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Measuring morbidity associated with urinary schistosomiasis: assessing levels of excreted urine albumin and urinary tract pathologies.

ABSTRACT: BACKGROUND:Urinary schistosomiasis is responsible for a variety of debilitating conditions; foremost perhaps are urinary tract pathologies (UTPs). Although portable ultrasonography can be used to detect UTPs visually, there is still a need for rapid morbidity assessment (henceforth referred to as RaMA) tools that can be deployed in the field during implementation, monitoring and evaluation of control programmes. We therefore aimed to determine associations between excreted urine-albumin, as measured using a HemoCue photometer, and UTPs, as detected by ultrasonography, in children and adults from an urinary schistosomiasis endemic area in Zanzibar. METHODOLOGY/PRINCIPAL FINDINGS:In a survey of 140 school-children of both sexes (aged 9 to 15 yr) and 47 adult males (> or =16 yr) on the island of Unguja, the prevalence of egg-patent urinary schistosomiasis was 36.4% (CI(95) 28.5-45.0%) and 46.8% (CI(95) 32.1-61.9%) (P = 0.14), and that of UTPs was 39.4% (CI(95) 31.0-48.3%) and 64.4% (CI(95) 48.8-78.1%) (P = 0.006), respectively. In school-children, raised urine-albumin concentrations (>40 mg/L) were associated, albeit non-significantly, with prevalence of infection (OR = 3.1, P = 0.070), but more specifically and significantly with the prevalence of micro-haematuria (OR = 76.7, P<0.0001). In adults, elevated urine-albumin excretion was associated with UTPs, particularly lesions of the bladder wall (OR = 8.4, P = 0.013). Albuminuria showed promising diagnostic performance, especially in school-aged children with sensitivity of 63.3% and specificity of 83.1% at detecting lower UTPs, i.e. bladder-wall lesions (ultrasonography as 'gold standard'). CONCLUSION/SIGNIFICANCE:This study indicates that albuminuria assays could be used as a RaMA tool for monitoring UTP prevalence during control programmes, as well as a tool for selecting those with more chronic bladder-wall lesions without resorting to ultrasonography.

SUBMITTER: Sousa-Figueiredo JC

PROVIDER: S-EPMC2752803 | biostudies-literature | 2009 Oct

REPOSITORIES: biostudies-literature

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Measuring morbidity associated with urinary schistosomiasis: assessing levels of excreted urine albumin and urinary tract pathologies.

Sousa-Figueiredo José C JC Basáñez María-Gloria MG Khamis I Simba IS Garba Amadou A Rollinson David D Stothard J Russell JR

PLoS neglected tropical diseases 20091006 10

<h4>Background</h4>Urinary schistosomiasis is responsible for a variety of debilitating conditions; foremost perhaps are urinary tract pathologies (UTPs). Although portable ultrasonography can be used to detect UTPs visually, there is still a need for rapid morbidity assessment (henceforth referred to as RaMA) tools that can be deployed in the field during implementation, monitoring and evaluation of control programmes. We therefore aimed to determine associations between excreted urine-albumin, ...[more]

PMID: 19806223

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Project description:Study designRetrospective review.ObjectiveCompare postoperative infection rates and 30-day outcomes in spine surgery patients with and without a preoperative urinary tract infection (UTI).Summary of background dataThere is mixed evidence regarding safety and risks when operating on spine patients with a preoperative UTI.MethodsUsing data from the American College of Surgeons National Surgical Quality Improvement Program, we identified all adult patients undergoing spine surgery between 2012 and 2017 with a preoperative UTI. Patients with other preoperative infections were excluded. Our primary outcome was any postoperative infection (pneumonia, sepsis, surgical site infection, and organ space infection). Our secondary outcomes included surgical site infections, non-infectious complications, return to operating room, and 30-day readmission and mortality. We used univariate, then multivariate Poisson regression models adjusted for demographics, comorbidities, laboratory values, and case details to investigate the association between preoperative UTI status and postoperative outcomes.ResultsA total of 270,371 patients who underwent spine surgery were analyzed. The most common procedure was laminectomy (41.9%), followed by spinal fusion (31.7%) and laminectomy/fusion (25.6%). Three hundred fourty one patients had a preoperative UTI (0.14%). Patients with a preoperative UTI were more likely to be older, female, inpatients, emergency cases, with a higher American Society of Anesthesiologists score, and a longer operating time (for all, P < 0.001). Patients with a preoperative UTI had higher rates of infectious and non-infectious complications, return to operating room, and unplanned readmissions (for all, P < 0.001). However, there was no significant difference in mortality (0.6% vs. 0.2%, P = 0.108). Even after controlling for demographics, comorbidities, labs, and case details, preoperative UTI status was significantly associated with more postoperative infectious complications (incidence rate ratio [IRR]: 2.88, 95% confidence interval [CI]: 2.25-3.70, P < 0.001).ConclusionPreoperative UTI status is significantly associated with postoperative infections and worse 30-day outcomes. Spine surgeons should consider delaying or cancelling surgery in patients with a UTI until the infection has cleared to reduce adverse outcomes.Level of evidence3.

Project description:OBJECTIVE:To study 1) whether the accuracy of point-of-care (POC) urine tests (dipstick, phase-contrast microscopy and culture) differs when performed on first-void urine (FVU) compared to mid-stream urine (MSU), and 2) if a delay of analysis up to four hours affects the accuracy of POC tests when performed on urine from symptomatic of urinary tract infection (UTI), non-pregnant women in general practice. DESIGN:Prospective diagnostic study using paired samples. Setting/Intervention: Three general practices in Copenhagen. Each woman delivered FVU and MSU samples from the same void. As a reference standard, 8?ml of MSU was sent for culture at the Microbiology Department. PATIENTS:117 women with one or more symptoms of UTI. MAIN OUTCOME MEASURES:Sensitivity, specificity and agreement with the reference standard of FVU and MSU with different time delays (zero vs. one vs. four hours) as compared to reference standard (MSU at time zero in boric acid tubes). RESULTS:All three POC tests performed on MSU were significantly more in agreement with the reference than when performed on FVU when analysis was done immediately. The error rate was 16% for MSU vs. 23% for FVU with POC culture, 27% vs. 40% with microscopy and 25% vs. 33% with dipstick testing. Delay of analysis up to four hours did not decrease agreement with the reference. Conclusion/Implication: MSU samples should be used in general practice for optimal accuracy of POC tests. Analysis can be delayed up to four hours. Key points Point-of-care tests (dipstick testing, microscopy and culture) for diagnosing urinary tract infection performed on mid-stream urine samples are significantly more accurate than when performed on first-void urine samples. Delay of analysis up to four hours did not decrease the accuracy of any of the point-of-care tests. Point-of-care culture was more accurate than dipstick and microscopy both when performed on mid-stream urine and first-void urine The main contaminant in first-void urine samples was Enterococci spp., which contributed to the majority of false positives.

Dataset Information

Measuring morbidity associated with urinary schistosomiasis: assessing levels of excreted urine albumin and urinary tract pathologies.

Publications

Measuring morbidity associated with urinary schistosomiasis: assessing levels of excreted urine albumin and urinary tract pathologies.

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