SIMPLIFIED TECHNIQUE FOR COUNTING THE NUMBER OF BACTERIA IN URINE AND OTHER FLUIDS

Fermented Carica papaya and Morinda citrifolia as Perspective Food Supplements for the Treatment of Post-COVID Symptoms: Randomized Placebo-Controlled Clinical Laboratory Study

Food supplements based on fermented Carica papaya and Morinda citrifolia, known for their immune modulating, redox balancing, and anti-inflammatory effects, were added to conventional treatment protocols prescribed to patients recovering after severe and moderate COVID-19 disease in order to alleviate long-lasting post-COVID symptoms. A randomized single-center placebo-controlled clinical laboratory study was designed and performed (total number of participants 188, with delta variant of virus 157, with omicron 31). Clinical statuses were assessed using computer tomography, electrocardiography, a questionnaire, and physical endurance. Plasma cytokines (IL-6, IL-8, IL-17A, and INF-gamma), nitrate/nitrite ratio, antioxidant activity (AOA), and polymorphonuclear leukocyte (PMN) ATP levels were determined before and 20 days following the addition of 28 g of fermented supplements twice per day. The capacity of PMN to phagocyte and the oral-nasal-pharyngeal microbiota were assessed. Clinical symptoms, IL-6, IL-8, and nitric oxide metabolites diminished significantly compared to the placebo group and their background expression. The PMN capacity to phagocyte, AOA, and ATP content remarkably increased. The oral-nasal-pharyngeal microbiota were unchanged. On these grounds, we suggest that fermented tropical fruits could efficiently diminish post-COVID clinical symptoms through several immune-modulating, redox balancing, and pro-energy mechanisms.

Medical Diagnostic Tests: A Review of Test Anatomy, Phases, and Statistical Treatment of Data

Diagnostic tests are approaches used in clinical practice to identify with high accuracy the disease of a particular patient and thus to provide early and proper treatment. Reporting high-quality results of diagnostic tests, for both basic and advanced methods, is solely the responsibility of the authors. Despite the existence of recommendation and standards regarding the content or format of statistical aspects, the quality of what and how the statistic is reported when a diagnostic test is assessed varied from excellent to very poor. This article briefly reviews the steps in the evaluation of a diagnostic test from the anatomy, to the role in clinical practice, and to the statistical methods used to show their performances. The statistical approaches are linked with the phase, clinical question, and objective and are accompanied by examples. More details are provided for phase I and II studies while the statistical treatment of phase III and IV is just briefly presented. Several free online resources useful in the calculation of some statistics are also given.

A Putative Role of Apolipoprotein L1 Polymorphism in Renal Parenchymal Scarring Following Febrile Urinary Tract Infection in Nigerian Under-Five Children: Proposal for a Case-Control Association Study

Background

Although urinary tract infection (UTI) resolves with prompt treatment in a majority of children, some children, especially those aged less than 5 years, also develop renal parenchymal scarring (RPS). RPS causes high blood pressure that may lead to severe chronic kidney disease and end-stage renal disease (ESRD). Although the risk of UTI is higher in white children than in black children, it is unknown whether RPS is more common in white children than in black children as data are scarce in this regard. A common genetic predisposition to kidney disease in African Americans and the sub-Saharan African blacks is the possession of apolipoprotein L1 (APOL1). APOL1 risk variants regulate the production of APOL1. APOL1 circulates in the blood, and it is also found in the kidney tissue. While circulating, APOL1 kills the trypanosome parasites; an increased APOL1 in kidney tissues, under the right environmental conditions, can also result in the death of kidney tissue (vascular endothelium, the podocytes, proximal tubules, and arterial cells), which, ultimately, is replaced by fibrous tissue. APOL1 may influence the development of RPS, as evidence affirms that its expression is increased in kidney tissue following UTI caused by bacteria. Thus, UTI may be a putative environmental risk factor responsible for APOL1-induced kidney injury.

Objective

The aim of this proposal was to outline a study that seeks to determine if the possession of two copies of either G1 or G2 APOL1 variant increases the risk of having RPS, 6 months following a febrile UTI among Nigerian under-five children.

Methods

This case-control association study seeks to determine whether the risk of RPS from febrile UTI is conditional on having 2 APOL1 risk alleles (either G1 or G2). Cases will be children with a confirmed RPS following a febrile UTI. Controls will be age-, gender-, and ethnic-matched children with a febrile UTI but without RPS. Children with vesicoureteral reflux and other congenital anomalies of the urinary tract are to be excluded. Association between predictor variables (ethnicity, APOL1 G1 or G2, and others) and RPS will be tested at bivariate logistic regression analyses. Predictors that attained significance at a P value of ˂.05 will be considered for multiple logistic regressions. Likelihood-based tests will be used for hypothesis testing. Estimation will be done for the effect size for each of the APOL1 haplotypes using a generalized linear model.

Results

The study is expected to last for 3 years.

Conclusions

The study is contingent on having a platform for undergoing a research-based PhD program in any willing university in Europe or elsewhere. The findings of this study will be used to improve the care of African children who may develop RPS following febrile UTI.

Registered Report Identifier

RR1-10.2196/9514

Paediatric Urinary Tract Infection: A Hospital Based Experience

INTRODUCTION

Paediatric Urinary Tract Infection (UTI) is one of the commonly encountered entities by paediatricians. Studies have shown easy vulnerability of paediatric urinary tract in any acute febrile illness and a miss in diagnosis could have long term consequences like renal scaring with its adverse effects. Bearing these evidence based preludes in view we designed our study to know the prevalence of UTI in Kashmir province.

AIM

Aim of the present study was to know the prevalence of UTI in febrile children and to know the sensitivity of different imaging modalities like Renal and Urinary Bladder Ultrasonography (RUS), Voiding Cystourethrography (VCUG) and Dimercaptosuccinic Acid (DMSA) scan in diagnosing UTI.

MATERIALS AND METHODS

A total of 304 patients, between 2 months to 10 years, with axillary temperature of ≥ 100.4^oF (38^oC), who did not have a definite source for their fever and who were not on antibiotics were included in the study. Detailed history and through clinical examination was done to rule out any potential or definite focus of infection as per the predesigned proforma. Routine urine examination with culture and sensitivity, followed by RUS and VCUG was done in all patients where routine urine examination was suggestive of UTI. DMSA was done in only culture proven cases after 6 months to document the renal scarring.

RESULTS

Out of 304 children, 140 were males and 164 were females, UTI was present in 40 patients who had fever without any apparent cause giving a prevalence of 13.2%. Escherichia coli (E. coli) were the commonest isolated organism, followed by Klebsiella and Citrobacter species. Renal and Urinary Bladder Ultrasonography (RUS) detected Vesicoureteral Reflux (VUR) in 25% (10/40) while VCUG showed VUR in 55% (22/40) giving a RUS sensitivity of 45% for detecting VUR. DMSA done only after 6 months in UTI diagnosed patients showed a renal scarring in 25% (10/40) patients.

CONCLUSION

Missing a febrile paediatric UTI, can prove a future catastrophe if not timely diagnosed and treated.

Asymptomatic bacteriuria in children with sickle cell anemia at The University of Nigeria teaching hospital, Enugu, South East, Nigeria

BACKGROUND

Urinary tract infection (UTI) is a common cause of childhood morbidity and mortality in the tropics. Children with sickle cell anemia (SCA) may have compromised kidney function arising from repeated vaso-occlusive episodes and recurrent symptomatic or asymptomatic UTI.

OBJECTIVES

This study aims at determining the prevalence of asymptomatic bacteriuria and sensitivity pattern in children with homozygous sickle haemoglobin compared to children with normal haemoglobin.

METHODS

One hundred children with SCA in stable state and 100 children with normal haemoglobin aged 2-12 years were screened for asymptomatic bacteriuria using midstream urine samples. The samples were incubated aerobically at 37°C for 24 hours within one hour of collection. Children whose urine samples yielded significant bacteriuria (≥ 10⁵ cfu/ml) on two consecutive cultures were regarded as having asymptomatic bacteriuria.

RESULTS

Asymptomatic bacteriuria was noted in 6% of children with SCA and occurred more in females than males (F: M = 5:1) when compared to 2% in children with normal haemoglobin. Escherichia coli was the commonest organism isolated (33.3%). All the organisms were resistant to co-trimoxazole and ampicillin while most were sensitive to gentamicin, ceftriaxone and the quinolones.

CONCLUSION

The risk of asymptomatic bacteriuria is three times more common in children with sickle cell anemia than in children with normal haemoglobin. It is therefore important to screen SCA patients, especially the females for UTI and should be treated according to the sensitivity result of the cultured organisms.

The effect of specimen processing delay on borate urine preservation

AIM

To investigate the effect on urine culture results and their clinical interpretation of delaying the processing of urine samples in which boric acid had been used as a preservative.

METHODS

792 mid-stream specimens of urine from patients attending their general practitioner were received in borate containing plastic jars. The specimens were cultured upon receipt, stored at room temperature, and then recultured the following morning.

RESULTS

After overnight delayed culture, the results were altered in 16% of samples and the clinical interpretation of these findings differed in 8% of specimens. In 28 samples (3.5%) the bacterium isolated on initial culture was not the same as that obtained by culture after overnight storage.

CONCLUSIONS

Boric acid urine preservation used for overnight delayed processing of samples is associated with a significant alteration in culture results and the attendant clinical interpretation of such specimens. Rapid transportation/processing of urine specimens must remain the optimum procedure.

Clinical and laboratory study of postvagotomy diarrhoea

Thirty-two patients with diarrhoea, on average four years following truncal vagotomy and drainage, were studied. A comparison was made with 24 patients without postvagotomy diarrhoea. The incidence of bacterial colonization of the upper small intestine was no different in the two groups, though patients with a gastroenterostomy had a significantly higher incidence than those with a pyloroplasty. There was a higher incidence of ;anaerobic colonization' in patients with diarrhoea, but statistical significance was not reached. Colonization was associated with significantly lower levels of gastric acid secretion. Though 13 patients with diarrhoea had an abnormal faecal fat excretion, no correlation could be found between this and the severity of the diarrhoea or bacterial colonization, either with an anaerobic or a coliform type flora.In patients with diarrhoea, no small intestinal mucosal abnormality was detected, the mean haematological and serum biochemistry values were within normal limits, and the body weight was similar to that before operation. Two patients with diarrhoea had abnormal haematological values five years following vagotomy and gastroenterostomy in association with ;anaerobic colonization' of the upper small intestine. As the incidence of haematological abnormalities after gastric surgery increases with time, colonized patients might merit particularly close clinical observation.

The effect of vagotomy and drainage on the small bowel flora

The incidence of small intestinal colonization in unoperated duodenal ulcer patients was low and similar to that in the normal population. The majority of patients seven to 10 days following truncal vagotomy and drainage were colonized whereas none of a control group of patients following simple closure of a perforated duodenal ulcer was colonized. In patients with pyloroplasty, this high incidence fell to control levels on average 18 months postoperatively, but in patients with a gastro-jejunostomy, the incidence remained raised probably due to the presence of the afferent loop. Only two patients developed episodic diarrhoea and there was no obvious association with small bowel colonization.

Covert bacteriuria of childhood. A clinical and epidemiological study

A 4-year screening programme for covert bacteriuria in Dundee primary schoolgirl entrants showed a prevalence of 1·6% and an annual incidence of 0·9%. Among 109 children with bacteriuria, 70% had symptoms of lower urinary tract infection, 35% had vesicoureteric reflux, and 23% radiological evidence of pyelonephritis. Both pyuria and a past history of urinary infection were related to radiological evidence of reflux or pyelonephritis. Covert bacteriuria was found more frequently in children from social classes IV and V; and their housing, home circumstances, and home care were worse than a control group, even when allowance was made for their social class differences. The children appeared generally healthy but were smaller than a control group. The data suggest that the great majority of these children are not seriously at risk and that there is at present not sufficient evidence to warrant prescriptive screening.

Premature rupture of membranes and effects of prophylactic antibiotics

A series of 100 infants born after prolonged rupture of membranes was studied to evaluate the risk of infection to the infant due to this circumstance alone, and to assess the effect of prophylactic antibiotics in its prevention. Evidence of bacterial colonization at birth was limited to 6 cases and no clinical infection ensued. Neonatal infection was uniformly low but the administration of antibiotics led to clinical candidiasis in 18% and the development of a replacement flora of fungi in the intestinal tract in 70%. It is concluded that the routine administration of prophylactic antibiotics to the infant born in these circumstances is unnecessary and potentially hazardous.

A study of some of the methods of urinary collecon in children

Three methods of urine collection used currently in the diagnosis of urinary tract infection in children were studied. One hundred and fifty-two hospital patients were investigated: 92 by clean-catch method, 32 by the adhesive plastic bag technique, and 28 by suprapubic bladder aspiration. Results indicate that in the great majority of children a satisfactory diagnosis can be made on bacteriological grounds by the examination of specimens passed naturally and collected with care. In a minority of cases further investigation by such means as bladder aspiration may be indicated and this gives conclusive results.

Asymptomatic bacteriuria in girl entrants to Dundee primary schools

During the statutory medical examination on entrance to primary school 943 5-year-old girls were screened for asymptomatic bacteriuria. A prevalence of 2.1% was found. None of the 20 children with asymptomatic bacteriuria was recognized by the parents as having a urinary infection, though 14 of them had symptoms of lower urinary tract infection. In 16 of the children with bacteriuria either the intravenous pyelogram or the micturating cystogram was abnormal. In 12 the height and weight were below the 25th percentile, and in this group the most severe radiological changes were found.Though the significance of asymptomatic bacteriuria is unknown, these results confirm that in this age group it is often associated with a urinary tract abnormality.