(2) Frequency of H. pylori Antibodies among Patients with Gastrointestinal Symptoms Attending Khartoum Teaching Hospital- Sudan Wafa Ibrahim Elhag 1 * andltayeb Omer Ali 2 CLINICIAN'S GUIDE TO URINE ANALYSIS By Prof. AL FADIL AL QBEID OMER

Indications -for Urine Analysis (1) 1) Disturbance of micturition, e.g: dysuria frequency, urgency. 2)Cases of urethritis, vaginitis, prostatitis renal failure, pyelonephritis, cystitis, glomerulonephritis. 3) Pain, e.g. loin, suprapubic, low back. 4) Cases of P.U.O, malaise, filariasis, shcistosomiasis, enteric fever, TB, onchocerciasis,, leptospirosis.

INDICATIONS FOR URINE ANALYSIS-(2) 5) Patients at high risk e.gi young girls, pregnant ladies, elderly. 6) Liver disease, jaundice, blackwater fever, malignancy. 7) Biochemical abnormalities, e.g: diabetes, calculi, cystinuria, pancreatic disease, nephrotic syndrome, congestive heart failure, severe dehydration.

Collection and Transport o-f Urine;- ( 1 ) 1) Early morning MSU is preferred -for culture. 2) Container should be dry and sterile. 3) Female patients need to clean the area around the urethral orifice with Mater, dry, and hold labia apart. 4) Urine collected should be at least 20 ml.

Collection and Transport of Urine ( 2 ) 5) Store urine at 4° C for one hour if immediate delivery is not ' possible. I-f delay-is more than one hour, add boric acid and store urine at room temperature. 6) Changes occuring in unpreserved urine ares a) Unreliable bacterial count due to bacterial multiplication. b) pH increases and destroys cast and cells. c) Glucose Mill be negative due to breakdown by bacteria.

Collection and Transport of Urine - (3 ) 7) For renal tuberculosis, collect entire first urine passed on three successive mornings in a large, clean container (not sterile). Store at 4 C until all three urines are collected. 8) To diagnose N. qhonorrheae. collect a urethral, cervical or rectal discharge. Urine and HVS are not helpful.

Criteria for Culture from Microscopical Examinations Examine a wet preparation of uncentrifuged urine specimen. Criteria for urine culture are: 1) Bacteria s + or more / HPF 2) Pus cells (WBC) s more than 5 / HPF 3) RBCs 1 or more / HPF 4) Casts + or more / HPF... 5) Epithelial cells: +++ or more / HPF

Criteria for Culture from Computerized Urine Pro-file 1)Leukocytes : 100/ul or more 2)Nitrite : Positive 3)pH : 5 or 9 4)Erythrocytes : 50/ul or more 5)Protein : 30 mg/dl or more

POSSIBLE PATHOGENS ( 1 ) 1)Bacteria; a)Gram positive: Enterococcus faecalis, B- haemolytic Streptococcus pyogenes group B, coagulase positive Staph aureus b)Gram negative : E. coli. Proteus species, Pseudomonas species, Klebsiella species, Sal. typhi, Sal. paratvphi

POSSIBLE PATHOGENS - ( 2 ) 2) Parasites: Sch. haematobium, T. vaginal is. Enterobius vermicularis. Wuchereria bancrofti, Onchocerca volvulus. 3) Other Pathoqenes; Myco. tuberculosis. Leptospira interroqans. Chlamydia, Mycoplasma. Candida species.

POSSIBLE PATHOGENS ( 3 ) 1) E. coli is the commonest pathogen, specially among women. Source of infection may be coitus or faecal contamination. 2) Nvco. tuberculosis is suggested if there is heavy pyuria and urine is sterile. 3) S. typhi and S. paratyphi are detected among 25% of enteric fever patients in the 3rd week of infection. They are not associated with pyuria. Typhoid carriers, may execrete S. tvphi in urine –for many years

POSSIBLE PATHOGENS AND COMMENSALS (4) 4) In leptospirosis, L. interroqans may be -found during the 2nd Meek of infection. 5)Moderate to many epithelial cells in -female urine indicates vaginal contamination Possible Commensals; 1) Urethra : Acinetobacter species, dephtheoids, yeast 2) Skin: Staph. epidermidis. Mvco. smeqmatis.