Circular fertilisers combining dehydrated human urine and organic wastes can fulfil the macronutrient demand of 15 major crops.

This study evaluated the potential for combining dehydrated human urine with one other form of organic waste to create circular fertilisers tailored to meet the macronutrient demand of 15 major crops cultivated globally. Through a reverse blending modelling approach, data on 359 different organic wastes were used to identify 38 fertiliser blends. Materials found to be particularly suitable as blending materials were various biochars and ashes, due to their low nitrogen and high phosphorus and/or potassium content, and byproduct concentrates, due to their high phosphorus content, since the nitrogen content of human urine is disproportionately higher than its phosphorus content. Several organic wastes were suitable for fertilising more than one crop. The macronutrient content of the simulated fertiliser blends was comparable to that of blended inorganic fertilisers, but only a few blends precisely matched the macronutrient demand of crops. Fertilising crops with some simulated fertilisers would potentially result in excess application of one or more macronutrients, and thus overfertilisation. For organic wastes with data available on their content of six or more heavy metals, it was found that the simulated fertilisers generally met European Union regulations on use of fertilisers of organic origin in agriculture. Overall, these findings suggest that fertiliser blends combining dehydrated human urine and organic wastes, both of which are widely available globally, could replace inorganic blended fertilisers in agriculture. Such recycling would help the global food system and water sector transition to circularity and promote better management of plant-essential nutrients in society.

Non-invasive urine-based ELISA using a recombinant Leishmania protein to diagnose tegumentary leishmaniasis.

The diagnosis of tegumentary leishmaniasis (TL) is hampered by variable sensitivity and/or specificity of the tests. Serological assays are suitable to diagnose visceral leishmaniasis (VL); however, they present low performance for the detection of TL cases. Additionally, blood collection to obtain patient serum represents a challenge, as it is an invasive and uncomfortable procedure, requiring laboratorial infrastructure and trained professionals. In this context, the present study proposed to evaluate patient urine to detect TL, given that this analyte has proven to be effective in ELISA experiments for the detection of VL cases. For this, a Leishmania protein called LiHyV, two specific B-cell epitopes derived from protein amino acid sequence, and a Leishmania antigenic extract (SLA) were used as antigens. A total of 215 paired urine and serum samples were evaluated, and results showed that, when serum was employed as an analyte, rLiHyV, Peptide1, Peptide2, and SLA presented a sensitivity of 85 %, 29 %, 58 %, and 31 %, respectively, and a specificity of 97.5 %, 98 %, 100 %, and 97.5 %, respectively, in the diagnosis of TL. When urine was used, rLiHyV, Peptide1, Peptide2, and SLA presented a sensitivity of 95 %, 74 %, 67 %, and 52 %, respectively, and a specificity of 100 %, 99 %, 98 %, and 86 %, respectively. In conclusion, preliminary data suggest that urine could be considered as an alternative biological sample for the detection of TL cases.

Removal of phenazopyridine from water, synthetic urine, and real sample by adsorption using graphene oxide: A DFT theoretical/experimental approach.

Herein, graphene oxide was used as the highly efficient phenazopyridine adsorbent from aqueous medium, synthetic, and human urine. The nanoadsorbent was characterized by different instrumental techniques. The adsorption capacity (1253.17 mg g-1) was reached at pH 5.0, using an adsorbent dosage of 0.125 g L-1 at 298 K. The Sips and Langmuir described the equilibrium data well. At the same time, the pseudo-second order was more suitable for fitting the kinetic data. Thermodynamic parameters revealed the exothermic nature of adsorption with an increase in randomness at the solid-liquid interface. The magnitude of the enthalpy variation value indicates that the process involves the physisorption phenomenon. At the same time, ab initio molecular dynamics data corroborated with the thermodynamic results, indicating that adsorbent and adsorbate establish hydrogen bonds through the amine groups (adsorbate) and hydroxyl groups on the adsorbent surface (weak interactions). Electrostatic interactions are also involved. Additionally, the adsorption assays conducted in simulated medium and human urine showed the excellent performance of adsorbent material to remove the drug in real concentrations excreted by the kidneys (removal values higher than 60%).

The applicability of the urine color scale in pediatric urology.

AIMS: To determine the level of agreement between healthcare professionals, patients and their parents/guardians in the interpretation of the urine color scale (UCS) in cases of urinary dysfunction, analyzing the applicability of the scale as a diagnostic tool determining the hydration status. METHODS: This was a cross-sectional study involving 5-17-year-old patients with lower urinary tract symptoms (LUTS) and enuresis. The study was conducted in a public healthcare referral center for pediatric urology in the Brazilian state of Bahia between October 2019 and March 2020. The Kolmogorov-Smirnov test was used to assess the distribution of the variables. Agreement was assessed using the kappa coefficient and weighted kappa. The z-test was used to determine significant differences between the kappa and weighted kappa. The statistical analysis was conducted using SPSS, version 14, and significance was established at p < 0.05. RESULTS: Forty-four patients were included. The kappa value was 32.4% (p = 0.000) for the agreement between healthcare professionals and patients, 41.9% (p = 0.000) for agreement between healthcare professionals and parents/guardians, and 25.0% (p = 0.001) for agreement between patients and parents/guardians. The weighted kappa was 70.6% (p = 0.000) for agreement between healthcare professionals and patients, 82.4% (p = 0.000) for agreement between healthcare professionals and parents/guardians, and 51.5% (p = 0.001) for agreement between patients and parents/guardians. There was a statistically significant difference in kappa values when the healthcare professionals were compared with the other groups. CONCLUSIONS: Although there were some inconsistencies in interpretation, the UCS proved to be a useful tool with which to evaluate patients' hydration status.

Presence of intracellular bacterial communities in uroepithelial cells, a potential reservoir in symptomatic and non-symptomatic people.

BACKGROUND: Urinary tract infection is one of the most common infections in humans, affecting women in more proportion. The bladder was considered sterile, but it has a urinary microbiome. Moreover, intracellular bacteria (IB) were observed in uroepithelial cells from children and women with urinary tract infections (UTIs). Here, we evaluated the presence of IB in urine from healthy people and patients with UTI symptoms. METHODS: Midstream urine was self-collected from 141 donors, 77 females and 64 males; 72 belonged to the asymptomatic group and 69 were symptomatic. IB was characterized by a culture-dependent technique and visualized by confocal microscopy. Urine was also subjected to the classical uroculture and isolated bacteria were identified by MALDI-TOF. RESULTS: One-hundred and fifteen uroculture were positive. A significant association was observed between the presence of symptoms and IB (P = 0.007). Moreover, a significant association between the presence of IB, symptoms and being female was observed (P = 0.03). From the cases with IB, Escherichia coli was the most frequent microorganism identified (34.7%), followed by Stenotrophomonas maltophilia (14.2%), Staphylococcus spp (14.2%), and Enterococcus faecalis (10.7%). Intracellular E. coli was associated with the symptomatic group (P = 0.02). Most of the intracellular Staphylococcus spp. were recovered from the asymptomatic group (P = 0.006). CONCLUSIONS: Intracellular bacteria are present in patients with UTI but also in asymptomatic people. Here, we report for the first time, the presence of S. maltophilia, Staphylococcus spp., and Enterobacter cloacae as intracellular bacteria in uroepithelial cells. These findings open new insights into the comprehension of urinary tract infections, urinary microbiome and future therapies. Uroculture as the gold standard could not be enough for an accurate diagnosis in recurrent or complicated cases.

Prácticas clínicas para el manejo de la bacteriuria asintomática preoperatoria en cirugía endourológica de litiasis urinaria / Clinical practices for the management of preoperative asymptomatic bacteriuria in endourological surgery for urolithiasis

Objetivo: Describir las prácticas de médicos especialistas en urología e infectología con práctica clínica en Colombia para el manejo de la bacteriuria asintomática (BA) preoperatoria de pacientes candidatos a cirugía de cálculos urinarios. Método: Estudio de corte transversal, con recolección de datos por medio de instrumento tipo encuesta, diligenciada por especialistas en urología e infectología en Colombia. Se excluyeron las encuestas con respuestas incompletas o participantes con práctica clínica fuera de Colombia. El análisis estadístico se realizó en SPSS v25.0. Se consideró significativa una p < 0,05. Resultados: Se incluyeron 187 participantes, 85% urólogos y 15% infectólogos. La conducta prequirúrgica más frecuente en el manejo de la BA preoperatoria fue iniciar tratamiento antibiótico dirigido por urocultivo 72 horas antes del procedimiento quirúrgico y llevar al paciente a cirugía dentro de los siguientes tres días. Se evidenciaron diferencias en la práctica clínica (uso de antibiótico postoperatorio, tratamiento de la BA en pacientes con derivación urinaria, tiempo de validez del urocultivo preoperatorio, recomendación de diferir procedimiento hasta tener urocultivo negativo) según la especialidad y el volumen asistencial. Conclusiones: Se ha identificado heterogeneidad en el manejo de la BA previo a cirugía endourológica en Colombia. Se abre una oportunidad para desarrollar recomendaciones colombianas para el manejo de la BA preoperatoria en urolitiasis

Objective: To describe practices from Colombian specialists in urology and infectology for the handling of preoperative asymptomatic bacteriuria (AB) in patients that are candidates for endourological surgery of urolithiasis. Method: Cross-sectional study, with data collection through a survey-type instrument completed by specialists in urology and infectology in Colombia. Surveys with incomplete responses or participants with clinical practice outside of Colombia were excluded. Statistical analysis was performed in SPSS v25.0. A p < 0.05 was considered significant. Results: One hundred eighty-seven participants were included, of which 85% were urologists and 15% were infectologists. The most frequent presurgical behavior in the management of preoperative AB was to start targeted antibiotic treatment 72 hours before the procedure and take the patient to surgery within the next three days. Differences were evident in clinical practice (use of postoperative antibiotics, treatment of AB in patients with urinary diversion, validity period of the preoperative urine culture, recommendation to defer the procedure until a negative urine culture is obtained) depending on the specialty and surgical or clinical volume. Conclusions: The present study has identified heterogeneity in the management of AB prior to endourological surgery in Colombia. An opportunity opens up for the development of Colombian recommendations for the management of preoperative AB in urinary lithiasi

Abscesos renales: experiencia en un hospital pediátrico de referencia / Renal abscesses: Experience at a referent Pediatric Hospital

INTRODUCCIÓN: El absceso renal es infrecuente en pediatría, con clínica y laboratorio inespecíficos. Ante su sospecha, es necesario realizar imágenes para establecer diagnóstico. Objetivo: Describir las características clínico-epidemiológicas, microbiológicas, diagnósticas y terapéuticas de abscesos renales en pediatría. PACIENTES Y MÉTODOS: Estudio retrospectivo, descriptivo, de pacientes internados con absceso renal, en seguimiento por Infectología del Hospital de Niños Ricardo Gutiérrez, durante 9 años. RESULTADOS: 15 pacientes (67% varones), mediana de edad 9 años (rango [r] 0,7-17). Cuatro pacientes con comorbilidades. El síntoma más frecuente fue fiebre seguido por dolor lumbar. El recuento medio de leucocitos en sangre fue de 15.700/mm3 (r: 7.100-45.000) y la PCR de 193 mg/L (r: 1-362). Cuatro pacientes presentaron urocultivo positivo: dos Escherichia coli, uno Klebsiella pneumoniae y E. coli y otro Candida albicans y K. pneumoniae. Ningún paciente presentó bacteriemia. El diagnóstico se confirmó por ecografía. Se realizó drenaje en siete pacientes, con aislamiento de Staphylococcus aureus en dos y Pseudomonas aeruginosa en uno. El tratamiento incluyó terapia combinada en 67%. Mediana de antibioterapia intravenosa fue 16 días (r: 7-49), total de 28 (r: 14-91). Un paciente requirió terapia intensiva y dos, nefrectomía. CONCLUSIÓN: Los abscesos renales son infrecuentes, con gran morbimortalidad. Sospechar en paciente con infección del tracto urinario (ITU) de evolución tórpida que persiste febril. En nuestro estudio, la alta sensibilidad de la ecografía renal permitió su diagnóstico precoz.

BACKGROUND: Renal abscesses are infrequent in pediatrics, with nonspecific clinical and laboratory findings. When suspected, imaging is essential to establish the diagnosis. Aim: To describe the clinical-epidemiological, microbiological, diagnostic and therapeutic characteristics of renal abscesses in pediatrics. METHODS: Retrospective and descriptive study of hospitalized patients with renal abscess, followed by Infectious Diseases Department of Ricardo Gutiérrez Children's Hospital during 9 years. Statistical analysis: Epi Info 7.2.2.6. RESULTS: 15 patients (67% male), median age 9 years (range [r] 0.7-17) were included. Four patients had underlying disease. The most frequent symptom was fever, with a median duration of 10 days (r:1-36), followed by lumbar pain. The median white blood cell count was 15,700/mm3 (r: 7,100-45,000) and CRP 193mg/L (r: 1-362). Four patients presented positive urine culture: 2 Escherichia coli, 1 Klebsiella pneumoniae and E. coli and 1 Candida albicans and K. pneumoniae. No patient had bacteremia. The diagnosis of abscess was confirmed by ultrasound. Surgical drainage was performed in 7 patients, with isolation of Staphylococcus aureus in 2 and Pseudomonas aeruginosa in 1. Empirical treatment included 3rd generation cephalosporin, combined in 67% of cases. The median of intravenous antibiotic therapy was 16 days (r: 7-49) with a total of 28 days (r:14-91). One patient required transfer to intensive care unit and 2 nephrectomy. CONCLUSION: Renal abscesses are infrecuent in pediatrics, but they present significant morbidity and mortality. It should be suspected in patients with urinary tract infection (UTI)with torpid evolution that persists with fever without antibiotic response. In our study, the high sensitivity of renal ultrasound allowed early diagnosis.

Usefulness of UF-5000 automatic screening system in UTI diagnosis.

We have evaluated the Sysmex UF-5000 cytometer use in microbiology for the screening of negative urines, looking for cut-off points to detect bacteria and leukocytes. The number of processed urines was 3569, the highest to date in these studies. The best general cut-off point has been 100 bact/µl, giving an area under the ROC curve of 0.868, a sensitivity of 96%, a specificity of 50%, 1.17% of false negatives, and saving 40% of cultures. The PPV and NPV have been 35.5 and 95.4 respectively. The leukocyte count has not been useful. Finally, we have evaluated urine screening usefulness, concluding that in laboratories such as ours (284 urines/working day) or smaller, it is not cost-effective.

Citraturia en pacientes pediátricos con urolitiasis / Citraturia in pediatric patients with urolithiasis

La urolitiasis en niños y adolescentes es etiológicamente multifactorial, incluyendo bajo volumen urinario o desequilibrio entre factores promotores e inhibidores de la cristalización urinaria. La hipocitraturia es una alteración bioquímica relacionada con pH urinario acido y dietas ricas en proteínas o deficientes en frutas y hortalizas. Objetivos: determinar los valores urinarios de citrato y de algunos promotores de la cristalización (calcio, ácido úrico y fósforo) en pacientes menores de 18 años con urolitiasis. Métodos: se incluyeron 68 pacientes menores de 18 años con diagnóstico de urolitiasis en quienes se realizaron los siguientes estudios: examen general de orina (muestra aislada), calcio, fosforo, ácido úrico y citrato (recolección de 24 horas), gases venosos, electrolitos séricos y ecosonograma renovesical. En los pacientes hipocitratúricos también se determinó la citraturia después de seis meses de tratamiento con citrato de potasio. Los pacientes se dividieron en dos grupos: grupo A, pacientes normocitratúricos y grupo B, pacientes hipocitratúricos. Resultados: cuarenta y tres pacientes (63%) presentaron antecedentes familiares de litiasis. valores de citraturia (mgs/24hrs): grupo total: X:280±108,8; grupo A: 488,503±112,4; grupo B: X:169,5±95,2. Se evidenció hipocitraturia en 44 pacientes (64,71%). Alteraciones asociadas (n/%): acidosis metabólica (23/33%), de los cuales 20 pacientes (87%) tuvieron hipocitraturia; hiperuricosuria (16/23,52%); hipercalciuria (15/22,05%); hiperfosfaturia (09/13,23%); pH urinario ácido (35/51%) y alcalino o neutro (33/49%); pH urinario persistentemente acido (18/41%). en 28 pacientes (41,17%) se encontraron alteraciones metabólicas mixtas. Conclusiones: la hipocitraturia se encontró en más de la mitad de los pacientes estudiados y se asoció de manera significativa con otras alteraciones metabólicas litogénicas(AU)

Urolithiasis in children and adolescents is etiologically multifactorial, including low urinary volume or imbalance between urinary crystallization promoting and inhibiting factors. Hypocitraturia is a biochemical alteration related to urinary acid pH and diets high in protein or low in fruits and vegetables. Objectives: to determine urinary values of citrate and crystallization promoters (calcium, uric acid and phosphorus) in patients less than 18 years of age with urolithiasis. Methods: sixty-eight patients under 18 years of age with a diagnosis of urolithiasis were submitted to the following studies: urinalysis (isolated urine sample), calcium, phosphorus, uric acid and citrate (24-hour collection), venous gases, serum electrolytes and abdominal ultrasonogram. In hypocytraturic patients, citraturia was also determined after six months of treatment with potassium citrate. Patients were divided into two groups: group A, normocytraturic patients, and group B, hypocytraturic patients. Results:. Forty-three patients (63%) had a family history of urolithiasis. urinary citrate values (mgs/24hrs): total group: X:280±108.8; group A: 488,503±112.4; group B: X:169.5±95.2. hypocitraturia was observed in 44 patients (64.71%). Associated alterations (n/%): metabolic acidosis (23/33%), of which 20 patients (87%) had hypocitraturia; hyperuricosuria (16/23.52%); hypercalciuria 15/22.05%; hyperphosphaturia 9/13.23%; urinary acid pH (35/51%) and alkaline or neutral (33/49%); persistently urinary acid pH (18/41%). Mixed metabolic alterations were found in 28 patients (41.17%). Conclusions: hypocitraturia was found in more than half of the patients and was significantly associated with other lithogenic metabolic alterations(AU)

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

Tira reactiva en orina para el diagnóstico de bacteriuria asintomática en gestantes / Orine reactive strip for diagnosing asymptomatic bacteriuria in pregnant women

INTRODUCCIÓN: Este documento técnico se realiza a solicitud de la Dirección de Salud Sexual y Reproductiva (DSARE) a través de la Dirección General de Intervenciones Estratégicas en Salud Pública. a. Cuadro clínico: Las infecciones urinarias son más frecuentes en las mujeres que en los hombres y esta tendencia se acentúa durante el embarazo debido a cambios fisiológicos. El 2 a 15% de las gestantes, se ve afectada por la bacteriuria asintomática, siendo un problema de salud pública, en algunos lugares en los que este índice es mayor. Se ha demostrado que la bacteriuria no tratada durante el embarazo se asocia con muchas complicaciones, siendo la complicación más frecuente el parto prematuro que se presenta en 5 al 10% de todos los embarazos, siendo causa de morbilidad y mortalidad perinatal, estando relacionado al 75% de las muertes perinatales y al 50% de las secuelas neurológicas. Otras complicaciones son bajo peso al nacer y pielonefritis, esta última condición se presenta con un riesgo de 20 a 30 veces más en las mujeres que tienen bacteriuria, que en las que no tienen la infección(1). Las infecciones del tracto urinario se diagnostican generalmente, mediante muestras de orina y pruebas con tiras reactivas o urocultivos (gold estándar). b. Tecnología sanitária: Una tira reactiva es un instrumento de diagnóstico simple utilizado para realizar un rápido examen físico-químico de orina con el objetivo de detectar algunos cambios patológicos. Consiste en una tira de material plástico o papel, con unas almohadillas impregnadas de reactivos químicos que reaccionan con las sustancias presentes en la orina, produciendo cambios cromáticos característicos, en relación a varias determinaciones simultáneas. Valores altos de leucocitos en la orina, son indicativos de infección urinaria, y son detectados por la tira reactiva a través de la detección de la enzima esterasa leucocitaria. Si bien el aumento de leucocitos está relacionado a infecciones urinarias; las nefritis intersticiales, tóxicas, las infecciones causadas por Trichomonas vaginalis, Chlamydia trachomatis y levaduras producen leucocituria, sin bacteriuria. La tira reactiva detecta la formación de nitritos, por la acción de bacterias reductoras de nitrato, que comúnmente causan infecciones urinarias. Las bacterias gram positivas, también causantes de infecciones urinarias, no son detectadas por este método. El urocultivo estándar se realiza mediante la inoculación de orina, con un asa calibrada, en una placa de agar-sangre (medio de crecimiento) y agar MacConkey (medio selectivo que facilita el desarrollo de la mayoría de las enterobacterias) y sembrando en estrías toda la superficie de la placa para obtener recuentos cuantitativos de colonias. Se incuban las placas aeróbicamente a 35 °C durante 18-20 horas. Cada bacteria viva, da lugar a una colonia, transcurrido el periodo de incubación se cuenta cada colonia de diferente morfología, informando el número de unidades formadoras de colonias por ml de orina (UFC/ml), multiplicando el factor de la alícuota tomada por el número de colonias contadas en la placa. De no observarse crecimiento, el cultivo se informa como "sin crecimiento". En muchos laboratorios se utiliza el medio de CLED (Cistina Lactosa Electrolito Deficiente) como único medio de cultivo, en sustitución del agar-sangre y agar MacConkey (2). El urocultivo, además de permitir identificar los organismos causales de la infección, permite determinar la sensibilidad a los antibióticos. OBJETIVO: Describir la evidencia científica disponible sobre la precisión diagnóstica de la tira reactiva de aplicación en orina, para el diagnóstico de bacteriuria asintomática en gestantes. METODOLOGÍA: Se realizó una búsqueda sistemática en Medline vía Pubmed, Cochrane y LILACS, complementada con la búsqueda en buscadores genéricos (Google Scholar) y literatura gris. Se prioriza guías de práctica clínica (GPC), revisiones sistemáticas (RS) con o sin metanálisis (MA) de ECA, ensayos clínicos aleatorizados controlados (ECA), evaluaciones de tecnología sanitaria (ETS) y evaluaciones económicas (EE) de América Latina. La calidad de la evidencia se valoró usando AMSTAR 2 para RS, la herramienta de evaluación de riesgo de sesgo de la colaboración Cochrane para ECA y AGREE II para las GPC. RESULTADOS: Se seleccionó cinco guías de práctica clínica (3­7) y una revisión sistemática con metanálisis(8) . No se identificaron evaluaciones de tecnología sanitaria ni evaluaciones económicas de la región. En el 2016, Rogozinska E et al., realizaron una revisión sistemática con metanálisis (8), cuyo objetivo fue determinar la exactitud de las pruebas rápidas de bajo costo en el punto de atención, para detectar bacteriuria asintomática en gestantes. Fueron nueve las pruebas evaluadas en 27 estudios (Tabla 11): 1) tiras reactivas con marcador para nitrito, 2) tiras reactivas con marcador para nitrito o leucocitos, 3) análisis de orina con contaje de bacterias (urianálisis), 4) dipslide (Uricult), 5) dipslide con tinción Gram en orina no centrifugada, 6) dipslide (Microstix-3), 7) prueba Griess para detectar nitritos, 8) prueba para reacción de clorhexidina y 9) test de catalasa. CONCLUSIONES: La Organización Mundial de la Salud (OMS) considera que el cultivo de muestras de orina es el método recomendado para diagnosticar la bacteriuria asintomática en gestantes; y en entornos donde no es posible realizar urocultivos, se recomienda realizar in situ la tinción de Gram a muestras de orina antes que usar tiras reactivas. La Revisión Sistemática (RS) seleccionada tuvo un nivel de confianza alta. Las GPC incluidas obtuvieron un puntaje en la valoración global de calidad mayor al 90%. Las pruebas rápidas analizadas en la RS mostraron los siguientes resultados de sensibilidad y especificidad: La sensibilidad agrupada de los dipstick para detección de nitritos positivos fue 55% (IC 95%: 42%- 67%) y la especificidad del 99% (IC 95%: 98% - 99%). La sensibilidad agrupada de los dipstick para la detección de leucocitos o nitritos positivos fue 73% (IC 95% :59% ­ 83%) y una especificidad del 89% (IC95%: 79%­ 94%); La reacción de clorhexidina y test de catalasa (Uriscreen test) contribuyeron a una sensibilidad del 100% (IC95%, 65%­100%) y una especificidad de 54% (IC95%: 46%­62%); el Test de Griess (nitritos) al ser comparado con la prueba de catalasa tuvo una sensibilidad del 65% (IC 95% 50%­78%) con una especificidad del 99% (IC 95% 98%­100%); el urinálisis (conteo de más de 20 bacterias/campo de alto poder [High Power Field (de sus siglas en inglés HPF)] tuvo una sensibilidad del 78% (IC 95%: 45%­94%) y una especificidad del 92% (IC 95%: 88%­94%); Dipslide (Uricult) tuvo una sensibilidad del 92% (IC95%: 69%­100%) y especificidad del 85% (IC95%: 24%­100%); y dipslide con tinción Gram en orina no centrifugada tuvo una sensibilidad de 86% (IC 95% 80%­91%) y una especificidad del 97% (IC95% 93%­ 99%); y el Dipslide (Microstix-3) tuvo una sensibilidad del 67% (IC95%: 38%- 88%) y una especificidad del 93% (IC95%: 89%-95%). El cultivo de orina es el "gold standard" para detectar bacteriuria asintomática. Esta prueba tiene una sensibilidad alta del 94%; siendo su especificidad 89% y su VPP 93%. Por ello, sigue siendo la prueba recomendada para detección de bacteriuria en gestantes; según lo reportado por los estudios incluidos en esta revisión, la tira reactiva presenta una sensibilidad baja, para detectar la bacteriuria asintomática. En los EESS donde existe escasez de recursos y personal entrenado debe accederse a otras pruebas como la prueba dipslide que ha demostrado ser útil, debido a que es muy probable que una gestante con una prueba dipslide positiva tenga un diagnóstico definitivo de bacteriuria asintomática, mientras que un resultado negativo descarta efectivamente la presencia de bacteriuria.

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

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

Aplicación práctica de la prueba de determinación del lipoarabinomanano en orina mediante inmunocromatografía de flujo lateral (LAM-ICL) para la detección de la tuberculosis activa en personas con VIH

Esta guía práctica tiene como objetivo ayudar a los países a implementar e incorporar la prueba Alere Determine™ TB LAM Ag (antígeno) en su algoritmo diagnóstico habitual para la tuberculosis (TB). Contiene nueva evidencia recopilada de numerosos estudios realizados después de que se publicara la primera política de la Organización Mundial de la Salud (OMS) sobre el uso de la prueba de determinación del lipoarabinomanano en orina mediante inmunocromatografía de flujo lateral (LAM-ICL) en el 2015 y se actualizara en noviembre del 2019. La prueba LAM-ICL ayudará a diagnosticar la TB activa en adultos, adolescentes y niños con infección por el VIH. En esta guía se incorporan nuevas recomendaciones sobre la inclusión de la prueba en los algoritmos de diagnóstico, teniendo en cuenta criterios específicos para las pruebas en entornos hospitalarios y ambulatorios, y también contiene información más detallada sobre el proceso de laboratorio para realizar la prueba y sobre las enseñanzas extraídas, lo que ayudará a orientar a los países para que lleven a cabo una implementación más rápida y sencilla de la prueba. El público destinatario incluye a los responsables de la formulación de políticas nacionales y subnacionales, al personal de salud de primera línea y los equipos directivos de los programas de VIH y tuberculosis, y a las principales partes interesadas en la tuberculosis, incluidos los asociados en la ejecución.