urinalysis cases

No. 10-0668/AF. U.S. v. Jerrod D. NUTT. CCA S31600 . Review granted on the following issues: WHETHER, UNDER MELENDEZ-DIAZ v. MASACHUSETTS , 129 S.CT. 2527 (2009), THE ADMISSION OF THE DRUG TESTING REPORT VIOLATES APPELLANT’S SIXTH AMENDMENT RIGHTS UNDER THE CONFRONTATION CLAUSE. WHETHER TRIAL DEFENSE COUNSEL’S FAILURE TO OBJECT TO THE ADMISSION OF THE DRUG LABORATORY REPORT AT TRIAL FORFEITED THE CONFRONTATION CLAUSE ISSUE, AND, IF SO, DID ADMISSION OF THE DRUG TESTING REPORT CONSTITUTE PLAIN ERROR? WHETHER THE CONFRONTATION CLAUSE WAS SATISFIED BY TESTIMONY FROM DR. TURNER. IF DR. TURNER’S TESTIMONY DID NOT ITSELF SATISFY THE CONFRONTATION CLAUSE, WAS THE INTRODUCTION OF TESTIMONIAL EVIDENCE NEVERTHELESS HARMLESS BEYOND A REASONABLE DOUBT UNDER THE CIRCUMSTANCES OF THIS CASE IF HE WAS QUALIFIED AS, AND TESTIFIED AS, AN EXPERT UNDER M.R.E. 703? No. 10-0461/NA. U.S. v. Joseph A. SWEENEY. CCA 200900468 . Review granted on the following issues: WHETHER, IN LIGHT OF THE UNITED STATES SUPREME COURT’S RULING IN MELENDEZ-DIAZ v. MASSACHUSETTS , 557 U.S. ___, 129 S.CT. 2527 (2009), THE ADMISSION INTO EVIDENCE OF THE NAVY DRUG SCREENING LABORATORY URINALYSIS DOCUMENTS VIOLATED APPELLANT’S SIXTH AMENDMENT RIGHT TO CONFRONT THE WITNESSES AGAINST HIM. WHETHER TRIAL DEFENSE COUNSEL’S OBJECTION TO THE DRUG LABORATORY REPORT CONSTITUTED A VALID CRAWFORD OBJECTION. IF NOT, THEN WHETHER TRIAL DEFENSE COUNSEL WAIVED OR FORFEITED THE CONFRONTATION CLAUSE ISSUE, AND, IF FORFEITED, WHETHER ADMISSION OF THE REPORT CONSTITUTED PLAIN ERROR.

Urinalysis Case Simulator

The LabCE Urinalysis Case Simulator, produced in collaboration with the Louisiana State University Health Sciences Center, includes 30 expert-reviewed cases, each with 50 slide images. Perform the analysis yourself and then compare your results with the experts.

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Each case has been assembled and peer-reviewed by a panel of experts from the Louisiana State University Health Sciences Center.

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Each case includes 50 slide images, for a total of 1,500 images included with the Urinalysis Case Simulator. Cases include casts, crystals, and more.

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The cases in the Urinalysis Case Simulator are ideal for laboratory science students and all laboratory professionals.

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At the conclusion of each case, you'll get access to a video summary. Experts from the LSU Health Science Center review the case, pointing out important features, and working through trickier identifications. Each video lasts 5 – 10 minutes.

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Urinalysis Case Simulator

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Urinalysis case studies

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Urinalysis and Case Studies

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Case filed in American Airlines urination incident, accused out: Police

The accused in the mid-air urination incident in the american airlines flight was released from custody on sunday, hours after he was handed over to the delhi police.

Topics American Airlines | Delhi Police

ANI General News Last Updated at March 5, 2023 15:30 IST

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The accused in the mid-air urination incident in the American Airlines flight was released from custody on Sunday, hours after he was handed over to the Delhi Police .

"A case has been registered in the matter. We will do our best in this case. The accused Aryan Vohra has been released," Devesh Kumar Mahla, DCP, IGI Airport said.

Police had earlier assured of taking "strongest possible action" against him.

Vohra, an accused in the case, was earlier handed over to the police earlier by the airlines along with the complaint.

He was caught for allegedly urinating on a US passenger in mid-air on an American Airlines flight from New York to New Delhi on Saturday night.

The airline also imposed a ban on the passenger from flying on any of its flights in the future.

"We received a complaint from American Airlines stating that there is one accused identified as Arya Vohra, a resident of Delhi. They stated that he did not behave properly and created a nuisance and also urinated on the co-passenger. On the basis of the complaint, we are contemplating action under IPC and Civil Aviation Act. The strongest possible action will be taken against him to deter other flyers to not to behave in this manner or do any such activity in the future," Devesh Kumar Mahla, DCP, IGI Airport earlier told ANI.

The official informed that the victim, however, has not come forward to register the complaint so far, and the complaint was filed by the airlines, on the basis of which the police are taking action.

"The airline has given a written complaint. The victim is not coming forward. On the basis of the complaint given by the airline as an authorised agent, we are moving forward. We will invoke sections as per the law. The airline handed over the accused along with the complaint to us and we are taking action accordingly," the DCP said.

Meanwhile, Vohra who is a student in the US was drunk, an official earlier said.

"American Airlines flight 292 with service from John F. Kennedy International Airport (JFK) to Indira Gandhi International Airport (DEL) was met by local law enforcement upon arrival in DEL due to a disruptive customer. The flight landed safely at 9:50 pm," an American Airline statement said.

The airline said that it has imposed a flying ban on the passenger for the future.

"Upon aircraft arrival, Purser informed that the passenger was heavily intoxicated, and was not adhering to crew instructions on board. He was repeatedly arguing with the operating crew, was not willing to be seated and continuously endangering the safety of crew and aircraft and after disturbing safety of fellow passengers, finally urinated on pax seated on 15G," American Airlines said in a statement.

Before landing American Airlines pilot contacted Delhi ATC regarding an unruly passenger on board and sought security and it was informed to CISF for take necessary action, "after landing of the aircraft, CISF personnel took him out from the aircraft and the said passenger misbehave with CISF personnel too," an airport official told ANI.

Earlier on November 26 last year, a man named Shankar Mishra allegedly urinated on a 70-year-old woman co-passenger in an inebriated condition in business class of an Air India New York-New Delhi flight, but the incident was not reported to the Directorate General of Civil Aviation (DGCA) which was attributed to the delay in reporting the incident by the airline crew. Mishra was later arrested by Delhi Police .

(Only the headline and picture of this report may have been reworked by the Business Standard staff; the rest of the content is auto-generated from a syndicated feed.)

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Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990.

Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition.

Chapter 191 urinalysis.

David M. Roxe .

Urinalysis is the examination of urine for certain physical properties, solutes, cells, casts, crystals, organisms, or particulate matter. Because urinalysis is easy, cheap, and productive, it is recommended as part of the initial examination of all patients and should be repeated as clinically warranted. This chapter focuses on what the physician may do in a few minutes with a urine sample, reagent strips, a microscope, and an inquiring mind. Such analysis may lead to more sophisticated chemical, immunologic, or bacteriologic studies.

The rationale and technique of urinalysis are straightforward. Nevertheless, various circumstances may alter the information obtained. For example, one should not be surprised if the urine analyzed did not come from the patient named, or that the protein and red cells were added to the urine after it reached the collection bottle. Such illicit treatment of the sample is not frequent, but may be used in an attempt to justify disability, military discharge, or need for hospitalization. Interestingly, if the temperature of fresh urine is checked, it may help to diagnose factitious oral or rectal fevers.

A sample should be obtained that is free of skin epithelium or bacteria, glandular secretions, skin salves, hair, lint, talcum, or other debris. In rare circumstances, it may be necessary to have the sample passed under observation to assure its source and freedom from exogenously introduced materials.

Ordinarily, a suitable sample may be obtained from a male simply by asking that the foreskin, if present, be pulled back, that the initial part of the stream be allowed to pass into the toilet, that the next ounce or two be collected, and that the last part of the stream be discarded with the first. In females, care must be taken to separate the labia, and the urine is collected similarly. During menstrual flow, a tampon helps keep menstrual fluid from mixing with voided urine. The utility of cotton balls, soaps, and scrubs to cleanse the meatal area is dubious, as the initial 40 to 50 ml of urine flow that is discarded is generally adequate to flush away meatal debris. The sample should be examined while fresh—indeed, while still warm—to give best results. On standing, particulate matter sediments out, bacteria proliferate and alter pH, casts may dissolve, and crystals may be lost. Refrigeration may cause precipitation of orange red crystals of uric acid, which can be redissolved by rewarming the urine.

Approximately 10 ml of well-mixed urine is taken for microscopic examination. If the urine is alkaline, 1 ml of dilute acetic acid will help dissolve phosphates that may obscure formed elements. There is no "gold standard" for how fast or how long one should centrifuge urine. I have found 3000 rpm for 3 minutes to be convenient. Others have favored 2000 rpm for 5 minutes. After centrifugation, the supernatant is discarded; the sediment is resuspended in the few drops that remain. A drop of this is placed on a slide, covered with a coverslip, and examined microscopically. No stain is routinely needed, nor is phase contrast ordinarily required. The microscope is adjusted so that relatively low light is used, and the slide is scanned under low power (100×), high power (400×), and, when protein is present, polarizing light. Low-power examination serves to identify areas of interest, high power permits identification and quantification, and polarizing light aids in identification of doubly refractile fat bodies and certain crystals. Criteria for "positive" findings on microscopic examination have been established and are useful guides for review ( Table 191.1 ).

Table 191.1

Criteria for Classification of Positive Urinary Sediment Examinations Using Bright Field Microscopy.

While urine is being centrifuged, a macroscopic examination consisting of inspection and reagent strip testing should be done. The color and clarity of the urine are apparent on inspection. Causes of unusually colored urines are shown in Table 191.2 . Turbidity of fresh urine suggests pus or red blood cells. When normal urine has cooled, crystals may precipitate and cause turbidity.

Table 191.2

Colored Urine.

Available reagent-impregnated strips provide information regarding renal function, carbohydrate metabolism, acid–base balance, liver function, and bacteriuria. It is necessary to follow instructions closely to obtain reliable results. In certain circumstances, misleading information may be suggested to the unwary observer.

The performance characteristics of one reagent strip are shown in Table 191.3 .

Table 191.3

Reagent Strip Sensitivity for Specific Tests.

Basic Science

The glomerular and tubular physiology involved in the formation and delivery of urine to the bladder and the mechanisms of bladder function are beyond the scope of this chapter.

The specific gravity of urine depends on a person's state of hydration, the integrity of the posterior pituitary, and the renal tubules. Normally, all urine leaving Henle's loop is dilute relative to plasma, and under forced hydration may contain as little as 50 mOsm/kg, roughly equivalent to a specific gravity of 1.001 or 1.002. Specific gravity of urine equals the weight of a given volume of urine divided by the weight of an equal volume of water:

When a urinometer is used, a correction must be made for temperature when very exact results are needed such that 0.001 is added or subtracted for each 3°C change above or below the calibration temperature recorded on the instrument. When protein is present in large amounts, all common methods are affected. There is no convenient correction factor for reagent strips. For refractometers or urinometers, it is necessary to subtract 0.003 for every 1 g/dl of protein in urine to be accurate. When glucose is present in large amounts, reagent strips should not be affected. It is necessary to subtract 0.004 from refractometer or urinometer readings for every 1 g/dl of glucose to correct the value. Values above 1.032 suggest the presence of exogenous solutes such as mannitol or iodinated contrast media.

The reagent strip method commonly available has three principal components: polymethylvinyl ether/maleic acid, bromothymol blue, and buffers. When specific gravity is high, the pKa of the polyelectrolyte is decreased and pH falls, resulting in a color change of the indicator. Highly buffered alkaline urine may, therefore, result in a factitiously low apparent specific gravity.

Urinary pH is an expression of the proton concentration in urine. Although the number of free protons excreted contributes only a trivial fraction of the approximately 80 mEq of acid an average person excretes daily, the free protons determine the efficacy of the titratable acid mechanism and the ammonium excretion mechanism, which together account for the bulk of excreted acid. When urinary pH is high, there are few proton acceptors in urine and the non-ionic diffusion of NH 3 , into the tubular lumen is relatively impeded. When pH is low, phosphates and other solutes efficiently accept protons and diffusion of NH 3 into the tubular lumen is facilitated. Normally, urine can be acidified to a pH value of 5.2 or less. Failure to do so in the face of systemic acidosis may indicate partial or complete renal tubular acidosis. Bacterial infection with urea-splitting organisms may produce an elevated urinary pH, so if fresh urine has leukocytes, bacteria, and an elevated pH, Proteus species would be suspected as the offending organism. (Other bacteria can split urea but are not as commonly responsible for urinary tract infection.)

Protein enters urine either because of altered glomerular permeability or because of tubular damage. Glomerular proteinuria always includes a large component of albumin. Tubular proteinuria is of low molecular weight, such as (β 2 -microglobulin. Reagent strip tests for protein are virtually (but not completely) specific for albumin, and depend upon the capacity of protein to change the color of an acid-base indicator at a constant pH maintained by a buffer in the strip section. Contrast media, tolbutamide, tolmetin, or penicillin, which may give false positive readings with heat and acetic acid, do not affect results with the reagent strip. Alkaline urine may give a false positive result with the reagent strip and a false negative result with acid precipitation techniques.

Glucose is normally present in human urine in small amounts. Glucose is usually not detectable because ketones, ascorbic acid, or other substances found in urine may cause false negative results by reagent strips even when urinary glucose approaches clearly abnormal values near 100 mg/dl. Copper reduction tests are not specific for glucose and may react with other hexoses, pentose, creatinine, uric acid, salicylates, and numerous other agents. When bacteria are present, glucose may be consumed, so a false negative could result from testing urine that is not fresh. When a hexokinase reagent strip is used, glucose concentrations below 2 mg/dl in morning urine from a fasting person correlate well with urinary tract infection. Large amounts of urinary glucose suggest diabetes mellitus, or, rarely, renal glycosuria.

Ketone bodies appear in urine as a consequence of accelerated fat metabolism. (β-Hydroxybutyric acid is quantitatively greatest, followed by acetoacetic acid and acetone. When large amounts are present, a fruity odor may be detectable. The commonly available tests for ketone bodies depend on the development of a purple compound in the presence of nitroprusside and alkali. Such tests will react with acetone or acetoacetic acid but not with β-hydroxybutyric acid. l -Dopa will give a false positive result with the nitroprusside-based tests. A ferric chloride method is available that gives false positive results for both l -dopa and salicylates. Ketone bodies are most likely to be present in the urine of an adult during diabetic ketoacidosis or when the patient has been fasting.

Bilirubin and urobilinogen appear in urine when there are abnormalities of bilirubin metabolism or liver function. Albumin-bound bilirubin (indirect bilirubin) is not water soluble and does not appear in the urine. Bilirubin conjugated with glucuronic or sulfuric acid is water soluble and appears in urine in amounts roughly correlated with the direct reacting serum bilirubin. The presence of conjugated bilirubin in detectable amounts (greater than 0.2 mg/dl) does not enable one confidently to distinguish between hepatocellular and obstructive jaundice, but does not commonly occur when hyperbilirubinemia is consequent to hemolysis. Reagent strips and tablets may give a false negative reaction when urine contains ascorbic acid. Phenothiazines may cause a false positive reaction in both cases.

When conjugated bilirubin reaches the bowel, bacterial action produces urobilinogen, which is reabsorbed into the portal circulation. Increased production of bilirubin or decreased hepatic clearance of urobilinogen from the portal circulation will increase the amount delivered to the kidney and excreted in the urine. Thus, hemolysis or hepatocellular dysfunction may increase urinary urobilinogen, while biliary obstruction will decrease delivery of conjugated bilirubin to the bowel, thereby reducing production of urobilinogen. Antibiotics, by altering bowel flora, may prevent production of urobilinogen.

These two tests, taken together, help to distinguish between hemolysis, hepatocellular disease, and biliary obstruction, as shown in Table 191.4 .

Table 191.4

Profiles of Urine Urobilinogen and Bilirubin in Health and Disease.

Hemoglobin is not normally present in urine. It may appear if there is intravascular hemolysis so that hemoglobin is filtered into the urine, or if red cells break apart within the urinary tract, liberating hemoglobin. Myoglobin also causes reddish brown urine and reacts with the reagent strip for hemoglobin. Typically, if serum and urine are both red, hemolysis is more likely, as the molecular weight of hemoglobin impedes its filtration. If serum is normal in color and urine is red, myoglobin is more likely because its smaller size favors filtration. Alternatively, of course, clear serum and red urine may represent bleeding within the urinary tract itself.

False negative reagent strip results may occur if urine contains large amounts of ascorbic acid. False positive results may be seen if povidone iodine solutions are rinsed into urine before testing.

Clinical Significance

The reduction of nitrate to nitrite by bacteria with consequent color change in a solution or on a reagent strip is a useful indicator of bacteriuria, and when positive, should be taken seriously. A negative result gives no assurance that significant infection is not present. Urine may not have been retained in the bladder long enough for bacteria to have reduced nitrate, and this will invariably be the case when a urinary catheter is in place. Moreover, certain pathogens, such as Streptococcus faecalis , do not reduce nitrate at all.

Patients who have hypokalemia, hypercalcemia, protein malnutrition, or polydipsia will not be able to concentrate urine appropriately. Diuretics similarly impair concentrating ability, especially if kaliopenia develops. These conditions must be considered when interpreting specific gravity in the two circumstances for which it has greatest use: evaluation of possible acute renal failure, and evaluation of renal dysfunction to distinguish glomerular from tubulointerstitial disease. It is often said that a specific gravity of more than 1.020 makes acute renal failure less likely, but this is true only if the value is not spuriously elevated by endogenous or exogenous solutes. It is also said that specific gravity tends to be elevated in primary glomerular disease and reduced in tubulointerstitial disease, but this is of value only when factors that might elevate or depress specific gravity are not present.

Reagent strips cannot be relied on to detect globulins or light chains. The combination of a "negative" strip result and a positive acid-precipitation test would be suggestive of multiple myeloma. Those with an aging population in their practice may find it productive to use both methods.

Remember that the presence of excess amounts of ascorbic acid in urine may affect three areas of the commonly used reagent strip: those that detect glucose, bilirubin, and hemoglobin. As people commonly take large amounts of ascorbic acid for various reasons, it is prudent to inquire specifically about this before interpreting the reagent strip results.

Careful analysis of the sediment usually takes about 5 minutes of patient examination of the area under the coverslip. The principal elements to be identified and quantified are cells, casts, and crystals.

Cells are ordinarily divided into red blood cells, white blood cells, epithelial cells, and atypical cells.

Red blood cells are associated with primary parenchymal disease such as glomerulonephritis, diabetes mellitus, polycystic kidney disease, drug reactions (e.g., penicillin), or collagen vascular disease. They may also be found with renal calculi, tumors of the urinary tract, upper or lower tract infections (cystitis or prostatitis), and trauma. The differential diagnosis of hematuria is considered in some detail in Chapter 184 .

White blood cells suggest inflammatory processes, with infection being the commonest of these. Other inflammatory stimuli, such as collagen vascular disease and allergic interstitial nephritis, also may cause pyuria. There is practical value in evaluating the pyuria by the company it keeps; for example, if white cells are found with red cells and red cell casts, then collagen vascular disease is more likely. If white cells are found by themselves in a patient with an acute onset of fever and dysuria, then infection is more likely.

Epithelial cells from any site in the urinary tract may be found in the sediment. Drugs, toxins, ischemia, instrumentation of the urinary tract, and tumors are among the causes for such cells to be sloughed into the sediment. Urine cytology studies may have particular utility when large numbers or unusual forms of epithelial cells are seen.

Casts are formed within the renal tubules and have a matrix of translucent protein that, by itself, forms the substance of the so-called hyaline cast. When there are inclusions in the cast such as red cells or white cells, they permit conclusion that the cells originated within the kidney. This is especially important when there is consideration of vasculitis or of pyelonephritis. Degenerating cellular debris may form granular casts. Hemoglobin, myoglobin, or bilirubin may be incorporated into pigmented casts.

Lipiduria is an important finding because of its association with the nephrotic syndrome. Fat may appear in urine as free fat, as inclusions within an oval fat body, or as the characteristically doubly birefringent cholesterol ester that is referred to as a "Maltese cross" after the cruciform emblem emblazoned on the shields and tunics of the Knights of Malta. Lipiduria is so abnormal that when found, it strongly suggests either fat embolization of the kidneys or the nephrotic syndrome, and the clinical context will readily differentiate in most cases. Finding lipiduria in a patient with proteinuria and edema permits one to anticipate the diagnosis of nephrotic syndrome while waiting for the laboratory to quantify cholesterol and serum albumin.

It is useful to look for bacteria. If the urine is truly fresh, the presence of even one bacterium per oil immersion field of unspun, gram-stained urine correlates reasonably well with a colony count of greater than 100,000 colonies per ml ( Wilson, 1975 ).

There has been controversy in recent years as to whether microscopic urinalysis is always necessary, especially if the macroscopic urinalysis is entirely negative. In the majority of cases, it will prove that when specific gravity is over 1.020, and the macroscopic examination is completely normal, the microscopic examination will likewise be normal. There will also be false negative results, and it is estimated that these will vary from 3 to 37% of all cases ( Schumann and Greenberg, 1979 ; Szwed and Schaust, 1982 ). Even when a special type of reagent strip is used, which is sensitive to leukocyte esterase, up to 3.3% of positive findings may be missed ( Shaw, Poon, and Wong, 1985 ). With routine reagent strips, the same authors found a 13% false negative result rate. Certainly, one could not delete the microscopic examination in a patient with signs or symptoms of hypertension or renal disease. In other cases, if it is omitted, one must accept missing 10% or more of positive findings—a loophole too large for most physicians" comfort.

Certain circumstances may warrant special stains as an adjunct to routine urinalysis. It has been suggested that a Wright's stain of the sediment may help to distinguish glomerular from lower tract sources of hematuria ( Chang, 1984 ). Technically, it is useful to add a drop of albumin solution to the sediment to obtain clear slides after staining. Glomerular lesions produce dysmorphic RBCs, while distal lesions produce cells similar to those seen in peripheral blood. Such stains would have to be done on fresh urine, as hypotonic urine would lead to cell lysis, and hypertonic urine to pyknotic cells if the urine stood for any length of time. The same staining technique may be used to search for eosinophiluria when allergic interstitial nephritis is suspected. This may be helpful when B-lactam antibiotics, non-steroidal inflammatory drugs, or other potentially toxic agents are used. Quantification of eosinophils as a percentage of total urinary white blood cells is helpful. When over 5% of urinary white cells are eosinophils, interstitial nephritis is more likely. When less than 5% are eosinophils, infection is commonly the cause ( Corwin, Korbat, and Schwartz, 1985 ).

The urine sediment may also reveal crystals, parasites, foreign bodies, spermatozoa or other findings. Assessment of the meaning of such findings—indeed, assessment of all the findings of urinalysis—depends upon the inquiring mind that asks an appropriate question. The mind, therefore, is the most important element of informative urinalysis. Because of that, it is best for the physician rather than anyone else to review the macroscopic findings, inspect the sediment, and interpret results for that unique patient, even as the physician does the physical examination rather than depend upon a technician's report.

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Urinalysis Case Studies Case Study Solution & Analysis

Harvard Case Studies

Harvard Business Case Studies Solutions – Assignment Help

In most courses studied at Harvard Business schools, students are provided with a case study. Major HBR cases concerns on a whole industry, a whole organization or some part of organization; profitable or non-profitable organizations. Student’s role is to analyze the case and diagnose the situation, identify the problem and then give appropriate recommendations and steps to be taken.

To make a detailed case analysis, student should follow these steps:

STEP 1: Reading Up Harvard Case Study Method Guide:

Case study method guide is provided to students which determine the aspects of problem needed to be considered while analyzing a case study. It is very important to have a thorough reading and understanding of guidelines provided. However, poor guide reading will lead to misunderstanding of case and failure of analyses. It is recommended to read guidelines before and after reading the case to understand what is asked and how the questions are to be answered. Therefore, in-depth understanding f case guidelines is very important.

Harvard Case Study Solutions

porter’s five forces model

STEP 2: Reading The Urinalysis Case Studies Harvard Case Study:

To have a complete understanding of the case, one should focus on case reading. It is said that case should be read two times. Initially, fast reading without taking notes and underlines should be done. Initial reading is to get a rough idea of what information is provided for the analyses. Then, a very careful reading should be done at second time reading of the case. This time, highlighting the important point and mark the necessary information provided in the case. In addition, the quantitative data in case, and its relations with other quantitative or qualitative variables should be given more importance. Also, manipulating different data and combining with other information available will give a new insight. However, all of the information provided is not reliable and relevant.

When having a fast reading, following points should be noted:

When reading the case for second time, following points should be considered:

After reading the case and guidelines thoroughly, reader should go forward and start the analyses of the case.

STEP 3: Doing The Case Analysis Of Urinalysis Case Studies:

To make an appropriate case analyses, firstly, reader should mark the important problems that are happening in the organization. There may be multiple problems that can be faced by any organization. Secondly, after identifying problems in the company, identify the most concerned and important problem that needed to be focused.

Firstly, the introduction is written. After having a clear idea of what is defined in the case, we deliver it to the reader. It is better to start the introduction from any historical or social context. The challenging diagnosis for Urinalysis Case Studies and the management of information is needed to be provided. However, introduction should not be longer than 6-7 lines in a paragraph. As the most important objective is to convey the most important message for to the reader.

After introduction, problem statement is defined. In the problem statement, the company’s most important problem and constraints to solve these problems should be define clearly. However, the problem should be concisely define in no more than a paragraph. After defining the problems and constraints, analysis of the case study is begin.

STEP 4: SWOT Analysis of the Urinalysis Case Studies HBR Case Solution:

SWOT analysis helps the business to identify its strengths and weaknesses, as well as understanding of opportunity that can be availed and the threat that the company is facing. SWOT for Urinalysis Case Studies is a powerful tool of analysis as it provide a thought to uncover and exploit the opportunities that can be used to increase and enhance company’s operations. In addition, it also identifies the weaknesses of the organization that will help to be eliminated and manage the threats that would catch the attention of the management.

This strategy helps the company to make any strategy that would differentiate the company from competitors, so that the organization can compete successfully in the industry. The strengths and weaknesses are obtained from internal organization. Whereas, the opportunities and threats are generally related from external environment of organization. Moreover, it is also called Internal-External Analysis.

In the strengths, management should identify the following points exists in the organization:

WEAKNESSES:

OPPORTUNITIES:

Following points can be identified as a threat to company:

Following points should be considered when applying SWOT to the analysis:

Pest analysis

STEP 5: PESTEL/ PEST Analysis of Urinalysis Case Studies Case Solution:

Pest analyses is a widely used tool to analyze the Political, Economic, Socio-cultural, Technological, Environmental and legal situations which can provide great and new opportunities to the company as well as these factors can also threat the company, to be dangerous in future.

Pest analysis is very important and informative. It is used for the purpose of identifying business opportunities and advance threat warning. Moreover, it also helps to the extent to which change is useful for the company and also guide the direction for the change. In addition, it also helps to avoid activities and actions that will be harmful for the company in future, including projects and strategies.

To analyze the business objective and its opportunities and threats, following steps should be followed:

PEST FACTORS:

These headings and analyses would help the company to consider these factors and make a “big picture” of company’s characteristics. This will help the manager to take the decision and drawing conclusion about the forces that would create a big impact on company and its resources.

STEP 6: Porter’s Five Forces/ Strategic Analysis Of The Urinalysis Case Studies Case Study:

To analyze the structure of a company and its corporate strategy, Porter’s five forces model is used. In this model, five forces have been identified which play an important part in shaping the market and industry. These forces are used to measure competition intensity and profitability of an industry and market.

porter’s five forces model

These forces refers to micro environment and the company ability to serve its customers and make a profit. These five forces includes three forces from horizontal competition and two forces from vertical competition. The five forces are discussed below:

STEP 7: VRIO Analysis of Urinalysis Case Studies:

Vrio analysis for Urinalysis Case Studies case study identified the four main attributes which helps the organization to gain a competitive advantages. The author of this theory suggests that firm must be valuable, rare, imperfectly imitable and perfectly non sustainable. Therefore there must be some resources and capabilities in an organization that can facilitate the competitive advantage to company. The four components of VRIO analysis are described below: VALUABLE: the company must have some resources or strategies that can exploit opportunities and defend the company from major threats. If the company holds some value then answer is yes. Resources are also valuable if they provide customer satisfaction and increase customer value. This value may create by increasing differentiation in existing product or decrease its price. Is these conditions are not met, company may lead to competitive disadvantage. Therefore, it is necessary to continually review the Urinalysis Case Studies company’s activities and resources values. RARE: the resources of the Urinalysis Case Studies company that are not used by any other company are known as rare. Rare and valuable resources grant much competitive advantages to the firm. However, when more than one few companies uses the same resources and provide competitive parity are also known as rare resources. Even, the competitive parity is not desired position, but the company should not lose its valuable resources, even they are common. COSTLY TO IMITATE: the resources are costly to imitate, if other organizations cannot imitate it. However, imitation is done in two ways. One is duplicating that is direct imitation and the other one is substituting that is indirect imitation. Any firm who has valuable and rare resources, and these resources are costly to imitate, have achieved their competitive advantage. However, resources should also be perfectly non sustainable. The reasons that resource imitation is costly are historical conditions, casual ambiguity and social complexity. ORGANIZED TO CAPTURE VALUE: resources, itself, cannot provide advantages to organization until it is organized and exploit to do so. A firm (like Urinalysis Case Studies) must organize its management systems, processes, policies and strategies to fully utilize the resource’s potential to be valuable, rare and costly to imitate.

STEP 8: Generating Alternatives For Urinalysis Case Studies Case Solution:

After completing the analyses of the company, its opportunities and threats, it is important to generate a solution of the problem and the alternatives a company can apply in order to solve its problems. To generate the alternative of problem, following things must to be kept in mind:

Once the alternatives have been generated, student should evaluate the options and select the appropriate and viable solution for the company.

STEP 9: Selection Of Alternatives For Urinalysis Case Studies Case Solution:

It is very important to select the alternatives and then evaluate the best one as the company have limited choices and constraints. Therefore to select the best alternative, there are many factors that is needed to be kept in mind. The criteria’s on which business decisions are to be selected areas under:

Alternatives should be measures that which alternative will perform better than other one and the valid reasons. In addition, alternatives should be related to the problem statements and issues described in the case study.

STEP 10: Evaluation Of Alternatives For Urinalysis Case Studies Case Solution:

If the selected alternative is fulfilling the above criteria, the decision should be taken straightforwardly. Best alternative should be selected must be the best when evaluating it on the decision criteria. Another method used to evaluate the alternatives are the list of pros and cons of each alternative and one who has more pros than cons and can be workable under organizational constraints.

STEP 11: Recommendations For Urinalysis Case Studies Case Study (Solution):

There should be only one recommendation to enhance the company’s operations and its growth or solving its problems. The decision that is being taken should be justified and viable for solving the problems.

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Forensic urinalysis of drug use in cases of alleged sexual assault

Affiliation.

The results of 3303 analyses of urine samples, collected in an independent testing programme from individuals who claimed to have been sexually assaulted and believed that drugs were involved, were examined in detail. Of the samples provided, 2026 (61.3%) proved positive for one or more substances. Alcohol, either alone or in combination with other drugs, was by far the commonest substance found, being present in 1358 samples (67.0% of positives). Cannabis was the second most prevalent drug, present in 613 samples, (30.3% of positives). Detailed examination of the testing results does not support the contention that any single drug, apart from alcohol, can be particularly identified as a 'date rape' drug. Rather, the alleged sexual assaults may often take place against a background of licit or recreational alcohol or drug use, where alcohol and other drugs are frequently taken together. The extensive forensic database examined here does not support the concept of a commonly occurring 'date rape' scenario, in which the victim's drink is covertly 'spiked' with a tablet, capsule or powder containing a sedative-hypnotic. This research highlights the need for the early collection of forensic samples in cases of alleged sexual assault. Law enforcement agencies and health professionals should establish guidelines and procedures to ensure that appropriate forensic samples (blood and urine) are collected in a timely manner following allegations of possible drug mediated sexual assault.

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Urinalysis Case Studies

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Urinalysis Case StudiesLab Dx Fall 2008 Case 1: A 28 year old man visits his physician complaining of an intense, sharp pain in his back and side. In a conversation with his physician, the patient confesses to eating a diet high in animal proteins such as meat, cheese, and fish. Results of a complete urinalysis are shown below. Chemical/Physical Analysis Color Yellow Appearance Clear Specific Gravity 1.025 pH 5.0 Glucose Protein Ketones Bilirubin Negative Trace 150mg/dL Negative Urobilinogen Blood Nitrite Leukocyte Normal Large Negative Negative

Microscopic Analysis >100 RBC/hpf 0-3 WBC/hpf 20-30 Bacteria/hpf 0-5 Squamous Epithelial Cells/hpf Unidentified Crystals Questions 1. 2. 3. Is the presence of WBCs with bacteria clinically significant? Suggest an explanation for blood in the urine. Below is a photomicrograph from the patient's urine sample:

QuickTime and a TIFF (Uncompressed ) decompressor are needed to see this pictu re.

**Note: Crystals were soluble in ammonia What is the cause of the patient's condition?

a) Uric acid crystals b) Cystine crystals c) Triple phosphate crystals 4. What is the diagnosis and treatment for this patient? a) Cystinuria b) Urinary tract infection c) Renal calculi caused by the formation of uric acid crystals1. No. Ordinarly, bacteria in the presence of WBCs would suggest a urinary tract infection. However, the 0-3 WBC/hpf is within the reference range and therefore is of no clinical significance. The relatively low levels of bacteria are also of no clinical significance. Their presence may be due to contamination. 2. There are two possible ways that blood could get into the urine. First, if the glomerulus was in some way damaged, its efficiency as a filter may be somewhat compromised. If this was the case, RBCs, protein, and other larger particles could get into the urine. However, in this case, the high blood result with only trace amounts of protein suggests that the problem did not occur at the glomerulus. This leads to the other cause of blood in the urine: damage to the urinary tract. If any part of the urinary tract is damaged, blood could get into the urine, even if the glomerulus is working fine. Renal calculi, or kidney stones, could cause damage to the renal tubules as they flow down the urinary tract. This damage would explain the presence of blood (in the absence of large amounts of protein). 3. Uric acid crystals are not soluble in ammonia. While triple phosphate crystals may have 6 sides, they are only insoluble in basic urines. This patient's urine is acidic and also it was noted that these crystals are soluble in alkaline pH. Answer = B 4. Cystinuria is the inability to absorb the amino acid cysteine from the intestines and renal tubules. Therefore, any cystine that may be present in ones diet (foods high in animal protein) will be excreted in the urine. Cystine is insoluble in an acidic pH and thus will lead to the formation of renal calculi in the urinary tract or bladder if the pH environment is acidic. Because cysteine is not an essential amino acid and can be made from methionine, there are no physiological consequences resulting from cystinuria. However, a patient with cystinuria will be susceptible to the pain associated with renal calculi. One option for treatment may be to increase the urine volume by drinking a lot of fluids. This may prevent stone formation. Another option is to choose a diet that is free of cystine. A diet high in animal protein, similar to the one this patient was on, contains large quantities of cystine. Vegetable proteins such as nuts and beans are low in cystine and should be considered. An additional way of preventing the formation of renal calculi would be to alkalise the urine. In an alkaline urine, cystine crystals dissolve so renal calculi will not form. Medications may also be available.

Case 2: A 12 year old boy was examined in the emergency room. his mother said he was having frequent urination lasting seeral days. he was also compalining of feeling weak and tired. Chemical/Physical Analysis color - pale yellow Clarity - clear pH - 6.0 Specific gravity - 1.025 Protein - Trace Glucose - 1000mg/dl Ketone - 5mg/dl Nitrite - neg Blood - neg Bilirubin - neg Urobilinogen - neg Leukocyte neg MICROSCOPIC Rbc - 0 to 2 per field Wbc - 0 to 2 Bacteria - few Epithelial Cells - few OTHER TESTS SSA( sulfosalicylic acid test) - trace QUESTIONS. 1) Which results are outside the normal range? 2) Based on these result, what might be the diagnosis? 3) What is the relationship between the appearance of ketones in urine and carbohydrate metabolism?Answers: Glucose is extremely high, and ketones are abnormal, since they should be 0. However, they are very low. This would more than likely indicate diabetes (type I). The presence of ketones in the urine indicates a shift from carbohydrate catabolism to fatty acid catabolism, since ketones are the end product of the FA pathway. Glucose should never be present in this amount. The normal renal threshold for glucoe

reabsorption is about 200mg/dL, and when stressed, it can reabsorb 300mG/dL. In cases of severe hyperglycemia (i.e. type I diabetes), the renal reabsorption threshold is exceeded, and glucose spills into the urine. This Px probably has a very high blood sugar (600-800 or so), and is probably ill, with flu-like symptoms. Other things to consider in diabetes: polyuria, polydipsia, polyphagia. Parents will say "he eats and eats and seems to be losing weight". Generally these Px present to the doctor in DKA, so proper management is imperative. Nugget: Na+ is normally the major osmotic attractant of serum, but in extreme hyperglycmeic cases, glucose takes over, and the Px will look like they are hyponatremic. A calculation can be done to correct for this, and serum Na+ is usually elevated, due to the dehydrated state of the body. Diabetes insipidus also presents with polyuria and glucosuria, but NO KETONES. The following cases do not have answers, so discuss away!

Case 3: Patient A is an 8 year old European American girl who woke up one morning with a fever and complaining of back pain on the right side just above her waist. At the physicians office later that morning on a clean catch, midstream urine sample, the following results were obtained. Chemical/Physical Analysis Color yellow Clarity cloudy SG 1.019 pH 6.0 Protein 1+ Glucose neg Ketones neg Blood 1+ Bilirubin neg Urobilinogen 0.1 Nitrite pos Leukocyte esterase 2+ Microscopic examination 40-60 WBC/hpf 0-8 RBC/hpf few squamous/lpf rare renal epithelial cell/hpf 3-6 WBC casts/hpf moderate bacteria 1. Are there any inconsistencies between the macroscopic, chemical and microscopic findings that need to be explained? If so, what might explain them?

2. What condition is indicated by this constellation of findings and which particular findings support this diagnosis? 3. Is any additional testing indicated for this patient? If yes, what test and what is its principle? 4. What is the source of the positive protein finding in this condition? 5. What is the purpose of assessing specific gravity in urine? Why is it important to know that the specific gravity was measured with a dipstik? Case 4: Patient B is a 14 year old African American boy who had a sore throat about two weeks ago but that is now gone. His mother has taken him to an urgent care facility because his ankles and hands seems very swollen and his urine is dark. The following results are on a clean catch, midstream sample collected at the urgent care facility. Chemical/Physical Analysis Color brown Clarity cloudy SG 1.026 pH 6.0 Protein 3+ Glucose negative Ketones negative Blood 3+ Bilirubin negative Urobilinogen 0.1 Nitrite negative Leukocyte esterase negative Microscopic examination 40-50 rbc/hpf 3-10 WBC/hpf 0-5 hyaline casts/lpf 0-2 rbc casts/lpf 1-3 granular casts/lpf few sq. epi/hpf 1. Are there any inconsistencies between the macroscopic, chemical and microscopic findings that need to be explained? If so, what might explain them? 2. What condition is indicated by this constellation of findings and which particular

findings support this diagnosis? 3. Is any additional testing indicated for this patient? If yes, what test and what is its principle? 4. What is the source of the positive protein finding in this condition? 5. Why are the patients ankles swelling? 6. What is the relationship of the patients prior sore throat to his present condition? 7. Why is the microscopic examination negative for bacteria? Case 6: Patient C is an 18 year European American female who sought treatment at the university health center complaining of frequent urination with burning. She reported that she had sexual intercourse two days previous to this visit and had no recent history illness. She was instructed to collect a clean catch, midstream sample that was tested with the following results. Chemical/Physical Analysis Color yellow Clarity cloudy SG 1.012 pH 5.5 Protein 1+ Glucose negative Ketones negative Blood 1+ Bilirubin negative Urobilinogen 0.1 Nitrite negative Leukocyte esterase 2+ Microscopic examination 50-75 WBC/lpf some in clumps 15-20 rbc/lpf many sq epi/lpf 1+ mucous many bacteria

1. Are there any inconsistencies between the macroscopic, chemical and microscopic findings that need to be explained? If so, what might explain them?

2. What condition is indicated by this constellation of findings and which particular findings support this diagnosis? 3. Is any additional testing indicated for this patient? If yes, what test and what is its principle? Case 6: Kenji is a 56 year old Asian American man who has been experiencing a sharp but intermittent pain in his back for some time. His wife has been pressing him to see a doctor but he has resisted until today because the pain has become more severe and persistent. Below are the results of a routine urinalysis on a clean catch midstream sample collected and tested in the physician office. Chemical/Physical Analysis Color yellow Clarity clear SG 1.009 pH 6.0 Protein negative Glucose negative Ketones negative Blood trace Bilirubin negative Urobilinogen 0.1 Nitrite negative Leukocyte esterase negative Microscopic examination 0-2 sq epi/lpf 2-5 rbc/hpf 0-1 WBC/hpf 1. Is the sample acceptable for evaluation? Explain your conclusion. 2. Are there any inconsistencies between the macroscopic, chemical and microscopic findings that need to be explained? If so, what might explain them? 3. What condition is suggested by this constellation of findings and which particular findings support this diagnosis? 4. Is any additional testing indicated for this patient? If yes, what test and what is its principle? Case 7: Obrian is an 8 year old African American boy who was hospitalized with pneumonia following a cold. He was treated with antibiotics and within a day of

beginning treatment, his urine turned dark. The results below are the from the second urine sample after the dark urine was discovered. A CBC collected shortly after the dark urine was reported showed an elevated white blood count with a left shift and toxic changes; normochromic, normocytic anemia with an occasional helmet cell and shistocyte; and normal platelet count and morphology. Chemical/Physical Analysis Color red-brown Clarity clear SG 1.015 pH 5.5 Protein trace Glucose negative Ketones negative Blood 4+ Bilirubin negative Urobilinogen negative Nitrite negative Leukocyte esterase negative 1. Is the sample acceptable for evaluation? Explain your conclusion. 2. Are there any inconsistencies between the macroscopic, chemical and microscopic findings that need to be explained? If so, what might explain them? 3. What condition is suggested by this constellation of findings and which particular findings support this diagnosis? 4. Is any additional testing indicated for this patient? If yes, what test and what is its principle? 5. What changes to the results of the urinalysis would be expected in the next few days? What is the principle of the test on the stik that will detect these changes? Case 8: Bobby Mcgee, a 56 year old white male, had some basic tests performed as part of an insurance policy screening. The urine sample was collected at the patients home and then delivered to a laboratory for testing and reporting. The sample was a random void without directions to collect it midstream or clean catch. Chemical/Physical Analysis Color yellow Clarity hazy SG 1.012 pH 6.0 Protein negative

Glucose negative Ketones negative Blood negative Bilirubin negative Urobilinogen 0.1 Nitrite negative Leukocyte esterase negative Microscopic examination: moderate calcium oxalate crystals few bacteria 1. Is the sample acceptable for evaluation? Explain your conclusion. 2. Are there any inconsistencies between the macroscopic, chemical and microscopic findings that need to be explained? If so, what might explain them? 3. What condition is suggested by this constellation of findings and which particular findings support this diagnosis? 4. Is any additional testing indicated for this patient? If yes, what test and what is its principle? 5. Under what conditions are crystals seen in urine? Which crystals are considered normal? Case 9: Harriet is a 40 year old African American woman who has been experiencing sharp pains under her ribs on the right side for several months. She seems to think that it is related to eating heavy meals. She has finally decided to see her physician because this morning when she woke up she noticed that her eyeballs had turned yellow and this was pretty scary to her. A urine sample collected in the physicians office showed the results below. Chemical/Physical Analysis Color dark yellow Clarity hazy SG 1.020 pH 5.5 Protein negative Glucose negative Ketones negative Blood negative Bilirubin positive Urobilinogen negative Nitrite negative

Leukocyte esterase negative Microscopic examination moderate sq. epi/hpf 1. Is the sample acceptable for evaluation? Explain your conclusion. 2. Are there any inconsistencies between the macroscopic, chemical and microscopic findings that need to be explained? If so, what might explain them? 3. What condition is suggested by this constellation of findings and which particular findings support this diagnosis? 4. Is any additional testing indicated for this patient? If yes, what test and what is its principle? Case 10: Bret is 18 month old European American boy seen in the doctors office for a routine well-child visit. The urine sample was collected with one of the pediatric bags. Chemical/Physical Analysis Color yellow Clarity hazy SG 1.013 pH 6.5 Protein negative Glucose negative Ketones negative Blood negative Bilirubin negative Urobilinogen 0.1 Nitrite negative Leukocyte esterase negative Microscopic examination 15-20 sq epis/lpf few uric acid crystals/lpf 1. Is the sample acceptable for evaluation? Explain your conclusion. 2. Which results are outside reference ranges or acceptable limits? 3. Are there any inconsistencies between the macroscopic, chemical and microscopic findings that need to be explained? If so, what might explain them?

4. What condition is suggested by this constellation of findings and which particular findings support this diagnosis? 5. Is any additional testing indicated for this patient? If yes, what test and what is its principle? Case 11: Lilia, a 35 year old Mexican American woman, provided the urine sample whose results are below during a routine physical examination. She was instructed to provide a mid-stream sample. Her weight was down approximately 10 pounds from the prior year and she said she had been working out and eating more healthfully. She was found to be healthy. Chemical/Physical Analysis Color straw Clarity clear SG 1.007 pH 5.5 Protein negative Glucose negative Ketones 1+ Blood negative Bilirubin negative Urobilinogen 0.1-1.0 EU Nitrite negative Leukocyte esterase negative Microscopic examination 0-2 sq epis/lpf 1. Is the sample acceptable for evaluation? Explain your conclusion. 2. Are there any inconsistencies between the macroscopic, chemical and microscopic findings that need to be explained? If so, what might explain them? 3. What condition is suggested by this constellation of findings and which particular findings support this diagnosis? 4. Is any additional testing indicated for this patient? If yes, what test and what is its principle?

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A urinalysis is a test of your urine. It's used to detect and manage a wide range of disorders, such as urinary tract infections, kidney disease and diabetes. A urinalysis involves checking the appearance, concentration and content of urine. For example, a urinary tract infection can make urine look cloudy instead of clear.
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STEP 4: SWOT Analysis of the Urinalysis Case Studies HBR Case Solution: SWOT analysis helps the business to identify its strengths and weaknesses, as well as understanding of opportunity that can be availed and the threat that the company is facing. SWOT for Urinalysis Case Studies is a powerful tool of analysis as it provide a thought to ...
Forensic urinalysis of drug use in cases of alleged sexual assault
The results of 3303 analyses of urine samples, collected in an independent testing programme from individuals who claimed to have been sexually assaulted and believed that drugs were involved, were examined in detail. ... Forensic urinalysis of drug use in cases of alleged sexual assault J Clin Forensic Med. 2001 Dec;8(4):197-205. doi: 10.1054 ...
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(DOC) Urinalysis Case Studies
Urinalysis Case Studies Lab Dx Fall 2008 Case 1: A 28 year old man visits his physician complaining of an intense, sharp pain in his back and side. In a conversation with his physician, the patient confesses to eating a diet high in animal proteins such as meat, cheese, and fish. Results of a complete urinalysis are shown below.