Urinalysis Quality Control at the Point-of-Care !

Clinical Issues

The goal of any clinical diagnostic test procedure is to provide critical information in a timely manner so that appropriate actions may be taken, ultimately improving patient outcomes. Point-of-care testing (POCT) is a term that has come to describe a multitude of rapid medical tests that can be performed at or near the site of patient care. The most compelling benefit of these tests is that, as opposed to having to wait hours or days for results to arrive from an outside laboratory, clinicians can obtain the results immediately, allowing for clinical management decisions to be made while the patient is still at the care facility. While the implementation of rapid diagnostic tests dates back to ancient history (sweet-tasting urine was once commonly used to diagnose diabetes mellitus), it was not until the 1950s that these rapid diagnostic methods gained any real predictive value. Today, the popularity and demand for POCT are increasing rapidly. TriMark Publications estimates that the global market for POCT was $14.5 billion in 2016, and is expected to grow by seven percent over the next five years.

Urinalysis dipsticks at the point-of-care:

Urinalysis using multi-analyte dipsticks is a point-of-care test performed at any hospital, clinical laboratory, doctor’s office, health clinic, and nursing facility. Various iterations of these tests have existed for decades, and they continue to be among the most commonly performed tests of any kind. Urinalysis dipsticks contain discrete reagent pads to semi-quantitatively test for the presence of bilirubin, blood, creatinine, glucose, ketones, leukocytes, nitrite, pH, protein, specific gravity, and urobilinogen in a urine sample.

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Source: MedicalLaboratoryObserver

Gallstones: Epidemiology, Pathophysiology and Management.

Gallstones grow inside the gallbladder or biliary tract. These stones can be asymptomatic or symptomatic; only gallstones with symptoms or complications are defined as gallstone disease. Based on their composition, gallstones are classified into cholesterol gallstones, which represent the predominant entity, and bilirubin (‘pigment’) stones. Black pigment stones can be caused by chronic hemolysis; brown pigment stones typically develop in obstructed and infected bile ducts. For treatment, localization of the gallstones in the biliary tract is more relevant than composition. Overall, up to 20% of adults develop gallstones and >20% of those develop symptoms or complications. Risk factors for gallstones are female sex, age, pregnancy, physical inactivity, obesity and over nutrition. Factors involved in metabolic syndrome increase the risk of developing gallstones and form the basis of primary prevention by lifestyle changes. Common mutations in the hepatic cholesterol transporter ABCG8 confer most of the genetic risk of developing gallstones, which accounts for ∼25% of the total risk. Diagnosis is mainly based on clinical symptoms, abdominal ultrasonography and liver biochemistry tests. Symptoms often precede the onset of the three common and potentially life-threatening complications of gallstones (acute cholecystitis, acute cholangitis and biliary pancreatitis). Although our knowledge on the genetics and pathophysiology of gallstones has expanded recently, current treatment algorithms remain predominantly invasive and are based on surgery. Hence, our future efforts should focus on novel preventive strategies to overcome the onset of gallstones in at-risk patients in particular, but also in the population in general.

Introduction

Gallstones (cholelithiasis) are masses in the gallbladder or biliary tract that are caused by abnormally high levels of either cholesterol or bilirubin (a breakdown product of heme) in bile (Fig. 1). Gallstones are common (∼10–20% of the global adult population), and >20% of people with gallstones will develop symptoms in their lifetime (including biliary colic or infections), usually in adulthood. Gallstone disease is defined by the occurrence of symptoms or complications caused by gallstones in the gallbladder and/or the bile ducts. From a clinical perspective and in treatment algorithms, those with asymptomatic stones are not generally classified as having gallstone disease. Gallstone disease is among the gastrointestinal conditions associated with the highest socioeconomic costs.

Read more: Gallstones: Epidemiology, Pathophysiology and Management.

Figure 1: Classification of gallstones.

PrimeView Poster:

Gallstones are masses in the gallbladder or biliary tract. 10–20% of adults will develop gallstones in their lifetime, and >20% of those will develop symptoms or complications. This Primer by Lammert et al. focuses on the formation of gallstones, summarizes the current principles of treatment of the stones and their potential complications and envisions future approaches for this widespread disease. And this PrimeView focuses on the most common risk factors, which include genetics, ethnicity, sex, age, drugs, parasites, over nutrition and pregnancy.

Frank Lammert, Kurinchi Gurusamy, Cynthia W. Ko,Juan-Francisco Miquel, Nahum Méndez-Sánchez, Piero Portincasa, Karel J. van Erpecum, Cees J. van Laarhoven& David Q.-H. Wang

View poster: Gallstone Poster (high-resolution PDF (1.30 MB))

Source: NatureReviewsDiseasePrimers