Thesis (M Med(Family Medicine))--University of Limpopo (Medunsa Campus), 2009. / Aim: To determine whether routine dipstick urinalysis adds value to the management of patients at Primary Health Care clinic (PHC) in Mankweng Hospital. Objectives: 1. To determine the prevalence of urine abnormality in patients. 2. To determine components of urine (i.e. blood, protein, glucose etc.) that shows abnormality. 3. To determine the association of urine abnormality with regard to age and gender. 4. To estimate the cost of doing dipstick urinalysis. Design: This was a cross-sectional, quantitative survey. A fresh urine sample collected from patients attending the clinic was tested for ten components using UriCHECK 10. The cost of the dipstick test was estimated. Setting: A Primary Health Care clinic in Mankweng Hospital which is a tertiary institution for the province of Limpopo, RSA. Results: A total of 227 patients participated in the study. Of these, 153(67%) were female and 74(33%) were male. Urine abnormality rate was 35%. The most (26%) abnormalities were found in the age group 20-24 years. The prevalence of abnormalities were 19% blood, 12% leukocytes, 4% protein, 11% ketones, 3% glucose, 3% nitrites and 0.4% urobilinogen. The total cost per 100 urine samples was R319.41. Conclusions: The prevalence of initial urinary abnormality at primary care setting is high. There is no significant association between urine abnormality and age. Females are more likely to show urine abnormality. Routine dipstick urinalysis does not lead to significant additional cost and can add value to the management of patients at a Primary Health Care setting.

Thesis (M.S.)--University of Michigan, 1978.

Thesis (M.S.)--University of Michigan, 1978.

Orientadores: Célia Regina Garlipp, Carlos Emilio Levy / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T18:20:39Z (GMT). No. of bitstreams: 1 Martinez_MayaraHidalgoMagri_M.pdf: 2010266 bytes, checksum: 23bb4f89ea7b258a0fd5fe0e20f6cc1f (MD5) Previous issue date: 2012 / Resumo: Infecção do trato urinário (ITU) é muito comum na prática clínica, acometendo pessoas de ambos os sexos em todas as faixas etárias. Para seu diagnóstico é importante definir rapidamente a presença de bacteriúria e piúria bem como a etiologia da doença através da urocultura. A urocultura é o teste microbiológico mais comum na prática laboratorial, embora seja um procedimento demorado e de custo relativamente elevado. Nosso objetivo foi avaliar a aplicação de um sistema automatizado de análise da urina (LabUMat/UriSed) como método de triagem para a investigação de ITU através da comparação de seus resultados com os das uroculturas. Analisamos amostras de urina de pacientes adultos e crianças de ambos os sexos provenientes de ambulatórios e enfermarias do Hospital de Clínicas da UNICAMP encaminhados às Seções de Líquidos Biológicos e Microbiologia da Divisão de Patologia Clínica para análise físicoquímica, sedimento e urocultura. Foram estabelecidos valores de cortes baseados na comparação dos resultados das uroculturas com os parâmetros urinários: leucócito-esterase, nitrito, leucócitos, bactérias e leveduras, sendo que a positividade de pelo menos um destes parâmetros classificava a amostra para uma triagem positiva para ITU. O estudo foi conduzido em três etapas: Na primeira etapa, a análise de 2126 amostras de urinas permitiu adotar um primeiro valor de corte para os parâmetros analisados: contagem de bactérias >11/campo; contagem de leucócitos >5/campo, presença de leveduras além de nitrito e leucócito-esterase positivos. Esses valores foram comparados com os resultados da urocultura em meio CLED e testados na rotina laboratorial. Em uma segunda etapa, com a finalidade de aprimorar o valor de corte dos parâmetros e aumentar o valor preditivo positivo sem comprometer o valor preditivo negativo, estabeleceu-se um novo valor de corte. Para tanto, foram analisadas 2075 amostras de urinas e com os seguintes valores de corte estabelecidos: contagem de bactérias 'maior ou igual'12,5/campo; contagem de leucócitos >5/campo, presença de leveduras e nitrito bem como leucócito-esterase positivo 'maior ou igual'2+. Esses valores foram comparados com os resultados das uroculturas em meio CLED e testados na rotina laboratorial. A fim de refinar e validar o teste de triagem para urocultura foram analisados, em uma terceira etapa, 1379 amostras de urina. Nesta etapa os valores de corte dos parâmetros foram: contagem de bactérias >12,5/campo, contagem de leucócitos >5/campo, presença de leveduras e leucócito - esterase positivos 'maior ou igual'2+. Nesta etapa as amostras cujos parâmetros urinários avaliados estavam abaixo do valor de corte, foram consideradas negativas para ITU e semeadas em meio CLED. As amostras em que pelo menos um dos parâmetros estudados estava acima do valor de corte, foram consideradas positivas, sendo semeadas em meio Chromagar a fim de se identificar presuntivamente os patógenos. O teste mostrou sensibilidade de 97%, valor preditivo negativo de 99%, valor preditivo positivo de 27%, especificidade de 59% e acurácia de 64%. Em todas as etapas observou-se uma potencial redução de 50% nas semeaduras de uroculturas. Os dados sugerem que o sistema automatizado LabUMat / UriSed é uma boa ferramenta para a triagem de ITU, especialmente se considerarmos os dados clínicos dos pacientes / Abstract: Urinary tract infection (UTI) is very common in clinical practice, affecting people of both genders in all age groups. For the laboratory diagnosis of UTI is of great importance the definition of significant bacteriuria and pyuria and a bacterial culture of a urine sample to establish the etiology of the disease. The quantitative urine culture is the commonest microbiology test in Clinical Pathology Laboratory practice, although it is a very time-consuming and expensive procedure. Our aim was to evaluate the performance of the LabUMat with UriSed System as a screening method for the investigation of UTI comparing its results with the outcome of urine culture. We studied urine samples from children and adults of both genders from outpatients and hospitalized patients from Clinical Hospital / UNICAMP referred to Body Fluids and Microbiology Laboratories at Division of Clinical Pathology for physicochemical analysis, sediment observation and urine culture. We established cut-off values based on the comparison of the outcome of urine cultures with urinary parameters: leukocyte esterase, nitrite and quantitative determination of bacteriuria, leukocyturia and presence of yeasts. A positivity of at least one parameter classified the sample as a positive screening of UTI. This study was conducted in three stages: In the first stage, the analysis of 2,126 urine samples allowed to adopt the first cut-off value for the parameters analyzed: quantification of bacteriuria (>11 elements/hpf), quantification of leukocyturia (>5 cells/hpf), presence of yeasts besides nitrite and leukocyte esterase positive. These values were compared with the outcome of uroculture in CLED agar medium culture and tested in the laboratory routine. In the second stage, in order to improve cut-off values of urinary parameters and increase the positive predictive value without compromising the negative predictive value, it was established a new cut-off value. We analyzed 2,075 urine samples with the following established cut-off values: quantification of bacteriuria (> or = 12.5 elements/hpf) and leukocyturia (> 5 cells/hpf), presence of yeasts, nitrite and leukocyte esterase positive (> or = 2+). These values were compared with the outcome of uroculture and tested in the laboratory routine. In order to refine and validate the screening test for uroculture were analyzed, in a third stage, 1,379 urine samples. In this stage the cutoff values of the parameters were: quantification of bacteriuria (>12.5 elements/hpf) and leukocyturia (> 5 cells/hpf), presence of yeasts and leukocyte esterase positive (> or = 2+). In this stage the urinary samples whose evaluated parameters were below the cut-off value were considered negative for UTI and were plated in CLED agar medium culture. Samples which at least one of the parameters evaluated was above the cut-off value, were considered positive, and were plated in Chromagar commercial medium, in order to presumptively identify pathogens. The test showed sensitivity of 97%, negative predictive value of 99%, positive predictive value of 27%, specificity of 59% and accuracy of 64%. In all stages we observed a potential 50% reduction in sowing urocultures. The data suggest that the LabUMat with UriSed System is a good tool for screening for UTI, especially if we consider patients' clinical data / Mestrado / Ciencias Biomedicas / Mestra em Ciências Médicas

Early detection and screening for urinary tract illnesses is a complex and widespread process which has implications for both preventative care, diagnosis, and treatment monitoring. In this paper, we investigate the use of Raman spectroscopy (RS) for the analysis of urine, a complex biological solution, for the detection of bladder cancer (BCa) and hematuria. Raman spectroscopy is a rapid, low cost, non-destructive analysis method with wide-ranging applicability due to the holistic data capturing nature of the scanning technique. Each Raman scan can be considered a 'snapshot' of the molecular makeup of the sample, and, through proper applications of algorithmic transformation and statistical analysis, many types of assessments can be performed on each sample. In this paper we address creating and utilizing a data pipeline for the purposes of analyzing and characterizing potential samples with hematuria and BCa. The algorithmic transformations utilized include baselining using either the Goldindec or ISREA methods, and intensity normalization. The statistical analysis methods utilized include principal component analysis (PCA), discriminant analysis of principal components (DAPC), analysis of variance (ANOVA), pairwise ANOVA, leave-one-out cross-validation (LOOCV), and partial least squares regression (PLSR). These components of the data pipeline serve to output qualitative or quantitative data, depending on the application. The Rametrix toolbox encompasses the tools required to transform and assess Raman spectra with PCA and DAPC. Using the Rametrix toolbox as well as ANOVA, pairwise ANOVA, and LOOCV, we were able to significantly detect the presence of bladder cancer in a specimen with 80% accuracy. Using the Rametrix toolbox, ANOVA, pairwise ANOVA, LOOCV, and PLSR, we were able to classify samples as pure urine, micro-, or macrohematuria with a greater than 91% accuracy, and quantify the amount of blood in the sample with a high correlation (R-squared value of 0.92). In combination, this style of data pipeline is shown to rapidly and accurately test for multiple symptoms or diseases using similar methodologies. / Master of Science / In the United States, over 37 million people live with chronic kidney disease, over 81 thousand new cases of bladder cancer will be diagnosed, and over 17 thousand people will die from bladder cancer. These serious renal and urinary tract illnesses require urinalysis as a major component of detection, diagnosis, and monitoring of the diseases. This level of required testing has significant costs, both in labor and financial impact. Reduction in both the labor and consumable reagent costs associated with urinalysis would serve to improve the ability for the healthcare system provide the necessary testing for these patients, and reduce the risk of shortages in both reagents and staff. We present a new analysis method, termed 'data pipeline', which would take data from a spectrographic data collection method, Raman Spectroscopy (RS), and generate useable output in the form of classification and quantification. These outputs are highly desired for urinalysis, as urine collection is largely the least invasive testing method related to the urinary tract. As we have shown, the RametrixTM toolbox, an algorithmic package of mathematical methods for assessing spectra, is the backbone of a data pipeline capable of detecting both hematuria, an early warning symptom of many urinary tract illness, and bladder cancer, a notably difficult to detect disease, with high accuracy. This method of analysis is non-destructive of the samples, requires no reagents or single use dipsticks, avoids subjective color assessment, and provides rapid results in a repeatable, potentially automatable manner. We investigate a critical component of this process, the baselining method, in order to further examine and refine the methodology by comparing the accuracy and statistical quality of the results with different baseline methods. It is our goal to implement this methodology with the best component processes, in order to achieve a highly robust, accurate tool for assisting in urinalysis testing.

Detecting lung cancer is di cult as it is hidden in the body, and current clinical methods are not elective at an early stage; the one-year survival rate after diagnosis in the World is just 29-33%. Acetyl amantadine (AcAm) is recognised as an exogeneous cancer biomarker because it is the product of a metabolic process known to be significantly up-regulated in cancerous cells. After ingestion, the an-tiparkinson and antiviral drug amantadine is acetylated in the body by the enzyme spermidine/spermine N1 acetyltransferase to give AcAm, which can be detected in patient’s urine. However, techniques previously used to quantify AcAm in urine, such as liquid chromatography-mass spectrometry (LC-MS), are undesirable for clin- ical adoption due to high costs and long run times. Further costs and delays result from the requirement for solid phase extraction (SPE). Therefore, it is highly desired to lower the costs and delays in processing by exploring different quantification approaches, ideally without the need for SPE processing. In this thesis, I investigate the use of surface enhanced Raman spectroscopy (SERS) to quantify AcAm in urinalysis. I prepare two kinds of Raman substrates with hydrophobic pocket surface capture agents beta -cyclodextrin (beta -CD) that work to extract the AcAm from the urine, followed by the surface enhanced Raman measurement using two kinds of Raman systems. The detection strategy is more economical than the currently used LC-MS approach, and enables development of an easy-to-use point-of-care tool that should provide a more rapid turnaround to the health care provider. The next step will be to use real samples. If it is achieved, it will be a promising step in early cancer diagnostics. / Graduate

In this dissertation fluorescence-based sensors for dissolved gases were developed for remote health monitoring applications including urine analysis. Detection of dissolved gases demonstrate diagnostic potential in body fluids, and indicate the metabolism of microorganisms driven by contaminated water. The emphasis of this research was on optimizing the sensitivity of fluorescence-based fluid sensing systems by configuring key design parameters towards cost reduction. A review of urine analysis indicated several methods for imaging, particle analysis, and detection of dissolved analytes. The review encourages readers to consider integrating sensing systems to provide additional context to results. An optical Dissolved Oxygen (DO) sensor was reproduced using phosphorescent organometallic dyes. The sensitivity of the DO sensor was experimentally optimized by employing Total Internal Reflection (TIR) of excitation light within the multilayered device by controlling the incident angle and sensitive film thickness. Novel 3D ray tracing-based computer models were developed based on the experimental results to explain the sensitivity enhancement mechanism of TIR. The path of light within the device and fluorescence generation sites were visualized and relative sensitivity was predicted. The model was validated by comparison with experimental results and expanded to predict the relative sensitivity of devices using different coupling strategies. This new optical model enables researchers to select an optimal coupling and detection scheme given their unique sensor design and application. A fluorescence based optofluidic sensor for Ammonia was redesigned based on experiment and simulation results. An optofluidic chip reader was produced to measure fluorescence sensors using low cost consumer electronics. The sensitivity of the ammonia sensor module has not been demonstrated; however, identified design challenges will be overcome in future efforts. As a result of this research, the cost of optofluidic sensing systems may be reduced towards enabling widely deployed remote monitoring networks for health and water quality. / Thesis / Doctor of Philosophy (PhD) / Dissolved gases have been detected in fluid samples as indicators of health and microbial activity by measuring changes in the intensity of fluorescence emitted from gas sensitive fluorescent dyes. These sensors can often be miniaturized and integrated to measure several parameters from a single platform. Several sensing platforms may be integrated into a continuous monitoring network. However, the cost of complete remote sensing networks prohibits the widespread deployment of these devices. The aim of this research was to improve the sensitivity of fluorescence-based sensors, reducing dependence on expensive detectors and light sources. The sensitivity of a fluorescence based dissolved oxygen sensor was optimized using Total Internal Reflection. A computer model was developed to identify important design parameters and their contributions to sensor performance. The model was validated by comparison with experimental measurements. Finally, an optical ammonia sensor is under development based on the dissolved oxygen experiments and model results.

Current screening methods for drug analysis with urine samples includes examination of the sample with an immunoassay. These methods are used to determine the concentration of drug metabolites contained within the sample prior to further confirmatory testing. Drug testing plays a crucial role in maintaining safe workplace environments and safety of individuals. However, a positive result can lead to heavy consequences for the employee including suspension or removal from the workplace. Therefore, a majority of individuals add commonly known products into the sample to evade detection by developing a false negative result. Although specimen integrity examinations are performed to identify tampering of the sample, these results are typically biased on the experience of the examiner. The purpose of this study was to develop an analytical screening technique that will detect the drug of interest as well as the presence of any additional products that may be added into the sample via Direct Analysis in Real Time – High Resolution/Mass Spectrometry (DART-HR/MS) which is an ambient ionization source that produces fast mass spectrum results that can provide semi-quantitative information of the target metabolite concentration. Although there are various studies that indicate the ability of the DART to detect drug compounds, there are no known studies that have examined how real-world urine samples are analyzed. Additionally, there are no current studies that take into consideration adulteration of the urine sample using the DART method. The results obtained in the study showed the ability for DART to identify molecular protonated peaks indicative of dextroamphetamine and/or the presence of masking agents. While the other target drugs could not be identified using this method, the identification of dextroamphetamine, adulterant products and the deuterated internal standard show promise in using this as a screening technique prior to confirmatory tests. Future work is currently being conducted to optimize the protocol for the evaluation of THC, cocaine and benzodiazepines.

Urinalysis is a common laboratory test used for diagnosis of a variety of systemic and genitourinary diseases. Although, collection of sample for urinalysis is extremely easy, when performed during an office visit, in pediatric and geriatric populations, who use diaper, such collection is not trivial and can result in missing important diagnostic information. For example, urinary tract infections (UTIs), are a major source of morbidity in incontinent elderly with dementia who cannot communicate their symptom to their caregivers. Although most UTIs are easily treatable with antibiotics, if not identified and treated timely, they can cause ascending infection, loss of kidney function, sepsis, and possible death. Deployment of smart, autonomous, diaper-embedded systems that can detect early signs of urinary dysfunction can have a significant impact on healthcare of our rapidly aging population. In this dissertation, I propose a diaper-embedded, low-cost, and disposable sensing platform comprising of a urine-activated battery and sensors for detection of nitrite (a surrogate for UTI), red blood cells (hematuria), and protein (proteinuria). I will first discuss my efforts to develop an optical/colorimetric nitrite sensor and a urine-activated power source, all fabricated on a hydrophobic paper/polymeric substrate through laser-assisted machining and lamination-assembly. The system stays in a dormant state until wetted by urine, after which the on-board power source is activated, awakening the rest of the measurement system (i.e., a light emitting diode, a photodetector, interface electronics, and a low-power Bluetooth module) and transmitting the presence or absence of nitrite in the urine to vicinal caregivers in a point-of-care and autonomous fashion. Thorough characterization of the performance and reliability analysis of the platform are also presented to envision its use as an end product. Afterwards, I will discuss the characterization of sensors, based on similar principle, for detecting red blood cells (hematuria) and protein (proteinuria), and the extendibility of the proposed platform for a multi-parameter system measuring nitrite, blood, and protein in the urine. Finally, I will conclude with other possible applications besides urinalysis for the proposed system.

In this series of work, we examined the role of measuring cytokine mRNA expression in the urinary sediments for the assessment of SLE disease activity. The Th-1/Th-2 imbalance observed in patients with active lupus nephritis supports its relevance in pathogenesis. Our results also suggest that urinary T-BET-to-GATA-3 expression ratio may predict lupus flare. The measurement of mRNA expression in the urinary sediment may provide valuable information for the assessment and risk stratification of SLE patients. (Abstract shortened by UMI.) / In this series of work, we investigated (i) the pattern of cytokine gene expression in the urinary sediment of lupus patients, (ii) the relation between the gene expression profile in the urinary sediment and the clinical and histological disease activity of lupus patients; and (iii) the application of this non-invasive method on the assessment and monitoring of SLE disease activity. / Systemic lupus erythematosus (SLE) is a relapsing autoimmune disease with clinical manifestations that affect multiple organ systems. Lupus nephritis (LN) is recognized as one of the most severe organ involvement in SLE and affects half of the lupus patients. LN is characterized by intra-renal lymphocyte activation and inflammation. Since most of the cytokines exert their effects in a paracrine fashion, measuring their expression at the site of pathology should be of biologic relevance. Although kidney biopsy is widely used to determine the histology and severity of LN, this invasive procedure has its own risk and is not practical for serial monitoring. We hypothesize that measurement of messenger RNA (mRNA) expression in the urinary sediment may provide a non-invasive means to assess the disease activity of lupus patients. / Chan Wing Yan. / "August 2005." / Adviser: Cheuk Chun Szeto. / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3692. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 302-333). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.