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1.
J Zoo Wildl Med ; 50(4): 983-987, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31926532

RESUMO

Two species of sloths in the family Megalonychidae, Hoffmann's (Choloepus hoffmanni) and Linnaeus's (Choloepus didactylus) two-toed sloths, are commonly held in zoological institutions. Despite frequent published reports of urinary tract disease in these species, reports of diagnostics are mostly limited to descriptions of hematology and serum chemistry. In this study, repeated urinalysis, urinary chemistry, serum chemistry, and radiographs were collected opportunistically from six Hoffmann's and five Linnaeus's sloths. Proteinuria, bacteriuria, low urine specific gravity, and crystalluria were common in the absence of other signs of urinary tract pathology.


Assuntos
Rim/fisiologia , Bichos-Preguiça/fisiologia , Urinálise/veterinária , Urina/química , Animais , Animais de Zoológico , Feminino , Masculino , Bichos-Preguiça/sangue , Bichos-Preguiça/urina
2.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 51(1): 74-80, 2020 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-31950793

RESUMO

Objective: To develop an assay for determination of 8-oxo-2'-deoxyguanosine and cotinine in human urine by hydrophilic chromatography tandem mass spectrometry (HILIC-MS/MS) with isotope dilution. Methods: The urine supernatant was 1∶5 diluted with 3 mmol/L ammonium formate aqueous solution containing 15N 5-8-OHdG and D 3-cotinine as internal standard. After being filtered through a 0.22 µm water filter, the sample solution was injected into ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) for analysis. Separation was performed on ACQUITY UPLC® BEH HILIC column (50 mm×3.0 mm, 1.7 µm) with isocratic elution (A∶B=10∶90) at 40 ℃. The mobile phase was composed with acetonitrile (B) and 3 mmol/L ammonium formate water soulution (A). The flow rate was 0.3 mL/min. Positive ion scan-multiple reaction monitoring (MRM) mode were used for monitoring and internal standard curves were applied for quantification. Results: Good linearity was obtained under the optimal conditions. Detection limits for 8-OHdG and cotinine were 0.064 µg/L and 0.035 µg/L respectively, the quantitation limits were 0.21 µg/L and 0.12 µg/L respectively, and the recoveries of the spiked urine samples were 92.6%-102% and 102%-106% respectively. Statistical analysis of 40 urine sample determination results obtained by using the above assay showed that there were significant differences in tobacco smoke exposure and tobacco-specific nitrosamine intake between active and passive smoker ( P<0.05). The concentration of NNAL and cotinine were higher in urine samples of active smoker. Tobacco smoke exposure was positively correlated with tobacco specific nitrosamine intake in both active and passive smokers (the correlation coefficients were 0.487 and 0.786 respectively, P<0.05). Conclusion: We successfully established a simple and fast assay for simultaneously detecting 8-oxo-2'-deoxyguanosine and cotinine in human urine. It was sensitive and accurate for quntification via the calibration by the isotope internal standards, and can meet the needs of batch analysis.


Assuntos
Cromatografia Líquida de Alta Pressão , Cotinina , Espectrometria de Massas em Tandem , Urinálise , /urina , Cotinina/urina , Humanos , Isótopos/química , Urinálise/métodos
3.
Clin Biochem ; 75: 70-77, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31707014

RESUMO

BACKGROUND: Dried specimens have been proposed in multiple environments to minimize costs associated with specimen storage and shipping in clinical studies. This report describes the development and validation of an automated method for qualitative toxicology screening of dried urine samples using LC-MS/MS. METHODS: Urine standards containing 41 compounds were prepared and applied to filter paper cards. Dried urine was eluted from the cards using a Dried Blood Spot (DBS) autosampler from Spark Holland, which was plumbed inline with a Thermo Scientific Turboflow chromatography system for subsequent MS/MS detection with selected reaction monitoring. Limits of detection, precision of peak areas, repeatability, and carryover studies were conducted. Concordance with a reference LC-MS/MS method using liquid samples was evaluated using remnant discarded specimens. RESULTS: The limit of detection ranged from 5 to 75 ng/mL for most compounds. At the LOD for each analyte, the peak area precision ranged from 8 to 29%. For 20 repeat injections of samples spiked at ±25% of the LOD, there was a 4% false positive rate for the 75% × LOD samples, and a 0.4% false negative rate for the +125% × LOD samples. In comparing 40 known positive specimens analyzed with the DUS method and a liquid urine reference method, there was 88% agreement. Analysis of 10 known negative specimens yielded negative results. There was no significant carryover detected up to 2000 ng/mL for any of the analytes in the assay. CONCLUSION: Using a robotic DUS sampling an inline HTLC-MS/MS system, we have developed and validated a fully-automated and robust method for multi-analyte detection of drugs of abuse in dried urine specimens.


Assuntos
Cromatografia Líquida/métodos , Ensaios de Triagem em Larga Escala , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/urina , Espectrometria de Massas em Tandem/métodos , Urinálise/métodos , Ensaios de Triagem em Larga Escala/instrumentação , Ensaios de Triagem em Larga Escala/métodos , Humanos , Limite de Detecção , Robótica/métodos
5.
N Z Med J ; 132(1488): 11-20, 2019 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-31851657

RESUMO

AIM: Unnecessary treatment of asymptomatic bacteriuria is a concern. Hutt Valley District Health Board sought to reduce clinically inappropriate urine culture requests through removal of urine dipsticks from wards and education of staff using Choosing Wisely principles. The purpose of this research is to quantitatively evaluate the success of these initiatives. METHODS: The numbers and results of urine cultures performed for Hutt Valley DHB were analysed, for the period from January 2015 to October 2017. Urinalyses were compared between those designated as 'inpatient' and those as 'outpatient', with the latter being the control of this study. The numbers of primary and secondary coded discharge diagnoses of UTIs were used as a measure of the negative impact of the interventions. RESULTS: There was a 28% reduction in monthly urine culture requests for inpatients, after staff education and removal of urine dipsticks, with no change in those for outpatients (the negative control). After the intervention, a higher proportion of urine cultures were positive for urinary pathogens (25.2% compared to 23.0%) and the average number of diagnoses of UTI in hospital discharges decreased 17% (from 161 to 134). CONCLUSION: The removal of urine dipsticks from wards and the education of staff significantly reduced the number of urine culture requests and is a useful strategy to reduce the overuse of antibiotics for asymptomatic bacteriuria without an increase in the number of UTIs. These simple interventions could be used at other hospitals as part of measures to reduce unnecessary care and overdiagnosis.


Assuntos
Sobremedicalização/prevenção & controle , Procedimentos Desnecessários/estatística & dados numéricos , Urinálise/estatística & dados numéricos , Adulto , Educação em Saúde , Humanos , Sobremedicalização/economia , Sobremedicalização/estatística & dados numéricos , Nova Zelândia , Procedimentos Desnecessários/economia , Urinálise/economia , Urinálise/métodos , Infecções Urinárias/diagnóstico , Infecções Urinárias/microbiologia
6.
N Z Med J ; 132(1488): 21-27, 2019 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-31851658

RESUMO

BACKGROUND: Urinalysis performed by dipstick testing is an aid to diagnosing urinary tract infections (UTI), and a tool in selecting patients who require urine culture and antibiotic treatment. Previous studies have demonstrated that UTI, especially in the elderly, are over-diagnosed and over-treated. We sought to study the pattern and yield of urinalysis and urine culture at our service in a tertiary institution. METHODS: A convenience sampling method was utilised to prospectively collect clinical data, through a pre-designed pro forma, from patients admitted to the General Medicine service at Christchurch Hospital between March and June 2016. RESULTS: The study included 395 patients, with a median age of 76 (range 15-100 years). The presence of urinary tract symptoms was documented in 94 patients (24%) and a non-specific syndrome of elevated temperature, confusion or subjective feverishness in 69 (17%). In symptomatic patients, 121 (74%) had a dipstick performed and 104 (86%) urine samples cultured. In the remaining patients, 181 (78%) had a dipstick performed and 81 (35%) had a urine sample sent for culture. CONCLUSIONS: We found a large number of urine dipsticks is being ordered unnecessarily in asymptomatic patients. A more useful test is urine microscopy and culture that is done on symptomatic patients only following careful clinical evaluation. Performing 'routine' urinalysis in patients presenting a wide variety of symptoms may lead to unnecessary urine cultures and treatment of asymptomatic bacteriuria. Efforts to reduce unnecessary tests and antibiotic treatment are a vital component of diagnostic stewardship programmes.


Assuntos
Medicina Geral/estatística & dados numéricos , Urinálise/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Estudos Prospectivos , Procedimentos Desnecessários/estatística & dados numéricos , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia , Adulto Jovem
7.
Gan To Kagaku Ryoho ; 46(11): 1741-1745, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31748484

RESUMO

BACKGROUND: Aside effect of anti-angiogenic agent treatment is proteinuria. Evaluation of the severity of adverse effects and the decision to discontinue treatment is based on the qualitative analysis of urinary proteins. However, a qualitative analysis result may not be indicative of the actual amounts of protein excreted. In this study, we evaluated the possibility of using the urine protein/creatinine ratio(UPCR), instead of a qualitative urine analysis, to monitor patients treated with antiangiogenic agents. METHODS: Urinalysis data of patients receiving anti-angiogenic agents-bevacizumab, ramucirumab, or aflibercept-were retrospectively analyzed from clinical records. Acorrelation between the urine protein content(qualitative and quantitative analyses)and continuity of anti-angiogenic agent treatment was evaluated. RESULTS: Atotal of 24 patients (age, 70.83±7.45 years)who received treatment for colorectal cancer(n=17), lung cancer(n=4), gastric cancer(n=2), and breast cancer(n=1)were included. One hundred and sixty-five urinalysis results were collected. Alinear correlation between the qualitative urinalysis results(1+to 3+)and UPCR(r=0.746, p<0.01)was obtained. In patients with a urine protein content of 2+(qualitative analysis), the UPCR was <2.0 for 25 patients and ≥2.0 but <3.5 for 4 patients. Similarly, in patients with a urine protein content of 3+, the UPCR was <2.0 for 3 patients and ≥2.0 but <3.5 for 1 patient. Seventeen patients with a urine protein content of 2+ and 3 patients with a urine protein content of 3+ discontinued treatment with anti-angiogenic agents before estimation of the UPCR could be performed. These figures were reduced to 4 patients and 2 patients, respectively, following UPCR assessment. CONCLUSIONS: Switching the estimation of proteinuria from a qualitative analysis to UPCR might lead to better safety monitoring and prevent unnecessary discontinuation of anti-angio- genic agent treatment.


Assuntos
Proteinúria , Urinálise , Idoso , Creatinina , Humanos , Testes de Função Renal , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
Forensic Sci Int ; 305: 109997, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31670217

RESUMO

With the increasing consumption of hemp seed products, it is important to establish whether biological samples from consumers contain trace cannabinoids that could mistakenly be attributed to cannabis abuse. Thus, we analyzed whether the cannabinoids, 11-nor-9-carboxy-tetrahydrocannabinol, cannabidiol, and cannabinol, can be detected in the urine of short-term (1 week) and long-term (12 weeks) consumers of hemp seed products. Using three hemp seed products that have recently been highly distributed in Korea, subjects consumed 30 g of hemp seeds (Group A, 53.1 (±0.5) µg THC and Group B, 124.81 (±1.5) µg THC) or 2 capsules of hemp seed oil (Group C, 11.1 µg THC) once a day at 10am. In the short-term study, the hemp seed product was consumed for 7 days, after which a single urine sample was collected. In the long-term study, the hemp seed product was consumed for 12 weeks, and urine samples were collected at 7 day intervals. For screening of the urine samples, we used COBAS C311, and for the confirmatory analysis we used gas chromatography/mass spectrometry. In the screening, all 64 samples from the short-term study were below the detection cutoff level of 25 ng/mL. In the long-term study, out of the 480 samples, 3 samples from 2 participants were above the cutoff level, but these samples were all negative in screening. In conclusion, our study demonstrated that when hemp seed products sold in Korea are consumed in normal quantities over the short- or long-term, urine samples do not test positive for cannabinoids.


Assuntos
Canabinoides/urina , Cannabis , Sementes , Adulto , Estudos de Casos e Controles , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Limite de Detecção , Masculino , Abuso de Maconha/diagnóstico , Pessoa de Meia-Idade , Sementes/química , Detecção do Abuso de Substâncias , Urinálise , Adulto Jovem
9.
Anal Bioanal Chem ; 411(27): 7293-7301, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31598741

RESUMO

A simple, sensitive, and naked-eye assay of metformin (MET), based on the host-guest molecular recognition of cucurbit[6]uril (CB[6])-modified silver nanoparticles, has been developed for the first time. The molecular recognition between CB[6] and MET is initially demonstrated and the related recognition mechanism is further discussed. CB[6]-modified AgNPs were first synthesized and then characterized by UV-vis spectroscopy, Fourier transform infrared spectroscopy, and transmission electron microscopy. The solution behavior of CB[6] in the presence of AgNO3 was also studied, and the correlative result revealed that AgNPs could combine with the carbonyl portals of CB[6]. On the basis of the molecular recognition of CB[6] and the surface plasmon resonance effect of AgNPs, CB[6]-modified AgNPs were used as visual probes to detect MET. In CB[6]-modified AgNP solution, the aggregation of CB[6]-modified AgNPs induced by MET triggered changes of color and the UV-vis absorption spectrum, which laid the foundation for the visual identification and spectrophotometric determination of MET. Under the optimized detection conditions, the UV-vis spectral assay had a good linear relationship in the range from 3 to 750 µM, and the limit of detection was 1 µM. According to the color changes, the minimum concentration recognized by the naked eye was about 75 µM. Furthermore, this assay has high selectivity for coexisting interferents and was also applied to MET detection in human urine samples. This strategy provides a novel and facile tool for highly selective and sensitive detection of MET. Graphical abstract.


Assuntos
Hidrocarbonetos Aromáticos com Pontes/química , Hipoglicemiantes/urina , Imidazóis/química , Nanopartículas Metálicas/química , Metformina/urina , Prata/química , Colorimetria , Humanos , Limite de Detecção , Nanopartículas Metálicas/ultraestrutura , Espectrofotometria Ultravioleta/métodos , Urinálise/métodos
10.
Biochem Med (Zagreb) ; 29(3): 030801, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31624465

RESUMO

Introduction: It has already been reported that subinhibitory concentrations of ß-lactam antibiotics can cause abnormal changes of bacterial forms, such as spheroplasts. Herein we report a case of Croatian male patient with Escherichia coli spheroplasts present in urine after treatment with tazobactam, on the tenth day of hospitalization. The aim of this report is to emphasize the inability of imaging based automated urine analysers to recognize some relatively uncommon forms of bacterial presentation in urine sediment. Materials and methods: During routine urine analysis, unusual particles were observed in patient urine. Urine sediment was examined by two urine analysers: Atellica 1500 (Siemens, Germany) and Iris iQ200 (Beckman Coulter, USA). Additionally, urine was sent for culture testing to Microbiology department. Results: Both urine analysers didn't indicate presence of bacteria in urine sediment. Unusual particles observed on the tenth day were classified as erythrocytes by both instruments. Dipstick test showed blood trace and microscopic analysis revealed bacteria in urine. Urine culture was positive for Escherichia coli. Careful examination of urine sediment has confirmed that shapes present in urine were abnormal bacterial forms called spheroplasts. Conclusions: Imaging based automated urine analysers are not able to recognize bacterial spheroplasts in urine sediment misclassifying it as erythrocytes. Microscopic examination remains the gold standard for urines with blood trace or negative blood, in which erythrocytes are reported by urine analyser in urine sediment. Failure to identify and follow up such cases may lead to inaccurate treatment decisions and puts patient safety at risk.


Assuntos
Eritrócitos , Escherichia coli/isolamento & purificação , Esferoplastos/isolamento & purificação , Urinálise/métodos , Urinálise/normas , Croácia , Humanos , Masculino , Pessoa de Meia-Idade
11.
Medicine (Baltimore) ; 98(40): e17368, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577737

RESUMO

This study evaluated the diagnostic performance of a new clinical approach based on decision tree (DT) analysis in adult patients with equivocal computed tomography (CT) findings of acute appendicitis (AA) compared with previous scoring systems.This retrospective study of 244 adult patients with equivocal CT findings included appendicitis (AG, n = 80) and non-appendicitis (NAG, n = 164) groups. The chi-squared automatic interaction detection algorithm was for AA prediction. A receiver operating characteristic curve analysis and area under the curve (AUC) were used to compare the DT analysis with Alvarado, Eskelinen score, and adult appendicitis scores (AAS).The following factors were selected for AA prediction: rebound tenderness severity, migration, urinalysis, symptom duration, leukocytosis, neutrophil count, and C-reactive protein levels. The DT comprised 11 final nodes with the following AA probabilities: node 1, 100% (16/16); node 2, 90% (9/10); node 3, 80% (8/10); node 4, 60.9% (14/23); node 5, 50% (3/6); node 6, 43.8% (7/16); node 7, 22.6% (12/53); node 8, 13% (10/77); node 9, 5.6% (1/18); node 10, 0% (0/12); and node 11, 0% (0/3). The AUC of the DT was higher (0.850 [95% confidence interval {CI}; 0.799-0.893]) than the Alvarado score (0.695 [95% CI; 0.633-0.752]), AAS (0.749 [95% CI; 0.690-0.802]), and the Eskelinen score (0.715 [95% CI; 0.654-0.770]). The results were statistically significant when compared with the AUCs of the Alvarado score, Eskelinen score, and AAS (P < .001, P < .001, P = .003, respectively).The DT-based approach facilitated AA diagnosis and determination of clinical status in patients with equivocal preoperative CT findings and ambiguous results.


Assuntos
Apendicite/diagnóstico , Árvores de Decisões , Dor Abdominal , Doença Aguda , Adulto , Algoritmos , Apendicite/sangue , Apendicite/diagnóstico por imagem , Proteína C-Reativa/análise , Técnicas de Apoio para a Decisão , Diagnóstico Diferencial , Feminino , Testes Hematológicos , Humanos , Masculino , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Urinálise
12.
Am J Vet Res ; 80(10): 907-911, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31556718

RESUMO

OBJECTIVE: To evaluate effects of the addition of glucose to dog and cat urine on urine specific gravity (USG) and determine whether glucosuria affects assessment of renal concentrating ability. SAMPLE: Urine samples from 102 dogs and 59 cats. PROCEDURES: Urine for each species was pooled to create samples with various USGs. Glucose was added to an aliquot of each USG pool (final concentration, 2,400 mg/dL), and serial dilutions of the glucose-containing aliquot were created for each pool. The USG then was measured in all samples. The difference in USG attributable to addition of glucose was calculated by subtracting the USG of the unaltered sample from the USG of the sample after the addition of glucose. The relationship between the difference in USG and the USG of the unaltered, undiluted sample was evaluated by the use of linear regression analysis. RESULTS: Addition of glucose to urine samples increased the USG. There was a significant relationship between USG of the undiluted sample and the difference in USG when glucose was added to obtain concentrations of 300, 600, 1,200, and 2,400 mg/dL in canine urine and concentrations of 600, 1,200, and 2,400 mg/dL in feline urine. The more concentrated the urine before the addition of glucose, the less change there was in the USG. Changes in USG attributable to addition of glucose were not clinically important. CONCLUSIONS AND CLINICAL RELEVANCE: Substantial glucosuria resulted in minimal alterations in specific gravity of canine and feline urine samples. Thus, USG can be used to assess renal concentrating ability even in samples with glucosuria.


Assuntos
Doenças do Gato/urina , Doenças do Cão/urina , Glucose/química , Glicosúria/veterinária , Urina/química , Animais , Gatos , Cães , Glicosúria/urina , Modelos Lineares , Refratometria/veterinária , Análise de Regressão , Gravidade Específica , Urinálise/veterinária
13.
Pan Afr Med J ; 33: 131, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31558930

RESUMO

Urinary tract infections (UTIs) are common. The diagnosis is confirmed by urine culture which is costly and takes at least 24 hours before results are known. The aim of this study was to determine the diagnostic accuracy of dipstick test for the diagnosis of UTI in symptomatic adult patients. We conducted a cross-sectional study in the department of Infectious Diseases, Sousse-Tunisia during a two-year period. We included all patients with clinical signs of UTI. Urine samples were tested for the presence of leukocyte esterase (LE) and nitrites. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of LE and nitrites were calculated against urine culture as gold standard. Four hundred thirty one patients, 139 men (32%) and 292 women (68%) were included. One hundred sixty six patients (39%) had UTI. The most frequently isolated microorganism was Escherichia coli (75%). LE had a high sensitivity (87%) but a low specificity (64%), while nitrites had a high specificity (95%) but a low sensitivity (48%). Combined positive LE and nitrites had a high PPV (85%) and combined negative LE and nitrites had a high NPV (92%), while positive LE combined with negative nitrites had a low PPV (47%) and a low NPV (53%). In conclusion, in adult patients with UTI symptoms, an alternate diagnosis should be considered if the LE is negative, while an early empirical antibiotic therapy against Enterobacteriaceae should be started if the nitrites are positive.


Assuntos
Hidrolases de Éster Carboxílico/urina , Infecções por Escherichia coli/diagnóstico , Nitritos/urina , Infecções Urinárias/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriúria/diagnóstico , Bacteriúria/microbiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fitas Reagentes , Sensibilidade e Especificidade , Tunísia , Urinálise/métodos , Infecções Urinárias/microbiologia , Adulto Jovem
14.
Artigo em Chinês | MEDLINE | ID: mdl-31495122

RESUMO

Objective: To develop a rapid detection method for 21 elements in urine with inductively coupled plasma mass spectrometry (ICP-MS) . Methods: The urine samples were directly diluted 20 times by 1% HNO(3), and detected by ICP-MS, Indium, Yttrium, and Lutecium were used as on-line internal standard. Fe was analyzed by Dynamic Reaction Cell (DRC) mode, As, Cr, V and Zn were analyzed by collision cell technology (CCT) mode, and Be, Mn, Ni, Cd, Sn, Bi, Pb, Re, Sb, W, Li, Cu, Se, Sr, Mo were analyzed by standard mode. Dynamic band-pass tuning (DBT) was used to eliminate interference for Fe. Results: All the elements have good linearity in their determination range, with the correlation coefficient r>0.999 5. The limits of detection of the 21 elements were in the range of 0.017-11.14 µg/L. The inter-precision (relative standard deviation, RSD) was less than 9.96%, and the intra-precision was less than 13.90% (except As RSD<18.91%) . The spike recovery of all elements fell within 81.1%-116.4%. Conclusion: The method was proved to be simple, fast, and accurate, and met the needs of testing requirements of large amounts of specimens.


Assuntos
Espectrometria de Massas , Oligoelementos/urina , Urinálise/métodos , Humanos
15.
BMJ Case Rep ; 12(8)2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31413059

RESUMO

We present a 44-year-old female with an initial presentation with distal renal tubular acidosis (RTA) after she presented with hypokalaemia and normal anion gap acidosis. Three years following the diagnosis, she presented with progressive renal impairment. In the absence of any clinical, biochemical and radiological clues, she underwent a renal biopsy which showed severe tubulitis secondary to lymphocytic infiltration. Serological investigations subsequently revealed positive anti-nuclear, anti-Sjögren's syndrome related antigen A (SS-A), and anti-Sjögren's syndrome related antigen B (SS-B) antibodies, supporting the diagnosis of Sjögren's syndrome. This case is unique in that distal RTA was the presenting clinical manifestation of Sjögren's syndrome. We hope that a consideration for Sjögren's syndrome is made in patients with seemingly idiopathic RTA.


Assuntos
Acidose Tubular Renal/diagnóstico , Síndrome de Sjogren/diagnóstico , Acidose Tubular Renal/sangue , Acidose Tubular Renal/complicações , Acidose Tubular Renal/urina , Adulto , Feminino , Humanos , Hipopotassemia/sangue , Hipopotassemia/complicações , Hipopotassemia/diagnóstico , Hipopotassemia/urina , Síndrome de Sjogren/sangue , Síndrome de Sjogren/complicações , Síndrome de Sjogren/urina , Urinálise
16.
Pediatrics ; 144(3)2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31395621

RESUMO

BACKGROUND AND OBJECTIVES: To determine factors associated with cerebrospinal fluid (CSF) testing in febrile young infants with a positive urinalysis and assess the probability of delayed diagnosis of bacterial meningitis in infants treated for urinary tract infection (UTI) without CSF testing. METHODS: We performed a retrospective cohort study using data from the Reducing Excessive Variability in Infant Sepsis Evaluation quality improvement project. A total of 20 570 well-appearing febrile infants 7 to 60 days old presenting to 124 hospitals from 2015 to 2017 were included. A mixed-effects logistic regression was conducted to determine factors associated with CSF testing. Delayed meningitis was defined as a new diagnosis of bacterial meningitis within 7 days of discharge. RESULTS: Overall, 3572 infants had a positive urinalysis; 2511 (70.3%) underwent CSF testing. There was wide variation by site, with CSF testing rates ranging from 64% to 100% for infants 7 to 30 days old and 10% to 100% for infants 31 to 60 days old. Factors associated with CSF testing included: age 7 to 30 days (adjusted odds ratio [aOR]: 4.6; 95% confidence interval [CI]: 3.8-5.5), abnormal inflammatory markers (aOR: 2.2; 95% CI: 1.8-2.5), and site volume >300 febrile infants per year (aOR: 1.8; 95% CI: 1.2-2.6). Among 505 infants treated for UTI without CSF testing, there were 0 (95% CI: 0%-0.6%) cases of delayed meningitis. CONCLUSIONS: There was wide variation in CSF testing in febrile infants with a positive urinalysis. Among infants treated for UTI without CSF testing (mostly 31 to 60-day-old infants), there were no cases of delayed meningitis within 7 days of discharge, suggesting that routine CSF testing of infants 31 to 60 days old with a positive urinalysis may not be necessary.


Assuntos
Bacteriúria/diagnóstico , Febre/microbiologia , Meningites Bacterianas/diagnóstico , Padrões de Prática Médica , Bacteriúria/líquido cefalorraquidiano , Líquido Cefalorraquidiano/microbiologia , Diagnóstico Tardio , Humanos , Lactente , Recém-Nascido , Meningites Bacterianas/líquido cefalorraquidiano , Padrões de Prática Médica/normas , Melhoria de Qualidade , Estudos Retrospectivos , Estados Unidos , Procedimentos Desnecessários/normas , Urinálise
17.
J Chromatogr A ; 1608: 460411, 2019 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-31405572

RESUMO

In the current study, for the first time, the sugaring-out effect was assessed in a conventional electromembrane extraction (EME) system. Utilizing the sugars in the donor solution as green additives can result in production of a pioneering and influential EME mode. Sugaring-out assisted electromembrane extraction was combined with high-performance liquid chromatography (HPLC) to enhance the extraction of four basic model drugs (pseudoephedrine, lidocaine, propranolol, and ketoconazole). In this mode of EME, not only the transfer of analytes through the supported liquid membrane (SLM) was improved, but also the whole extraction system became more stable than the conventional one in the same voltage. The type and concentration of sugars were optimized in addition to the common experimental parameters influencing the EME, and figures of merit were also studied. Under the optimum conditions, repeatability (RSD%) was obtained in the range of 2.8-6.9% in the water, while RSD value was obtained in the range of 8.2-11.8% (n = 3) for conventional EME with the same state. The linearity range was also in the interval of 5.0-1000.0 ng mL-1 and limits of quantification and detection were in the ranges of 5.0-10.0 ng mL-1 and 1.5-3.0 ng mL-1, respectively, in the introduced EME. Extraction recoveries in the range of 41.2 and 80.8% were obtained resulting in enrichment factors in the range of 96-189. In light of such factor, new suggested EME mode was assessed in the real biological samples including human plasma and urine in order to prove the sugaring-out efficiency in EME systems.


Assuntos
Análise Química do Sangue/métodos , Preparações Farmacêuticas/isolamento & purificação , Açúcares/química , Urinálise/métodos , Cromatografia Líquida de Alta Pressão , Eletrônica , Humanos , Membranas Artificiais , Preparações Farmacêuticas/sangue , Preparações Farmacêuticas/urina
18.
Anal Bioanal Chem ; 411(25): 6591-6601, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31372698

RESUMO

Exosomes are vesicles secreted by cells having a size range from 30 to 150 nm and carrying genetic materials that are important for intercellular functions, including cancer progression. Mounting evidence shows that tumor cells secrete more exosomes than normal cells. Thus, it is important to be able to efficiently isolate and quantify exosomes for potential use in clinical diagnostics, as well as to develop a deeper understanding of their role in intercellular processes. Current methods for exosome isolation and quantification are time-consuming and expensive. Few of these methods are able to combine exosome isolation and quantification into a singular operation scheme. However, a new efficient, rapid, and low-cost isolation and quantification method for exosomes in human urine samples using polyester (PET) capillary-channeled polymer (C-CP) fibers in a hydrophobic interaction chromatography (HIC) protocol has been developed. The process has been verified via scanning electron microscopy (SEM) before and after the capture of exosomes on the fiber surfaces. Sample load and elution rates were optimized to affect high resolution and throughput. Isolated exosomes were quantified based on a UV absorbance response curve created using a commercial human urine-derived exosome standard with an exosome concentration of 7.32 × 1011 mL-1. The loading capacity of a 30-cm C-CP PET column was ~ 7 × 1011 exosomes. An inter-injection washing method with PBS was developed to improve the reproducibility with a 2.9% RSD achieved for 7 complete isolation cycles. Graphical abstract.


Assuntos
Cromatografia Líquida de Alta Pressão/instrumentação , Exossomos/química , Poliésteres/química , Urina/química , Desenho de Equipamento , Humanos , Interações Hidrofóbicas e Hidrofílicas , Urinálise/instrumentação
19.
Ann Biol Clin (Paris) ; 77(4): 381-389, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31418699

RESUMO

The SFBC working group aimed to deal with biological tests outside the french nomenclature that may be useful in the context of urinary exploration of metabolism. This section will be divides into three parts: 1) nutritional assessment using urinary urea; 2) metabolic assessment of urolithiasis; 3) exploration of tubulopathies. National and international recommendations support the evaluation of nutritional status from urea measurements in urine and dialysate with the following indications: primary metabolic evaluation of urolithiasis patients, monitoring of protein intake in chronic renal failure stage 3 or stage 5D with residual diuresis. For the management of the urolithiasis disease, biomedical tests recommended by the national and international guidelines are the measurement of the urinary density using refractometry in the primary metabolic evaluation as well as the determination of oxalemia in the diagnosis (patients with GFR< 30 mL/min/1.73 m2) and follow-up (patients with GFR< 60 mL/min/1.73 m2) of primary hyperoxaluria. The determination of the bicarbonaturia is retained for the in depth exploration of urolithiasis and tubular acidosis. The measure of chlore in urine is used to evaluate the volume status during metabolic alkalosis and to calculate the urinary anionic gap during metabolic acidosis.


Assuntos
Metabolismo Energético/fisiologia , Nefropatias/diagnóstico , Avaliação Nutricional , Urinálise/métodos , Urolitíase/diagnóstico , Humanos , Nefropatias/patologia , Nefropatias/urina , Túbulos Renais/patologia , Padrões de Referência , Refratometria/métodos , Refratometria/normas , Urinálise/normas , Urolitíase/urina
20.
Nutrients ; 11(8)2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31430927

RESUMO

Caffeine is commonly taken via the daily dietary consumption of caffeine-containing foods. The absorbed caffeine is metabolized to yield various metabolites by drug-metabolizing enzymes, and measuring the levels of each caffeine metabolite can provide useful information for evaluating the phenotypes of those enzymes. In this study, the urinary concentrations of caffeine and its 13 metabolites were determined, and the phenotypes of drug metabolic enzymes were investigated based on the caffeine metabolite ratios. Human urine samples were pretreated using solid phase extraction, and caffeine and its metabolites were analyzed using liquid chromatography-tandem mass spectrometry. Based on the urinary caffeine metabolite concentrations, the caffeine metabolite ratios were calculated for six human subjects at specified time points after caffeine intake. Variations in urinary metabolite levels among individuals and time points were reported. In addition, the resultant enzyme activities showed different patterns, depending on the metabolite ratio equations applied. However, some data presented a constant metabolite ratio range, irrespective of time points, even at pre-dose. This suggests the possibility of urinary caffeine metabolite analysis for routine clinical examination. These findings show that urinary caffeine and the metabolite analysis would be useful in evaluating metabolic phenotypes for personalized medicine.


Assuntos
Arilamina N-Acetiltransferase/metabolismo , Cafeína/metabolismo , Cafeína/urina , Citocromo P-450 CYP1A2/metabolismo , Citocromo P-450 CYP2A6/metabolismo , Xantina Oxidase/metabolismo , Adulto , Biomarcadores/metabolismo , Biomarcadores/urina , Cromatografia Líquida de Alta Pressão , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Urinálise , Adulto Jovem
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