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PubMed1992

The diagnostic value of haematuria and proteinuria in Schistosoma haematobium infection in southern Nigeria.

Haematuria and proteinuria as detected by chemical reagent strips correlated moderately (r = 0.7) with prevalence and intensity of infection with Schistosoma haematobium in an area of Anambra State, Nigeria. Differences attributable to age and sex were also reflected in a similar pattern, all peaks occurring in the 5-14 year age group. The differences observed with varying levels of intensity and haematuria at both 10 and 50 erythrocytes/microliter (p < 0.001) and proteinuria at 0.3 g/dl (p < 0.01) were statistically significant. At a proteinuria level of 1 g/dl, the observed differences were however not statistically significant (p > 0.5). The percentage of specimens from children (0-14 years) positive for S. haematobium eggs and with at least traces of haematuria and proteinuria (63.4% and 95%, respectively) was higher than in adults (33.3% and 80.2%, respectively). All individuals with more than 50 eggs/10 ml of urine were correctly identified using both indices either separately or in combination. For egg counts of less than 50 eggs/10 ml of urine, false diagnosis occurred in only 5% of all specimens examined. The sensitivity and specificity of haematuria and proteinuria at trace quantities was very high, but haematuria had a higher predictive value for a positive test (PvPt) and was considered the overall better indicator. A combination of both indices did not significantly increase the PvPt. When trace haematuria and moderate proteinuria were combined, both the sensitivity, specificity and PvPt were all above 90%, giving the best overall values in all the combinations made.

Adolescent↗
PubMed1985

The effect of hypoglycaemia on visual function: a clinical and electrophysiological study.

Disturbance of vision commonly accompanies hypoglycaemia. This study was designed to investigate the nature of the visual disturbance, the blood glucose threshold at which the disturbance occurred and the physiological basis. Measurements were made of the corrected visual acuity, colour vision (100 Hue test), visual evoked potentials (VEP), electroencephalography (EEG) frequency analysis and psychometry (digit recall) during stepwise induction of controlled hypoglycaemia produced by an intravenous insulin infusion. Six male volunteers and five insulin-dependent diabetic subjects were studied. During hypoglycaemia corrected visual acuity was unchanged. Colour vision was significantly impaired. Baseline VEP were normal in both groups but significantly prolonged during hypoglycaemia (mean increment 10.8 ms) and increased by greater than 5 ms in nine out of 11 subjects. Quantitative EEG analysis demonstrated slowing with a power density spectral shift from fast alpha to slow alpha, theta and delta which correlated with VEP latency and amplitude changes. The findings have clinical implications. A deterioration in colour vision is likely to impair the ability to read reagent strips by eye. VEP measurements in diabetic patients are likely to be misleading if hypoglycaemia is present; EEG changes are a sensitive index of cortical dysfunction during hypoglycaemia and provide a theoretical basis for developing a portable device to detect early hypoglycaemia.

Adult↗
PubMed2007

Vasoactive drugs enhance pancreatic islet blood flow, augment insulin secretion and improve glucose tolerance in female rats.

Pravastatin, irbesartan and captopril are frequently used in the treatment of patients with Type 2 diabetes. These drugs also exert beneficial metabolic effects, causing an improved glucose tolerance in patients, but the precise mechanisms by which this is achieved remain elusive. To this end, we have studied whether these drugs influence insulin secretion in vivo through effects on islet blood perfusion. Captopril (3 mg/kg of body weight), irbesartan (3 mg/kg of body weight) and pravastatin (0.5 mg/kg of body weight) were injected intravenously into anaesthetized female Wistar rats. Blood flow rates were determined by a microsphere technique. Blood glucose concentrations were measured with test reagent strips and serum insulin concentrations were measured by ELISA. Pancreatic blood flow was markedly increased by pravastatin (P<0.001), captopril (P<0.05) and irbesartan (P<0.01). Pancreatic islet blood flow was significantly and preferentially enhanced after the administration of captopril (P<0.01), irbesartan (P<0.01) and pravastatin (P<0.001). Kidney blood flow was enhanced significantly by pravastatin (P<0.01), irbesartan (P<0.05) and captopril (P<0.01). Captopril and pravastatin also enhanced late-phase insulin secretion and positively influenced glycaemia in intraperitoneal glucose tolerance tests. In conclusion, the present study suggests that a local pancreatic renin-angiotensin system and pravastatin treatment may be selectively controlling pancreatic islet blood flow, augmenting insulin secretion and thereby improving glucose tolerance. Our findings indicate significant gender-related differences in the vascular response to these agents. Since statins and renin-angiotensin system inhibitors are frequently used by diabetic patients, the antidiabetic actions of these drugs reported previously might occur, in part, through the beneficial direct islet effects shown in the present study.

Angiotensin Receptor Antagonists↗
PubMed2001

Important causes of hypoglycaemia in patients with diabetes on peritoneal dialysis.

AIM: Diabetes is now the commonest cause of end-stage renal failure, so there are many diabetic patients receiving dialysis therapy. There are several important ways in which dialysis practice can impinge unfavourably on glucose control. This study focuses on the interaction between maltose-derived metabolites in a new peritoneal dialysis fluid and blood glucose measurements using reagent sticks that depend on the glucose dehydrogenase method. CASE REPORT: We report the cases of three patients, with insulin-treated diabetes and end-stage renal disease treated with peritoneal dialysis, who experienced symptomatic hypoglycaemia with inaccurate glucose readings on reagent strips when converted to icodextrin. CONCLUSION: Careful teamwork between diabetes and renal physicians and specialist nurses is highly desirable to achieve good glucose control in a group of patients at particular risk of microvascular and macrovascular complications.

Adult↗
PubMed1999

The performance of school-based questionnaires of reported blood in urine in diagnosing Schistosoma haematobium infection: patterns by age and sex.

This study investigates the performance of school-based questionnaires of reported blood in urine as an indicator of the prevalence of Schistosoma haematobium infection in schools and the presence of infection in individuals. In most schools (87%), the prevalence of reported blood in urine underestimates the prevalence of S. haematobium infection. Predictive value analysis suggests that a threshold of 30% reported blood in urine would identify most of the high prevalence schools (i.e. those with 50% or more children infected with S. haematobium). Although the prevalence of S. haematobium infection was greater in males than females, girls reported a lower prevalence of blood in urine than boys even at comparable levels of infection. Reported blood in urine in females was more specific (identifying 10% more uninfected girls than the sign in boys), but was far less sensitive (identifying less than 20% of infected girls than boys). The sensitivity of reported blood in urine was also related to age, being significantly lower in girls over 14 years of age. The proportion of infected children who reported blood in urine was also lower in schools where the prevalence of reported blood in urine is less than 30%. The results suggest that the selective treatment of children based on reported blood in urine in low prevalence schools would miss a high proportion of infected children, particularly girls. It remains unclear whether other rapid assessment techniques, such as the use of reagent strips, would offer greater cost-effectiveness.

Adolescent↗
PubMed2002

Assessing diabetic control--reliability of methods available in resource poor settings.

AIMS AND METHODS: To examine the reliability of random venous or capillary blood glucose testing, random urine glucose testing, and a current symptom history in predicting a high HbA1c in Type 2 diabetic patients taking oral hypoglycaemic agents in a poorly controlled rural African population. RESULTS: For a cut-off point for HbA1c of > or = 8%, for random venous plasma glucose of > or = 14 mmol/L (present in 47.2% of subjects), specificity was 97.1% (95% CI 85.1-99.9), sensitivity 56.8% (48.8-64.5) and positive predictive value (PPV) 98.9% (94.2-99.9). HbA1c > or = 8% is predicted by a random capillary blood glucose of 17 mmol/L (present in 28.4% of subjects) with specificity 100% (90.0-100.0), PPV 100% (93.7-100.0) and sensitivity of 34.3% (27.2-42.1). HbA1c > or = 8% is predicted by the presence of heavy glycosuria (> or = 55 mmol/L) (present in 35.6%) with specificity 94.1% (80.3-99.3), sensitivity of 41.9% (34.1-49.9) and PPV 97.1% (89.9-99.6). Polyuria/nocturia (present in 31.3%) was the only symptom found to be associated with poor control, with a specificity for predicting HbA1c of > or = 8% of 81.5% (61.9-93.7), PPV 89.1% (76.4-96.4) and sensitivity 30.6% (22.9-39.1). CONCLUSIONS: Where resources are short, random glucose testing can be used to detect a significant proportion of those with the worst control with a high degree of specificity enabling primary care staff to modify treatment safely. Where facilities are limited capillary blood or urine testing with reagent strips, may be substituted for venous plasma testing in the laboratory. A symptom history was insufficient to replace biochemical testing, but where this is unavailable, urinary symptoms may be helpful.

Black People↗
PubMed1998

Evaluation of the Accusport Lactate Analyser.

An investigation of the Accusport Lactate Analyser (ACC) was undertaken to assess its accuracy, linearity, reliability, and versatility. Accuracy was determined by comparing 32 blood assays on the ACC with those obtained using the Kodak Ektachem E250 (E250). Linearity was determined over the range 1.2-18.7 mmol/L. Reliability was measured at 1.7 (low) and 14.4 (high) mmol/L concentrations. Versatility involved determining the optimal sample volume, influence of haematocrit, and the effect of time delay from sampling to assay. Assays determined using the ACC confirm good agreement with the E250. The difference between the two methods compared for lactate determination does not exceed 1.1 mmol/L for concentrations up to approximately 20 mmol/L. Linearity is demonstrated by the regression equation y = 0.026 + 0.970x, r = 0.995. Reliability is expressed by the coefficient of variation of 7% (low) and 4.6% (high). The optimal sample size for accurate assay was determined to be between 20 microL and 50 microL. Mean lactate value did not vary significantly between a haematocrit of 35% and 45%. The Accusport is accurate, linear up to at least 18.7 mmol/L, has good reliability at high and low concentrations, and is able to analyse whole blood up to 15 minutes after sample application to the reagent strip.

Adult↗
PubMed2001

Comparison of test characteristics of urine dipstick and urinalysis at various test cutoff points.

STUDY OBJECTIVE: We compare the test characteristics of urine dipstick and urinalysis at various test cutoff points in women presenting to emergency departments and an intermediate care center with symptoms of urinary tract infection. METHODS: This was a prospective, observational study of adult women presenting to 1 of 2 community hospital EDs or an intermediate care center with dysuria, urgency, or urinary frequency on history, or suprapubic or costovertebral angle tenderness on examination. Patients who had taken antibiotics in the past 72 hours, had indwelling Foley catheters, symptomatic vaginal discharge, diabetes mellitus, immunodeficiency disorders, or were unable to provide a reliable history were excluded. The patient's clean-catch or catheterized urine specimen was tested immediately by a nurse using a Multistix 9 SG reagent strip. A second aliquot was sent within 1 hour of collection to the hospital laboratory, where a semiautomated microscopic urinalysis and a urine culture were performed. A positive urine culture was defined as more than 100,000 colonies of 1 or 2 uropathogenic bacteria per mL of urine at 48 hours. Dipstick and urinalysis data were compared with urine culture results. Sensitivity, specificity, and predictive values were calculated at various definitions of a positive test, or "test cutoff points," for combinations of leukocyte esterase, nitrite, and blood on dipstick and for RBCs and WBCs on urinalyses. The probability of an erroneous decision to withhold treatment on the basis of a negative test result was defined as "undertreatment," or 1 minus the negative predictive value. "Overtreatment" was defined as 1 minus the positive predictive value. RESULTS: Three hundred forty-three patients were enrolled in this study. Twelve patients were withdrawn because of missing laboratory results. Forty-six percent (152/331) of patients had positive urine cultures. If urine dipstick results are defined as positive when leukocyte esterase or nitrite is positive or blood is more than trace, the overtreatment rate is 47% (156/331) and the undertreatment rate is 13% (43/331). If urinalysis results are defined as positive when WBCs are more than 3 per high-power field or RBCs are more than 5 per high-power field, the overtreatment rate is 44% (146/331) and the undertreatment rate is 11% (36/331). Matched pairs of test characteristics were identified when the analysis was repeated using more than 10,000 colonies per mL as a positive culture. CONCLUSION: In this patient population, similar overtreatment and undertreatment rates were identified for various test cutoff points for urine dipstick tests and urinalysis. Although a urine dipstick may be equivalent to a urinalysis for the diagnosis of urinary tract infection, the limitations in the diagnostic accuracy of both tests should be incorporated into medical decisionmaking.

Adolescent↗
PubMed2001

Urinary schistosomiasis in schoolchildren in Dar-es-Salaam, Tanzania, and the factors influencing its transmission.

The prevalence of urinary schistosomiasis among the schoolchildren living in Kigogo administrative ward of the Kinondoni district of Dar-es-Salaam city, Tanzania, and the factors influencing the transmission of the causative agent, Schistosoma haematobium, were investigated in a cross-sectional study. The estimate of overall prevalence, based on microscopical examination of a single urine sample/subject, was 47.6%. Compared with the girls, the boys were more likely to be excreting schistosome eggs (54.6% v. 40.8%; P = 0.004) and had, in general, higher intensities of infection (54 v. 38 eggs/10 ml urine; P = 0.001). The children aged 10-14 years had higher prevalences and intensities of infection than those in the younger or older age-group studied. The sensitivity of micro-haematuria as an indicator of infection (compared with the microscopical examination of single urine samples) was 84.3% overall, reaching 92% among the children excreting > or = 50 eggs/10 ml urine. The corresponding positive and negative predictive values were 77% and 84%, respectively. The sensitivity, specificity and positive and negative predictive values of the history of haematuria as an indirect screening technique for S. haematobium were 60.4%, 72.7%, 67% and 67%, respectively. Recreational activities such as bathing, swimming and playing in the water were the most frequent activities attracting children to water bodies and carried the highest risks of infection with S. haematobium. Knowledge about the disease, especially on the symptoms and mode of transmission, was generally good but the methods of prevention were inadequately known. Chemotherapy to control urinary schistosomiasis in schoolchildren is recommended; infected children may be identified on the basis of haematuria, detected using questionnaires or reagent strips. Additional health education, to heighten awareness of the disease and its prevention, would also be beneficial.

Adolescent↗
PubMed2006

Mucosal innate immune factors in the female genital tract are associated with vaginal HIV-1 shedding independent of plasma viral load.

Recent studies indicate that mucosal innate immune factors modulate HIV-1 infection in vitro. Our interest was to examine the levels of innate mucosal factors for their potential association with HIV-1 shedding in the female genital tract. Vaginal lavages were collected from HIV-1-infected women who had vaginal viral loads (VVL) that were below, within, or above the 90% confidence interval (CI) predicted by their matched plasma viral loads. Innate immune factors [cathepsin D, lactoferrin (Lf), myeloid related protein (MRP)-8, MRP-8/14, secretory leukocyte protease inhibitor, and gp340], cytokines (IL-1beta and TNF-alpha), and chemokines (MIP-1alpha, MIP-1beta, RANTES, and SDF-1alpha) were quantified by ELISA. Leukocyte levels were determined using a leukocyte reagent strip for urinalysis. Lf, MRP-8/14, gp340, and IL-1beta levels were significantly higher in vaginal lavages above the 90% CI and generally correlated with each other and with VVL. Leukocyte levels were significantly higher in the lavages that had virus shedding above the 90% CI and correlated strongly with Lf levels and VVL. In this group of women, these results suggest that the levels of certain innate immune factors are more closely associated with HIV-1 shedding in the genital mucosa than plasma virus concentrations.

Adolescent↗
PubMed1979

A rapid (4--6-hour) urine-culture system for direct identification and direct antimicrobial susceptibility testing.

This study evaluates a new direct rapid system for urine cultures, including detection and quantitation of positive specimens by Gram stain, direct identification by 4--6-hour incubation of sediment with reagent strips, and antibiotic susceptibility testing by direct (3--4-hour) disk-elution methods. Of 987 routine urine specimens, 121 had significant (less than or equal to 10(5) colony-forming units/ml) gram-negative bacilluria, of which 89% were detected by the Gram stain. Direct rapid identification was correct in 94%. Results of direct disk-elution antimicrobial tests showed overall agreement with results of standard disk diffusion of 93% of tests, and major discrepancies in 4%. For urine specimens with gram-negative bacilluria, this system permitted detection, quantitation, identification, and antimicrobial susceptibility testing in four to six hours with reasonable, though not complete, accuracy.

Anti-Bacterial Agents↗
PubMed1994

Circulating anodic and cathodic antigen in serum and urine from Schistosoma haematobium-infected Cameroonian children receiving praziquantel: a longitudinal study.

A cohort of 148 Cameroonian children infected with Schistosoma haematobium was followed before praziquantel therapy and 1, 2, 3, 5, and 12 months thereafter. Egg output, the reagent strip index (RSI, a pathological marker), and circulating anodic antigen (CAA) and circulating cathodic antigen (CCA) in serum and urine were quantified. At enrollment, the median level of egg output was 365/10 mL of urine; 97% of children had a positive RSI; CAA was detected in serum from 76% of children and in urine from 64%; and CCA was detected in serum from 55% of children and in urine from 87%. Two months after chemotherapy, egg output and RSI had decreased significantly; reinfection later developed in parallel with increases in the serum and urine concentrations of CAA and the urine concentrations of CCA. The measurement of CAA and CCA is useful for diagnosis, evaluation of disease severity, and follow-up of chemotherapy in individuals infected with S. haematobium.

Adolescent↗
PubMed1984

Intermittent chemotherapy with trichlorfon (metrifonate) reverses proteinuria, hematuria, and leukocyturia in urinary schistosomiasis: results of a three-year field study.

Trichlorfon (metrifonate) was given intermittently to 37 schoolboys with urinary schistosomiasis living in a hyperendemic area of the Sudan. Patients were followed up for three years. Initially, 10 mg of trichlorfon/kg of body weight was administered; this dosage was repeated 14 days and 16 months later. Patients still excreting eggs after 24 months received a fourth dose. At month 24, 61% and at month 36, 56% of the patients had no detectable egg excretion; the others showed severe reduction of egg output. The number of ova excreted was always paralleled by a combined scale of hematuria, leukocyturia , and proteinuria, as assessed by urine analysis reagent strips. Quantitative urine analysis at month 36 revealed pathological findings in only eight individuals. Thus, trichlorfon given three or four times in a dose of 10 mg/kg of body weight spaced over a period of two years was highly effective in reducing parasite load and disease in children living under hyperendemic conditions.

Child↗
PubMed2000

Indicators of postpyloric feeding tube placement in children.

OBJECTIVE: To determine the validity of five indicators (color, pH, and concentrations of bilirubin, pepsin, and trypsin in aspirated gastrointestinal secretions) in predicting postpyloric placement of feeding tubes in critically ill children. DESIGN: Prospective, observational study. SETTING: University teaching hospital. PATIENTS: A total of 96 gastrointestinal aspirates were obtained from 53 children requiring placement of a nasoenteric feeding tube. INTERVENTIONS: Feeding tubes were aspirated by applying suction with a 20-mL syringe. Repeat aspirates from the same patient were obtained on different days. All aspirations were performed within 30 mins of obtaining a radiograph to assess tube position. MEASUREMENTS AND MAIN RESULTS: Aspirates were inspected visually for color. pH and bilirubin concentrations were determined at the bedside by using reagent strips. Pepsin and trypsin concentrations were measured spectrophotometrically in a research laboratory. The sensitivity, specificity, predictive values, and efficiency for each indicator and their 95% confidence intervals were determined based on the position of the feeding tube on the radiograph. Aspirate pH > or =6 had the lowest positive predictive value (76%, range 67% to 85%) but high negative predictive value (94%, range 89% to 99%) for determining postpyloric positioning of the feeding tube. Bilirubin concentration > or =5 mg/dL (> or =86 micromol/L) had the highest positive predictive value (96%, range 91% to 100%) and lowest negative predictive value (88%, range 81% to 95%). Overall efficiency was best for the appearance of a clear yellow aspirate color (93%, range 88% to 98%), pepsin concentration < or =20 microg/mL (94%, range 89% to 99%), and trypsin concentration > or =50 microg/mL (94%, range 89% to 99%). CONCLUSIONS: Simple bedside assessment of gastrointestinal aspirate color, pH, and bilirubin concentration is useful for predicting feeding tube position. Use of these tests may reduce the number of radiographic studies needed to confirm postpyloric positioning. Laboratory-determined pepsin and trypsin concentrations predict tube position with a high degree of accuracy. Development of simple and inexpensive bedside tests for the detection of gastrointestinal enzymes may be useful.

Adolescent↗
PubMed1981

Screening for asymptomatic bacteriuria in pregnant patients: three office screening systems versus quantitative culture.

We screened 691 asymptomatic prenatal patients by quantitative culture of clean voided urine specimens and one of three office screening devices to detect bacteriuria. The ability of each screening system to detect a single pathogenic organism in concentration equal to or greater than 100,000/ml was analyzed. Microstix-3 reagent strips had 87.5% accuracy, with the smallest number of false-positive results (6.7%). The Bacturcult system was correct in 75% of cases, but yielded 30% false-positive results. The Testuria system was least accurate (62.5%) and had the highest incidence of false-positive tests (71%).

Bacteriological Techniques↗
PubMed1985

Determination of serum theophylline by apoenzyme reactivation immunoassay system.

A reagent strip for the quantitative analysis of theophylline in serum or plasma was evaluated. The strip is based on the apoenzyme reactivation immunoassay system (ARIS) technique and is intended for use with the Ames Seralyzer reflectance photometer. The method gave CVs at three theophylline levels ranging from 3.8 to 6.3% (within run) and from 2.8 to 6.9% (day to day). The regression lines obtained from the correlation studies were y = 0.959x + 0.51 (n = 105, r = 0.9906, Sy/x = 0.56) for the comparison ARIS (y) versus Syva enzyme multiplied immunoassay (x) methods, and y = 0.986x + 0.32 (n = 105, r = 0.9832, Sy/x = 0.62) for the comparison ARIS (y) versus Abbott TDx fluorescence polarization immunoassay (x) methods. The interference from triglycerides, hemoglobin, bilirubin, and ascorbic acid, and the cross-reactivity of 8-chlorotheophylline, caffeine, 1,3-dimethyluric acid, theobromine, and 1,7-dimethylxanthine, were also investigated and discussed. The method was found to be reliable, simple, and rapid. It provides a practicable solution for immediate determinations of theophylline.

Apoenzymes↗
PubMed2001

No evidence of accelerated loss of kidney function in living kidney donors: results from a cross-sectional follow-up.

BACKGROUND: There is a lack of kidneys available for kidney transplantation, and living donors are increasingly used. It is important to examine the possible long-term adverse affect on the renal function and blood pressure of the donors. METHODS: We have made a comprehensive follow-up of all living kidney donors at our center from 1964 to 1995. Of 402 donors still alive, we were able to get information about serum creatinine, urinary proteins, and blood cells in urine using reagent strips, and blood pressure from 87%. The glomerular filtration rate (GFR) was estimated using a formula and was measured with Iohexol clearance in 43 of the donors. Individual data on GFR and the prevalence of hypertension were compared with the age- and gender-expected values. RESULTS: The mean age of the examined donors was 61 years (SD:13) at follow-up, and the time since donation was 12 years (SD:8). The average estimated GFR was 72% (SD:18) of the age-predicted value. The ratio of the estimated to the predicted GFR showed no correlation to the time since donation, indicating that there is no accelerated loss of renal function after donation. GFR below 30 ml/min was found in five donors. No donor died in uremia or had dialysis treatment before death. However, three donors developed renal disease, and one was in dialysis treatment. In two of these cases, hereditary factors were possibly involved. Hypertension was present in 38% of the donors but the age-adjusted prevalence of hypertension among donors was not higher than in the general population. Significant proteinuria (> or =1.0 g/L) was found in 3% and slight proteinuria (<1.0 g/L) in 9% of the donors. Proteinuria was associated with hypertension and a lower GFR. CONCLUSIONS: On average, the remaining renal function of kidney donors did not deteriorate more rapidly than what may be expected from ageing. However one-third of the female and half of the male donors developed hypertension and, approximately, 10% displayed proteinuria. Nevertheless, our study supports the continued use of living kidney donors if strict criteria are used for acceptance.

Adult↗
PubMed2002

Detection of pepsin and glucose in tracheal secretions as indicators of aspiration in mechanically ventilated children.

OBJECTIVES: The detection of glucose in tracheal secretions has been used as an indicator of aspiration in mechanically ventilated, tube-fed children. Pepsin detection may be a more specific indicator. We determined the frequency of pepsin and glucose detection in tracheal secretions of mechanically ventilated children and studied the relationships between tracheal secretion pepsin and glucose and clinical evidence of gastroesophageal reflux. DESIGN: Prospective observational study. SETTING: University teaching hospital. PATIENTS: A convenience sample of mechanically ventilated children. INTERVENTIONS: Tracheal secretions were collected at the time of routine endotracheal tube suctioning. Tracheal aspirate glucose concentrations were assessed by using glucose oxidase reagent strips. Tracheal aspirate pepsin was detected by laboratory immunoassay. MEASUREMENTS AND MAIN RESULTS: One hundred tracheal aspirates were collected from 37 children. Pepsin (>or=1 microg/mL) was detected in nine aspirates, and glucose (>or=20 mg/dL) was detected in 59 aspirates. Overall, five (13.5%) patients had at least one pepsin-positive aspirate, and 33 (89%) had at least one glucose-positive aspirate. Patients with at least one pepsin-positive aspirate were more likely to have clinical evidence of gastroesophageal reflux than patients with pepsin-negative aspirates (5 of 5 vs. 9 of 32, p <.01, Fisher's exact test). Tracheal aspirate glucose positivity was unrelated to the administration of tube feedings and gastroesophageal reflux. No relationship between pepsin and glucose positivity was observed. CONCLUSIONS: Pepsin is detectable in tracheal secretions of mechanically ventilated children at risk for aspiration. Elevated glucose concentrations in tracheal secretions can occur by mechanisms other than aspiration of glucose-rich formula. Pepsin may be a more specific marker for aspiration than glucose.

Journal Article↗