Context: Point-of-care glucose meters are an integral part in the assessment of patients with altered mental status. For this reason, glucose meters are checked for interference from commonly encountered substances, including acetaminophen. The Nova StatStrip® glucose meter has previously been reported to be resistant to interference. We report a case of a very high acetaminophen concentration causing interference with this point-of-care glucose meter.Case report: A 25-year-old female presented after an overdose of acetaminophen and diphenhydramine combination product. Patient was minimally responsive, so a point-of-care glucose check was attempted using the Nova StatStrip® glucose meter. Five different meters were attempted, and each showed an error message. Laboratory analysis using Beckman Coulter® Unicel DxC 800 revealed a glucose of 180 mg/dL and an acetaminophen concentration of 465 mg/L. Serum spiked with acetaminophen at different concentrations revealed interference with the Nova StatStrip® glucose meter at a concentration of 399 mg/L and above. To our knowledge, this interference with the Nova StatStrip® glucose meter has not been reported in the medical literature.Conclusion: Very high levels of acetaminophen can interfere with point-of-care glucose meters, even those that have previously been reported to be robust such as the Nova StatStrip® glucose meter. Clinicians should be aware of this possible interference when treating patients with acetaminophen overdose.

Overdiagnosis and overtreatment of urinary tract infection (UTI) with antibiotics is a concern. In older adults, diagnosis of UTI using near-patient urine tests (reagent strip tests, dipsticks) is advised against because the age-related increase in asymptomatic bacteriuria can cause false-positive results. Instead, UTI diagnosis should be based on a full clinical assessment. Previous research lacks systematic information on urine dipstick use in hospitals. The aim of this study was to examine the use of urine dipstick tests and microbiology among older adult hospital admissions in relation to recommended UTI diagnostic criteria. A further aim was to assess factors associated with the use of dipsticks.
A case series review of patients aged ≥70 years admitted to two NHS Trust hospitals in England. Records from 312 patients admitted in 2015 meeting inclusion criteria were selected at random.
Of 298 complete patient records, 54% had at least one urine dipstick test recorded. 13% (21/161) of patients who received a urine dipstick test were diagnosed as having a UTI, only 2 out of these 21 cases had two or more clinical signs and symptoms. 60 patients received a second dipstick test, leading to 13 additional cases of UTI diagnosis. Dipstick tests were more likely to be performed on patients with a history of falls (OR 1.93, 95% CI:1.21, 3.07, p < 0.01), and less likely on those with dementia (OR 0.44, 95% CI: 0.22, 0.87, p < 0.05). The most common reason for testing was routine admissions policy (49.1% of cases), but these cases were predominantly in one hospital.
Use of urine dipstick tests was high among older adults admitted to hospitals. Most cases were asymptomatic and therefore received inappropriate antibiotic therapy. This paper highlights the need to implement new Public Health England diagnostic guidelines to hospital admission and emergency departments.

Patients very often consult for lower urinary tract symptoms, that do not necessarily equate to common cystitis. When urinary leucocytes and nitrites are absent, the urinary strip has a very good negative predictive value and makes the diagnosis of a lower urinary tract infection very unlikely. One then has to search for other diagnoses and to clarify the nature of the symptoms, irritating or obstructive ones, their duration and to correlate them to the patient\'s age and gender. In sexually active young patients, infectious diseases predominate, such as uretritis or vaginitis, while, with age, the prevalence of dysfunction of vesical emptying, benign prostatic hyperplasia or atrophic vaginitis increase.

A 35-year-old male patient presented with painful gross macroscopic haematuria. Urinalysis using Makromed test strips showed a negative reading for blood. Subsequent laboratory analysis showed the presence of gross haematuria. A referral to a consultant urologist confirmed a diagnosis of renal stones. Subsequent investigations by the author indicated that a manufacturing fault was responsible for this error. Discussion with the manufacturer identified a fault in the packaging which led to photosensitive light degradation of enzyme pathways, resulting in a false negative finding. In situations when gross clinical findings are not supported by on -site diagnostic tests, the clinician should consider the possibility that the diagnostic tool is at fault and not the clinician. Makromed urine tests strips (MUTS) have been used in this practice for several years. There had been no previous concerns raised by any clinician within the group practice, nor by the Primary Care Trust, or any authoritative professional body. Argyropoulos et al. (2004) reported that renal stones cause haematuria in 92.9% of cases.

We describe a child who presented with hallucinations in whom urine dipstick testing was positive for amphetamines. As a result the child protection team were involved. Subsequently, the urinalysis done by gas chromatography showed no amphetamines but a large quantity of ephedrine. The child had been given cough mixture which contains ephedrine. A cross-reaction had occurred between ephedrine and amphetamine when using the urinary dipsticks. This case highlighted the importance of clinicians being aware of the diagnostic accuracy and pitfalls of the investigations requested. In particular, this is critical when the results of such tests have such far reaching medicolegal and social consequences.

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OBJECTIVE: The aims of this study were firstly to assess and compare the prevalence of dental erosion and dietary intake between three groups of children; children with asthma, those with significant tooth erosion but with no history of asthma, and children with no history of asthma or other medical problems. Secondly, to discover whether there was a relationship between medical history and dietary practises of these children and the levels of dental erosion. Thirdly, to measure and compare their salivary flow rates, pH and buffering capacity.
METHODS: The study consisted of 3 groups of children aged 11-18 years attending Birmingham Dental Hospital: 20 children with asthma requiring long-term medication, 20 children referred with dental erosion, and 20 children in the age and sex matched control group. Tooth wear was recorded using a modification of the tooth wear index (TWI) of Smith and Knight. Data on the medical and dietary history were obtained from a self-reported questionnaire supplemented by a structured interview. The salivary samples were collected under standard methods for measurements.
RESULTS: Fifty percent of the children in the control group had low erosion and 50% moderate erosion. However, high levels were recorded in 35% of children in the asthma group and 65% in the erosion group. There appeared to be no overall differences in diet between the groups. There was an association between dental erosion and the consumption of soft drinks, carbonated beverages and fresh fruits in all the three groups. More variables related to erosion were found in the erosion and asthma groups. A comparison between the three groups showed no significant differences in unstimulated and stimulated salivary flow rates, or pH and buffering capacity.
CONCLUSIONS: There were significant differences in the prevalence of erosion between the three groups, children with asthma having a higher prevalence than the control group. Although there was a relationship between the levels of erosion and some medical history and acidic dietary components, these did not explain the higher levels in asthmatic children. Further investigation is required into the factors affecting the increased prevalence of erosion in children with asthma.

OBJECTIVE: To examine baseline renal screening practices and the effect of nurse case management of patients with diabetes in a group model health maintenance organization (HMO).
METHODS: We performed both 1-year retrospective and 1-year prospective studies of renal assessment practices and ACE inhibitor usage in a cohort of 133 diabetic patients enrolled in a randomized controlled trial of a diabetes nurse case management program in a group model HMO. In accordance with American Diabetes Association recommendations, urine dipstick and quantitative protein and microalbuminuria testing rates were calculated.
RESULTS: At baseline, 77% of patients were screened for proteinuria with dipsticks or had quantitative urine testing. Of patients with negative dipstick findings, 30% had appropriate quantitative protein or microalbumin follow-up at baseline. Baseline ACE inhibitor usage was associated with decreased follow-up testing (relative risk = 0.47). Nurse case management was associated with increased quantitative protein or or microalbumin testing and increased follow-up testing (relative risk = 1.65 and 1.60, respectively).
CONCLUSIONS: We found a higher degree of adherence to recommendations for renal testing than has been reported previously. Nurse case management intervention further increased renal screening rates. The inverse association between ACE inhibitor usage and microalbumin testing highlights a potentially ambiguous area of current clinical pathways.

A rapid dipstick test for scrub typhus was prospectively evaluated in Chiangrai, northern Thailand. Sera from 162 patients with fever of unclear etiology were tested by a dot blot immunoassay using two different antigen concentrations. Dipsticks coated with lower concentration of antigen lacked sensitivity compared with the indirect immunoperoxidase test. Dipsticks with higher antigen concentration had increased sensitivity that was equivalent to that of the immunoperoxidase test. By increasing the antigen concentration on the dipstick, sensitivity increased from 67% to 100%, positive predictive value increased from 90% to 93%, and negative predictive value rose from 92% to 100%. The specificity of both antigen concentrations was 98%. This study establishes that scrub typhus can be confirmed serologically by use of a dipstick assay and that serodiagnosis can be effectively tailored to a target population.

OBJECTIVE: To evaluate the performance of reagent test strips in screening pregnant women for asymptomatic bacteriuria at their first visit to an antenatal clinic.
METHODS: Prospective case series.
METHODS: Antenatal clinic of a large inner city maternity hospital.
METHODS: All women attending for their first antenatal clinic. Patients taking antibiotics for any reason and those with urinary tract symptoms were excluded.
METHODS: A midstream urine specimen was divided; half was sent for microscopy and formal bacteriological culture and the other half was tested with a commercial reagent strip test for the presence of blood, protein, nitrite, and leucocyte esterase.
METHODS: Sensitivity, specificity, and positive and negative predictive values of the reagent strips in diagnosing asymptomatic bacteriuria (defined as 10(5) colony forming units/ml urine).
RESULTS: Sensitivity was low, with a maximum of 33% when all four tests were used in combination. Specificity was high, with typical values of 99% or more. Positive predictive value reached a maximum of 69% and negative predictive value was typically 95% or more.
CONCLUSIONS: Urine reagent strips are not sufficiently sensitive to be of use in the screening for asymptomatic bacteriuria and therefore many patients would be missed. In view of the potentially serious sequelae of this condition in pregnant women we recommend that formal bacteriological investigation remain the investigation of choice in this group of patients.