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Asymptomatic Bacteriuria in the ElderlyRodhe, Nils January 2008 (has links)
The aim of this thesis was to explore the features of asymptomatic bacteriuria (ASB) in elderly people living in the community, and to seek diagnostic tools to discriminate between ASB and symptomatic urinary tract infection (UTI). All men and women aged 80 and over living in an urban district of Falun, Sweden, were invited to participate. Urine samples were obtained together with information on symptoms and on health indicators. The same cohort was surveyed again after 6 and 18 months. Urinary cytokines were analysed in 16 patients with UTI, in 24 subjects with ASB and in 20 negative controls. ASB occurred at baseline in 19.0% of women and 9.4% of men, and was found at least once in 36.9% of women and in 20.2% of men. ASB in women was associated with reduced mobility and urge urinary incontinence. Of those with ASB at baseline, 60% still had bacteriuria at 6 and 18 months, but among those with repeated findings of ASB with E. coli, only 40% had the same bacterial strain after 18 months. In women, the risk of developing a UTI within 24 months was higher among those with ASB at baseline than in those without. Urinary levels of cytokines (CXCL1, CXCL8 and IL-6) and leukocyte esterase were higher in patients with UTI than in patients with ASB. There is convincing evidence that ASB is harmless and should not be treated with antibiotics. However, such treatment is still often given, thereby unnecessarily contributing to the increased number of bacteria resistant to common antibiotics. This study confirms the high prevalence of ASB in elderly people living in the community. In order not to be misled by a urinary test showing bacteria, it is important to restrict urinary testing for bacteria to patients where there is a suspicion of UTI. In elderly patients with diffuse symptoms or in patients who are unable to communicate their symptoms, further diagnostic help could possibly be obtained by evaluating the urinary levels of leukocyte esterase and/or IL-6.
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Comparison of a leukocyte esterase test with endometrial cytology for the diagnosis of subclinical endometritis and correlation with first service pregnancy rate in postpartum Holstein cowsCouto, Gabriel B. 11 1900 (has links)
L’objectif de la présente étude était d’évaluer un test d’estérase leucocytaire (LE) pour le diagnostic de l’endométrite subclinique chez les vaches Holstein en période postpartum. Les tests effectués à partir d’échantillons provenant soit de l’endomètre (UtLE) ou du col utérin (CxLE) ont été comparés à la cytologie endométriale (CE). Par ailleurs, deux méthodes d’évaluation des lames ont été comparées. Deux cent quatre vingt-cinq vaches Holstein de 5 troupeaux laitiers commerciaux ont été évaluées entre 21 et 47 jours en lait (JEL). Soixante sept vaches ont été diagnostiquées avec une endométrite clinique suite à un examen transrectal et vaginoscopique et ont été exclues de l’étude. Deux cent dix-huit vaches ont eu des prélèvements pour la CE et le test LE. La fonction ovarienne a été déterminée à la palpation transrectale. La banque de données utilisée pour chacune des vaches a été effectuée à partir du logiciel DSA (Dossier de Santé Animale) laitier. Le pourcentage de neutrophiles était significativement corrélé avec les scores de LE utérin et cervical. L’activité de CxLE et UtLE diminuait significativement avec les JEL, mais n’était pas associée au risque de gestation à 90 JEL (n= 186). Le pourcentage de neutrophiles mesuré à la CE entre 32 et 47 JEL était associé significativement au risque de gestation à 90 JEL (n=94, P=0.04). Pour la même période, selon une analyse de survie, les vaches avec >2,6% de neutrophiles à la CE étaient définies comme étant atteintes d’une endométrite subclinique avec une prévalence de 56%. Les résultats indiquent que le test d’estérase utérin ou cervical a une bonne concordance avec le pourcentage de neutrophiles à la CE. Une endométrite subclinique diagnostiquée par cytologie endometriale entre 32 et 47 JEL est associée à une réduction du risque de gestation au premier service. / The point toward this study was to determine the diagnostic test characteristics of the leukocyte esterase activity test for subclinical endometritis in postpartum Holstein dairy cows. The objectives were 1) to compare uterine leukocyte esterase activity and the endometrial cytology (EC), 2) to compare leukocyte esterase activity of the cervix (CxLE) and the uterus (UtLE), 3) Compare two methods of assessing the slides (i.e. an exhaustive method and a rapid method). Two hundred eighty five post partum Holstein cows from 5 commercial dairy herds had a post partum evaluation between 21 and 47 days in milk (DIM). Sixty seven cows where diagnosed with clinical endometritis by transrectal and vaginoscopy examinations and were excluded from the study. Two hundred eighteen cows were enrolled for endometrial cytology and esterase activity test. The ovarian status was determined by transrectal examination. Computerized databank, dairy DSA (Dossier de Santé Animale) indexing all the cows was used to retrieve individual information for analysis. The percentage of neutrophils was significantly correlated with the LE from the uterus and cervix. The LE from cervix and uterus decreased significantly with DIM, however, they were not statistically associated with pregnancy risk at 90 DIM (n=186). Between 32-47 DIM, the percentage of neutrophils and risk of pregnancy at 90 DIM were associated (n=94, P=0.04). For the same period, survival analysis identified cows with > 2.6 % neutrophils on EC as subclinical endometritis cows with a prevalence of 56%. The two methods for assessing the slides were correlated by 81%. Subclinical endometritis diagnosed by endometrial cytology between 32 and 47 DIM was associated with reduced risk of pregnancy at first service.
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Comparison of a leukocyte esterase test with endometrial cytology for the diagnosis of subclinical endometritis and correlation with first service pregnancy rate in postpartum Holstein cowsCouto, Gabriel B. 11 1900 (has links)
L’objectif de la présente étude était d’évaluer un test d’estérase leucocytaire (LE) pour le diagnostic de l’endométrite subclinique chez les vaches Holstein en période postpartum. Les tests effectués à partir d’échantillons provenant soit de l’endomètre (UtLE) ou du col utérin (CxLE) ont été comparés à la cytologie endométriale (CE). Par ailleurs, deux méthodes d’évaluation des lames ont été comparées. Deux cent quatre vingt-cinq vaches Holstein de 5 troupeaux laitiers commerciaux ont été évaluées entre 21 et 47 jours en lait (JEL). Soixante sept vaches ont été diagnostiquées avec une endométrite clinique suite à un examen transrectal et vaginoscopique et ont été exclues de l’étude. Deux cent dix-huit vaches ont eu des prélèvements pour la CE et le test LE. La fonction ovarienne a été déterminée à la palpation transrectale. La banque de données utilisée pour chacune des vaches a été effectuée à partir du logiciel DSA (Dossier de Santé Animale) laitier. Le pourcentage de neutrophiles était significativement corrélé avec les scores de LE utérin et cervical. L’activité de CxLE et UtLE diminuait significativement avec les JEL, mais n’était pas associée au risque de gestation à 90 JEL (n= 186). Le pourcentage de neutrophiles mesuré à la CE entre 32 et 47 JEL était associé significativement au risque de gestation à 90 JEL (n=94, P=0.04). Pour la même période, selon une analyse de survie, les vaches avec >2,6% de neutrophiles à la CE étaient définies comme étant atteintes d’une endométrite subclinique avec une prévalence de 56%. Les résultats indiquent que le test d’estérase utérin ou cervical a une bonne concordance avec le pourcentage de neutrophiles à la CE. Une endométrite subclinique diagnostiquée par cytologie endometriale entre 32 et 47 JEL est associée à une réduction du risque de gestation au premier service. / The point toward this study was to determine the diagnostic test characteristics of the leukocyte esterase activity test for subclinical endometritis in postpartum Holstein dairy cows. The objectives were 1) to compare uterine leukocyte esterase activity and the endometrial cytology (EC), 2) to compare leukocyte esterase activity of the cervix (CxLE) and the uterus (UtLE), 3) Compare two methods of assessing the slides (i.e. an exhaustive method and a rapid method). Two hundred eighty five post partum Holstein cows from 5 commercial dairy herds had a post partum evaluation between 21 and 47 days in milk (DIM). Sixty seven cows where diagnosed with clinical endometritis by transrectal and vaginoscopy examinations and were excluded from the study. Two hundred eighteen cows were enrolled for endometrial cytology and esterase activity test. The ovarian status was determined by transrectal examination. Computerized databank, dairy DSA (Dossier de Santé Animale) indexing all the cows was used to retrieve individual information for analysis. The percentage of neutrophils was significantly correlated with the LE from the uterus and cervix. The LE from cervix and uterus decreased significantly with DIM, however, they were not statistically associated with pregnancy risk at 90 DIM (n=186). Between 32-47 DIM, the percentage of neutrophils and risk of pregnancy at 90 DIM were associated (n=94, P=0.04). For the same period, survival analysis identified cows with > 2.6 % neutrophils on EC as subclinical endometritis cows with a prevalence of 56%. The two methods for assessing the slides were correlated by 81%. Subclinical endometritis diagnosed by endometrial cytology between 32 and 47 DIM was associated with reduced risk of pregnancy at first service.
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