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1.
BMC Infect Dis ; 20(1): 555, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32736601

RESUMO

BACKGROUND: Determine TB-LAM is the first point-of-care test (POC) for HIV-associated tuberculosis (TB) and rapidly identifies TB in those at high-risk for short-term mortality. While the relationship between urine-LAM and mortality has been previously described, the outcomes of those undergoing urine-LAM testing have largely been assessed during short follow-up periods within diagnostic accuracy studies. We therefore sought to assess the relationship between baseline urine-LAM results and subsequent hospitalization and mortality under real-world conditions among outpatients in the first year of ART. METHODS: Consecutive, HIV-positive adults with a CD4 count < 100 cells/uL presenting for ART initiation were enrolled. TB diagnoses and outcomes (hospitalization, loss-to-follow and mortality) were recorded during the first year following enrolment. Baseline urine samples were retrospectively tested using the urine-LAM POC assay. Kaplan Meier survival curves were used to assess the cumulative probability of hospitalization or mortality in the first year of follow-up, according to urine-LAM status. Cox regression analyses were performed to determine independent predictors of hospitalization and mortality at three months and one year of follow-up. RESULTS: 468 patients with a median CD4 count of 59 cells/uL were enrolled. There were 140 patients (29.9%) with newly diagnosed TB in the first year of follow-up of which 79 (56.4%) were microbiologically-confirmed. A total of 18% (n = 84) required hospital admission and 12.2% (n = 57) died within a year of study entry. 38 out of 468 (8.1%) patients retrospectively tested urine-LAM positive - including 19.0% of those with microbiologically-proven TB diagnoses (n = 15/79) and 23.0% (n = 14/61) of those with clinical-only TB diagnoses; 9 of 38 (23.7%) of patients retrospectively testing LAM positive were never diagnosed with TB under routine program conditions. Among all patients (n = 468) in the first year of follow-up, a positive urine-LAM result was strongly associated with all-cause hospitalization and mortality with a corresponding adjusted hazard ratio (aHR) of 3.7 (95%CI, 1.9-7.1) and 2.6 (95%, 1.2-5.7), respectively. CONCLUSIONS: Systematic urine-LAM testing among ART-naïve HIV-positive outpatients with CD4 counts < 100 cells/uL detected TB cases that were missed under routine programme conditions and was highly predictive for subsequent hospitalization and mortality in the first year of ART.


Assuntos
Infecções por HIV/complicações , Lipopolissacarídeos/urina , Tuberculose/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/urina , Contagem de Linfócito CD4 , Feminino , Seguimentos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Testes Imediatos , Estudos Prospectivos , Estudos Retrospectivos , África do Sul/epidemiologia , Resultado do Tratamento , Tuberculose/mortalidade , Tuberculose/terapia , Tuberculose/urina , Urinálise/métodos
2.
PLoS One ; 15(7): e0236591, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735600

RESUMO

There has been rapidly accelerating interest in the utilization of volatile organic compounds (VOCs) as non-invasive methods for rapid point-of-care medical diagnostics. There is widespread variation in analytical methods and protocols, with little understanding of the effects of sample storage on VOC profiles. This study aimed to determine the effects on VOC profiles of different storage times, at room temperature, prior to freezing, of sealed urine samples from healthy individuals. Analysis using Field Asymmetric Ion Motility Spectrometry (FAIMS) determined the alterations in VOC and total ion count profiles as a result of increasing room temperature storage times. Results indicated that increasing exposure time to room temperature prior to freezing had a threefold effect. Firstly, increased urinary VOC profile variability, with a plateau phase between 12 and 48 hours, before further degradation. Secondly, an increase in total ion count with time exposed to room temperature. Finally, a deterioration in VOCs with each sample run during the analysis process. This provides new insight into the effect of storage of urine samples for VOC analysis using FAIMS technology. Results of this study provide a recommendation for a 12-hour maximum duration at room temperature prior to storage.


Assuntos
Urinálise/métodos , Compostos Orgânicos Voláteis/urina , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Temperatura , Fatores de Tempo
3.
PLoS One ; 15(7): e0235328, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628701

RESUMO

OBJECTIVE: Current urinary tract infection (UTI) diagnostic strategies that rely on leukocyte esterase have limited accuracy. We performed an aptamer-based proteomics pilot study to identify urine protein levels that could differentiate a culture proven UTI from culture negative samples, regardless of pyuria status. METHODS: We analyzed urine from 16 children with UTIs, 8 children with culture negative pyuria and 8 children with negative urine culture and no pyuria. The urine levels of 1,310 proteins were quantified using the Somascan™ platform and normalized to urine creatinine. Machine learning with support vector machine (SVM)-based feature selection was performed to determine the combination of urine biomarkers that optimized diagnostic accuracy. RESULTS: Eight candidate urine protein biomarkers met filtering criteria. B-cell lymphoma protein, C-X-C motif chemokine 6, C-X-C motif chemokine 13, cathepsin S, heat shock 70kDA protein 1A, mitogen activated protein kinase, protein E7 HPV18 and transgelin. AUCs ranged from 0.91 to 0.95. The best prediction was achieved by the SVMs with radial basis function kernel. CONCLUSIONS: Biomarkers panel can be identified by the emerging technologies of aptamer-based proteomics and machine learning that offer the potential to increase UTI diagnostic accuracy, thereby limiting unneeded antibiotics.


Assuntos
Aptâmeros de Nucleotídeos/química , Proteômica/métodos , Máquina de Vetores de Suporte , Urinálise/métodos , Infecções Urinárias/diagnóstico , Adolescente , Biomarcadores/urina , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Projetos Piloto , Estudos Prospectivos , Infecções Urinárias/urina
4.
Anticancer Res ; 40(6): 3477-3484, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32487647

RESUMO

BACKGROUND/AIM: The Paris System (TPS) has recently been proposed as a method to standardize urinary cytology reporting. In this study, we evaluated the impact of implementing TPS compared to the traditional reporting system. PATIENTS AND METHODS: In total, 299 urine samples were reclassified according to TPS. We examined correlations between cytological and histological diagnoses, and calculated probabilities for detecting high-grade urothelial carcinoma (HGUC). RESULTS: TPS resulted in a decrease in the proportion of cases diagnosed as atypical urothelial cell (AUC) (43% to 31%). Among the AUC cases, the proportion of histologically confirmed HGUC cases rose (75% to 80%), as did the proportion of low-grade urothelial neoplasms (57% to 71%). All probabilities for detecting HGUC significantly increased using TPS. CONCLUSION: TPS improved the diagnostic yield of urinary cytology. The implementation of TPS is expected to be a major step towards standardizing urinary cytology reporting and providing clear information to clinicians.


Assuntos
Citodiagnóstico/métodos , Biópsia Líquida/métodos , Urinálise/métodos , Neoplasias Urológicas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Guias de Prática Clínica como Assunto , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Neoplasias Urológicas/urina
5.
BMC Infect Dis ; 20(1): 301, 2020 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-32321418

RESUMO

BACKGROUND: In Ghana, pre-school-aged children (PSAC) are at risk of intestinal schistosomiasis and are living in need of praziquantel treatment. To better assess the infection burden within this vulnerable demographic group, we have provided a comparative assessment of the prevalence of Schistosoma mansoni in pre-school-aged children by urine circulating cathodic antigen (CCA) dipsticks, real-time PCR Taqman® faecal assays and Kato-Katz coproscopy. METHODS: In all, 190 pre-school-aged children were sampled from three endemic communities (viz. Tomefa, Torgahkope/Adakope, and Manheam) around Weija dam, Southern Ghana. Fresh stool and urine samples were collected from all participants for diagnosis. RESULTS: Among all the three communities, the urine-CCA assay recorded the highest prevalence values of 90.5% (95% CI 80.4-96.4), 87.9% (95% CI 76.7-95), and 81.2% (95% CI 69.9-89.6) in Tomefa, Torgahkope/Adakope, and Manheam respectively. Prevalence by real-time PCR was 50% (95% CI 35.5-64.5), 8% (95% CI 2.2-19.2) and 16.7% (95% CI 8.3-28.5), while by Kato-Katz was 55.6% (95% CI 42.5-68.1), 8.6% (95% CI 2.9-19) and 11.6% (95% CI 5.1-21.6) respectively. Children aged 1 year and over were found to be positive with the urine-CCA assay; by the ages of 3-4, over 50% were urine-CCA patent. The sensitivity and specificity of the POC-CCA dipsticks, when compared against the combined results of Kato-Katz/TaqMan results was found to be 84.1% (95% CI = 72.7-92.1) and 12.9% (95% CI = 6.6-22) respectively. CONCLUSIONS: We propose that the urine-CCA dipstick may be a useful rapid diagnostic tool to estimate the prevalence of intestinal schistosomiasis in PSAC, particularly in rapid identification of at-risk areas. However, our assessment has shown that it possible to record false positives when compared to combined Kato-Katz and qPCR results. To guide PSAC praziquantel treatment needs, we propose the urine CCA assay should be included in routine surveillance of intestinal schistosomiasis alongside other diagnostics such as Kato-Katz and urine filtration.


Assuntos
Antígenos de Helmintos/urina , Testes Diagnósticos de Rotina/métodos , Fezes/parasitologia , Reação em Cadeia da Polimerase em Tempo Real/métodos , Esquistossomose mansoni/diagnóstico , Urinálise/métodos , Animais , Antígenos de Helmintos/análise , Bioensaio/métodos , Líquidos Corporais/química , Líquidos Corporais/imunologia , Líquidos Corporais/parasitologia , Pré-Escolar , Fezes/química , Feminino , Gana/epidemiologia , Humanos , Lactente , Masculino , Sistemas Automatizados de Assistência Junto ao Leito , Praziquantel/uso terapêutico , Prevalência , Schistosoma mansoni/genética , Schistosoma mansoni/imunologia , Schistosoma mansoni/isolamento & purificação , Esquistossomose mansoni/tratamento farmacológico , Esquistossomose mansoni/parasitologia , Esquistossomose mansoni/urina , Sensibilidade e Especificidade
6.
Isr Med Assoc J ; 22(4): 236-240, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32286027

RESUMO

BACKGROUND: Urinary tract infection (UTI) is a common bacterial infection in children. ​​​​​​​Early treatment may prevent renal damage in pyelonephritis. The choice of empiric antibiotic treatment is based on knowledge of the local susceptibility of urinary bacteria to antibiotics. In Israel the recommended empiric oral antibiotic treatment are First or second generation cephalosporin, trimethoprim-sulfamethoxazole or amoxicillin-clavulanic acid. OBJECTIVES: To describe resistance rates of urine bacteria isolated from children with UTI in the community settings. Identify risk factors for resistance. METHODS: A retrospective cross-sectional study of UTI in children aged 3 months to 18 years diagnosed with UTI and treated as outpatients in a large community clinic between 7/2015 and 7/2017 with a diagnosis of UTI. RESULTS: A total of 989 urinary samples were isolated, 232 were included in the study. Resistance rates to cephalexin, cefuroxime, ampicillin/clavulanate and Trimethoprim-Sulfamethoxazole were 9.9%, 9.1%, 20.7%, and 16.5%, respectively. Urinary tract abnormalities and recurrent UTI were associated with an increase in antibiotic resistance rates. Other factors such as age, fever, and previous antibiotic treatment were not associated with resistance differences. CONCLUSIONS: Resistance rates to common oral antibiotics were low compared to previous studies performed in Israel in hospital settings. First generation cephalosporins are the preferred empiric antibiotics for febrile UTI for outpatient children. Amoxicillin/clavulanate is not favorable due to resistance of over 20% and the broad spectrum of this antibiotic. Care should be taken in children with renal abnormalities as there is a worrying degree of resistance rates to the oral first line antibiotic therapy.


Assuntos
Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia , Adolescente , Fatores Etários , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Estudos Transversais , Feminino , Seguimentos , Humanos , Lactente , Israel , Masculino , Testes de Sensibilidade Microbiana , Pacientes Ambulatoriais/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Estatísticas não Paramétricas , Resultado do Tratamento , Urinálise/métodos , Infecções Urinárias/fisiopatologia , Urodinâmica/fisiologia
7.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(4): 420-424, 2020 Apr 06.
Artigo em Chinês | MEDLINE | ID: mdl-32268651

RESUMO

Objective: To evaluate the feasibility of three spot urine methods (Kawasaki, INTERSALT and Tanaka) for estimating the 24 h urinary sodium excretion in the Chinese population. Methods: In 2017, 1 499 participants aged 18 to 69 years old were selected from Yiwu City, Haining City, Taishun County, Yinzhou District of Ningbo City and Liandu District of Lishui City of Zhejiang Province by using the multistage random sampling method. Sociodemographic information of the subjects was collected with questionnaires and physical measurements were performed. 24 h urine was collected and urinary volume was recorded. The concentrations of urinary sodium, potassium and creatinine were also measured. Kawasaki, INTERSALT and Tanaka spot urine methods were applied to estimate the 24 h urinary sodium excretion and compared with actual values among 1 426 participants who passed urine integrity test. Results: The age of participants was (46.71±14.04) years old, including 700 males, accounting for 49.1%. The actual value of 24 h urinary sodium excretion was (167.10±74.70) mmol, but Kawasaki method overestimated it as (184.61±57.10) mmol, and INTERSALT and Tanaka methods underestimated it as(134.62±39.21) and (143.20±35.66) mmol. Estimated difference (95%CI) (mmol) from small to large was Kawasaki method [17.51 (13.54, 21.47)], Tanaka method [-23.90 (-27.60, -20.20)] and INTERSALT method [-32.48 (-36.29, -28.67)]. With the increase of 24 h sodium intake, all estimation methods changed from the overestimation to underestimation. In those with 24 h sodium intake <9.0 g, the estimated difference (95%CI) of the INTERSALT method was the smallest as 43.15 (37.73, 48.57) and 1.26 (-2.10, 4.63) mmol for <6.0 and 6.0-8.9 g groups, respectively. In those with 24 h sodium intake≥9.0 g, the Kawasaki method had the smallest estimated difference (95%CI) as -12.50 (-18.14, -6.86) and -53.73 (-61.25, -46.22) for 9.0-11.9 g and ≥ 12.0 g group, respectively. The consistency analysis of the Bland-Altman method showed that the Kawasaki method had the best consistency with actual measured value and it had the least number of points outside the range (69 points accounting for 4.84%). Conclusion: Among the three spot urine methods, the Kawasaki method has better applicability in predicting the excretion of 24 h urine sodium in the Chinese population.


Assuntos
Sódio/urina , Urinálise/métodos , Adolescente , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático , China , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Potássio/urina , Adulto Jovem
8.
PLoS Negl Trop Dis ; 14(4): e0008246, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32324742

RESUMO

The development of an accurate protein-based antigen detection assay for diagnosis of active visceral leishmaniasis (VL) would represent a major clinical advance. VL is a serious and fatal disease caused by the parasites Leishmania infantum and Leishmania donovani. The gold standard confirmatory diagnostic test for VL is the demonstration of parasites or their DNA from aspirates from spleen, lymph node, and bone marrow or from blood buffy coats. Here we describe the production and use of monoclonal antibodies (mAbs) for the development of a sensitive and specific antigen detection capture ELISA for VL diagnosis. This test simultaneously detects six leishmania protein biomarkers that we have previously described (Li-isd1, Li-txn1, Li-ntf2, Ld-mao1, Ld-ppi1 and Ld-mad1). The initial clinical validation of this new mAb-based multiplexed capture ELISA showed a sensitivity of ≥93%. The test was negative with 35 urine samples from healthy control subjects as well as with 30 patients with confirmed non-VL tropical diseases (cutaneous leishmaniasis, n = 6; Chagas disease, n = 6; schistosomiasis, n = 6; and tuberculosis, n = 12). These results strongly support the possible utility of this mAb-based multiplexed capture ELISA as a promising diagnostic test for active VL as well as for monitoring the treatment efficacy of this disease. The test is ready for upscaling and validation for clinical use.


Assuntos
Anticorpos Monoclonais/imunologia , Antígenos de Protozoários/urina , Leishmania donovani/química , Leishmania infantum/química , Leishmaniose Visceral/diagnóstico , Urinálise/métodos , Urina/química , Adolescente , Adulto , Idoso , Anticorpos Antiprotozoários/imunologia , Antígenos de Protozoários/imunologia , Biomarcadores/urina , Criança , Pré-Escolar , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Adulto Jovem
9.
Ann Biol Clin (Paris) ; 78(2): 139-146, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32319942

RESUMO

The pre-analytical step of the cytobacteriological examination of urine (CBEU) is one of the most critical in microbiology. The objectives of our study were to determine the rate of urinary contamination and to analyze the factors that would facilitate this in order to propose solutions to this problem. METHOD: This is a 26-month descriptive study including all CBEU requests to our laboratory. Urine was treated in accordance with the recommendations of the medical microbiology recommendations. Urine was considered contaminated in the case of polymorphic culture with at least three different types of germs with a count from 103 CFU/mL. RESULTS: We collected 16,412 CBEU requests. Urine was contaminated in 4,830 cases (29.43%). Of the contaminated urine, 39.23% (n=1,895) was from emergency departments, 79.44% (n=3,837) was collected in the middle of the stream, 69.83% (n=3,373) was from a female patient and 16.34% (n=789) was from children under the age of 5. DISCUSSION AND CONCLUSION: To reduce urine contamination, quality instructions describing sampling procedures should be available and samples in the middle of the stream and through the collection adhesive bags should be replaced by sus-pubic puncture samples in children, whenever the profit/risk ratio of this method is favourable.


Assuntos
Urinálise/normas , Infecções Urinárias/diagnóstico , Coleta de Urina/normas , Urina/microbiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Reações Falso-Positivas , Feminino , Hospitais Universitários , Humanos , Lactente , Recém-Nascido , Masculino , Técnicas Microbiológicas/métodos , Técnicas Microbiológicas/normas , Pessoa de Meia-Idade , Marrocos/epidemiologia , Fase Pré-Analítica/normas , Fase Pré-Analítica/estatística & dados numéricos , Estudos Retrospectivos , Fatores Sexuais , Urinálise/métodos , Urinálise/estatística & dados numéricos , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Coleta de Urina/métodos , Coleta de Urina/estatística & dados numéricos , Adulto Jovem
10.
Int J Clin Oncol ; 25(7): 1278-1284, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32347432

RESUMO

BACKGROUND: Proteinuria induced by lenvatinib is a class effect that occurs secondary to VEGFR suppression. Withholding of lenvatinib is required in cases with severe proteinuria. Urine protein-creatinine ratio (UPCR, g/gCre) has recently attracted attention as an alternative to 24-h urine collection for assessing proteinuria. The aim of this study was to examine the correlation between the results of proteinuria assessed by the dipstick test and UPCR, and to investigate the influence of proteinuria grading with UPCR on lenvatinib dose adjustment compared to that with only the dipstick test. METHOD: Three hundred and ten urine samples from 63 patients with advanced thyroid cancer under treatment with lenvatinib, which were tested by both the dipstick test and UPCR were analyzed. Lenvatinib was withheld when there was evidence of CTCAE grade 3 proteinuria, and restarted when it resolved. The frequency of proteinuria, correlation between the results of the dipstick test and UPCR test, and the effect of dose withholding in cases with results of 3 + in the dipstick test were calculated. RESULTS: Proteinuria was seen in 56 (88.9%) patients. Of the 154 dipstick 3 + samples, only 56 (36.4%) were judged as more than 3.5 g/gCre by UPCR (grade 3 proteinuria), although none of the 1 + and only 3.7% of 2 + samples were judged as grade 3 proteinuria. We were able to prevent unnecessary lenvatinib interruption due to proteinuria in 63.6% of dipstick 3 + samples by assessment of UPCR. CONCLUSIONS: Urinalysis by combination of the dipstick test and UPCR assessment might be a better strategy for preventing unnecessary interruption of lenvatinib.


Assuntos
Antineoplásicos/efeitos adversos , Compostos de Fenilureia/efeitos adversos , Proteinúria/induzido quimicamente , Quinolinas/efeitos adversos , Neoplasias da Glândula Tireoide/tratamento farmacológico , Urinálise/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/administração & dosagem , Antineoplásicos/uso terapêutico , Creatinina/urina , Feminino , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Compostos de Fenilureia/administração & dosagem , Compostos de Fenilureia/uso terapêutico , Proteinúria/diagnóstico , Quinolinas/administração & dosagem , Quinolinas/uso terapêutico , Neoplasias da Glândula Tireoide/mortalidade , Neoplasias da Glândula Tireoide/urina
11.
PLoS One ; 15(3): e0230072, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32182259

RESUMO

In the urinary metabolomics for finding biomarkers in urine, owing to high concentrations of urea, for chromatography-based metabolomic analysis, urea needed to be degraded by urease. This urease pretreatment has been the key step of sample preparation for standard urinary metabolomics until today even for mass spectrometry-based analysis. The urease pretreatment involving incubation of urine with urease contradicts the concept of metabolome sampling, which should immediately arrest metabolic reactions to prevent alterations of a metabolite profile. Nonetheless, the impact of urease pretreatment has not been clearly elucidated yet. We found that activities of urease and endogenous urinary enzymes and metabolite contaminants from the urease preparations introduce artefacts into metabolite profiles, thus leading to misinterpretation.


Assuntos
Biomarcadores/urina , Metaboloma , Metabolômica/métodos , Manejo de Espécimes/métodos , Urease/metabolismo , Urinálise/métodos , Urina/química , Adulto , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Urinálise/normas
12.
Medicine (Baltimore) ; 99(11): e19284, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176052

RESUMO

High levels of albuminuria have been demonstrated to associate with hearing loss in non-diabetic people, while the clinical impact of low-grade albuminuria has attracted less attention. This cross-sectional population-based study aimed to examine whether hearing loss in non-diabetic United States (US) adults is independently associated with low-grade albuminuria or reduced estimated glomeruli filtration rate (eGFR).A total of 2518 participants aged 20 to 69 years were selected from the US National Health and Nutritional Examination Survey database. Participants with diabetes or high-grade albuminuria were excluded. Hearing loss was assessed using low-frequency pure-tone average (LFPTA) thresholds (0.5, 1.0, 2.0 kHz) and high-frequency pure-tone average (HFPTA) thresholds (3.0, 4.0, 6.0, 8.0 kHz). Logistic and linear regression analyses were used to evaluate associations between renal function indicators and hearing loss.The median age of included participants was 37.4 years, and 55% of them were female. Multivariate analysis revealed that participants with urinary albumin-to-creatinine ratio (UACR) in the highest tertile had a significantly higher risk of hearing loss (OR, 1.79; 95% CI, 1.01-3.19) and higher HFPTA thresholds (ß: 2.23; SE: 0.77). Participants with eGFR <60 mL/min/1.73 m had higher LFPTA thresholds (ß: 4.31; SE: 1.79). After stratification by sex, a significant risk remained only for males in the highest UACR tertile, with 2.18 times the risk of hearing loss (95% CI, 1.06-4.48).Non-diabetic US males with low-grade albuminuria are at increased risk of hearing loss, independent of eGFR.


Assuntos
Albuminúria/complicações , Albuminúria/diagnóstico , Comorbidade , Perda Auditiva/epidemiologia , Perda Auditiva/etiologia , Adulto , Distribuição por Idade , Idoso , Audiometria/métodos , Glicemia/análise , Estudos Transversais , Diabetes Mellitus , Taxa de Filtração Glomerular , Perda Auditiva/diagnóstico , Humanos , Incidência , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Inquéritos Nutricionais , Valores de Referência , Medição de Risco , Índice de Gravidade de Doença , Estados Unidos , Urinálise/métodos
13.
Transplant Proc ; 52(3): 823-828, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32111385

RESUMO

BACKGROUND: Human polyoma virus-associated nephropathy frequently refers to allograft failure after kidney transplant. Thus, the early detection of viral activation is extremely important for these immunocompromised patients. METHODS: Previously, urine polyoma virus-infected cells (decoy cells) were indicated as the virus action, usually screened by the routine papanicolaou cytology in renal biopsy, but these methods are complex and the positive rate is low. In this article, the direct microscopy observation method, Wright-Giemsa staining, and Sternheimer-Malbin (SM) staining were all used to screen the decoy cells in urine samples of 213 kidney transplant patients who had used immunosuppressive drugs. RESULTS: Among them, decoy cells were detected in 40 cases (18.8%) by the direct observation method, 44 cases (20.7%) by Wright-Giemsa staining and 49 cases (23.0%) by SM staining. Furthermore, the most common polyoma viruses, BK and JC viruses, were also confirmed in 41 (83.7%) cases among these 49 decoy cell-positive samples. Importantly, compared with other decoy cell detection methods, SM staining is fast, easy to operate, and has a high positive rate. CONCLUSION: Therefore, SM staining is recommended as a fast and effective method for screening urine decoy cells in kidney transplant patients.


Assuntos
DNA Viral/urina , Nefropatias/diagnóstico , Infecções por Polyomavirus/diagnóstico , Polyomavirus/genética , Complicações Pós-Operatórias/diagnóstico , Coloração e Rotulagem/métodos , Adulto , Vírus BK/genética , Feminino , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Vírus JC/genética , Nefropatias/patologia , Nefropatias/urina , Nefropatias/virologia , Transplante de Rim/efeitos adversos , Masculino , Teste de Papanicolaou , Infecções por Polyomavirus/urina , Infecções por Polyomavirus/virologia , Complicações Pós-Operatórias/urina , Complicações Pós-Operatórias/virologia , Transplante Homólogo , Urinálise/métodos , Ativação Viral
14.
PLoS One ; 15(2): e0228467, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32040516

RESUMO

Urethritis, or inflammation of the urethra, is one of the most common reasons men seek clinical care. Sexually transmitted pathogens including Neisseria gonorrhoeae are responsible for over half of the symptomatic urethritis cases in U.S. men. Recently, clinics in Indianapolis, Columbus, Atlanta, and other U.S. cities began to note increasing numbers of men presenting with urethritis and Gram-negative intracellular diplococci in their urethral smears who test negative for N. gonorrhoeae. Many of these discordant cases, which have periodically reached highs of more than 25% of presumed gonococcal cases in some sexually transmitted infection clinics in the U.S. Midwest, are infected with strains in a novel urethrotropic clade of Neisseria meningitidis ST-11 (US_NmUC). However, no cultivation-independent tests are available for the US_NmUC strains, and prior studies relied on microbial culture and genome sequencing to identify them. Here, we describe a PCR test that can identify the US_NmUC strains and distinguish them from commensal and invasive N. meningitidis strains as well as N. gonorrhoeae. Our SimpleProbe®-based real-time PCR assay targets a conserved nucleotide substitution in a horizontally acquired region of US_NmUC strain genomes. We applied the assay to 241 urine specimens whose microbial compositions had previously been determined by deep shotgun metagenomic sequencing. The assay detected the single US_NmUC positive case in this cohort, with no false positives. Overall, our simple and readily adaptable assay could facilitate investigation of the pathogenesis and epidemiology of the US_NmUC clade.


Assuntos
Neisseria meningitidis/genética , Reação em Cadeia da Polimerase em Tempo Real/métodos , Uretrite/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Reações Falso-Positivas , Gonorreia/diagnóstico , Gonorreia/epidemiologia , Gonorreia/microbiologia , Gonorreia/urina , Humanos , Masculino , Pessoa de Meia-Idade , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/isolamento & purificação , Neisseria meningitidis/classificação , Neisseria meningitidis/isolamento & purificação , Polimorfismo de Nucleotídeo Único , Doenças Bacterianas Sexualmente Transmissíveis/diagnóstico , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , Doenças Bacterianas Sexualmente Transmissíveis/microbiologia , Doenças Bacterianas Sexualmente Transmissíveis/urina , Estados Unidos/epidemiologia , Uretra/microbiologia , Uretra/patologia , Uretrite/diagnóstico , Urinálise/métodos , Sequenciamento Completo do Genoma , Adulto Jovem
15.
Clin Chem ; 66(2): 324-332, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-32040576

RESUMO

BACKGROUND: Rapid identification of fentanyl at the point-of-care is critical. Urine fentanyl concentrations in overdose cases start at single-digit nanograms per milliliter. No fentanyl point-of-care assay with a cutoff at single-digit nanograms per milliliter is available. METHODS: A competitive lateral flow assay (LFA) was developed using gold nanoparticles and optimized for rapid screening of fentanyl in 5 minutes. Urine samples from 2 cohorts of emergency department (ED) patients were tested using the LFA and LC-MS/MS. The 2 cohorts consisted of 218 consecutive ED patients with urine drug-of-abuse screen orders and 7 ED patients with clinically suspected fentanyl overdose, respectively. RESULTS: The LFA detected fentanyl (≥1 ng/mL) and the major metabolite norfentanyl (≥10 ng/mL) with high precision. There was no cross-reactivity with amphetamine, cocaine, morphine, tetrahydrocannabinol, methadone, buprenorphine, naloxone, and acetaminophen at 1000 ng/mL and 0.03%, 0.4%, and 0.05% cross-reactivity with carfentanil, risperidone, and 9-hydroxyrisperidone, respectively. In 218 consecutive ED patients, the prevalence of cases with fentanyl ≥1 ng/mL or norfentanyl ≥10 ng/mL was 5.5%. The clinical sensitivity and specificity of the LFA were 100% (95% CI, 75.8-100%) and 99.5% (95% CI, 97.3-99.9%), respectively. The positive and negative predictive values were 92.3% (95% CI, 66.7-98.6%) and 100% (95% CI, 98.2-100%), respectively. The concordance between the LFA and LC-MS/MS was 100% in the 7 suspected fentanyl overdose cases (5 positive, 2 negative). CONCLUSIONS: The LFA can detect fentanyl and norfentanyl with high clinical sensitivity and specificity in the ED population with rapid fentanyl screening needs.


Assuntos
Overdose de Drogas/diagnóstico , Fentanila/análise , Detecção do Abuso de Substâncias/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/urina , Bioensaio , Cromatografia Líquida/métodos , Overdose de Drogas/urina , Serviço Hospitalar de Emergência , Feminino , Fentanila/análogos & derivados , Fentanila/urina , Ouro , Humanos , Imunoensaio/métodos , Masculino , Nanopartículas Metálicas , Pessoa de Meia-Idade , Testes Imediatos , Sensibilidade e Especificidade , Espectrometria de Massas em Tandem/métodos , Urinálise/métodos
16.
Ann Biol Clin (Paris) ; 78(1): 87-92, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32108586

RESUMO

Serum proteins and urinary proteins electrophoresis are useful biological tests. They are often prescribed for the screening of monoclonal gammopathys and also during follow-up for treatment response. This test can be accredited according to standard NF ISO 15189 since laboratories use analysers and adapted reagents, but there are numerous protocols for the method validation. This paper present the results of a survey proposed in 2019 to biologists by CNBH and SFBC. The aim of this survey is to give biologists a choice among several protocols that have been positively evaluated by COFRAC.


Assuntos
Acreditação , Análise Química do Sangue/normas , Eletroforese/normas , Laboratórios/normas , Urinálise/normas , Análise Química do Sangue/métodos , Proteínas Sanguíneas/análise , Proteínas Sanguíneas/química , Comportamento de Escolha , Testes Diagnósticos de Rotina/normas , Eletroforese/métodos , Humanos , Ensaio de Proficiência Laboratorial/métodos , Proteinúria/diagnóstico , Proteinúria/urina , Controle de Qualidade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Inquéritos e Questionários , Urinálise/métodos , Estudos de Validação como Assunto
17.
Arch Biochem Biophys ; 681: 108279, 2020 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-31982394

RESUMO

Because long-term occupational exposure to low concentrations of acrylamide (ACR) has the potential to cause neurological damage, it is important to identify biomarkers that can be used to evaluate this risk. In the present study, urine metabolomics of the ACR-exposed and non-exposed groups to identify potential metabolites was carried out using ultra high performance liquid chromatography coupled with quadrupole time of flight mass spectrometry. Serum biochemical indexes of the exposed and non-exposed groups were also determined. Principal component analysis showed a differential separation between exposed group and non-exposed group and a total of 7 metabolites were identified in positive and negative ionization modes; Area under curve of anthranilic acid, ß-guanidinopropionic acid and mesobilirubinogen were 0.980, 0.843 and 0.801 respectively and these metabolites showed high sensitivity and specificity. The 13 biochemical indexes were divided into three classes based on physiological functions. Only biomarkers of dysregulated liver function including alanine aminotransferase, aspartic transaminase, total bilirubin, direct bilirubin and triglyceride were significantly higher in the exposed group than in the non-exposed group. This study identifies important related metabolic changes in the bodies of workers after long-term occupational exposure to low concentration ACR and suggests new biomarkers of nervous system injury caused by ACR. The study also provides a sound basis for exploring the biochemical mechanisms and metabolic pathways of nervous system toxicity caused by ACR.


Assuntos
Acrilamida/efeitos adversos , Biomarcadores/urina , Metabolômica/métodos , Exposição Ocupacional/efeitos adversos , Acrilamida/metabolismo , Adulto , Biomarcadores/metabolismo , Cromatografia Líquida de Alta Pressão/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espectrometria de Massas em Tandem/métodos , Urinálise/métodos
18.
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
8-Hidroxi-2'-Desoxiguanosina , Cromatografia Líquida de Alta Pressão , Cotinina , Espectrometria de Massas em Tandem , Urinálise , 8-Hidroxi-2'-Desoxiguanosina/urina , Cotinina/urina , Humanos , Isótopos/química , Urinálise/métodos
19.
PLoS One ; 15(1): e0227694, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31961894

RESUMO

OBJECTIVES: Diabetes is a global epidemic, and the high cost of annually and quantitatively measuring urine albumin excretion using the turbidimetric immunoassay is challenging. We aimed to determine whether a semi-quantitative urinary albumin-creatinine ratio test could be used as a screening tool for microalbuminuria in diabetic patients. METHODS: We assessed the diagnostic accuracy of the semi-quantitative method. The costs of false results in the semi-quantitative method were calculated based on the annual probability of disease progression analyzed through a systematic literature review and meta-analysis. The pooled long-term cost-saving effect of the semi-quantitative method compared with the quantitative test was assessed using a Markov model simulating a long-term clinical setting. Diagnostic accuracy and the cost-saving effect were also validated in an independent external cohort. RESULTS: Compared with the quantitative test, the semi-quantitative method had sensitivities of 93.5% and 81.3% and specificities of 61.4% and 63.1% in the overall sample of diabetic patients (n = 1,881) and in diabetic patients with eGFR ≥60 ml/min/1.73 m2 and a negative dipstick test (n = 1,110), respectively. After adjusting for direct and indirect medical costs, including the risk of disease progression, which was adjusted by the meta-analyzed hazard ratio for clinical outcomes, it was determined that using the semi-quantitative method could save 439.4 USD per person for 10 years. Even after adjusting the result to the external validation cohort, 339.6 USD could be saved for one diabetic patient for 10 years. CONCLUSIONS: The semi-quantitative method could be an appropriate screening tool for albuminuria in diabetic patients. Moreover, it can minimize the testing time and inconvenience and significantly reduce national health costs.


Assuntos
Albuminúria/diagnóstico , Diabetes Mellitus/urina , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/urina , Programas de Rastreamento/métodos , Urinálise/métodos , Albuminúria/urina , Estudos de Coortes , Redução de Custos/estatística & dados numéricos , Humanos , Programas de Rastreamento/economia , Reprodutibilidade dos Testes , República da Coreia , Urinálise/economia , Urinálise/estatística & dados numéricos
20.
PLoS One ; 15(1): e0227257, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31910242

RESUMO

PURPOSE: Multidrug-resistant Enterobacteriaceae in urinary tract infection (UTI) has spread worldwide; one cause is overuse of broad-spectrum antimicrobial agents such as fluoroquinolone antibacterials. To improve antimicrobial agent administration, this study aimed to calculate a probability prediction formula to predict the organism strain causing UTI in real time from dip-stick testing and flow cytometry. METHODOLOGY: We examined 372 outpatient spot urine samples with observed pyuria and bacteriuria using dip-stick testing and flow cytometry. We performed multiple logistic-regression analysis on the basis of 11 measurement items and BACT scattergram analysis with age and sex as explanatory variables and each strain as the response variable and calculated a probability prediction formula. RESULTS: The best prediction formula for discrimination of the bacilli group and cocci or polymicrobial group was a model with 5 explanatory variables that included percentage of scattergram dots in an angular area of 0-25° (P<0.001), sex (P<0.001), nitrite (P = 0.002), and ketones (P = 0.133). For a predicted cut-off value of Y = 0.395, sensitivity was 0.867 and specificity was 0.775 (cross-validation group: sensitivity = 0.840, specificity = 0.760). The best prediction formula for P. mirabilis and other bacilli was a model with percentage of scattergram dots in an angular area of 0-20° (P<0.001) and nitrite (P = 0.090). For a predicted cut-off value of Y = 0.064, sensitivity was 0.889 and specificity was 0.788 (cross-validation group: sensitivity = 1.000, specificity = 0.766). CONCLUSION: Simultaneous use of the calculated probability prediction formula with urinalysis results facilitates real-time prediction of organisms causing UTI, thus providing helpful information for empiric therapy.


Assuntos
Gestão de Antimicrobianos , Infecções por Enterobacteriaceae/microbiologia , Enterobacteriaceae/isolamento & purificação , Urinálise/métodos , Infecções Urinárias/microbiologia , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Enterobacteriaceae/efeitos dos fármacos , Enterobacteriaceae/fisiologia , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/urina , Estudos de Viabilidade , Feminino , Citometria de Fluxo , Fluoroquinolonas/farmacologia , Fluoroquinolonas/uso terapêutico , Humanos , Modelos Logísticos , Masculino , Sensibilidade e Especificidade , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/urina
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