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PubMed1988

Collection of urine specimens in general practice: to clean or not to clean?

The usefulness of preparatory vulval cleansing before urine specimen collection was evaluated in women aged 16 to 75 years attending a general practice. A total of 316 specimens were examined, 158 from women with symptoms of cystitis and 158 from controls. No significant differences were found in the numbers of contaminated or unreliable results between the specimens collected with and those collected without preparatory cleansing.

Adolescent↗

PubMed1995

Urinary albumin excretion in a population based cohort.

In order to compare a 1-h daytime urine specimen collection with a timed overnight collection, as well as different ways of expressing urinary albumin excretion: (urinary albumin excretion rate (UAE), urinary albumin concentration (UAC), and urinary albumin creatinine ratio (UACR)), a population of 922 people of whom 35 had diabetes was examined. The median age was 47 (range 26-65) years. The results of the different ways of collecting urine specimens and the different expressions of urinary albumin excretion were related to known cardiovascular risk factors. The daytime collection showed higher values of urinary albumin excretion than the overnight collections. Systolic blood pressure was an important risk factor correlated to UAE and UACR in the day as well as the overnight collection, followed by HbA1C in the total group and by BMI in the non-diabetic group. UAC showed significant relation to triglycerides and HDL-cholesterol. In conclusion, urinary albumin in a 1-h daytime collection showed a similar correlation to cardiovascular risk factors as the excretion of albumin in overnight collected urine. Follow-up studies are needed to compare day collections of urine as predictors of cardiovascular disease and early death with overnight collections.

Adult↗

PubMed1993

[Deficiency in medium chain acyl coA dehydrogenase manifested as febrile coma].

A 21-month-old infant developed coma with hypotonia during a viral infection. Acyl CoA dehydrogenase deficiency was diagnosed on the basis of results of the chromatographic study of organic acids performed on a urine specimen collected during the acute episode. However, other disorders of mitochondrial and fatty acid oxygenation can generate similar symptoms. Emphasis is put on the need for collecting urine specimens in patients who develop alterations in consciousness and hypoglycemia without ketonuria during prolonged fasting or repeated vomiting due to a viral infection. Urine chromatography can suggest which enzyme is defective, although the diagnosis should always be confirmed by a study of fatty acid oxygenation in lymphocytes or fibroblasts.

Acyl-CoA Dehydrogenases↗

PubMed2007

Changes in urine markers and symptoms after bladder distention for interstitial cystitis.

PURPOSE: We evaluated changes in urine markers and symptom scores after bladder distention in patients with interstitial cystitis. MATERIALS AND METHODS: Study subjects were 33 new patients who had undergone no prior interstitial cystitis treatment. Urine specimens were taken before and 1 month after bladder distention. University of Wisconsin symptom scores were done the same day as the urine specimen collection. Urine marker levels and symptom scores before and after distention were compared. Changes in markers were tested for associations with changes in symptom scores and other markers. Markers and specific symptoms before distention were tested for their association with post-distention symptom improvement. RESULTS: After distention the median total University of Wisconsin score decreased significantly (28.5 before, 20 after, p <0.001). A total of 12 patients (36%) had at least 30% improvement in University of Wisconsin score, and 8 patients (24%) had at least 50% improvement. No pre-distention markers or symptoms predicted which patients would have a good response. There were 2 urine markers that improved significantly after distention: anti-proliferative factor activity (median -96% before, -17% after, p <0.001) and heparin-binding epidermal growth factor-like growth factor levels (median 0.34 ng/mg creatinine before, 4.1 after, p <0.001). None of the changes in urine markers associated with changes in symptom scores. CONCLUSIONS: The median symptom score for newly diagnosed patients with interstitial cystitis decreased after distention, but only a minority of patients had at least 30% symptom improvement. Bladder distention altered urine anti-proliferative factor activity and heparin-binding epidermal growth factor-like growth factor levels toward normal, but the mechanism of symptom relief after distention is still unknown.

Adult↗

PubMedDate not supplied

Urinary tract infection in full-term newborn infants: risk factor analysis.

OBJECTIVE: To analyze the correlation of risk factors to the occurrence of urinary tract infection in full-term newborn infants. PATIENTS AND METHODS: Retrospective study (1997) including full-term infants having a positive urine culture by bag specimen. Urine collection was based on: fever, weight loss > 10% of birth weight, nonspecific symptoms (feeding intolerance, failure to thrive, hypoactivity, debilitate suction, irritability), or renal and urinary tract malformations. In these cases, another urine culture by suprapubic bladder aspiration was collected to confirm the diagnosis. To compare and validate the risk factors in each group, the selected cases were divided into two groups: Group I - positive urine culture by bag specimen collection and negative urine culture by suprapubic aspiration, and Group II - positive urine culture by bag specimen collection and positive urine culture by suprapubic aspiration. RESULTS: Sixty one infants were studied, Group I, n = 42 (68.9%) and Group II, n = 19 (31.1%). The selected risk factors (associated infectious diseases, use of broad-spectrum antibiotics, renal and urinary tract malformations, mechanical ventilation, parenteral nutrition and intravascular catheter) were more frequent in Group II (p<0.05). Through relative risk analysis, risk factors were, in decreasing importance: parenteral nutrition, intravascular catheter, associated infectious diseases, use of broad-spectrum antibiotics, mechanical ventilation, and renal and urinary tract malformations. CONCLUSION: The results showed that parenteral nutrition, intravascular catheter, and associated infectious diseases contributed to increase the frequency of neonatal urinary tract infection, and in the presence of more than one risk factor, the occurrence of urinary tract infection rose up to 11 times.

Catheterization↗

PubMedDate not supplied

Taking a midstream specimen of urine.

Collecting midstream specimens of urine (MSU) is a common nursing activity. It is indicated for adults and children who are continent and can empty their bladder on request. The general principle is to collect the midstream or middle part of a void if a urinary tract infection (UTI) is suspected. Since this is one of the most frequently occurring infections, an MSU may be required in many areas of clinical practice. Yet despite being a regular nursing activity, the procedure is often undertaken incorrectly.

Asepsis↗

PubMed2003

Female prisoners' preferences of collection methods for testing for Chlamydia trachomatis and Neisseria gonorrhoeae infection.

BACKGROUND: There is an increasing reliance on noninvasive techniques to collect specimens for the detection of sexually transmitted infections. The acceptability of these methods among the general population has been explored, but little is known about their acceptability among women confined in prison. GOAL: The goal was to compare female prisoners' preferences for collection of specimens (self-collected vaginal swab specimens, urine collection, or pelvic examination) for detection of Chlamydia trachomatis and Neisseria gonorrhoeae. STUDY DESIGN: A cross-section of inmates in a large federal prison provided urine samples and self-collected vaginal swab specimens. Women then completed a questionnaire regarding the ease of each method and their preferences for future specimen collection. RESULTS: A total of 535 women between the ages of 18 and 52 years (median = 33) participated in the study. More than half of the participants (57%) reported no difference between urine and swab in terms of ease of collection. Approximately 30% of participants said they would prefer to give a swab specimen in the future rather than collect urine (21%), but nearly half of the women expressed no preference for one method over the other. Most participants (60%) expressed a preference for providing a self-collected swab specimen rather than having a pelvic examination (23%), but nearly 17% expressed a preference for one over the other. CONCLUSION: The study population of female federal prisoners expressed no aversion to the self-collection of either vaginal swab or urine specimens for STD testing. A majority of participants expressed a preference for noninvasive techniques rather than a pelvic examination.

Adolescent↗

PubMed2003

Urinary excretion profiles of 11-nor-9-carboxy-Delta9-tetrahydrocannabinol: a Delta9-THC-COOH to creatinine ratio study #2.

Subjects with a history of chronic marijuana use were screened for cannabinoids in urine specimens with the EMIT((R)) II Plus cannabinoids assay with a cut-off value of 50 ng/ml. All presumptively positive specimens were submitted for confirmatory analysis for the major urinary cannabinoid metabolite (Delta(9)-THC-COOH) by GC-MS with a cut-off value of 15 ng/ml. Creatinine was analyzed in each specimen as an index of dilution. Huestis and Cone [J. Anal. Toxicol. 22 (1998) 445] reported that serial monitoring of Delta(9)-THC-COOH to creatinine ratios in paired urine specimens collected at least 24h apart could differentiate new drug use from residual Delta(9)-THC-COOH excretion. The best accuracy (85.4%) for predicting new marijuana use was a Delta(9)-THC-COOH/creatinine ratio > or =0.5 (dividing the Delta(9)-THC-COOH to creatinine ratio of specimen 2 by the specimen 1 ratio). In a previous study in this laboratory [J. Anal. Toxicol. 23 (1999) 531], urine specimens were collected from chronic marijuana users at least 24h apart and dilute urine specimens (creatinine values <2.2 micromol/l) were excluded from the data analysis. The objective of the present study was to determine whether creatinine corrected urine specimens positive for cannabinoids could differentiate new marijuana use from the excretion of residual Delta(9)-THC-COOH in chronic users of marijuana based on the Huestis 0.5 ratio. Urine specimens (N=946) were collected from 37 individuals with at least 48h between collections. All urine specimens were included in the data review irrespective of creatinine concentration. The mean urinary Delta(9)-THC-COOH concentration was 302.4 ng/ml, mean Delta(9)-THC-COOH/creatinine ratio (ng/ml Delta(9)-THC-COOH/(mmol/l) creatinine) was 29.3 and the Huestis ratio calculation indicated new drug use in 83% of all sequentially paired urine specimens. The data were sub-divided into three groups (A-C) based on the mean Delta(9)-THC-COOH/creatinine values. Interindividual Delta(9)-THC-COOH/creatinine mean values ranged from 2.2 to 13.8 in group A (264 specimens, N=15 subjects) where 80.7% of paired specimens indicated new drug use. In group B, mean Delta(9)-THC-COOH/creatinine values ranged from 15.3 to 37.8 in 444 specimens (N=14 subjects) and 83.3% of paired specimens indicated new drug use. In group C, individual mean Delta(9)-THC-COOH/creatinine values were >40.1 (41.3-132.5) in 238 urine specimens (N=8 subjects) and 85.3% of paired urine specimens indicated new marijuana use. Correcting Delta(9)-THC-COOH excretion for urinary dilution and comparing Delta(9)-THC-COOH/creatinine concentration ratios of sequentially paired specimens (collected at least 48h apart) provided an objective indicator of new marijuana use in this population.

Cannabinoids↗

PubMed1985

Specimen collection time for enzyme analysis in urine.

Catalytic activity of N-acetyl-beta-D-glucosaminidase, alanine aminopeptidase, lactate dehydrogenase, isoenzyme 1 of lactate dehydrogenase, lysozyme, gamma-glutamyl transferase and alkaline phosphatase in urine specimens collected between 6 a.m. and 9 a.m. were determined in 25 patients with acute renal failure. We found no statistical differences (Wilcoxon's t test) between specimens collected at 6 a.m. and 9 a.m. We conclude that, in renal patients, the first morning specimen (overnight urine) may be used for enzyme analysis.

Acute Kidney Injury↗

PubMed1999

Are Newcastle urine collection pads suitable as a means of collecting specimens from infants?

The collection of uncontaminated urine specimens from infants is not straightforward. This quasi-experimental study was designed to investigate whether 'Newcastle urine collection pads' are suitable for this purpose. A minimum of two urine specimens were collected from 50 children aged one day to five years, one using a pad and the other by using a sterile adhesive bag. Since pad specimens successfully demonstrated the presence of urinary tract infection and a lower contamination rate than bag specimens; it is concluded that they are suitable. Pad specimens contained fewer cells than bag specimens, which must be acknowledged by clinicians.

Child, Preschool↗

PubMedDate not supplied

Urinary tract infection in full-term newborn infants: value of urine culture by bag specimen collection.

OBJECTIVE: To evaluate the efficacy of urine culture by bag specimen for the detection of neonatal urinary tract infection in full-term newborn infants. Retrospective study (1997) including full-term newborn infants having a positive urine culture (> 100,000 CFU/ml) by bag specimen collection. The urinary tract infection diagnosis was confirmed by positive urine culture (suprapubic bladder aspiration method). The select cases were divided into three groups, according to newborn infant age at the bag specimen collection: GI (< 48 h, n = 17), GII (48 h to 7 d, n = 35) and GIII (> 7 d, n = 9). Sixty one full-term newborn infants were studied (5.1% of total infants). The diagnosis was confirmed on 19/61 (31.1%) of full-term infants born alive. Distribution among the groups was: GI = 2/17 (11.8%), GII = 10/35 (28.6%), and GIII = 7/9 (77.7%). The most relevant clinical symptoms were: fever (GI--100%, GII--91.4%) and weight loss (GI--35.3%, GII--45.7%). Urine culture results for specimens collected by suprapubic aspiration were: E. coli GI (100%), GII (40%) and GIII (28.6%), E. faecalis GI (30%), Staphylococcus coagulase-negative GII (20%) and GIII (42.8%), and Staphylococcus aureus GII (10%). Correlation between positive urine culture collection (bag specimen method) and urinary tract infection diagnosis, using relative risk analysis, produced the following results: GI = 0.30 (CI 95% 0.08-1.15), GII = 0.51 (CI 95% 0.25-1.06) and GIII = 3.31 (CI 95% 1.8-6.06). The most frequent urinary tract infection clinical signs in the first week were fever and weight loss, while non-specific symptomatology occurred later. E. coli was most frequent infectious agent, although from the 7th day of life, staphylococcus was noted. The urine culture (bag specimen method) was effective in detecting urinary tract infection only after the 7th day of life.

Algorithms↗

PubMed1999

Urinary excretion profiles of 11-nor-9-carboxy-delta9-tetrahydrocannabinol: a delta9-THCCOOH to creatinine ratio study.

Monitoring the major cannabinoid metabolite (delta9-THCCOOH) to creatinine ratio (M/C) has been used to predict new drug use. According to Huestis and Cone, the best accuracy (85.4%) for predicting new marijuana use was a ratio > or = 0.5 from two urine specimens collected at least 24 h apart. Manno et al. recommended an M/C ratio of > or = 1.5. Subjects with a history of chronic marijuana use were screened for cannabinoid use by immunoassay (50-ng/mL cutoff), and presumptive positives were confirmed by gas chromatography-mass spectrometry for delta9-THCCOOH (15-ng/mL cutoff). Creatinine was analyzed with a cutoff concentration of 25 mg/dL. The study objective was to apply the criteria from both groups of workers to determine if consecutive urine specimens (collected at least 24 h apart) positive for cannabinoids could be used to differentiate new marijuana use from the excretion of residual cannabinoid metabolite (delta9-THCCOOH) in an uncontrolled setting. Serial urine specimens (826) were collected from 26 individuals. Huestis and Cone and Manno et al. ratios indicated new drug use in 83% and 33% of serial urine specimens collected at least 24 h apart, respectively. Clinically, the Huestis and Cone ratio is recommended because of a lower false-negative rate (7.4%) than the Manno et al. false-negative rate (24%). In legal situations, we recommend using the Manno et al. ratio because of its lower false-positive rate (0.1%) as stated by Huestis and Cone.

Cannabis↗

PubMed2003

Comparing first-void urine specimens, self-collected vaginal swabs, and endocervical specimens to detect Chlamydia trachomatis and Neisseria gonorrhoeae by a nucleic acid amplification test.

We set out to determine the prevalences of Chlamydia trachomatis and Neisseria gonorrhoeae by ligase chain reaction as well as to determine the prevalence of Trichomonas vaginalis by culture in a large and diverse national sample of non-health-care-seeking young women entering the military; we also sought to compare the abilities of three different techniques of collecting specimens (first-void urine, self-collected vaginal swab, and clinician-collected endocervical swab) to identify a positive specimen. A cross-sectional sample of young women was voluntarily recruited; as a part of their routine entry pelvic examination visit, they completed a self-administered reproductive health questionnaire and provided first-void urine (used to detect C. trachomatis and N. gonorrhoeae) and self-collected vaginal swabs (used to detect C. trachomatis, N. gonorrhoeae, and T. vaginalis). The number of positive tests divided by the number of sexually active women screened by each sampling method determined the rates of prevalence. The rate of infection with any of the three sexually transmitted diseases (STDs) tested was 14.1%. The total positive rates for each STD (identified by >/=1 specimen) were the following: for C. trachomatis, 11.6%; N. gonorrhoeae, 2.4%; and T. vaginalis, 1.7%. The proportions of positives identified by specimen type were, for C. trachomatis and N. gonorrhoeae, respectively, endocervix, 65 and 40%; urine, 72 and 24%; and vagina, 81 and 72%. The proportions of positives when specimen results were combined were, for C. trachomatis and N. gonorrhoeae, respectively, cervix plus urine, 86 and 49%; cervix plus vagina, 91 and 93%; and vagina plus urine, 94 and 79%. We concluded that STDs were epidemic in this population. Self-collected vaginal swabs identified the highest number of positive test results among single specimens, with the combined cervix-vagina results identifying the highest number of positive results. Self-collected vaginal swab collections are a feasible alternative to cervical specimen collections in this population, and the use of multiple types of specimens increases the positive yield markedly.

Adolescent↗

PubMed1976

Enzyme induction by enflurane in man.

Concentrations of 6-beta-hydroxycortisol (6-OHF), a polar metabolite of cortisol formed in the endoplasmic reticulum (microsomes) of the liver, and 17-hydroxycorticosteroids (17-OHCS) were measured in the urines of six healthy adult male volunteers exposed to a mean of 9.6 MAC-hours of enflurane anesthesia as an index of possible enzyme induction. The ratio of 6-OHF to 17-OHCS in 24-hour urine specimens collected five days before anesthesia was compared with the ratio of these metabolites in 24-hour urine specimens collected 16 to 18 hours after anesthesia. The ratio of 6-OHF to 17-OHCS increased markedly in five and decreased slightly in one volunteer following anesthesia. The results indicate that enflurane may cause induction of hepatic microsomal enzymes.

17-Hydroxycorticosteroids↗

PubMed1993

Response of the Emit II amphetamine/methamphetamine assay to specimens collected following use of Vicks inhalers.

The possible cross-reactivity of l-methamphetamine (desoxyephedrine) to the Syva Emit II amphetamine/methamphetamine assay was evaluated in urine specimens collected from seven subjects using Vicks Inhalers. The subjects were six males and one female ranging from 24 to 47 years of age. Four subjects used the inhaler every two waking hours for five consecutive days, while three subjects inhaled hourly for three consecutive days. All urine voids were collected, totaling 150 specimens. All specimens were analyzed by the Emit II assay on a Hitachi 717 automatic analyzer with a 1000-ng/mL d-methamphetamine cutoff calibrator. None of the inhaler specimens produced an Emit II response equal to or greater than the cutoff calibrator; all were negative. Specimens producing the highest rates were further analyzed by chiral GC/MS. The highest concentrations of l-methamphetamine were observed in urines from two subjects inhaling hourly: 1390, 1290, and 740 ng/mL. These specimens were collected the evenings of the second and third day. When used as directed or even with double the daily dose, Vicks Inhalers did not cause false-positive results in urine tested with the Emit II Amphetamine/Methamphetamine assay.

Administration, Inhalation↗

PubMed1987

Study of calcium phosphate crystalluria.

When the frequency of heavy calcium phosphate crystalluria was compared among postprandial urine specimens collected from 152 healthy persons (group 1) and 108 patients with calcium urolithiasis (group 2), there was no significant difference between these groups. However, the frequency of crystalluria was significantly greater in 49 patients in group 2 who required or had required surgical intervention for calcium stone disease than in group 1 (p less than 0.05). Calcium phosphate precipitates collected from 7 urine specimens by repeated centrifugation were studied by infrared, X-ray, thermal and electron probe analyses. The principal component of the precipitates was poorly crystallized apatite associated with some organic material. The precipitates from the 7 samples appeared as aggregates of fine spherules less than 1 micron. in diameter, and the calcium-to-phosphate molar ratio of a spherule ranged from 1.02 to 1.19. We conclude that not only calcium oxalate crystalluria but calcium phosphate crystalluria may have an important role in the formation of urinary stones.

Adult↗

PubMed2003

Urinary excretion profiles of 11-nor-9-carboxy-Delta9-tetrahydrocannabinol. Study III. A Delta9-THC-COOH to creatinine ratio study.

Huestis and Cone reported in [J. Anal. Toxicol. 22 (1998) 445] that serial monitoring of Delta9-THC-COOH/creatinine ratios in paired urine specimens collected at least 24h apart could differentiate new drug use from residual Delta(9)-THC-COOH excretion following acute marijuana use in a controlled setting. The best accuracy (85.4%) for predicting new marijuana use was for a Delta(9)-THC-COOH/creatinine ratio > or = 0.5 (dividing the Delta9-THC-COOH/creatinine ratio of specimen no. 2 by the specimen no. 1 ratio). In previous studies in this laboratory [J. Anal. Toxicol. 23 (1999) 531 and Forensic Sci. Int. 133 (2003) 26], urine specimens were collected from chronic marijuana users > or = 24 h or > = 48 h apart in an uncontrolled setting. Subjects with a history of chronic marijuana use were screened for cannabinoids with the EMIT II Plus cannabinoids assay (cut-off 50 ng/ml) followed by confirmation for Delta9-THC-COOH by GC-MS (cut-off 15 ng/ml). Creatinine was analyzed as an index of dilution. The objective of the present study was to evaluate whether creatinine corrected specimens could differentiate new marijuana or hashish use from the excretion of residual Delta(9)-THC-COOH in chronic marijuana users based on the Huestis 0.5 ratio. Urine specimens (N=376) were collected from 29 individuals > or = 96 h between urine collections. The mean urinary Delta9-THC-COOH concentration was 464.4 ng/ml, mean Delta9-THC-COOH/creatinine ratio (ng/(ml Delta9-THC-COOH mmoll creatinine)) was 36.8 and the overall mean Delta9-THC-COOH/creatinine ratio of specimen 2/mean Delta9-THC-COOH/creatinine ratio of specimen 1 was 1.37. The Huestis ratio calculation indicated new drug use in 83% of all sequentially paired urine specimens. The data were sub-divided into three groups (Groups A-C) based on mean Delta9-THC-COOH/creatinine values. Interindividual mean Delta9-THC-COOH/creatinine values ranged from 4.7 to 13.4 in Group A where 80% of paired specimens indicated new drug use (N=10) and 20.4-39.6 in Group B where 83.6% of paired specimens indicated new drug use (N=7). Individual mean Delta9-THC-COOH/creatinine values ranged from 44.2 to 120.2 in Group C where 84.5% of paired urine specimens indicated new marijuana use (N=12). Correcting Delta9-THC-COOH excretion for urinary dilution and comparing Delta9-THC-COOH/creatinine concentration ratios of sequentially paired specimens (collected > or = 96 h apart) may provide an objective indicator of ongoing marijuana or hashish use in this population.

Creatinine↗

PubMed2005

Nonfatal and fatal DOB (2,5-dimethoxy-4-bromoamphetamine) overdose.

2,5-Dimethoxy-4-bromoamphetamine (DOB) is a strongly acting hallucinogen with an estimated effective dose of 2 mg for an 80 kg man. The case of two men who ingested a new "hallucinogen LSD-like" designer drug is reported here. They experienced intense hallucinations (onset after 15 min) and vomiting. The men became unconscious and fell into deep coma lasting several days. After an unknown period of time elapsed they were admitted to a hospital in a comatose state. One subject (AX, body mass 113 kg) survived, while the second subject (BX, body mass 65 kg) experienced convulsions, metabolic acidosis and died 6 days later. Gastric, blood, and urine specimens collected on admission into the hospital were sent for toxicological examination. Ethanol concentrations in the blood samples were less than 0.2 g/kg. CEDIA urine screening indicated the presence of THCOOH in both cases, while cocaine and its metabolites were only indicated in the urine from AX. Immunoassay for amphetamines was negative in urine specimens collected from both subjects. GC-MS analysis for unknown drugs allowed for the discovery of the presence of DOB in the gastric and urine samples of both persons. DOB-targeted analysis for the acetylated analyte confirmed its presence in both subjects. Quantitative analysis yielded concentrations in serum of 13 ng/ml (AX) and 19 ng/ml (BX). This report on both nonfatal and fatal DOB overdose cases is based on clear toxicological evidence, and is the first documentation of DOB consumption in the Czech Republic.

DOM 2,5-Dimethoxy-4-Methylamphetamine↗