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On Sep 2018




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Prof. Somashekhar Nimbalkar
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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : May | Volume : 16 | Issue : 5 | Page : EC46 - EC49 Full Version

Utility of Urine Reagent Strips for Analysis of Cerebrospinal Fluid in Emergency Settings: A Cross-sectional Study


Published: May 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/53751.16407
MR Manjunath, Rumana Tasneem, BG Malathi, HP Srujan

1. Associate Professor, Department of Pathology, Mandya Institute of Medical Sciences, Mandya, Karnataka, India. 2. Senior Resident, Department of Pathology, Mysore Medical College and Research Institute, Mysore, Karnataka, India. 3. Associate Professor, Department of Pathology, Mandya Institute of Medical Sciences, Mandya, Karnataka, India. 4. Undergraduate Student, Mandya Institute of Medical Sciences, Mandya, Karnataka, India.

Correspondence Address :
Dr. Rumana Tasneem,
#2469, 5th Cross, Gandhinagar, Mandya-571401, Karnataka, India.
E-mail: drrumana.mims@gmail.com

Abstract

Introduction: Meningitis is the inflammation of the meninges which covers brain and spinal cord, which if not identified on time will result in permanent neurological deficit or death. Mainly divided into septic and aseptic meningitis, differentiating these two and timely intervention would prevent neurological damage. Cerebrospinal Fluid (CSF) analysis helps to arrive at a diagnosis of meningitis which requires relevant trained staff and adequately equipped laboratory. These are not available in most of the healthcare centers in rural settings.

Aim: To evaluate the role of urinary reagent strip method in rapid analysis of CSF, to assist the clinician in the bedside diagnosis or exclusion of meningitis and to compare the values obtained by rapid method with that of results obtained by automated analyser.

Materials and Methods: This cross-sectional study was done in Pathology laboratory of Mandya Institute of Medical Sciences, District Hospital, Karnataka, Mandya, India. A total of 30 samples evaluated during the period of two months in 2019 (15th August to 15th October). Cerebrospinal fluid analysis was tested using combur- 10 urinary reagent strip and microscopy examination as reference standards. Automated analysers were used for the analysis of protein and glucose; and Neubauer’s counting chamber was used for leucocytes count. Statistical Package for the Social Science (SPSS) version 22.0 and Microsoft Excel were used to analyse data and generate tables.

Results: The sensitivity and specificity of urinary strips in the analysis of cerebrospinal fluid for glucose, protein, leucocytes was 50.00%, 41.67%, 78.57% and 92.31%, 88.89%, 68.75% respectively. Diagnostic accuracy of urinary strip tests for glucose, protein and leucocytes were 83.33% 93.34% 86.67% respectively.

Conclusion: The study shows the reliable sensitivity and specificity in some parameters, hence can be used in remote settings.

Keywords

Automated analyser, Bacterial meningitis, Dirui urinary reagent strips, Lumbar puncture, Medical emergency

Cerebrospinal Fluid (CSF) flows in subarachnoid space that lies between arachnoid and piamater (1). The production of CSF is from choroid plexus and lateral ventricles (2). The main functions of CSF include a) mechanical protection to brain from physical shocks; b) chemical protection and regulatory function to create a buffer for optimal neuronal signalling; c) circulation and exchange of nutrients and waste and; d) excretory of brain metabolites (3),(4).

Meningitis is the inflammation of meninges. The causative agents include bacterial, viral, fungal and parasitic infections (5). If meningitis is not identified rapidly, it can result in permanent neurological damage or even death (6). Globally, bacterial meningitis is the leading cause of mortality among children under five years of age (7). Viral meningitis is also known as aseptic meningitis which is less severe and requires only symptomatic treatment. Cerebrospinal fluid analysis helps to arrive at a diagnosis of meningitis for timely medical intervention.

Healthcare personnel with relevant training and adequately equipped laboratory are required for the analysis of cerebrospinal fluid which are not available in most healthcare centres in rural settings (8). In such areas, a rapid test which can help in quick diagnosis will be very useful. Current diagnosis methods are time consuming and expensive. As meningitis is a medical emergency, rapid diagnosis is very important to initiate necessary treatment and reduce morbidity and mortality (9). Urinary reagent strips have been used previously as a rapid diagnostic test in diagnosis of meningitis. However, there have been variations in correlation between standard biochemical methods and outcome of urinary reagent method and also there are no well-defined cut-off values defines for urinary reagent strip method to establish diagnosis of meningitis (10).

Several studies were carried out on the role of urinary reagent strips with different outcomes. A study done by Akram D and Shaikkh AM for the rapid evaluation of cerebrospinal fluid analysis in remote areas by use of glucometer works as cost-effective tool and rapid results (11). Omar M et al., have proposed the use of the urinary strip reagent in evaluation of synovial fluid for septic arthritis for leucocytes and glucose. It has got high sensitivity and specificity which can be utilised for diagnosing septic arthritis (12). A similar study was done by Koulaouzidis A for the diagnosis of bacterial peritonitis using the leucocyte esterase strips (13). Joshi D et al., showed that urinary reagent strips can reliably predict raised CSF protein (>100 mg/dL), decreased glucose (<40 mg/dL), and increased neutrophil count (>10/mm3). These strips can therefore be relied upon to make a rapid diagnosis of meningitis and initiate appropriate treatment, particularly in areas with limited resources (14).

The present study intends to evaluate the usefulness of urinary strip method and correlate its values with the standard biochemical test. An attempt has also been made to define cut-off values which will have high specificity for diagnosing meningitis. This method will help clinicians to quickly arrive at a diagnosis and initiate timely intervention.

Study Objectives:

• To evaluate the role of urinary strip reagent method in the analysis of CSF to assist clinicians in bedside diagnosis or exclusion of meningitis.
• To compare the values obtained by rapid method with that of results obtained by automated analyser.

Material and Methods

A cross-sectional study was carried out in 30 CSF samples over a period of two months in 2019 (15th August-15th October). CSF samples from patients of any age group who had an indication for lumbar puncture like fever, headache, intractable vomiting, altered sensorium, neurological deficit, irritability, behavioural changes, seizures and meningeal signs like neck stiffness, Kernig’s sign, Brudzinski’s sign were included. The samples were received within one hour of tap from lumbar puncture. The study did not involve any additional risk to the participants as samples collected for routine diagnosis were used for the present study. No additional invasive procedure was therefore required to collect samples. The study proposal was submitted to Institutional Ethics Committee (IEC) and approval was obtained.

Inclusion criteria:

1. CSF samples received within one hour of lumbar puncture tap.
2. Sample volume ≥0.5 mL

Exclusion criteria:

1. Haemorrhagic taps
2. Samples received after one hour of tap
3. Inadequate samples <0.5 mL

Index Test

Followed by the dirui urinary reagent strips which can detect parameters like protein, glucose and leucocyte esterase activity in the urine were utilised for this test. This was done by an independent blind investigator. The test was performed by adding few drops of undiluted CSF fluid to the respective patches on the urinary reagent and colour change will be noted. The colour change was then matched with colour coding provided by the manufacturer and the results were recorded and interpreted as in (Table/Fig 1).

Depending on the colour changes, leucocytes are graded as per the values provided by the dirui company. The reagent strip-based colour changes observation for protein as per the values provided by the dirui company (Table/Fig 2).

The normal level of CSF glucose is 2/3rd of the plasma level. Very low levels of glucose are seen in bacterial meningitis. Using the determined strip, if the values were above or below 50 mg/dL with the interpretation being no change in colour as <50 mg/dL and any change in colour as >50 mg/dL (Table/Fig 3).

The reagent strip-based colour changes observation for glucose as per the values provided by the dirui company.

Definitive Test

Total leucocyte count was carried out by Neubauer’s counting chamber, by charging with undiluted CSF sample, which is followed by differential count done from the smears prepared from centrifuged sediment smear stained with May-Grunwald-Giemsa (MGG) stain. The results were recorded and interpreted.

The CSF samples were processed and analysed in abott automated analyser for protein and glucose. The results are recorded and interpreted. The standard reference values of Neubauer’s chamber and abott automated ranges from 0-5 cells/cumm and Protein-15-45 mg/dL; Glucose-45-80 mg/dL respectively.

Statistical Analysis

The accuracy of the reagent strip was estimated using standard statistical tests and tabulated in the form of sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) and Positive and Negative Likelihood Ratios (PLR and NLR). Statistical Package for the Social Science (SPSS) version 22.0 and Microsoft Excel were used to analyse data and generate tables.

Results

The study was conducted on 30 CSF samples. Majority of the samples received were from patients in the age group of 30-60 years. Males and females represented 20 (66.67%) and 10 (33.33%) of samples respectively.

Three parameters were studied for analysis of CSF i.e., glucose, proteins, and leucocytes using the urinary strip. The values were correlated with reference standard values, i.e., for cell count-Neubauer’s chamber; protein and glucose-Abott automated instrument. In the present study, dirui urinary strips used for the analysis of cerebrospinal fluid. The strip had a moderate sensitivity and specificity for leucocytes ≥15 cells/cumm. With respect to proteins, the results are acceptable for a higher cut-off level of ≥100 mg/dL (Table/Fig 4).

Leucocytes: Leucocytes were detected by the esterase activity. The sensitivity and specificity for leucocytes by the strip method for >15 cells/cumm showed moderate sensitivity and specificity of 78.57% and 68.75%, respectively. The PPV, NPV, PLR, NLR and accuracy showed to be 68.75%, 78.57%, 2.43%, 0.32% and 86.67%, respectively.

Proteins: The reagent strip had a sensitivity and specificity of 41.67% and 88.89%, respectively. This shows sensitivity towards proteins is very low compared to specificity. The PPV, NPV, PLR, NLR and accuracy showed to be 71.43%, 69.57%, 3.41%, 0.67% and 93.34%, respectively.

Glucose: Glucose was detected in CSF by glucose oxidase- peroxidase method. The reagent strip test for glucose had a sensitivity and specificity of 50.00% and 92.31%, respectively. This study for glucose also showed low sensitivity and high specificity. The PPV, NPV, PLR, NLR and accuracy showed to be 50.00%, 92.31%, 2.75%, 0.76% and 83.33%, respectively.

Discussion

Meningitis is an emergency medical condition which has a high mortality rate. In order to prevent the postneurological consequences, antibiotics have to be started within three hours. Cerebrospinal fluid analysis has to be done within one hour of tap and it should not be refrigerated and delayed as it causes autolysis of the leucocytes and gives a false negative result. More recently, liberal use of antibiotics has led to emergence of the resistant strains that cause meningitis.

Abdelmotaleb GS et al., showed leucocyte sensitivity and specificity at cut-off >10 cells as 100% and 75% respectively (15). Gupta A and Dwivedi T by use of cut-off ≥10 cells/cumm and confidence interval of 95% for leucocytes, the sensitivity and specificity as 100% and 96.3%, respectively (16). Bhat A et al., showed sensitivity and specificity by use of strip test as 36.36% and 85.71% respectively by using cut-off >10 cells/cumm (10). Rajkumar D et al., with the use of confidence interval of 95% showed that the sensitivity and specificity of leucocytes as 90% and 91.67%, respectively for diagnosis of meningitis (17). Sharma D and Uradiya I study group showed that leucocyte sensitivity and specificity at as 94% and 98.5%, respectively at a cut-off >10 cells (18). This study also showed almost same results for leucocytes as Bhat A et al., with sensitivity and specificity being 78.57% and 68.75%, respectively (10). This study is in contrast with these studies (Table/Fig 5) (8),(10),(15),(16),(17),(18).

Abdelmotaleb GS et al., showed protein reagent strip sensitivity and specificity as 100% and 50% respectively at a cut-off 100 mg/dL (15). Gupta A and Dwivedi T showed sensitivity of 98.9% and low specificity of 54.2% with confidence interval of 95% (16). Bhat A et al., showed sensitivity of 100% and very low specificity of 28.57% with the use of cut-off >30 mg/dL (10). Rajkumar D et al., showed a sensitivity and specificity for protein with confidence interval of 95% as 93.20% and 91.49%, respectively (17). Sharma D and Uradiya I study showed protein reagent strip sensitivity and specificity as 100% and 50%, respectively and with accuracy of 99% (18). The present study showed sensitivity of 41.67% which is in contrast to other studies and specificity of 88.89% which is similar to that of other studies.

Abdelmotaleb GS et al., showed glucose reagent strip sensitivity and specificity as 96.8% and 100% at cut-off 46 mg/dL (15). Gupta A and Dwivedi T showed with the use of confidence interval of 95%, sensitivity and specificity as 98.1% and 92.3%, respectively (16). Sharma D and Uradiya I Glucose reagent strip sensitivity and specificity as 98.5% and 100% at cut-off 50 mg/dL and with accuracy of 99% (19). Rajkumar D et al., showed sensitivity and specificity of 90.00% and 91.67%, respectively with confidence interval of 95% (17). The present study showed very low sensitivity for glucose which is in contrast to other studies but specificity of 92.31% which is similar to other studies.

Sharma D and Uradiya I showed the accuracy for leucocytes, protein and glucose as 97%, 99% and 99%, respectively (18). Rajkumar D et al., showed that the accuracy for the leucocytes, protein and glucose as 90.67%, 92.675 and 90.67%, respectively (17). The present study showed accuracy for leucocytes, protein and glucose as slight similar to that of other studies as 86.67%, 93.34% and 83.33%, respectively. Abdelmotaleb GS et al., mention that use of this urinary strip reagent in diagnosis of meningitis is a qualitative or semi-quantitative method. It does not give an accurate result and it should not be taken as final test result, the result obtained can be used to make a decision, whether to start antibiotics immediately or not (15).

In the present study, the leucocytes sensitivity and specificity by strip method were 78.57% and 68.75%, respectively. The reagent strip is highly specific for glucose and protein (92.31%, 94.12%, respectively) but is less sensitive (50.00%, 53.85%, respectively). The reagent strip is moderately specific and sensitive for leucocytes. The strips are highly specific for the estimation of glucose and protein and moderately specific for leucocytes estimation, but they are low sensitive for estimation of glucose and protein but moderately sensitive for leucocytes estimation.

The protein and glucose tests by urinary strip were found to be reliable and can be used as screening test for the diagnosis. It also helps the clinician suspecting meningitis in remote areas to decide whether to administer antibiotics or not. The leucocytes test by urinary strip test, showed to be less helpful in the diagnosis, as it had showed more false positive results compared to the values obtained through the Neubauer’s chamber. This method, therefore, cannot be used as a substitute to standard automated analysers and Neubauer’s chamber. The results obtained in the present study did not fully correspond to the standard method.

Limitation(s)

The major drawback of the present study is the small sample size compared to other studies. The present study results may have differed because of the use of different method of urinary strips, that might have affected sensitivity and specificity. Standardising this method by using a particular type/make of strips, may help in validating this method.

Conclusion

Based on the results of these studies, it was concluded that urinary strip reagent can be utilised for analysis of cerebrospinal fluid as it has got reliable sensitivity and specificity. Though, the present study results did not fully correlate with other studies, this method may still be utilised as a tool in remote areas where automated analysers are unavailable to guide in clinical decision making.

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DOI and Others

DOI: 10.7860/JCDR/2022/53751.16407

Date of Submission: Jan 06, 2022
Date of Peer Review: Feb 04, 2022
Date of Acceptance: Mar 25, 2022
Date of Publishing: May 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 07, 2022
• Manual Googling: Mar 09, 2022
• iThenticate Software: Mar 19, 2022 (9%)

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