC, laboratory-based NGAL, and NGALds values, both overall and separated at each time point. On day 1, we observed no significant difference in WBC, both NGALds (p = 0.3, 0.9, and 0.2) between Gram-positive, Gram-negative, polymicrobial, and sterile peritonitis. No significant difference has been found between de novo versus relapsing peritonitis for all markers (p > 0.05). We observed a parallel decrease of WBC and both NGAL in patients with favorable outcomes. WBC count and both pNGAL resulted higher in patients with negative outcomes (defined as relapsing peritonitis, peritonitis-associated catheter removal, peritonitis-associated hemodialysis transfer, peritonitis-associated death) at day 10 (p = 0.04, p = 0.03, and p = 0.05, respectively) and day 15 (p = 0.01, p = 0.04, and tendency for p = 0.005). There was a tendency toward higher levels of WBC and NGAL in patients with a negative outcome at day 5. No significant difference in all parameters was proven at day 1 (p = 0.3, p = 0.9, p = 0.2) between groups. Conclusion: This study confirms pNGAL as a valid and reliable biomarker for the diagnosis of PD-peritonitis and its monitoring. Its trend is parallel to WBC count during peritonitis episodes, in particular, patients with unfavorable outcomes.

MO45-2 Usefulness of urine dipstick test in the management of adverse events associated with immune checkpoint inhibitors

MO45-2 Usefulness of urine dipstick test in the management of adverse events associated with immune checkpoint inhibitors

Diagnostic evaluation of leukocyte esterase reagent strip in bedside rapid diagnosis of spontaneous bacterial peritonitis in cirrhotic patients

Background: Spontaneous bacterial peritonitis (SBP) is the most common and serious infection of liver cirrhosis patients with ascites. If not intervened with early antibiotic treatment leads to high morbidity and mortality. Thus, early diagnosis and treatment of SBP are needed for survival. Leukocyte esterase reagent can aid in early diagnosis. Aims and Objectives: This study aimed to assess the diagnostic accuracy of the leukocyte esterase dipstick test for the diagnosis of SBP in resource poor settings. Materials and Methods: This cross-sectional study was conducted during August 2018–January 2019 on patients with cirrhotic liver disease and ascites in a tertiary care medical college hospital, Puducherry. All patients underwent abdominal paracentesis, and ascitic fluid was subjected to cell counts, biochemistry tests, culture, and leukocyte esterase test (Multistrix SG8- Seimens) at 120 s and graded with five levels. Grade 3 was positive (125 polymorphonuclear leukocytes [PMNL]/mL) and grade 4 (<500/mL), which exceeds the threshold for SBP (<250 PMNL/mL). Sensitivity, specificity, positive, and negative predictive value (PPV and NPV) was calculated. Results: A total of 50 ascitic fluids were analyzed. Nine out of 50 (18%), 16 (32%), and 4 (8%) were positive for cell count method, Leucocyte esterase reagent (LER) test and culture, respectively. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy for LER test were 6.25%, 91.18%, 25%, 67.39%, and 64%, respectively. Conclusion: The LER strip test is useful for SBP diagnosis in an emergency and resource poor setting. It provides good diagnostic accuracy and high NPV and it is cost effective and better bedside tool for SBP diagnosis.

Development and validation of a parsimonious prediction model for positive urine cultures in outpatient visits

Urine culture is often considered the gold standard for detecting the presence of bacteria in the urine. Since culture is expensive and often requires 24-48 hours, clinicians often rely on urine dipstick test, which is considerably cheaper than culture and provides instant results. Despite its ease of use, urine dipstick test may lack sensitivity and specificity. In this paper, we use a real-world dataset consisting of 17,572 outpatient encounters who underwent urine cultures, collected between 2015 and 2021 at a large multi-specialty hospital in Abu Dhabi, United Arab Emirates. We develop and evaluate a simple parsimonious prediction model for positive urine cultures based on a minimal input set of ten features selected from the patient’s presenting vital signs, history, and dipstick results. In a test set of 5,339 encounters, the parsimonious model achieves an area under the receiver operating characteristic curve (AUROC) of 0.828 (95% CI: 0.810-0.844) for predicting a bacterial count ≥ 105 CFU/ml, outperforming a model that uses dipstick features only that achieves an AUROC of 0.786 (95% CI: 0.769-0.806). Our proposed model can be easily deployed at point-of-care, highlighting its value in improving the efficiency of clinical workflows, especially in low-resource settings.

Kidney outcomes associated with haematuria and proteinuria trajectories among patients with IgA nephropathy in real-world clinical practice: The Japan Chronic Kidney Disease Database.

Among patients with Immunoglobulin A (IgA) nephropathy, we aimed to identify trajectory patterns stratified by the magnitude of haematuria and proteinuria using repeated urine dipstick tests, and assess whether the trajectories were associated with kidney events. Using a nationwide multicentre chronic kidney disease (CKD) registry, we analysed data from 889 patients with IgA nephropathy (mean age 49.3 years). The primary outcome was a sustained reduction in eGFR of 50% or more from the index date and thereafter. During follow-up (median 49.0 months), we identified four trajectories (low-stable, moderate-decreasing, moderate-stable, and high-stable) in both urine dipstick haematuria and proteinuria measurements, respectively. In haematuria trajectory analyses, compared to the low-stable group, the adjusted hazard ratios (HRs) (95% confidence interval [CI]) for kidney events were 2.59 (95% CI, 1.48-4.51) for the high-stable, 2.31 (95% CI, 1.19-4.50) for the moderate-stable, and 1.43 (95% CI, (0.72-2.82) for the moderate-decreasing groups, respectively. When each proteinuria trajectory group was subcategorized according to haematuria trajectories, the proteinuria group with high-stable and with modest-stable haematuria trajectories had approximately 2-times higher risk for eGFR reduction ≥50% compared to that with low-stable haematuria trajectory. Assessments of both haematuria and proteinuria trajectories using urine dipstick could identify high-risk IgA nephropathy patients.

İdrar Kültürlerinden İzole Edilen Escherichia Coli Suşlarının Antibiyogramlarının Değerlendirilmesi

Objective: Our aim in this study is to determine the antimicrobial resistance profiles of Escherichia coli strains known to cause urinary tract infections most frequently in the region, to obtain microbiological data about their current status, and to contribute to the development of clinical strategies for the prevention and management of these infections.
 Materials and methods: Our study includes patients with E. coli isolated from urine cultures. In the study, urine cultures and antibiograms of patients between January 2019 and January 2020 were scanned retrospectively. 662 patients over the age of 18 were included in the study. The files of the patients included in the study, the information registered in the system and the pre-filled forms were examined by examining age, gender, reproductive status in urine cultures, ESBL status, antibiograms, hospitalization status, admission outpatient clinic, reason for hospitalization, chronic and additional diseases, symptom status, the blood, nitrite, leukocyte parameters in the urinary dipstick test and the antibiotic treatment started were recorded.
 Results: The antibiotics most frequently resistant to E. coli strains were cefuroxime (88.5%), tobramycin (75%), ceftazidime (72.9%), cefepime (59.5%) and ampicillin (57.5%). The antibiotics with the highest sensitivity were imipenem (100%), amikacin (99.1%), meropenem (98.2%), nitrofurantoin (96.3%) and fosfomycin (96.3%). It was observed that 25.7% of E. coli strains were ESBL positive.
 Conclusion: Our findings showed that E. coli strains, which are the most common causative agents of urinary tract infections, have high resistance to many antibiotics commonly used in treatment. Considering the local resistance rates in empirical treatment and starting the treatment by making a urine culture will guide the treatment. As a result of our research, we think that the use of fosfomycin and nitrofurantoin in uncomplicated infections and the use of carbapenems and aminoglycoside antibiotics in complicated infections and upper urinary tract involvement are appropriate in the empirical treatment of urinary tract infections.

A Comparative Study of Rapid Trypsinogen 2 Strip Test Versus Serum Amylase and Serum Lipase in Diagnosis of Acute Pancreatitis in A Tertiary Care Hospital, Salem

Aims & Objectives: To assess the diagnostic usefulness of a quick urine trypsinogen 2 strip test to blood amylase and lipase in instances with acute pancreatitis. Methods: Patients who may have an acute pancreatitis diagnosis and have recent onset of stomach pain are included. In these cases, serum samples of amylase and lipase are sent before a urine sample is examined using a dipstick test for urinary trypsinogen-2. Fifty-two participants were included in the research. Ultrasound and CECT abdomen were used to monitor patients and confirm the diagnosis. A number of metrics were computed and compared, including sensitivity, specificity, PPV, NPV, and accuracy. Result: During June 2022 and June 2023, 52 consecutive patients complaining of upper abdominal discomfort were included in the research. Acute pancreatitis was the diagnosed diagnosis in 45 of the 52 patients, whereas other causes of abdominal discomfort were present in 7 individuals. The pee dipstick test was positive in 44 of the 45 instances, but was negative in 5 of the 7 cases when the discomfort in the abdomen was caused by anything other than a urinary tract infection. It was shown to have a 97.78 percent sensitivity, a 71.43 percent specificity, and a 94.23 % accuracy. Conclusion: Acute pancreatitis may be diagnosed quickly and easily with a fast urine trypsinogen-2 test. This study shows that the dipstick test is just as accurate as the gold standard procedures and may be used alternately with them.

Application of delta gap equation for the assessment of metabolic acidosis in renal failure patients

Introduction: Metabolic acidosis is commonly encountered in chronic kidney disease (CKD) which contributes to its progression. The metabolic acidosis in chronic kidney disease is presumed to be due to accumulation of unmeasured anions leading to a high anion gap (AG). The aim of the study was to assess the metabolic acidosis in renal failure patients using the calculation of delta gap. Methods: 100 renal failure cases were included. Their abnormal urea and creatinine values were utilized to calculate the BUN/creatinine ratio for all the cases. Based on the dipstick urine testing grading, proteinuric renal diseases were identified. The urine and serum osmolality were calculated in these renal failure patients. Serum osmolality was calculated using the values of serum sodium and urea. Urinary density which is also called urine specific gravity was used for indirect calculation of urine osmolality. Modified delta gap equation was applied for quick evaluation of mixed metabolic acid-base disorders. Results: Out of the 100 cases, 41 were proteinuric renal disease cases and 59 were non-proteinuric renal disease cases. High anion gap metabolic acidosis were seen in 65% of the total 100 cases. In 33% of the total cases, non-anion gap metabolic acidosis was also seen in addition to the high anion gap metabolic acidosis as it is evidenced by the delta gap value of less than -6 mmol/L. Conclusions: Earlier identification of the type and causative mechanism of metabolic acidosis in these patients may help to decrease the morbidity and mortality of these patients. The delta gap that can be easily calculated using this quick and short equation at the bedside may serve as a marker in the management of metabolic acidosis in renal failure patients. Keywords: delta gap; modified quick equation; metabolic acidosis; renal failure

S117 Diagnostic Accuracy of the Urine trypsinogen-2 Dipstick Test in Early Post-ERCP Pancreatitis Prediction

S117 Diagnostic Accuracy of the Urine trypsinogen-2 Dipstick Test in Early Post-ERCP Pancreatitis Prediction

Urinary Tract Infection Bacteria Classification: Artificial Intelligence-based Medical Application

Urinary tract infection (UTI) is a type of health disorder, an infection in the urinary glands mainly caused by bacteria. Currently, conventional early detection methods that have been established involve rapid dipstick strip test and urine culture analysis, which have suboptimal accuracy and effectiveness. Several retrospective studies regarding UTI bacteria classification have shown promising results, but still have limitations regarding prediction accuracy and technical simplicity. This study aims to implement a method based on artificial intelligence (AI) in classifying images of bacteria that causes UTIs. Eight artificial intelligence methods based on deep neural networks were used in the study; the models were evaluated and compared based on the prediction's effectiveness and accuracy. This study also seeks to create the easiest method of classifying bacteria causing UTIs using a computer-based application with the best obtained AI-based model. The best training results using an intelligent approach placed DenseNet201 as the method with the highest accuracy (83.99%). Then, the output model was used as a knowledge reference for the designed computer-based application. Real-time prediction results will appear in the application window.

Biomarker-confirmed suboptimal adherence to isoniazid preventive therapy among children with HIV in western Kenya.

The aim of this study was to assess the level and correlates of biomarker-confirmed adherence to isoniazid (INH) preventive therapy (IPT) among children with HIV (CLHIV). This prospective cohort study assessed adherence among CLHIV on IPT in public sector HIV clinics from 2019 through 2020. Adherence was assessed by pill counts or caregiver or self-reports, and urine biomarkers (in-house dipstick and Isoscreen). Both urine biomarker tests detect INH metabolites within 48 h of ingestion. Consistent adherence was defined as having positive results on either biomarker at all visits. Correlates of biomarker-confirmed nonadherence at each visit were evaluated using generalized estimating equations. The in-house dipstick was validated using Isoscreen as the reference. Among 97 CLHIV on IPT with adherence assessments, median age was 10 years (IQR 7-13). All were on ART at IPT initiation (median duration 46 months [IQR 4-89]); 81% were virally suppressed (<1000 copies/ml). At all visits, 59% ( n = 57) of CLHIV reported taking at least 80% of their doses, while 39% ( n = 38) had biomarker-confirmed adherence. Viral nonsuppression (adjusted risk ratio [aRR] = 1.65; 95% confidence interval [95% CI] 1.09-2.49) and the sixth month of IPT use (aRR = 2.49; 95% CI 1.34-4.65) were independent correlates of biomarker-confirmed nonadherence at each visit. Sensitivity and specificity of the in-house dipstick were 98.1% ( 94.7 - 99.6%) and 94.7% ( 88.1 - 98.3%) , respectively, versus Isoscreen. Biomarker-confirmed adherence to IPT was sub-optimal and was associated with viral nonsuppression and duration of IPT. Urine dipstick testing may be useful in assessing adherence to IPT in clinical care.

B-037 Comparison of Performance between Siemens Clinitek + Status Analyzer to ARKRAY AUTION MAX AX-4030 for Suspected Urinary Tract Infections

Abstract Background The purpose of the study is to evaluate the performance and agreement of the rapid point-of-care (POCT) urine dipstick testing in the emergency department (ED) to a laboratory-automated platform. Methods A total of 30 urine specimens were collected from the emergency department at our hospital and were simultaneously tested for urinalysis (UA) on the POCT Siemens Clinitek Status+ analyzer using the Multistix 10SG strip. In the laboratory, we performed the tests on the automated ARKRAY Aution MAXTM instrument, using the Aution Sticks 9EB strips. Samples with more than a trace of leukocyte esterase and/or nitrates are considered positive for a urinalysis and further, the samples were reflexed to urine culture. The performance of both platforms was analyzed using EP Evaluator (Data Innovations LLC.). Results A total of 30 urine specimens were analyzed for UA using both the POCT and automated laboratory analyzers. The agreement (95% CI) between leukocyte esterase, nitrites, and blood are as follows: 53.3% (36.1 to 69.8%); 96.7% (83.3 to 99.4%), and 70.0% (52.1 to 83.3%) (see Table 1). Furthermore, out of the 30 specimens that were tested on both platforms, there was prominent discordance between the POCT and lab UA test. The 7 urine samples that were negative on POCT were positive on the laboratory UA platform. All 7 were sent for urine culture, out of 7 only 1 sample was positive for culture which was abnormal: &amp;gt;100 000 CFU/ml Escherichia coli. Out of 30 urine samples specimens that were tested on both platforms, 23 urine samples were in concordance with both platforms out of which 8 urine samples tested positive for culture (5 were E. coli, 1 was E. coli combined with Klebsiella pneumoniae, 1 was solely Klebsiella pneumoniae, 1 was Staphylococcus saprophyticus, and 1 was Streptococcus agalactiae). The remaining 15 urine samples resulted in no significant growth of bacteria or suggesting contamination. The sensitivity of POCT UA and laboratory-performed UA was 89% and 100% respectively. Furthermore, the specificity of POCT UA and laboratory-performed UA was 36% and 7% respectively. Conclusion Our data shows although POCT UA is rapid, a prominent disparity is observed between the POCT UA and automated lab testing. The lab-performed UA has greater sensitivity and specificity compared to the POCT UA. Clinicians should interpret the urine dipstick test results in a clinical context that includes the patient’s history and symptoms, especially when using POCT in the ED.

Progress in the Diagnostic and Predictive Evaluation of Crush Syndrome.

Crush syndrome (CS), also known as traumatic rhabdomyolysis, is a syndrome with a wide clinical spectrum; it is caused by external compression, which often occurs in earthquakes, wars, and traffic accidents, especially in large-scale disasters. Crush syndrome is the second leading cause of death after direct trauma in earthquakes. A series of clinical complications caused by crush syndrome, including hyperkalemia, myoglobinuria, and, in particular, acute kidney injury (AKI), is the main cause of death in crush syndrome. The early diagnosis of crush syndrome, the correct evaluation of its severity, and accurate predictions of a poor prognosis can provide personalized suggestions for rescuers to carry out early treatments and reduce mortality. This review summarizes various methods for the diagnostic and predictive evaluation of crush syndrome, including urine dipstick tests for a large number of victims, traditional and emerging biomarkers, imaging-assisted diagnostic methods, and developed evaluation models, with the aim of providing materials for scholars in this research field.

Comparison of three spot proteinuria measurements for pediatric nephrotic syndrome: based on the International pediatric Nephrology Association 2022 Guidelines

Background Pediatric nephrotic syndrome (NS) requires routine proteinuria monitoring, which is costly and affects patients’ quality of life. The gold-standard 24-h urine protein (UP) measurement is challenging in children, and first-morning urine collection requires specific conditions, making it difficult in outpatient settings. Studies have reported comparability of second or random morning urine sample to the first-morning specimen. This study aimed to compare outcomes of random morning proteinuria measurements to 24-h UP and the roles of the urinary protein creatinine ratio (UPCR) and dipstick tests in pediatric NS, based on International Pediatric Nephrology Association (IPNA) 2022 Guidelines. Method Twenty-four-hour and morning urine samples were collected from 92 pediatric NS patients. These were subjected to automated analyses for 24-h UP, UPCR, and semi-automated dipstick analysis. A blinded doctor performed manual dipstick analysis. Results UPCR had a stronger correlation with 24-h UP than with automated and manual urine dipstick tests. UPCR had the highest sensitivity and specificity for predicting no remission/relapse and high sensitivity but low specificity for complete remission. The optimal UPCR cutoff for remission was 0.44 mg/mg and for no remission/relapse was 2.08 mg/mg. Automated and manual dipstick tests demonstrated limited sensitivity but high specificity and similar AUC values for remission/relapse. Conclusion UPCR was sensitive and specific for diagnosing no remission/relapse and sensitive but not specific for detecting remission. Manual and automated urine dipstick tests were comparable for remission and no remission/relapse detection. This study supports the IPNA 2022 Guidelines, as 2 mg/mg was the optimal UPCR cutoff for no remission/relapse, while for remission the optimal cutoff was 0.4 mg/mg.

URINARY TRACT DISEASES IN MALE PERISAN CAT

Urinary tract diseases are one of the various problems that can occur in pets, especially cats. Urolithiasis, kidney failure, urinary tract infections are examples of disorders of the urinary tract which are often a problem in cats. This treatment aims to discuss diagnostic and treatment techniques in Persian cats with urinary tract disorders. A 3-year-old male Persian cat came to the Teaching Animal Hospital, Udayana University, because he had dysuria and had hematuria 3 months ago before being examined. Supporting examinations include a complete blood count, ultrasound examination, dipstick test and urine sedimentation examination. Blood tests showed that the cat had leukocytosis, ultrasonography showed hyperechoic crystalline particles of urine in the lumen of the urinary bladder, thickening of the muscularis part of the bladder wall and results of urine sedimentation showed crystals of magnesium ammonium phosphate (struvite) and calcium oxalate. The diagnosis is LUTD due to thickening of the muscularis wall of the VU and the presence of struvite and calcium oxalate crystals. with a faustal prognosis. The treatment given was insertion of a urinary catheter, administration of the antibiotic ciprofloxacin (PO) and dexamethasone (PO) anti-inflammatory drugs, as well as the herbal medicine Kejibeling® orally for 5 days. After a week of treatment, the cat can urinate smoothly. The diagnostic and therapeutic methods provided help treat cases of urinary tract disorders. Good condition monitoring and maintenance management are required during the maintenance period.