scholarly journals Smell—Adding a New Dimension to Urinalysis

Biosensors ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. 48
Author(s):  
Eva H. Visser ◽  
Daan J. C. Berkhout ◽  
Jiwanjot Singh ◽  
Annemieke Vermeulen ◽  
Niloufar Ashtiani ◽  
...  
Keyword(s):  
High Risk ◽  
Bacterial Growth ◽  
Pediatric Population ◽  
Potential Biomarker ◽  
Volatile Organic ◽  
Dipstick Urinalysis ◽  
Set Up ◽  
Diagnostic Work ◽  
Tract Infections ◽  
Work Up

Background: Urinary tract infections (UTI) are among the most common infections in children. The primary tool to detect UTI is dipstick urinalysis; however, this has limited sensitivity and specificity. Therefore, urine culture has to be performed to confirm a UTI. Urinary volatile organic compounds (VOC) may serve as potential biomarker for diagnosing UTI. Previous studies on urinary VOCs focused on detection of UTI in a general population; therefore, this proof-of-principle study was set up in a clinical high-risk pediatric population. Methods: This study was performed at a tertiary nephro-urological clinic. Patients included were 0–18 years, clinically suspected of a UTI, and had abnormal urinalysis. Urine samples were divided into four groups, i.e., urine without bacterial growth, contamination, colonization, and UTI. VOC analysis was performed using an electronic nose (eNose) (Cyranose 320®) and VOC profiles of subgroups were compared. Results: Urinary VOC analysis discriminated between UTI and non-UTI samples (AUC 0.70; p = 0.048; sensitivity 0.67, specificity 0.70). The diagnostic accuracy of VOCs improved when comparing urine without bacterial growth versus with UTI (AUC 0.80; p = 0.009, sensitivity 0.79, specificity 0.75). Conclusions: In an intention-to-diagnose high-risk pediatric population, UTI could be discriminated from non-UTI by VOC profiling, using an eNose. Since eNose can be used as bed-side test, these results suggest that urinary VOC analysis may serve as an adjuvant in the diagnostic work-up of UTI in children.

scholarly journals Optimizing the diagnostic work-up of acute uncomplicated urinary tract infections

2008 ◽  
Vol 9 (1) ◽  
Author(s):  
Bart J Knottnerus ◽  
Patrick JE Bindels ◽  
Suzanne E Geerlings ◽  
Eric P Moll van Charante ◽  
Gerben ter Riet
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Diagnostic Work ◽  
Tract Infections ◽  
Work Up ◽  
Diagnostic Work Up

scholarly journals Workload, diagnostic work-up and treatment of urinary tract infections in adults during out-of-hours primary care: a retrospective cohort study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Michelle Spek ◽  
Jochen W. L. Cals ◽  
Guy J. Oudhuis ◽  
Paul H. M. Savelkoul ◽  
Eefje G. P. M. de Bont
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Electronic Patient Records ◽  
Out Of Hours ◽  
Diagnostic Work ◽  
Tract Infections ◽  
Work Up ◽  
Diagnostic Work Up

Abstract Background Urinary tract infections (UTIs) are one of the most common infections in primary care. Previous research showed that GPs find it challenging to diagnose UTIs and frequently divert from guidelines leading to unwarranted antibiotic prescriptions and inefficient use of diagnostics such as urinary cultures. We hypothesise that management of UTIs during out-of-hours care may be extra challenging due to a higher workload and logistical issues regarding diagnostic work-up and obtaining results. We therefore aimed to study the workload, diagnostic work-up and treatment of UTIs during out-of-hours primary care. Methods We performed a retrospective observational cohort study in which we analysed a full year (2018) of electronic patient records of two large Dutch GP out-of-hours centres. All adult patients with UTI symptoms were included in this study. Descriptive statistics and multivariate regression were used to analyse diagnostics and subsequent management. Results A total of 5657 patients were included (78.9% female, mean age of 54 years), with an average of eight patients per day that contact a GP out-of-hours centre because of UTI symptoms. Urinary dipsticks were used in 87.5% of all patients visiting the out-of-hours centres with UTI symptoms. Strikingly, urinary cultures were only requested in 10.3% of patients in which urinary culture was indicated. Seventy-four percent of the patients received antibiotics. Seventy-nine percent of the patients with a negative nitrite test still received antibiotics. Remarkably, patients at risk of complications because of a UTI, such as men, received fewer antibiotic prescriptions. Conclusions In total, 74% of the patients received antibiotics. 8 out of 10 patients still received an antibiotic prescription in case of a negative nitrite test, and 9 out of 10 patients with an indication did not receive a urine culture. In conclusion, we found that correctly diagnosing UTIs and prescribing antibiotics for UTIs is a challenge that needs major improvement, especially during out-of-hours GP care.

Stroke as Presenting Feature of COVID-19 in a Pediatric Patient

2021 ◽  
Author(s):  
Shanna Swartwood ◽  
Gary R. Nelson ◽  
Audie C. Espinoza
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Adult Population ◽  
Acute Onset ◽  
Cerebrovascular Complications ◽  
Novel Virus ◽  
Polymerase Chain ◽  
Diagnostic Work ◽  
Novel Coronavirus ◽  
Work Up

AbstractNeurologic manifestations of severe acute respiratory syndrome coronavirus 2, the virus responsible for novel coronavirus 2019 (COVID-19) infection, have been frequently reported in the adult population but remain relatively rare in pediatric patients, specifically in regard to cerebrovascular accidents (CVAs). We present the case of a previously healthy 16-year-old adolescent boy with no preceding infectious symptoms who developed acute onset of left-sided weakness and slurred speech subsequently diagnosed with acute ischemic stroke (AIS). After performing a thorough diagnostic work-up, no clear etiology for AIS was identified. He was found to be COVID-19 positive by reverse transcription polymerase chain reaction upon admission. Accumulating evidence supports a link between COVID-19 and a systemic prothrombotic state suggesting pediatric patients who present with AIS and no other risk factors should be screened for this novel virus and potentially for extracranial sources of thrombi. As the rates of positive COVID-19 infection increase in the pediatric population, pediatricians and other pediatric subspecialists should be aware of the potential neurological and cerebrovascular complications of this novel virus to avoid delays in evaluation and intervention.

Flow Cytometric Immunophenotyping in Myelodysplasia: Discovery and Diagnosis

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. SCI-24-SCI-24
Author(s):  
Arjan A Van de Loosdrecht ◽  
Theresia M. Westers
Keyword(s):  
High Risk ◽  
Research Funding ◽  
Severe Dysplasia ◽  
Diagnostic Score ◽  
Flow Cytometric ◽  
Transfusion Requirements ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up ◽  
Myeloid Progenitors

Abstract Diagnosis of myelodysplastic syndromes (MDS) is based on the integration of results from diagnostic tools. Initial laboratory assessments in patients with suspected MDS comprise analysis of peripheral blood and bone marrow with the gold standard of cytomorphology, conventional cytogenetics and interphase fluorescence-in-situ hybridization (FISH). Single nucleotide polymorphism (SNP) array and next-generation sequencing (NGS) are emerging techniques. The pathological hallmark of MDS is dysplasia. Flow cytometry (FC) can identify aberrancies in antigen expression and differentiation patterns that are indicative of dysplasia. FC is regarded instrumental and now even recommended in the diagnostic work-up of (suspected) MDS, especially when dysplasia by cytomorphology is minimal and cytogenetics shows no (typical) abnormalities. No single FC marker has been identified that is specific for MDS. The WHO-2008 classification recommends the presence of three or more FC aberrancies as highly suggestive for MDS. Minimal requirements to analyze dysplasia by FC have been proposed by the European LeukemiaNet (ELNet) working group (ELNet iMDS-Flow. ELNet recommendations should enable a categorization of FC results in cytopenic patients as "normal", "suggestive of", or “high probability of” MDS. FC as a single technique is not sufficient for the diagnosis of MDS and should be part of an integrated diagnostic work-up. Within the ELNet-iMDS-Flow group, a score based on four cardinal parameters was validated in MDS patients with <5% blasts and non-clonal cytopenic controls. This diagnostic score comprises: a) SSC of granulocytes (reflecting granularity) as ratio to lymphocytes; b) percentage of CD34+ myeloid progenitors of nucleated cells; c) percentage of B cell progenitors within the total CD34+ compartment; and d) expression of CD45 on CD34+ myeloid progenitors as ratio to lymphocytes. An abnormal value for every single parameter is assigned 1 point; MDS is highly suggestive when a score of 2 or more is obtained. Sensitivity of this diagnostic score was 70% and specificity 92%. It was demonstrated that this score also separates distinct subgroups with respect to prognosis within IPSS-R risk groups. Most flow scores mainly incorporate markers that cover the myelomonocytic lineage, e.g. the flow cytometric scoring system (FCSS). The latter separates patients with no and mild-to-moderate dysplasia from those with severe dysplasia. The FCSS has recently been shown to add significantly in separating patients into low or high risk disease in the revised IPSS subgroups. Finally, FCSS originally designed as a prognostic score, but can also be applied as a diagnostic score as combined with the 4-parameter FC diagnostic score to further improve sensitivity and specificity. Flow profiles based on the myelomonocytic lineage may fail to recognize MDS patients that exclusively show erythroid and/or megakaryocytic dysplasia. Analysis of megakaryocytes is hampered by their paucity. Recent advances shows that when adding erythroid markers such as CD71, CD36 and CD117/CD105 may add significantly to the diagnostic score of MDS by FC. Interestingly, aberrancies in the myelomonocytic lineage have been shown in patients with solely erythroid dysplasia with impact on prognosis. In addition, aberrant FC profile of myeloid progenitors has been associated with high transfusion requirements and disease progression as well as with a short duration of response or even lack of response to growth factor and azacitidine treatment. In conclusion, FC is a useful tool in the diagnostic work-up of MDS. Further studies on the value of FC in diagnosis, prognosis and predicting response to treatment are ongoing, as well as correlation of FC results with data obtained by SNP and NGS within prospective multicenter clinical trials in low and high risk MDS. Disclosures Van de Loosdrecht: celgene: Honoraria, Research Funding; alexion: Research Funding.

Screening for colorectal cancer by faecal occult blood test: comparison of immunochemical tests

2000 ◽  
Vol 7 (1) ◽  
pp. 35-37 ◽  
Author(s):  
G. Castiglione ◽  
M. Zappa ◽  
G. Grazzini ◽  
T. Rubeca ◽  
P. Turco ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Occult Blood ◽  
Faecal Occult Blood Test ◽  
Population Based ◽  
Latex Agglutination ◽  
Faecal Occult Blood ◽  
Faecal Occult ◽  
Diagnostic Work ◽  
Work Up

Objective To compare two immunochemical faecal occult blood tests based on reversed passive haemagglutination (RPHA) or latex agglutination (Hdia) in a population based screening setting. Method Hdia was interpreted according to three positivity thresholds: 100, 150, or 200 ng of haemoglobin/mg of specimen solution. A total of 5844 subjects were recruited into the study, from 17 432 invited subjects aged 50–70. Results Positivity rates were 3.3% for RPHA, Hdia100 3.5%, Hdia150 2.5%, Hdia200 2.0%. Among subjects complying with the diagnostic work up, colorectal cancer (CRC) was detected in 19 subjects (17 RPHA positive, 16 Hdia100 positive, 15 Hdia150 positive, 14 Hdia200 positive) and high risk adenoma/s in 41 subjects (28 RPHA positive, 32 Hdia100 positive, 29 Hdia150 positive, 25 Hdia200 positive). The prevalence of screen positive CRC in the population was for RPHA 2.9‰, Hdia100 2.7‰, Hdia150 2.6‰, Hdia200 2.4‰. The prevalence of screen positive high risk adenomas in the population was for RPHA 4.8‰, Hdia100 5.5‰, Hdia150 5.0‰, Hdia200 4.3‰. Conclusion Hdia100 was as sensitive as RPHA for cancer and high risk adenomas. As Hdia is less technically complex than RPHA, it is a valid alternative to the latter, provided that full automation of the development procedure is available. Increasing the positivity threshold of Hdia up to 150 or 200 ng of haemoglobin/mg of specimen solution is not advisable as the increase in specificity is too small to justify the corresponding decrease in the detection of screen positive cancers in the population.

scholarly journals Back pain and scoliosis in children: When to image, what to consider

2017 ◽  
Vol 30 (5) ◽  
pp. 393-404 ◽  
Author(s):  
Sonia F Calloni ◽  
Thierry AGM Huisman ◽  
Andrea Poretti ◽  
Bruno P Soares
Keyword(s):  
Back Pain ◽  
Imaging Techniques ◽  
Pediatric Population ◽  
Laboratory Findings ◽  
Persistent Symptoms ◽  
Imaging Approach ◽  
Diagnostic Work ◽  
Work Up ◽  
Comprehensive History

Back pain and scoliosis in children most commonly present as benign and self-limited entities. However, persistent back pain and/or progressive scoliosis should always be taken seriously in children. Dedicated diagnostic work-up should exclude etiologies that may result in significant morbidity. Clinical evaluation and management require a comprehensive history and physical and neurological examination. A correct imaging approach is important to define a clear diagnosis and should be reserved for children with persistent symptoms or concerning clinical and laboratory findings. This article reviews the role of different imaging techniques in the diagnostic approach to back pain and scoliosis, and offers a comprehensive review of the main imaging findings associated with common and uncommon causes of back pain and scoliosis in the pediatric population.

Pediatric Demyelinating Disease: Emerging Patterns from Multiple Sclerosis to Anti-Myelin Oligodendrocyte Glycoprotein‐Associated Encephalomyelitis

Neurographics ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. 139-151
Author(s):  
J. Aw-Zoretic ◽  
A. Harrell ◽  
J.P. Rubin ◽  
S. Palasis
Keyword(s):  
Demyelinating Disease ◽  
Pediatric Population ◽  
Clinical History ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Demyelinating Diseases ◽  
Imaging Features ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up ◽  
Made In

Ongoing progress is being made in the understanding of pediatric demyelinating diseases, including the recent discovery of anti-myelin oligodendrocyte glycoprotein (anti-MOG) encephalitis. Radiologists play a key role in the diagnostic work-up of these patients. Demyelinating diseases can be challenging to differentiate from each other and can mimic anti-MOG encephalitis, especially because the various disorders can present with nonspecific radiologic cord findings and overlapping CNS features. There are some key imaging features that can be explained by the more recent development in the pathophysiological basis of these different entities. Attention to pertinent clinical history allows for improved diagnostic accuracy. Identifying MR imaging predictors of a particular demyelinating diagnosis in the pediatric population can have broad implications on treatment.

18F-Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET): An Important Tool in the Management of Infection in Patients with Hematological Cancer.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1160-1160
Author(s):  
Elias J. Anaissie ◽  
Marisa H. Miceli ◽  
Steve D. Strout ◽  
Laurie Jones-Jackson ◽  
Ronald C. Walker ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Joint Infection ◽  
Laboratory Findings ◽  
Suspected Infection ◽  
Severe Immunosuppression ◽  
Positron Emission ◽  
Vascular Infections ◽  
Diagnostic Work ◽  
Tract Infections ◽  
Work Up

Abstract Background: FDG-PET is useful for detecting cancer (ca) sites and preliminary data suggest a role in bone and joint infection, mostly in non-immunosuppressed hosts. Purpose: To determine the role of FDG-PET in the management of infection in patients (pts) with hematological ca. Patients and Methods: Between 10/01/2001 and 5/31/2004, FDG-PET scans performed for ca staging and /or for the diagnosis of suspected infection that were reported as showing increased radiotracer uptake at extramedullary sites were reviewed. Results of FDG-PET were correlated with clinical and laboratory findings to identify episodes of infection. Results: 184 infections were documented by FDG-PET in 164 pts (90% multiple myeloma). Median age was 58 years (range 25–79) and 108 pts were males. 59 pts were neutropenic (<1000 neutrophils/ml) and 32 had severe immunosuppression (neutrophils, lymphocytes and / or CD4 counts <100 cells/ml).FDG-PET identified respiratory tract infections (118; including pneumonia/empyema, 112 and sinusitis, 6), vascular infections (27; septic thrombophlebitis (STP), 16 and infection of implantable catheter, 11), discitis / osteomyelitis (19), gastrointestinal tract infections (10; colitis, 5; diverticulitis and abdominal abscess (2 each) and esophagitis, 1), periodontal abscesses (10), cellulitis (2) and mastoiditis (1). 59 infections were microbiologically documented including bacterial (42), fungal (13), viral and mycobacterial (2 each). FDG-PET detected infectious foci despite severe immunosuppression (32 episodes). FDG-PET contributed to pt management including identification of the presence and site of infection (77), determination of its extent (81), modification of the diagnostic work-up and /or therapy (71) and evaluation of response (79). 58 clinically silent infections were detected among pts undergoing FDG-PET for ca staging. Conclusion: In pts with hematological ca, FDG-PET is a useful tool for establishing the presence, site (s), and extent of infection with various pathogens and in various organs, even in the setting of severe immunosuppression. FDG-PET can identify clinically silent infections and infections not detectable by other methods (such as STP) and can result in significant changes in pt management.

scholarly journals Serum WNT-induced secreted protein 1 level as a potential biomarker for thyroid nodules

2021 ◽  
Vol 17 (3) ◽  
pp. 226-233
Author(s):  
Gulhan Duman ◽  
Baris Sariakcali
Keyword(s):  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Secreted Protein ◽  
Potential Biomarker ◽  
Cytological Evaluation ◽  
The Difference ◽  
Diagnostic Work ◽  
Work Up ◽  
Benign Group ◽  
Benign Thyroid

Background. Thyroid nodule (TN) is a common thyroid disease worldwide, and it has increased significantly last decades. Most TNs are usually incidental findings of asymptomatic, benign lesions discovered by imaging modalities performed for reasons unrelated to thyroid diseases. The purpose of this study was to investigate the value of serum WNT-induced secreted protein 1 (WISP1) level as a supporting biomarker to perform differential diagnosis of benign and non-benign thyroid nodules. Materials and methods. The study was completed with the 89 patients undergone fine needle aspiration biopsy and 43 controls. The patients were composed of 96 (72.7 %) females and 36 (27.3 %) males. And they were divided into 2 group according to the Bethesda cytological evaluation as Benign (Bethesda 2) and Non-Benign (Bethesda 3–6) groups. Their serum WISP1 levels were measured by an ELISA method. Results. There were 58 (43.9 %) patients in Benign (Bethesda 2) and 31 (23.5 %) in non-Benign (Bethesda 3–6) groups. In the contrary nodule size was bigger in the Non-benign group than that benign group (p = 0.006). The serum WISP1 level in the Benign (Bethesda 2) group was significantly higher than that in the and Non-Benign (Bethesda 3–6) group, and controls (p < 0). The difference between benign and non-benign group accordingly to their echogenicitiy was significant (p < 0.05). In benign group there was 76.9 % mixed echoic nodules, 76.7 % isoechoic nodules 68.4 % isohypoechoic nodules and 35.7 % hypoechoic nodules. In the non-benign group, the highest hypoechoic echo (64.3 %), the least mixed echo (23.1 %), while in the benign group, the most mixed echo (76.9 %), the least hypoechoic echo (35.7 %) was present. There was no relation between WISP1 levels and echogenicity with Kruskal-Wallis H test. Conclusions. According to the preliminary results of current study, addition of serum WISP1 measurement to the differential diagnostic work-up of thyroid nodules patients may provide supportive information. In thyroid nodules patients with Benign (Bethesda 2) category of cytological evaluation, a higher level of serum WISP1 may support cytological diagnosis.

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