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      Urine foaming test, a promising diagnostic test for COVID-19 infection

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      Northern Clinics of Istanbul
      Kare Publishing

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          Abstract

          To the Editor, We read with interest the article published by Kurtulmus et al. [1] titled: The urine foaming test in COVID-19 as a useful tool in diagnosis, prognosis, and follow-up: Preliminary results discussing a point of care, easily done urine test to detect COVID-19 infection. We applaud the researchers’ effort in presenting a low-cost test at a time when the world is in the edge of global recession because of the COVID-19 pandemic where such tests are highly needed by the financially challenged health-care systems globally. The researchers depended on a physical character of the urine, namely, foam formation that can instantly be quantified visually which would identify COVID-19-specific metabolites and metabolic degradation products as a result of reacting with a newly developed reagent for this purpose. Foam formation in this study ought to be interpreted with caution since several factors can contribute to foam formation and can simply be overlooked in such studies. First, concentrated urine which is expected in subjects who have recent viral illness resulting in poor oral intake can lead to foam formation. This is a consequence of an increase in the concentrations of the normally present amphipathic substances responsible for foam formation in the urine resulting from dehydration following poor oral intake [2]. Second, alkaline urine for any reason can interfere with foam formation by decreasing surface tension and give a falsely negative results [3]. Third, the authors excluded subjects with diabetes mellitus and nephrotic disorders but nevertheless, subjects with low-grade proteinuria can still form a foamy urine which could have affected result interpretation. Finally, we acknowledge that the study by Kurtulmus et al. [1] remains to be important and time sensitive. We do advise considering our critique in their future multicenter observational study as they suggested.

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          Foamy Urine

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            Surface tension, proteinuria, and the urine bubbles of Hippocrates

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              The urine foaming test in COVID-19 as a useful tool in diagnosis, prognosis and follow-up: Preliminary results

              OBJECTIVE: We aimed to develop a simple, rapid urine test based on the level of foaming that occurs in the urine sample due to the excretion of peptide structures containing amino acids specific to the antigenic structure of COVID-19. In this study, we present the preliminary results of the first clinical study with a newly developed urine foaming test (UFT). METHODS: This study was conducted in a tertiary hospital in Istanbul. After obtaining the approval of the ethics committee, urine samples were taken from three groups of patients whose informed consent was obtained. The groups were created according to the COVID-19 Diagnostic Guide of Ministry of Health: A: outpatients with suspected COVID-19, B: inpatients for follow-up and treatment, C: patients treated in intensive care unit (ICU). Also, 30 healthy volunteers were included as the control group D. Urine samples taken from all groups were delivered to the laboratory. 2.5 ml urine sample was added to the test tube and shaken for 15 seconds and the level of foam formed was visually evaluated according to the color scale. Other data of the patients were obtained from the hospital information management system and the physician caring for the patient. The clinical status, PCR test results, computed tomography (CT), if any, laboratory tests, and UFT results were compared and the level of statistical significance was expressed as p≤0.05 in the 95% confidence intervals (CI). Performance characteristics, such as sensitivity, specificity, positive and negative predictive value of the UFT, were statistically calculated according to the RT-PCR result and/or CT. RESULTS: A statistically significant difference was observed between UFT distributions of the control, outpatient, inpatient and ICU patients (p=0.0001). The results of UFT orange and red in inpatients and ICU patients were statistically significantly higher than in the control and outpatient groups. The diagnostic accuracy of UFT was detected in all group, the pooled sensitivity was 92% (95% CI: 87–95%) and specificity was 89% (95% CI: 80–98%). CONCLUSION: Our preliminary results suggest that the UFT is useful, particularly in predicting the clinical severity of COVID-19. The UFT could be recommended as a point of care test, rapid and non-invasive method in the diagnosis and follow-up of COVID-19.
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                Author and article information

                Journal
                North Clin Istanb
                North Clin Istanb
                Northern Clinics of Istanbul
                Kare Publishing (Turkey )
                2148-4902
                2536-4553
                2021
                02 March 2021
                : 8
                : 2
                : 199
                Affiliations
                [1]Department of Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
                Author notes
                Correspondence: Zeid J KHITAN, MD. 1690 Medical Center Drive, Huntington, WV, 25701, USA. Tel: +001-304-691-1092 e-mail: zkhitan@ 123456marshall.edu
                Article
                NCI-8-199a
                10.14744/nci.2021.13845
                8039105
                91143995-c948-4e20-8a88-25d4b86839e7
                Copyright: © 2021 by Istanbul Northern Anatolian Association of Public Hospitals

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

                History
                : 14 December 2020
                : 14 January 2021
                Categories
                Letters to the Editor

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