The predictive value of urine dipstick glucose test in the Screening for gestational diabetes mellitus in a tertiary private hospital in Kenya

Background: Worldwide, there is no consensus on the best approach to diagnose gestational diabetes mellitus (GDM) and though oral glucose tolerance testing (OGTT) is considered the gold standard, practices in the administration and interpretation of the test differ depending on the guidelines in use. Previous studies have questioned the utility of glycosuria as a screening test for GDM. Since the studies were conducted, there have been diagnostic threshold changes that might impact its utility. Justification: Diagnostic cut-offs of OGTT used in GDM diagnosis have evolved over time necessitating re-evaluation of glycosuria. The study was aimed at re-assessing the utility of glycosuria during pregnancy in the local population, where OGTT is not widely available, following adoption of the new diagnostic cut-offs. Objectives To determine the predictive value of any glycosuria as a screening test for GDM diagnosed by International Association of Diabetes Pregnancy Study Groups (IADPSG) and other criteria. To compare the predictive values of glycosuria of varying levels and to determine the association of any glycosuria with risk factors for GDM. Methods: Retrospective cohort study of consecutively sampled obstetric patients who had OGTT and urine dipstick done from 2013-2018. Positive and negative predictive values, sensitivity and specificity of glycosuria were calculated. Binary logistic regression was done to determine the association of glycosuria with the risk factors for GDM. Results: Positive and negative predictive values, sensitivity and specificity of any glycosuria were 23.64%, 91.04%, 5.65% and 98.13% respectively when IADPSG criteria were applied. This was better performance than when other criteria were applied and it improved further with increasing severity of glycosuria. Glycosuria was associated with BMI, previous GDM and a family history of diabetes. Conclusion: Despite the improved predictive value of glycosuria, it is still an unreliable screening test. OGTT should thus be made available to all pregnant wome

Prognosticating COVID-19: A need for Africa-specific laboratory predictors

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Researching COVID to Enhance Recovery (RECOVER) adult study protocol: Rationale, objectives, and design.

IMPORTANCE: SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or other health effects after the acute phase of infection; termed post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are ill-defined. The objectives of the Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC in Adults (RECOVER-Adult) are to: (1) characterize PASC prevalence; (2) characterize the symptoms, organ dysfunction, natural history, and distinct phenotypes of PASC; (3) identify demographic, social and clinical risk factors for PASC onset and recovery; and (4) define the biological mechanisms underlying PASC pathogenesis. METHODS: RECOVER-Adult is a combined prospective/retrospective cohort currently planned to enroll 14,880 adults aged ≥18 years. Eligible participants either must meet WHO criteria for suspected, probable, or confirmed infection; or must have evidence of no prior infection. Recruitment occurs at 86 sites in 33 U.S. states, Washington, DC and Puerto Rico, via facility- and community-based outreach. Participants complete quarterly questionnaires about symptoms, social determinants, vaccination status, and interim SARS-CoV-2 infections. In addition, participants contribute biospecimens and undergo physical and laboratory examinations at approximately 0, 90 and 180 days from infection or negative test date, and yearly thereafter. Some participants undergo additional testing based on specific criteria or random sampling. Patient representatives provide input on all study processes. The primary study outcome is onset of PASC, measured by signs and symptoms. A paradigm for identifying PASC cases will be defined and updated using supervised and unsupervised learning approaches with cross-validation. Logistic regression and proportional hazards regression will be conducted to investigate associations between risk factors, onset, and resolution of PASC symptoms. DISCUSSION: RECOVER-Adult is the first national, prospective, longitudinal cohort of PASC among US adults. Results of this study are intended to inform public health, spur clinical trials, and expand treatment options. REGISTRATION: NCT05172024

Researching COVID to Enhance Recovery (RECOVER) adult study protocol: Rationale, objectives, and design.

ImportanceSARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or other health effects after the acute phase of infection; termed post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are ill-defined. The objectives of the Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC in Adults (RECOVER-Adult) are to: (1) characterize PASC prevalence; (2) characterize the symptoms, organ dysfunction, natural history, and distinct phenotypes of PASC; (3) identify demographic, social and clinical risk factors for PASC onset and recovery; and (4) define the biological mechanisms underlying PASC pathogenesis.MethodsRECOVER-Adult is a combined prospective/retrospective cohort currently planned to enroll 14,880 adults aged ≥18 years. Eligible participants either must meet WHO criteria for suspected, probable, or confirmed infection; or must have evidence of no prior infection. Recruitment occurs at 86 sites in 33 U.S. states, Washington, DC and Puerto Rico, via facility- and community-based outreach. Participants complete quarterly questionnaires about symptoms, social determinants, vaccination status, and interim SARS-CoV-2 infections. In addition, participants contribute biospecimens and undergo physical and laboratory examinations at approximately 0, 90 and 180 days from infection or negative test date, and yearly thereafter. Some participants undergo additional testing based on specific criteria or random sampling. Patient representatives provide input on all study processes. The primary study outcome is onset of PASC, measured by signs and symptoms. A paradigm for identifying PASC cases will be defined and updated using supervised and unsupervised learning approaches with cross-validation. Logistic regression and proportional hazards regression will be conducted to investigate associations between risk factors, onset, and resolution of PASC symptoms.DiscussionRECOVER-Adult is the first national, prospective, longitudinal cohort of PASC among US adults. Results of this study are intended to inform public health, spur clinical trials, and expand treatment options.RegistrationNCT05172024