***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIM To compare urinary gram staining and dipstick for the detection of urinary tract infection (UTI)in  febrile infants . METHODS Prospect i ve study of 175 febrile infants aged 124 months . In all infants , a urine specimen was analyzed to detect UTI . The dipstick test was used to detect leukocytes and nitrites and sample s were taken for gram staining and urine culture . Urine was obtained by urethral catheterization . Positive urine results were defined as 50.000 colony forming units per millimeter of urinary tract pathogen . RESULTS The mean age was 9.8 months ( SD : 6.64 ) .  Urine culture was positive in 87 patients ( 49.5 % ) . Diagnosis of UTI was confirmed in 91 patients ( 51.9 % ) , of whom 74 were admitted for clinical ly suspected pyelonephritis ( 81.3 % ) . Gram stain had the highest specificity ( 98.9 % ) and pyuria the highest sensitivity ( 90.8 % ) . Better results were obtained using the combination of dipstick and Gram stain with a sensitivity of 93.1 % , specificity of 98.4 % , positive predictive value of 98.5 % and negative predictive value of 92.5 % . CONCLUSIONS Urinary Gram stain appears to be more reliable than dipstick in detecting UTI in febrile infants but the results of both tests should be interpreted together Objective . To determine the validity of the Uriscreen , a rapid diagnostic test based on the detection of urine catalase for the early detection of urinary tract infection ( UTI ) in children , compared with st and ard urinalysis and dipstick tests . Study Design . Cross-sectional study . Study Population . Children 1 month to 17 years of age who presented to the emergency department of a pediatric tertiary care center between March and November of 1996 with symptoms suggestive of UTI . Methods . Urine specimens obtained from a r and om sample of 121 patients were evaluated simultaneously for possible UTI by Uriscreen ( catalase test ) , urinalysis ( microscopic pyuria ) , dipstick ( leukocyte esterase and nitrite ) , and quantitative urine culture . All specimens were collected by one of three sterile techniques ( midstream void technique , bladder catheterization , or suprapubic aspiration ) , as appropriate for age , and tested immediately . Using the quantitative urine culture as the gold st and ard ( reference test ) , the sensitivity , specificity , and positive and negative predictive values of all the screening tests were determined and compared . Age , sex , temperature , presenting symptoms , and method of urine collection were recorded for each participant . Results . Of the 121 patients , 35 ( 28.9 % ) had positive culture results : 30 girls ( 85.7 % ) and 5 boys ( 14.3 % ) . Compared with urinalysis and dipstick tests , Uriscreen had the highest sensitivity ( 100 % vs 88.6 % and 97.1 % , respectively ) and the highest negative predictive value ( 100 % vs 95 % and 98.6 % , respectively ) , but the poorest specificity ( 68.6 % vs 88.4 % and 82.5 % , respectively ) and positive predictive value ( 56.4 % vs 75.6 % and 69.4 % , respectively ) . Conclusions . The clinical use of Uriscreen for the presumptive diagnosis of UTI in children is limited and not significantly superior to urinalysis or the dipstick test . However , because of its 100 % sensitivity and negative predictive value and its ease of use , rapidity , and low cost , it is recommended highly for ruling out the diagnosis of UTI . In laboratories , a negative Uriscreen result may prevent the need for performing expensive urine cultures A study was performed to evaluate the extent to which the medical literature may be misleading as a result of selective publication of r and omized clinical trials ( RCTs ) with results showing a statistically significant treatment effect . Three hundred eighteen authors of published trials were asked whether they had participated in any unpublished RCTs .  The 156 respondents reported 271 unpublished and 1041 published trials . Of the 178 completed unpublished RCTs with a trend specified , 26 ( 14 % ) favored the new therapy compared to 423 of 767 ( 55 % ) published reports ( p less than 0.001 ) . For trials that were completed but not published , the major reasons for nonpublication were " negative " results and lack of interest . From the data provided , it appears that nonpublication was primarily a result of failure to write up and su bmi t the trial results rather than rejection of su bmi tted manuscripts . The results of this study imply the existence of a publication bias of importance both to meta- analysis and the interpretation of statistically significant positive trials Objectives . To determine the association of clear urine by visual inspection with the absence of significant bacteruria , and to compare it with st and ard urinalysis . Methods . The study was performed in the emergency department of Children 's Hospital Medical Center , Cincinnati , Ohio . It was a prospect i ve , convenience sample of children < 21 years of age who had catheterized or midstream clean-catch urine specimen collected for culture . Clinical findings including the presence or absence of fever , abdominal pain , dysuria , frequency , and urgency were collected for each patient . Urine was visually assessed for clarity by 2 independent observers using a st and ardized technique . St and ard laboratory urinalysis and microscopy were also performed on all specimens . A positive urine culture was defined as ≥104 colony-forming unit (CFU)/mL of a urinary pathogen if obtained by catheterization and ≥105 CFU/mL if obtained by midstream . Results . Sample s were obtained from 159 patients ranging in age from 4 weeks to 19 years . Females comprised 77 % of the patients . One hundred ten of the sample s ( 69 % ) were clear to visual inspection . There were a total of 29 positive cultures ; however , 3 were in children with clear urine . The finding of clear urine on visual inspection had a negative predictive value of 97.3 % . These results were similar to those obtained with st and ard urinalysis . Conclusion . Clear urine on visual inspection can not completely eliminate the possibility that a child has a urinary tract infection . However , it is a reproducible test that offers the advantages of being simple , fast , and inexpensive . The finding of clear urine should be considered a reasonable and relatively effective bedside screen for the presence of a urinary tract infection Children presenting with symptoms attributable to urinary tract infection ( UTI ) are not uncommonly referred to paediatric departments for assessment . The aim of this study was to evaluate the use of rapid dipstick tests  in the diagnosis of urinary tract infection in children . Urine was collected from 375 children admitted to a general paediatric ward , in whom UTI was a possibility on clinical grounds . Of these , 124 were less than one year old . Urine was tested with a dipstick for the presence of nitrite and leucocyte esterase .  Bacterial culture and examination for white cells , red cells and other formed elements were performed . The results of the dipstick tests , microscopy and culture were correlated with the clinical details . Combination of a negative dipstick test for nitrite and leucocyte esterase showed a negative predictive value for UTI of 96.9 % and a specificity of 98.7 % . In children less than a year old these values were 96.7 % and 99.2 % respectively . The  leucocyte esterase strip  test showed a negative predictive value for pyuria of 94.3 % with a specificity of 86.9 % . In children less than a year old these values were 93.1 % and 84.4 % respectively . The use of  dipsticks  for the detection of urinary nitrate and leucocyte esterase in daily clinical practice is recommended . In children , the absence of both nitrite and leucocyte esterase in urine indicates that UTI is unlikely ; however , positive dipstick tests for nitrite and /or leucocyte esterase are not specific indicators of UTI , and should not be used in place of laboratory examination . The  dipstick method is most likely to be useful as a screening test to exclude UTI in children , but may be less suitable for infants . It should not be used to diagnose urinary tract infection OBJECTIVE To assess the usefulness of laboratory parameters , including peripheral white blood cell ( WBC ) count , C-reactive protein ( CRP ) concentration , erythrocyte sedimentation rate ( ESR ) , and microscopic urinalysis ( UA ) , for identifying febrile infants younger than 8 weeks of age at risk for urinary tract infection ( UTI ) , and comparison of st and ard UA and hemocytometer WBC counts for predicting the presence of UTI . METHODS A total of 162 febrile children < 8 weeks of age were enrolled in this prospect i ve study . All underwent clinical evaluation and laboratory investigation , including WBC count and differential ; ESR ; CRP ; blood culture ; a lumbar puncture for cell count and differential , glucose level , protein level , Gram stain , and culture ; and a UA and urine culture . All urine specimens were obtained by suprapubic aspiration and microscopically analyzed with st and ard UA as well as with hemocytometer WBC counts . Quantitative urine cultures were performed . Sensitivity , specificity , accuracy , likelihood ratios , and receiver operating characteristic ( ROC ) curves were determined for each of the screening tests . RESULTS There were 22 positive urine culture results of at least 100 colony-forming unit/mL. Eighteen of these 22 patients were males , and all were uncircumcised . There were significant differences for pyuria > /=5 WBCs/hpf , pyuria > /=10 WBC/microL , CRP > 20 mg/L , and ESR > 30 mm/hour between culture-positive and culture-negative groups ( P < .05 ) . The ROC area for hemocytometer WBC count , st and ard UA , peripheral WBC count , ESR , and CRP concentration were.909 + /-.045,.791 + /-.065,.544 + /-.074 , . 787 + /-.060 , and .822 + /-.036 , respectively . The ROC curve analysis indicates that the CRP , ESR , and st and ard UA were powerful but imperfect tools with which to discriminate for UTI in potentially infected neonates . Hemocytometer WBC counts had the highest sensitivity , specificity , accuracy , and likelihood ratios for identifying very young infants with positive urine culture results . For all assessment s , hemocytometer WBC counts were significantly different , compared with the st and ard urinalysis . ESR , CRP , and peripheral WBC counts were not helpful in identifying UTI in febrile infants . CONCLUSION UTI had a prevalence of 13.6 % in febrile infants < 8 weeks of age . The CRP , ESR , and st and ard UA were imperfect tools in discriminating for UTI , and the sensitivity of these laboratory parameters was relatively low .  Hemocytometer WBC count  was a significantly better predictor of UTI in febrile infants OBJECTIVE To determine if culture specimens of urine collected in perineal bags is reliable in detecting  urinary tract infections in infants . MATERIAL AND METHODS A prospect i ve study was carried out in a pediatric emergency room of an urban teaching hospital . Forty-eight infants , 12 months old or less , requiring an uncontaminated urine specimen due to the evaluation of febrile illness , suspected urinary tract infection or to a previously contaminated urine culture specimen . Two consecutive urine specimens were collected for culture . A urine specimen was collected in a perineal bag and afterwards all patients underwent suprapubic bladder aspiration . Cultures were considered positive if pure growth of more than 1.000 colonies/ml developed in the suprapubic aspiration urine specimen . RESULTS Thirty-two infants had coincident cultures in both urine specimens . A positive culture specimen of urine collected in a perineal bag ( pure growth of more than 100,000 colonies/ml ) had high sensitivity ( 100 % ) and high specificity 88.6 % in predicting positive cultures from urine obtained by suprapubic aspiration . CONCLUSION A urine culture specimen meticulously collected with a perineal bag is a good screening method for detecting urinary tract infection in low risk infants Background To avoid potential contamination , it is recommended that the first few drops of urine be discarded when obtaining a catheterized urine sample from a child being evaluated for a urinary tract infection ( UTI ) . The existing evidence to make such a recommendation is scant . Our goal , therefore , was to determine whether the urinalysis , Gram stain , and culture results were significantly different from the initial and later urine sample s collected from catheterized children . Methods A prospect i ve diagnostic discrimination between early and later urine sample s was conducted on a convenience sample of pediatric patients being evaluated for a UTI in an urban emergency department . Results of the urinalysis , Gram stain , and quantitative culture were compared between the early and later stream urine sample s. Results Data from 86 children were analyzed . Four of 80 patients had a false identification of low colony count bacteruria from the early but not from the later stream . For patients with negative cultures , the early stream was also more likely to falsely identify ≥ 5 wbc/hpf ( P < 0.01 ) or bacteruria ( P < 0.05 ) on urinalysis than the later stream . Conclusions There is a small but potentially meaningful contamination of the early stream 
    Output:
    
A test for glucose showed promise in potty-trained children .
Conclusion Dipstick negative for both LE and nitrite or microscopic analysis negative for both pyuria and bacteriuria of a clean voided urine , bag , or nappy/pad specimen may reasonably be used to rule out UTI .
These patients can then reasonably be excluded from further investigation , without the need for confirmatory culture .