Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
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Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
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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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

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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

Important Notice

Original article / research
Year : 2012 | Month : May | Volume : 6 | Issue : 4 | Page : 671 - 673

Reagent Strip Testing (RST) For Asymptomatic Bacteriuria (ASB) in Pregnant Women: A Cost-effective Screening Tool in Under-resourced Settings

Balamurugan S, Chaitanya Shah, Jayapriya S., Priyadarshini S., Jeya M., Ramesh Rao K.

1. Professor of Pathology 2. Final Year Medical Student 3. Assistant Professor of Microbiology 4. Associate Professor of Microbiology 5. HOD Microbiology 6. HOD Pathology NAME OF DEPARTMENT (S)/INSTITUTION(S) TO WHICH THE WORK IS ATTRI BUTED: Chettinad Medical College & Research Institute, Padur, Kancheepuram, India - 603103.

Correspondence Address :
Balamurugan S.
3 D KG Traditions
1 North Gopalapuram First Street, Chennai, India - 600086
Phone: 09444443996
E-mail: kayalb75@yahoo.co.in

Abstract

Context: Bacteriuria in asymptomatic pregnant women, when it is not detected and treated, may lead to a number of maternal and foetal complications. Culture, though it is a gold standard test for the diagnosis of bacteriuria, it is time consuming and expensive and it is not available at all the healthcare settings. A pre-screen with a simple, rapid and less expensive near patient testing by using reagent strips (RST) can minimise the requirement of the culture, especially in antenatal women without urinary symptoms.

Aims: This study evaluated the performance characteristics of Reagent Strip Testing (RST) as compared to bacteriologic culture in detecting bacteriuria.

Settings and Design: A prospective, blinded study.

Methods and Material: Urine samples from 100 consecutive women without urinary symptoms, who attended routine antenatal clinics were subjected to Reagent Strip Testing (RST) (by using four infection associated markers - leukocyte esterase, nitrites, blood and protein) and Bacteriologic Culture.

Statistical Analysis Used: The performance characteristics of Reagent Strip Testing were evaluated against the gold standard urine culture. Different markers singly, or in combination, were assessed to find out the best test strategy for the Reagent Strip Positivity.

Results: The prevalence of ASB in pregnant women, as was determined by culture, was 13%. Reagent Strip Testing (RST) for bacteriuria by using a single marker leucocyte esterase or nitrites yielded a sensitivity of 85% and 62%, which increased to 100%, with a negative predictive value of 1, if the criterion was broadened to positivity with one or more of four infection associated markers. This seemed to be a good rule out test strategy that could reduce the number of urine samples which were sent for culture. Thus, an algorithm of pre-screening the urine samples for infection with reagent strips by using four infection associated markers and performing the culture only on dipstick positive cases could prove to be cost effective in averting the complications which were associated with ASB.

Conclusions: Urinary dipstick testing in a near patient setting is a valuable resource to screen out the negative urine specimens at the point of care. If properly implemented, this programme can result in an improved use of the laboratory resources and it can aid the clinicians in instant clinical decision making.

Keywords

Reagent Strip Testing (RST), Asymptomatic Bacteriuria, Antenatal, India

Introduction
Infections of the urinary tract are common problems in pregnancy that are associated with serious maternal and perinatal morbidity. They may be symptomatic or asymptomatic. Untreated asymptomatic bacteriuria (ASB) leads to the development of pyelonephritis, intrauterine growth retardation and pre term birth and low-birth-weight infants. The prevalence of asymptomatic bacteriuria among pregnant women, as has been quoted in the western literature, varies from 2 to 10%. Fewer studies on this topic are available on the Indian scenario and the reported prevalence rate is as high as 8% [1,2]. The relatively high prevalence of asymptomatic bacteriuria during pregnancy and its significant consequences on women and on their pregnancies, plus the ability to avoid the sequelae with treatment, justify the screening of pregnant women for bacteriuria (1). The debate lies on the manner of the screening. The gold standard for the detection of bacteriuria is urine culture. However, the full bacteriological analysis is both time-consuming and expensive and a vast majority of the antenatal urine specimens will be negative O riginal Articleto the culture. Thus, a number of other screening methods have been proposed. These procedures are predicated on the concept that the pre-screening of the urine specimens for significant bacteriuria may reduce the need for culture of the non significant samples, increase the cost effectiveness of the culture and assist in immediate patient management. Dipstick urine analysis or Reagent Strip Testing (RST) is a simple and rapid test that can be done at the bedside of the patients and if it is effective, it can minimize the number of samples which are sent for urine culture and make the patient care better [3, 4].

We screened pregnant women who attended the antenatal clinic at our hospital for asymptomatic bacteriuria with dipstick and compared the results with urine culture. Leukocyte esterase and nitrites have been extensively studied for the screening of urinary infections. We included four infection associated markers (leukocyte esterase, nitrites, blood and protein) and assessed whether these could improve the diagnostic performance of the reagent strip testing. In India, there is insufficient local data on the prevalence of ASB and very few studies have been done on RST for bacteriuriaamong pregnant women. This prompted us to do this study so that a cost-effective screening of ASB could be done.

Material and Methods

In this prospective blinded study, clean catch midstream urine samples from 100 consecutive pregnant women who attended the routine antenatal check up were collected after taking their informed consent. Institutional Ethics Clearance was also obtained prior to the start of the study. The mean age of the patients who were studied was 24 years (range: 19- 33 years). Of the 100, 15 presented during the Ist trimester, 45 during the IInd trimester and 40 during the IIIrd trimester. The patients were excluded if they had urinary symptoms or if they had used antibiotics during the preceding two weeks.

All the urine samples were subjected to RST and bacteriologic culture. RST was done at the point of care with a Bayer’s 10 parameters urine reagent strip (which included the four infection related markers- leucocyte esterase, nitrites, protein and blood). The samples were collected in a sterile container and they were taken to the Microbiology Laboratory within 1 hour. If there was a delay of more than 1 hour, the specimens were stored in a refrigerator for not more than 4 hours. The specimens were cultured in blood agar and MacConkey’s agar by using the standard loop technique. The criterion for clinically significant bacteriuria was either a pure or predominant culture of > 105 colony forming units (CFU)/ml, two organisms in similar proportions at > 105 CFU/ml, or 104–105 CFU/ml (1) of a gram negative organism or two organisms where the gram negative organism clearly predominated. All the specimens were also examined microscopically for pyuria and bacteriuria (1). Microscopy was considered as positive if the results had > 5 pus cells/hpf or >20 bacteria/hpf in the spun samples. Culture was used as a reference method for determining the performance of the urine microscopy and the dipstick data. The performance characteristics of the reagent strips were calculated for the two specific markers, leucocyte esterase and nitrites individually and also for different combinations of the four infection associated markers, in order to find out whether the marker combinations improved the diagnostic efficiency. The sensitivity, specificity, positive predictive value, negative predictive value, the positive likelihood ratio and the negative likelihood ratio were calculated by using the Med Calc statistical software [Tables/Fig-1 & 2].

Results

The prevalence of ASB in the present study was 13% (13/100) as was determined by the quantitative culture by using the criteria which was stipulated by Patel et al. The most common organism which was isolated was E.coli (4/13), followed by Klebsiella (2/13) and coagulase negative Staphylococcus (CONS) (2/13). The performance characteristics of RST for leucocyte esterase and nitrites and the 6 different marker combinations are given in Tables 1 and 2. The sensitivity and the specificity for leucocyte esterase were 85% and 71% and for nitrites, they were 62% and 71%. By using different marker combinations, any one of the four positivities (i.e. positive for one or more of leucocyte esterase or nitrite or blood or protein) yielded the maximum sensitivity (100%) and any one of two positivities (positive for either leucoyte esterase or nitrite) yielded the maximum specificity (83%).

Discussion

Asymptomatic bacteriuria is the presence of actively multiplying bacteria at a time when the patient has no urinary symptoms and this poses a risk for many maternal and foetal complications. In the present study on 100 asymptomatic pregnant women who attended the routine antenatal check-up, 13 were found to be urine culture positive (13%). This was comparable to the figures which were quoted in the international literature (4% to 23.5%). There are not many studies on the incidence of ASB in India. In a study which was by Lavanya SV et al., the incidence of ASB was 8.4% in a south Indian population. E.coli, Klebsiella and CONS were the most grown organisms on culture, whose uropathogenic spectra were similar to that of others (2). The early detection of ASB is essential for an early treatment and for the avoidance of complications. Bacteriologic culture which is needed to confirm urinary infection, is time consuming and it requires laboratory facilities and competent personnel, which may not be available at all levels of healthcare. So, it may be prudent to have a screening test that is inexpensive, simple and rapid, thatwhich has high sensitivity and reasonable specificity and that which subjects only the positive samples to the culture. This can ensure the optimal use of the lab resources in the improvement of patient care. Reagent Strip Testing (RST) is a potential screening tool for urinary infections, as it is simpler and rapid and as it can be done at the point of care. We evaluated the performance characteristics of these reagent strips against bacteriologic culture by using the four infection associated markers- leucocyte esterase, nitrites, protein and blood- which were available in the multi parameter reagent strips. Most of the workers have studied leucocyte esterase and nitrites and they have reported a variable sensitivity of 16.7 to 92% and a specificity of 83.4 to 100% in detecting urinary infection [4,5] and our results were comparable with theirs- a sensitivity and a specificity of 85% and 71% for leucocyte esterase and a sensitivity and a specificity of 62% and 71% and nitrites respectively. Leucocyte esterase is an enzyme which is produced by neutrophils and its positivity suggests pyuria and not necessarily bacteriuria. So, its negative results do not exclude infection. The test for nitrites relies on the break down of urinary nitrates to nitrites by many gram positive and negative organisms, especially if they are found in significant numbers. Its negative results do not rule out infection. In order to improve the diagnostic efficiency of RST, we decided to use four infection associated biochemical markers (leucocyte esterase, nitrites, blood and protein) in different combinations. The criterion for positivity with any one the four infection associated markers yielded the highest sensitivity (100%), a specificity of 73.6%, a positive likelihood ratio of 3.8, a negative likelihood ratio of 0, a positive predictive value of 0.4 and a negative predictive value of 1 [Table/Fig-2].

A high NPV implied that when the test yielded a negative result, it was most likely that it was correct in its assessment. This made RST a good rule-out test. Our results were comparable to those of Patel et al., (98.3% sensitivity and 0.98% negative predictive value). The ultimate goal of a diagnostic testing is to refine the pre test probability to the point where the physician can confidently make a treat or no-treat decision. The low false negative rate and the difference in the pre test (0.13) and the post test probability (positive result – 0.36, and negative result – 0.0) makes this combination an effective rule out strategy, considerably reducing the number of samples (from 100 to 64) that needed to be sent for culture. To conclude, the high prevalence of ASB (13% in our study) and the associated complications warrant the screening of pregnant women for asymptomatic bacteriuria. The strategy of the pre screening of urine samples by Reagent Strip Testing (RST) by using positivity for any one of the four infection associated markers, followed by urine culture, ensures a high diagnostic performance andpotential cost savings and it reduces the laboratory workload considerably. It’s time that we have a look at this strategy for improving the healthcare and for reducing the maternal and foetal morbidity and mortality.

Acknowledgement

Indian Council for Medical Research for partial funding as part of Short term Students project

References

1.
Patel HD, Livsey SA, Swann RA, Bukhari SS. Can urine dipstick testing for urinary tract infection at the point of care reduce the laboratory workload? J Clin Pathol 2005; 951–54.
2.
Lavanya SV, Jogalakshmi D. Asymptomatic bacteriuria in antenatal women. Indian Journal of Microbiology 2002; 105-06
3.
Rouse DJ, Andrews WW, Goldenberg RL, Owen John. Screening and treatment of asymptomatic bacteriuria of pregnancy to prevent pyelonephritis: a cost-effectiveness and cost-benefit analysis. Obstet Gynecol 1995; 119-23.
4.
Sescon NI CGaringalao-Molin, F D.a, Ycasiano CEJ, Saniel MC, Manalastas RM. Prevalence of asymptomatic bacteriuria and associated risk factors in pregnant women. Phil J Microbiol Infect Dis 2003; 32(2):63-69.
5.
Lang TA, Secic M. Reporting the performance characteristics of disease. In the book ‘How to report statistics in medicine: annotated guidelines for authors’. ACP publications 2006; 125-48.

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