Albumin testing in urine using a smart-phone

Second-order scattering sensor based on the Zn0.97La0.03O compound for selective and stable detection of glycated albumin

Here, we presented a second-order scattering sensor based on the Zn0.97La0.03O compound (LaZnO) for selective and stable detection of glycated albumin (GA, glycemic long-term biomarker). The LaZnO sample was obtained through the co-precipitation method and then characterized using microscopic and spectroscopic techniques. Furthermore, the selectivity, molecular interference, temporal stability, and pH effects of the LaZnO SOS signal in the absence and presence of GA were investigated. The results indicate the stability of the SOS signal over more than 60 days. Assays conducted within the pH range of 5 to 8 indicate that the detection of GA remains unaffected under the given conditions. Selectivity studies show that the SOS signal of LaZnO is reduced only upon contact with GA, while interference studies show that detection is not affected by other chemical species. Additionally, the calibration curve test showed high sensitivity of the material, with a detection limit of 0.55 µg/ml. All the results suggest that LaZnO can deliver efficiency, selectivity, accuracy, and fast response as a GA biosensor, emphasizing LaZnO's usefulness in detecting protein biomarkers.

Rational design of a FA1-targeting anti-interference fluorescent probe for the point-of-care testing of albuminuria

Albuminuria is a crucial urine biomarker of human unhealthy events such as kidney diseases, cardiovascular diseases, and diabetes. However, the accurate diagnosis of albuminuria poses a significant challenge owing to the severe interference from urine fluorescence and urine drugs. Here, we report a novel flavone-based fluorescent probe, DMC, by incorporating the FA1-targeting methylquinazoline group into a flavone skeleton with the extend π-conjugation. DMC exhibited a rapid response time, high sensitivity, and selectivity towards human serum albumin (HSA) in urine. Moreover, the red-shifted fluorescence and the FA1-targeted HSA-binding of DMC efficiently mitigated the interference from both urine fluorescence and urine drug metabolites. Furthermore, the establishment of a portable testing system highlighted the potential for point-of-care testing, offering a user-friendly and accurate approach to diagnose A2-level and A3-level albuminuria. We expect that the success of this DMC-based diagnostic platform in real urine samples can signify a significant advancement in early clinical diagnosis of albuminuria and its associated diseases.

A digital image colorimetry system based on smart devices for immediate and simultaneous determination of enzyme-linked immunosorbent assays

Standard enzyme-linked immunosorbent assays based on microplates are frequently utilized for various molecular sensing, disease screening, and nanomedicine applications. Comparing this multi-well plate batched analysis to non-batched or non-standard testing, the diagnosis expenses per patient are drastically reduced. However, the requirement for rather big and pricey readout instruments prevents their application in environments with limited resources, especially in the field. In this work, a handheld cellphone-based colorimetric microplate reader for quick, credible, and novel analysis of digital images of human cancer cell lines at a reasonable price was developed. Using our in-house-developed app, images of the plates are captured and sent to our servers, where they are processed using a machine learning algorithm to produce diagnostic results. Using FDA-approved human epididymis protein of ovary IgG (HE4), prostate cancer cell line (PC3), and bladder cancer cell line (5637) ELISA tests, we successfully examined this mobile platform. The accuracies for the HE4, PC3, and 5637 tests were 93%, 97.5%, and 97.2%, respectively. By contrasting the findings with the measurements made using optical absorption EPOCH microplate readers and optical absorption Tecan microplate readers, this approach was found to be accurate and effective. As a result, digital image colorimetry on smart devices offered a practical, user-friendly, affordable, precise, and effective method for quickly identifying human cancer cell lines. Thus, healthcare providers might use this portable device to carry out high-throughput illness screening, epidemiological investigations or monitor vaccination campaigns.

Development of a Quantitative Digital Urinalysis Tool for Detection of Nitrite, Protein, Creatinine, and pH

This paper presents a cost-effective, quantitative, point-of-care solution for urinalysis screening, specifically targeting nitrite, protein, creatinine, and pH in urine samples. Detecting nitrite is crucial for the early identification of urinary tract infections (UTIs), while regularly measuring urinary protein-to-creatinine (UPC) ratios aids in managing kidney health. To address these needs, we developed a portable, transmission-based colorimeter using readily available components, controllable via a smartphone application through Bluetooth. Multiple colorimetric detection strategies for each analyte were identified and tested for sensitivity, specificity, and stability in a salt buffer, artificial urine, and human urine. The colorimeter successfully detected all analytes within their clinically relevant ranges: nitrite (6.25-200 µM), protein (2-1024 mg/dL), creatinine (2-1024 mg/dL), and pH (5.0-8.0). The introduction of quantitative protein and creatinine detection, and a calculated urinary protein-to-creatinine (UPC) ratio at the point-of-care, represents a significant advancement, allowing patients with proteinuria to monitor their condition without frequent lab visits. Furthermore, the colorimeter provides versatile data storage options, facilitating local storage on mobile devices or in the cloud. The paper further details the setup of the colorimeter's secure connection to a cloud-based environment, and the visualization of time-series analyte measurements in a web-based dashboard.

Moving toward smart biomedical sensing

The development of novel biomedical sensors as highly promising devices/tools in early diagnosis and therapy monitoring of many diseases and disorders has recently witnessed unprecedented growth; more and faster than ever. Nonetheless, on the eve of Industry 5.0 and by learning from defects of current sensors in smart diagnostics of pandemics, there is still a long way to go to achieve the ideal biomedical sensors capable of meeting the growing needs and expectations for smart biomedical/diagnostic sensing through eHealth systems. Herein, an overview is provided to highlight the importance and necessity of an inevitable transition in the era of digital health/Healthcare 4.0 towards smart biomedical/diagnostic sensing and how to approach it via new digital technologies including Internet of Things (IoT), artificial intelligence, IoT gateways (smartphones, readers), etc. This review will bring together the different types of smartphone/reader-based biomedical sensors, which have been employing for a wide variety of optical/electrical/electrochemical biosensing applications and paving the way for future eHealth diagnostic devices by moving towards smart biomedical sensing. Here, alongside highlighting the characteristics/criteria that should be met by the developed sensors towards smart biomedical sensing, the challenging issues ahead are delineated along with a comprehensive outlook on this extremely necessary field.

Flash Characterization of Smartphones Used in Point-of-Care Diagnostics

Rapidly growing interest in smartphone cameras as the basis of point-of-need diagnostic and bioanalytical technologies increases the importance of quantitative characterization of phone optical performance under real-world operating conditions. In the context of our development of lateral-flow immunoassays based on phosphorescent nanoparticles, we have developed a suite of tools for characterizing the temporal and spectral profiles of smartphone torch and flash emissions, and their dependence on phone power state. In this work, these tools are described and documented to make them easily available to others, and demonstrated by application to characterization of Apple iPhone 5s, iPhone 6s, iPhone 8, iPhone XR, and Samsung Note8 flash performance as a function of time and wavelength, at a variety of power settings. Flash and torch intensity and duration vary with phone state and among phone models. Flash has high variability when the battery charge is below 10%, thus, smartphone-based Point-of-Care (POC) tests should only be performed at a battery level of at least 15%. Some output variations could substantially affect the results of assays that rely on the smartphone flash.

Computational Portable Microscopes for Point-of-Care-Test and Tele-Diagnosis

In bio-medical mobile workstations, e.g., the prevention of epidemic viruses/bacteria, outdoor field medical treatment and bio-chemical pollution monitoring, the conventional bench-top microscopic imaging equipment is limited. The comprehensive multi-mode (bright/dark field imaging, fluorescence excitation imaging, polarized light imaging, and differential interference microscopy imaging, etc.) biomedical microscopy imaging systems are generally large in size and expensive. They also require professional operation, which means high labor-cost, money-cost and time-cost. These characteristics prevent them from being applied in bio-medical mobile workstations. The bio-medical mobile workstations need microscopy systems which are inexpensive and able to handle fast, timely and large-scale deployment. The development of lightweight, low-cost and portable microscopic imaging devices can meet these demands. Presently, for the increasing needs of point-of-care-test and tele-diagnosis, high-performance computational portable microscopes are widely developed. Bluetooth modules, WLAN modules and 3G/4G/5G modules generally feature very small sizes and low prices. And industrial imaging lens, microscopy objective lens, and CMOS/CCD photoelectric image sensors are also available in small sizes and at low prices. Here we review and discuss these typical computational, portable and low-cost microscopes by refined specifications and schematics, from the aspect of optics, electronic, algorithms principle and typical bio-medical applications.

Analytical Challenges in Diabetes Management: Towards Glycated Albumin Point-of-Care Detection

Diabetes mellitus is a worldwide-spread chronic metabolic disease that occurs when the pancreas fails to produce enough insulin levels or when the body fails to effectively use the secreted pancreatic insulin, eventually resulting in hyperglycemia. Systematic glycemic control is the only procedure at our disposal to prevent diabetes long-term complications such as cardiovascular disorders, kidney diseases, nephropathy, neuropathy, and retinopathy. Glycated albumin (GA) has recently gained more and more attention as a control biomarker thanks to its shorter lifespan and wider reliability compared to glycated hemoglobin (HbA1c), currently the “gold standard” for diabetes screening and monitoring in clinics. Various techniques such as ion exchange, liquid or affinity-based chromatography and immunoassay can be employed to accurately measure GA levels in serum samples; nevertheless, due to the cost of the lab equipment and complexity of the procedures, these methods are not commonly available at clinical sites and are not suitable to home monitoring. The present review describes the most up-to-date advances in the field of glycemic control biomarkers, exploring in particular the GA with a special focus on the recent experimental analysis techniques, using enzymatic and affinity methods. Finally, analysis steps and fundamental reading technologies are integrated into a processing pipeline, paving the way for future point-of-care testing (POCT). In this view, we highlight how this setup might be employed outside a laboratory environment to reduce the time from measurement to clinical decision, and to provide diabetic patients with a brand-new set of tools for glycemic self-monitoring.

Lectin-Functionalized Chitosan Nanoparticle-Based Biosensor for Point-of-Care Detection of Bacterial Infections

The WHO estimates an average of 10 million deaths per year due to the increasing number of infections and the predominance of drug resistance. To improve clinical outcomes and contain the spread of infections, the development of newer diagnostic tools is imperative to reduce the time and cost involved to reach the farthest population. The current study focuses on the development of a point-of-care technology that uses crystal violet entrapped, lectin functionalized chitosan nanoparticles to detect the presence of clinically relevant bacterial infections. Spherical nanoparticles of <200 nm in diameter make up the biosensing nanomaterial, showed specific clumping in the presence of bacteria to form visible aggregates as compared to a nonbacterial sample. Visible agglutination confirmed the presence of bacteria in the samples. The devices require just 100 μL of sample and were tested with various bacteria-spiked saline, simulated urine, artificial sputum, and simulated respiratory and wound swabs. The developed device did not require any sample preparation or sophisticated instruments while enabling rapid differentiation between bacterial and nonbacterial infections within 10 min. The in vitro results with bacteria-spiked simulated samples reveal 100% sensitivity and specificity with a limit of detection of 10⁵ cfu/mL. The nanomaterial developed was found to be stable for more than 90 days at accelerated conditions. The developed device can be a screening tool for home-based or clinical assessment and follow the treatment accordingly, reducing exposure to broad-spectrum antibiotics in the case of nonbacterial infections.

The Current State of Optical Sensors in Medical Wearables

Optical sensors play an increasingly important role in the development of medical diagnostic devices. They can be very widely used to measure the physiology of the human body. Optical methods include PPG, radiation, biochemical, and optical fiber sensors. Optical sensors offer excellent metrological properties, immunity to electromagnetic interference, electrical safety, simple miniaturization, the ability to capture volumes of nanometers, and non-invasive examination. In addition, they are cheap and resistant to water and corrosion. The use of optical sensors can bring better methods of continuous diagnostics in the comfort of the home and the development of telemedicine in the 21st century. This article offers a large overview of optical wearable methods and their modern use with an insight into the future years of technology in this field.

Remote Digital Urinalysis With Smartphone Technology as Part of Remote Management of Glomerular Disease During the SARS-CoV-2 Virus Pandemic: Single Centre Experience in 25 Patients

Background

The COVID-19 pandemic has necessitated the provision of healthcare through remote and increasingly digitalized means. The management of glomerular pathology, for which urinalysis is crucial, has been notably affected. Here we describe our single-centre experience of using remote digital urinalysis in the management of patients with glomerular disease during the COVID-19 pandemic.

Method

All patients with native kidney glomerular disease who consented to participate in digital smartphone urinalysis monitoring between March 2020 and July 2021 were included. Electronic health records were contemporaneously reviewed for outcome data. Patient feedback was obtained through the testing portal.

Results

Twenty-five patients utilized the digital urinalysis application. A total of 105 digital urinalysis tests were performed for a wide variety of indications. Four patients experienced a relapse (detected remotely) and two patients underwent three successful pregnancies. The majority of patients were managed virtually (60%) or virtually and face to face (F2F) combined (32%). The average number of clinic reviews and urine tests performed during the pandemic either virtually and/or F2F was comparable to levels pre-pandemic and the ratio of reviews to urinalysis (R:U) was stable (pre-pandemic 1:0.9 versus during the pandemic 1:0.8). Patients seen exclusively F2F with supplementary home monitoring had the highest R:U ratio at 1:2.1. A total of 95% of users provided feedback, all positive.

Conclusion

Remote urinalysis proved a safe and convenient tool to facilitate decision-making where traditional urinalysis was difficult, impractical or impossible. Our approach allowed us to continue care in this vulnerable group of patients despite a lack of access to traditional urinalysis.

Optical-Based Biosensors and Their Portable Healthcare Devices for Detecting and Monitoring Biomarkers in Body Fluids

The detection and monitoring of biomarkers in body fluids has been used to improve human healthcare activities for decades. In recent years, researchers have focused their attention on applying the point-of-care (POC) strategies into biomarker detection. The evolution of mobile technologies has allowed researchers to develop numerous portable medical devices that aim to deliver comparable results to clinical measurements. Among these, optical-based detection methods have been considered as one of the common and efficient ways to detect and monitor the presence of biomarkers in bodily fluids, and emerging aggregation-induced emission luminogens (AIEgens) with their distinct features are merging with portable medical devices. In this review, the detection methodologies that use optical measurements in the POC systems for the detection and monitoring of biomarkers in bodily fluids are compared, including colorimetry, fluorescence and chemiluminescence measurements. The current portable technologies, with or without the use of smartphones in device development, that are combined with optical biosensors for the detection and monitoring of biomarkers in body fluids, are also investigated. The review also discusses novel AIEgens used in the portable systems for the detection and monitoring of biomarkers in body fluid. Finally, the potential of future developments and the use of optical detection-based portable devices in healthcare activities are explored.

Smartphone-based technique for the determination of a titration equivalence point from an RGB linear-segment curve with an example application to miniaturized titration of sodium chloride injections

A smartphone-based technique for determining the titration equivalence point from a linear-segment curve was developed for the first time. In this method, a titrant in an increasing microliter-volume was added to a set of sample aliquots containing an indicator covering both sides of the equivalence point. The solutions were subsequently photographed in one shot, in a dark box using a smartphone camera and an illuminating screen of a tablet or light emitting diode lamps arranged below a white acrylic sheet as a light source. After the colors of the solutions were delineated to Red, Green, and Blue (RGB) values, 1/log G was used to construct a plot in which the equivalence point was located at the intersection of the two lines in the region before and after the equivalence point. The technique was successfully applied to the miniaturized titration of sodium chloride injections, showing the good linear relationship of equivalence points to the sodium chloride concentration in the range of 0.4163-0.9675% w/v (R² of 0.9998). The assay was accurate (% recovery of 98.92-100.52), precise (% relative standard deviation ≤ 1.20), and unaffected by the use of different types of microplates, smartphones, and RGB analysis tools. Additionally, it required no expensive nor complicated equipment and offered the possibility of performing analysis on a single smartphone device when it was used with a mobile application developed to aid data processing and immediate production of reports of analytical results.

Smartphone-based optical analysis systems

During the past few decades, there has been a growing trend towards the use of smartphone-based analysis systems. This is mainly due to its ubiquity, its increasing computing capacity, its relatively low cost and the ability to acquire and process data at the same time. Furthermore, there are many sensors integrated into a smartphone, for example a complementary metal-oxide semiconductor (CMOS) sensor. A CMOS sensor enables optical analysis for example by using it as a colorimeter, photometer or spectrometer. This review explores the current state-of-the-art smartphone-based optical analysis systems in various areas of application. It is organized into three sections, each of which investigates one class of smartphone-based devices: (i) smartphone-based colorimeters (ii) smartphone-based photo- and spectrometers and (iii) smartphone-based fluorimeters.

A modular microscopic smartphone attachment for imaging and quantification of multiple fluorescent probes using machine learning

Portable smartphone-based fluorescent microscopes are becoming popular owing to their ability to provide major functionalities offered by regular benchtop microscopes at a fraction of the cost. However, smartphone-based microscopes are still limited to a single fluorophore, fixed magnification, the inability to work with a different smartphones, and limited usability to either glass slides or cover slips. To overcome these challenges, here we present a modular smartphone-based microscopic attachment. The modular design allows the user to easily swap between different sets of filters and lenses, thereby enabling utility of multiple fluorophores and magnification levels. Our microscopic smartphone attachment can also be used with different smartphones and was tested with Nokia Lumia 1020, Samsung Galaxy S9+, and an iPhone XS. Further, we showed imaging results of samples on glass slides, cover slips, and microfluidic devices. A 1951 USAF resolution test target was used to quantify the maximum resolution of the microscope which was found to be 3.9 μm. The performance of the smartphone-based microscope was compared with a benchtop microscope and we found an R2 value of 0.99 using polystyrene beads and blood cells isolated from human blood samples collected from Robert Wood Johnson Medical Hospital. Additionally, to count the particles (cells and beads) imaged from the smartphone-based fluorescent microscope, we developed artificial neural networks (ANNs) using multiple training algorithms, and evaluated their performances compared to the control (ImageJ). Finally, we did ANOVA and Tukey's post-hoc analysis and found a p-value of 0.97 which shows that no statistical significant difference exists between the performance of the trained ANN and control (ImageJ).

ONCOPEDS: A mobile application to improve early diagnosis and timely referral in childhood cancer in a low- and middle-income country-A pilot study

BACKGROUND

Diagnosis delay in children and adolescents with cancer is a public health problem in Peru that leads to high rates of advanced disease and mortality. We aimed to assess the implementation feasibility and potential utility of ONCOpeds®, a mobile application that provides consultations with pediatric oncologists, in reducing the latency to diagnosis (LD) and referral time (RT) among children and adolescents in Peru diagnosed with cancer.

MATERIAL AND METHODS

A prospective pilot study was conducted in the region of Callao between November 2017 and April 2018. Primary and secondary care providers were trained on the use of ONCOpeds in five educational sessions. Patients younger than 18 years who resided in Callao and were diagnosed with cancer at four pediatric cancer units in Lima were analyzed by referral type: ONCOpeds facilitated or conventional.

RESULTS

ONCOpeds was successfully installed in the smartphones of 78 primary and secondary care providers of Callao. During the study period, 23 new cases of cancer in children and adolescents from the region were diagnosed. Ten patients received ONCOpeds-facilitated referrals and 13 received conventional referrals. The RT decreased among those who received ONCOpeds-facilitated referrals by 66% (P = 0.02); however, the LD did not significantly decrease with the use of ONCOpeds.

CONCLUSIONS

The implementation of ONCOpeds was found to be feasible in this pilot study, having a potential utility in improving early diagnosis and referral in children and adolescents newly diagnosed with cancer. Directions for future research include multicenter studies with a larger population to further test the application's effectiveness.

Measurement of serum phosphate levels using a mobile sensor

The measurement of serum phosphate concentration is crucial for patients with advanced chronic kidney disease (CKD) and those on maintenance dialysis, as abnormal phosphate levels may be associated with severe health risks. It is important to monitor serum phosphate levels on a regular basis in these patients; however, such measurements are generally limited to every 0.5-3 months, depending on the severity of CKD. This is due to the fact that serum phosphate measurements can only be performed at regular clinic visits, in addition to cost considerations. Here we present a portable and cost-effective point-of-care device capable of measuring serum phosphate levels using a single drop of blood (<60 μl). This is achieved by integrating a paper-based microfluidic platform with a custom-designed smartphone reader. This mobile sensor was tested on patients undergoing dialysis, where whole blood samples were acquired before starting the hemodialysis and during the three-hour treatment. This sampling during the hemodialysis, under patient consent, allowed us to test blood samples with a wide range of phosphate concentrations, and our results showed a strong correlation with the ground truth laboratory tests performed on the same patient samples (Pearson coefficient r = 0.95 and p < 0.001). Our 3D-printed smartphone attachment weighs about 400 g and costs less than 80 USD, whereas the material cost for the disposable test is <3.5 USD (under low volume manufacturing). This low-cost and easy-to-operate system can be used to measure serum phosphate levels at the point-of-care in about 45 min and can potentially be used on a daily basis by patients at home.

Application of smartphone-based spectroscopy to biosample analysis: A review

The emergence of the smartphones has brought extensive changes to our lifestyles, from communicating with one another, to shopping and enjoyment of entertainment, and from studying to functioning at the workplace (and in the field). At the same time, this portable device has also provided new possibilities in scientific research and applications. Based on the growing awareness of good health management, researchers have coupled health monitoring to smartphone sensing technologies. Along the way, there have been developed a variety of smartphone-based optical detection platforms for analyzing biological samples, including standalone smartphone units and integrated smartphone sensing systems. In this review, we outline the applications of smartphone-based optical sensors for biosamples. These applications focus mainly on three aspects: Microscopic imaging sensing, colorimetric sensing and luminescence sensing. We also discuss briefly some limitations of the current state of smartphone-based spectroscopy and present prospects of the future applicability of smartphone sensors.

Smartphone-assisted detection of nucleic acids by light-harvesting FRET-based nanoprobe

Point-of-care assays for optical detection of biomolecular markers attract growing attention, because of their capacity to provide rapid and inexpensive diagnostics of cancer and infectious diseases. Here, we designed a nanoprobe compatible with a smartphone RGB camera for detection of nucleic acids. It is based on light-harvesting polymeric nanoparticles (NPs) encapsulating green fluorescent donor dyes that undergo efficient Förster Resonance Energy Transfer (FRET) to red fluorescent acceptor hybridized at the particle surface. Green-emitting NPs are based on rhodamine 110 and 6G dyes paired with bulky hydrophobic counterions, which prevent dye self-quenching and ensure efficient energy transfer. Their surface is functionalized with a capture DNA sequence for cancer marker survivin, hybridized with a short oligonucleotide bearing FRET acceptor ATTO647N. Obtained 40-nm poly(methyl methacrylate)-based NP probe, encapsulating octadecyl rhodamine 6G dyes with tetrakis(perfluoro-tert-butoxy)aluminate counterions (~6000 dyes per NP), and bearing 65 acceptors, shows efficient FRET with >20% quantum yield and a signal amplification (antenna effect) of 25. It exhibits ratiometric response to the target DNA by FRET acceptor displacement and enables DNA detection in solution by fluorescence spectroscopy (limit of detection 3 pM) and on surfaces at the single-particle level using two-color fluorescence microscopy. Using a smartphone RGB camera, the nanoprobe response can be readily detected at 10 pM target in true color and in red-to-green ratio images. Thus, our FRET-based nanoparticle biosensor enables detection of nucleic acid targets using a smartphone coupled to an appropriate optical setup, opening the way to simple and inexpensive point-of-care assays.

Core-shell nanoparticles as platform technologies for paper based point-of-care devices to detect antimicrobial resistance

Globally, rapid development of antibiotic resistance amongst pathogens has led to limited treatment options and high indirect costs to health management. There is a need to avoid misuse of available antibiotics and to develop rapid, affordable and accessible diagnostic technologies to detect drug resistance even in resource limited settings. This study reports the development of instrument-free point-of-care devices for detection of antibiotic resistance for rapid diagnosis of drug resistance in the penicillin, cephalosporin and carbapenem groups of antibiotics. The simple paper-based devices for flow through assay determine the presence of resistant bacteria in a sample by a visible colour change within 30 minutes. At the center of this technology is the unique sensing nanomaterial comprising of core-shell nanoparticles layered with specific antibiotics. The core is comprised of chitosan nanoparticles of size ∼15 nm coated with the starch-iodine indicator to form a shell increasing the size to ∼47 nm. The test strip is coated with the nanoparticles, air-dried and overlayed with the required antibiotic. In the presence of penicillin, cephalosporin and carbapenem resistant bacteria, the core-shell nanoparticles undergo a visible colour change from blue to white. The core-shell nanoparticles were deposited on paper to form a point-of-care device. Devices were developed to screen for three main classes of antibiotics namely penicillins, cephalosporins and carbapenems. The devices were validated using standard resistant and susceptible ATCC strains in three different sample types, pure colony, broth culture and saline suspensions. The change of colour from blue to white was considered a positive test. The time of detection was found to be 30 min, while the limit of detection was 10⁵ cfu ml^-1. The device exhibited 100% sensitivity and specificity with known resistant and susceptible cultures not only from pure colonies but also from direct samples of spiked saline suspensions with graded confounding factors of albumin, glucose, and urea. The inter-device reproducibility and storage stability of the devices was established. The developed point-of-care devices have potential as screening devices for antimicrobial resistance.

Colorimetric Urinalysis for On-Site Detection of Metabolic Biomarkers

Over the past few decades, colorimetric assays have been developed for cost-effective and rapid on-site urinalysis. Most of these assays were employed for detection of biomarkers such as glucose, uric acid, ions, and albumin that are abundant in urine at micromolar to millimolar levels. In contrast, direct assaying of urinary biomarkers such as glycated proteins, low-molecular-weight reactive oxygen species, and nucleic acids that are present at significantly lower levels (nanomolar to picomolar) remain challenging due to the interferences from the urine sample matrix. State-of-the-art assays for detection of trace amounts of urinary biomarkers typically utilize time-consuming and equipment-dependent sample pretreatment or clean-up protocols prior to assaying, which limits their applicability for on-site analysis. Herein, we report a colorimetric assay for on-site detection of trace amount of generic biomarkers in urine without involving tedious sample pretreatment protocols. The detection strategy is based on monitoring the changes in optical properties of poly(3-(4-methyl-3'-thienyloxy)propyltriethylammonium bromide) upon interacting with an aptamer or a peptide nucleic acid in the presence and absence of target biomarkers of relevance for the diagnosis of metabolic complications and diabetes. As a proof of concept, this study demonstrates facile assaying of advanced glycation end products, 8-hydroxy-2'-deoxyguanosine and hepatitis B virus DNA in urine samples at clinically relevant concentrations, with limits of detection of ∼850 pM, ∼650 pM, and ∼ 1 nM, respectively. These analytes represent three distinct classes of biomarkers: (i) glycated proteins, (ii) low-molecular-weight reactive oxygen species, and (iii) nucleic acids. Hence, the proposed methodology is applicable for rapid detection of generic biomarkers in urine, without involving sophisticated equipment and skilled personnel, thereby enabling on-site urinalysis. At the end of the contribution, we discuss the opportunity to translate the homogeneous assay into a paper-based format.

Detection of renal biomarkers in chronic kidney disease using microfluidics: progress, challenges and opportunities

Chronic kidney disease (CKD) typically evolves over many years in a latent period without clinical signs, posing key challenges to detection at relatively early stages of the disease. Accurate and timely diagnosis of CKD enable effective management of the disease and may prevent further progression. However, long turn-around times of current testing methods combined with their relatively high cost due to the need for established laboratory infrastructure, specialized instrumentation and trained personnel are drawbacks for efficient assessment and monitoring of CKD, especially in underserved and resource-poor locations. Among the emerging clinical laboratory approaches, microfluidic technology has gained increasing attention over the last two decades due to the possibility of miniaturizing bioanalytical assays and instrumentation, thus potentially improving diagnostic performance. In this article, we review current developments related to the detection of CKD biomarkers using microfluidics. A general trend in this emerging area is the search for novel, sensitive biomarkers for early detection of CKD using technology that is improved by means of microfluidics. It is anticipated that these innovative approaches will be soon adopted and utilized in both clinical and point-of-care settings, leading to improvements in life quality of patients.

Current and emerging trends in point-of-care urinalysis tests

Introduction: The development of point-of-care testing (POCT) has made clinical diagnostics available, affordable, rapid, and easy to use since the 1990s.The significance of this platform rests on its potential to empower patients to monitor their own health status more frequently, in the convenience of their home, so that diseases can be diagnosed at the earliest possible time-point. Recent advances have expanded traditional formats such as qualitative or semi-quantitative dipsticks and lateral flow immunoassays to newer platforms such as microfluidics and paper-based assays where signals can be measured quantitatively using handheld devices.Areas covered: This review discusses: (1) working principles and operating mechanisms of both existing and emerging POCT platforms, (2) urine analytes measured using POCT in comparison to the laboratory or clinical 'gold standard,' and (3) limitations of existing POCT and expectations of emerging POCT in urinalysis.Expert opinion: Currently, a variety of biological samples such as urine, saliva, serum, plasma, and other fluids can be applied to POCT for quick diagnosis, especially in resource-limited settings. Emerging platforms will increasingly empower individuals to monitor their health status through frequent urine analysis even from their homes. The impact of these emerging technologies on healthcare is likely to be transformative.

Synthetic molecular recognition nanosensor paint for microalbuminuria

Microalbuminuria is an important clinical marker of several cardiovascular, metabolic, and other diseases such as diabetes, hypertension, atherosclerosis, and cancer. The accurate detection of microalbuminuria relies on albumin quantification in the urine, usually via an immunoturbidity assay; however, like many antibody-based assessments, this method may not be robust enough to function in global health applications, point-of-care assays, or wearable devices. Here, we develop an antibody-free approach using synthetic molecular recognition by constructing a polymer to mimic fatty acid binding to the albumin, informed by the albumin crystal structure. A single-walled carbon nanotube, encapsulated by the polymer, as the transduction element produces a hypsochromic (blue) shift in photoluminescence upon the binding of albumin in clinical urine samples. This complex, incorporated into an acrylic material, results in a nanosensor paint that enables the detection of microalbuminuria in patient samples and comprises a rapid point-of-care sensor robust enough to be deployed in resource-limited settings.

A cost-effective method for purification and characterization of human urinary albumin

We describe a simplified approach for the purification and characterization of urinary albumin, a key biomarker currently used for understanding the onset and prognosis of microalbuminuria. Urinary albumin was purified from human urine collected from diabetic kidney disease patients by using 2-stage tangential flow filtration process and set of column chromatography steps. The relative molecular mass of urinary albumin is 66,871 Da (SYNAPT G2 High Definition Mass Spectrometry System). Isolated urinary albumin was analyzed by SDS-PAGE, Western blotting, immunoelectrophoresis, Ouchterlony double-immunodiffusion, single radial immunodiffusion, size-exclusion HPLC and peptide mass fingerprint analysis. The size-exclusion HPLC elution profile of the purified urinary albumin was similar to that of a reference form of native albumin. Peptide mass fingerprint analysis of the purified urinary albumin yielded peptides that partially matched with known sequence of ALBU_HUMAN (P02768). This is the first report of purification and validation of immunochemically reactive form of urinary albumin from a large volume of urine of diabetic kidney disease patients. In this purification approach, the cost of the purified albumin is significantly lower.

Molecularly imprinted based surface plasmon resonance nanosensors for microalbumin detection

Human serum albumin (HSA) is a major blood plasma protein also found in urine where its existence may be a marker of some types of liver or kidney dysfunction. Herein, we fabricated a novel surface plasmon resonance (SPR) nanosensor for selective, sensitive, and label-free microalbumin detection both in aqueous and urine sample solutions. First, HSA-imprinted nanoparticles were synthesized, which consist of ethylene glycol dimethacrylate and N-methacryloyl-L-leucine methyl ester as a cross-linker and functional monomer. The nanoparticles were characterized by zeta-size and scanning electron microscope analyses and were dropped onto the SPR chip surface to make HSA sensitive nanosensor. Characterization studies of HSA-imprinted SPR chip were carried out by atomic force microscopy, Fourier-transform infrared spectroscopy, contact angle, and ellipsometer. The limit of detection and limit of quantification values of HSA-imprinted SPR nanosensor were calculated as 0.7 pM and 1.9 pM for the concentration range of 0.15-500 nM. Selectivity studies of HSA-imprinted SPR nanosensor were achieved with hemoglobin and transferrin proteins which were chosen as competitor molecules. HSA-imprinted SPR nanosensor was displayed highly selective and sensitive to HSA.

Benchmarking Smartphone Fluorescence-Based Microscopy with DNA Origami Nanobeads: Reducing the Gap toward Single-Molecule Sensitivity

Smartphone-based fluorescence microscopy has been rapidly developing over the last few years, enabling point-of-need detection of cells, bacteria, viruses, and biomarkers. These mobile microscopy devices are cost-effective, field-portable, and easy to use, and benefit from economies of scale. Recent developments in smartphone camera technology have improved their performance, getting closer to that of lab microscopes. Here, we report the use of DNA origami nanobeads with predefined numbers of fluorophores to quantify the sensitivity of a smartphone-based fluorescence microscope in terms of the minimum number of detectable molecules per diffraction-limited spot. With the brightness of a single dye molecule as a reference, we compare the performance of color and monochrome sensors embedded in state-of-the-art smartphones. Our results show that the monochrome sensor of a smartphone can achieve better sensitivity, with a detection limit of ∼10 fluorophores per spot. The use of DNA origami nanobeads to quantify the minimum number of detectable molecules of a sensor is broadly applicable to evaluate the sensitivity of various optical instruments.

Smartphone-based clinical diagnostics: towards democratization of evidence-based health care

Recent advancements in bioanalytical techniques have led to the development of novel and robust diagnostic approaches that hold promise for providing optimal patient treatment, guiding prevention programs and widening the scope of personalized medicine. However, these advanced diagnostic techniques are still complex, expensive and limited to centralized healthcare facilities or research laboratories. This significantly hinders the use of evidence-based diagnostics for resource-limited settings and the primary care, thus creating a gap between healthcare providers and patients, leaving these populations without access to precision and quality medicine. Smartphone-based imaging and sensing platforms are emerging as promising alternatives for bridging this gap and decentralizing diagnostic tests offering practical features such as portability, cost-effectiveness and connectivity. Moreover, towards simplifying and automating bioanalytical techniques, biosensors and lab-on-a-chip technologies have become essential to interface and integrate these assays, bringing together the high precision and sensitivity of diagnostic techniques with the connectivity and computational power of smartphones. Here, we provide an overview of the emerging field of clinical smartphone diagnostics and its contributing technologies, as well as their wide range of areas of application, which span from haematology to digital pathology and rapid infectious disease diagnostics.

From Point-of-Care Testing to eHealth Diagnostic Devices (eDiagnostics)

Point-of-care devices were originally designed to allow medical testing at or near the point of care by health-care professionals. Some point-of-care devices allow medical self-testing at home but cannot fully cover the growing diagnostic needs of eHealth systems that are under development in many countries. A number of easy-to-use, network-connected diagnostic devices for self-testing are needed to allow remote monitoring of patients' health. This Outlook highlights the essential characteristics of diagnostic devices for eHealth settings and indicates point-of-care technologies that may lead to the development of new devices. It also describes the most representative examples of simple-to-use, point-of-care devices that have been used for analysis of untreated biological samples.

A smartphone-based on-site nucleic acid testing platform at point-of-care settings

We developed a smartphone-based on-site nucleic acid testing (NAT) platform that can image and analyze lateral flow nucleic acid assays at point-of-care settings. An inexpensive add-on was devised to run lateral flow assays while providing homogeneous ambient light for imaging. In addition, an Android app with a user-friendly interface was developed for the result analysis and management. Linear color calibration is implemented inside the app to minimize the colorimetric reaction difference between smartphones. A relationship function between nucleic acid concentration and colorimetric reaction was established and evaluated by leave-one-out cross validation. The predicted concentration and true concentration showed a good agreement with an R-squared value of 0.96. This smartphone-based NAT platform can be used to diagnose infectious diseases and monitor disease progression, and assess treatment efficacy, especially for resource-limited settings.

A Passive Mixing Microfluidic Urinary Albumin Chip for Chronic Kidney Disease Assessment

Urinary albumin level is an important indicator of kidney damage in chronic kidney disease (CKD) but effective routine albumin detection tools are lacking. In this paper, we developed a low-cost and high accuracy microfluidic urinary albumin chip (UAL-Chip) to rapidly measure albumin in urine. The UAL-Chip offers three major features: (1) we incorporated a fluorescent reaction assay into the chip to improve the detection accuracy; (2) we constructed a passive and continuous mixing module in the chip that provides user-friendly operation and greater signal stability; (3) we applied a pressure-balancing strategy based on the immiscible oil coverage that achieves precise control of the sample-dye mixing ratio. We validated the UAL-Chip using both albumin standards and urine samples from 12 CKD patients and achieved an estimated limit of detection (LOD) of 5.2 μg/mL. The albumin levels in CKD patients' urine samples measured by UAL-Chip is consistent with the traditional well-plate measurements and clinical results. We foresee the potential of extending this passive and precise mixing platform to assess various disease biomarkers.

Design of a 3D printed compact interferometric system and required phone application for small angular measurements

A 3D printed smartphone based interferometric system is proposed, and its usability has been demonstrated by measuring small angular rotations. All necessary fringe processing and data analysis have been performed within the phone itself using custom designed application developed in an android platform. The main objective of the proposed work is to demonstrate the usability of modern smartphone and 3D printing technology for optical interferometric applications. The smartphone camera has been used to record the interference fringes which has been formed due to the change in the optical path difference (OPD) between light rays reflected from the top and bottom surface of a microscopic glass slide. The angular variation of the slide causes a detectable change in the OPD between the interfering beams which subsequently would cause a variation in the fringe pattern. By evaluating necessary interferometric parameters, small angular rotation can be computed within the smartphone application. With the designed smartphone based interferometric system, angular rotation as small as 0.02° can be measured accurately and reliably having a dynamic range of -3.68° to 3.68°. Due to the involvement of the smartphone as a platform for recording as well as onboard fringe processing, the designed interferometric system can be visualized as a truly field portable tool for different optical metrological applications.

Photonic crystal enhanced fluorescence immunoassay on diatom biosilica

Fluorescence biosensing is one of the most established biosensing methods, particularly fluorescence spectroscopy and microscopy. These are two highly sensitive techniques but require high-grade electronics and optics to achieve the desired sensitivity. Efforts have been made to implement these methods using consumer grade electronics and simple optical setups for applications such as point-of-care diagnostics, but the sensitivity inherently suffers. Sensing substrates, capable of enhancing fluorescence are thus needed to achieve high sensitivity for such applications. In this paper, we demonstrate a photonic crystal-enhanced fluorescence immunoassay biosensor using diatom biosilica, which consists of silica frustules with sub-100 nm periodic pores. Utilizing the enhanced local optical field, the Purcell effect and increased surface area from the diatom photonic crystals, we create ultrasensitive immunoassay biosensors that can significantly enhance fluorescence spectroscopy as well as fluorescence imaging. Using standard antibody-antigen-labeled antibody immunoassay protocol, we experimentally achieved 100× and 10× better detection limit with fluorescence spectroscopy and fluorescence imaging respectively. The limit of detection of the mouse IgG goes down to 10^-16 M (14 fg/mL) and 10^-15 M (140 fg/mL) for the two respective detection modalities, virtually sensing a single mouse IgG molecule on each diatom frustule. The effectively enhanced fluorescence imaging in conjunction with the simple hot-spot counting analysis method used in this paper proves the great potential of diatom fluorescence immunoassay for point-of-care biosensing.

Smartphone spectrometer for colorimetric biosensing

We report on a smartphone spectrometer for colorimetric biosensing applications. The spectrometer relies on a sample cell with an integrated grating substrate, and the smartphone's built-in light-emitting diode flash and camera. The feasibility of the smartphone spectrometer is demonstrated for detection of glucose and human cardiac troponin I, the latter in conjunction with peptide-functionalized gold nanoparticles.

Automated 3D-Printed Microfluidic Array for Rapid Nanomaterial-Enhanced Detection of Multiple Proteins

We report here the fabrication and validation of a novel 3D-printed, automated immunoarray to detect multiple proteins with ultralow detection limits. This low cost, miniature immunoarray employs electrochemiluminescent (ECL) detection measured with a CCD camera and employs touch-screen control of a micropump to facilitate automated use. The miniaturized array features prefilled reservoirs to deliver sample and reagents to a paper-thin pyrolytic graphite microwell detection chip to complete sandwich immunoassays. The detection chip achieves high sensitivity by using single-wall carbon nanotube-antibody conjugates in the microwells and employing massively labeled antibody-decorated RuBPY-silica nanoparticles to generate ECL. The total cost of an array is $0.65, and an eight-protein assay can be done in duplicate for $0.14 per protein with limits of detection (LOD) as low as 78-110 fg mL-1 in diluted serum. The electronic control system costs $210 in components. Utility of the automated immunoarray was demonstrated by detecting an eight-protein prostate cancer biomarker panel in human serum samples in 25 min. The system is well suited to future clinical and point-of-care diagnostic testing and could be used in resource-limited environments.

Single-Image-Referenced Colorimetric Water Quality Detection Using a Smartphone

In this paper, we present a smartphone platform for colorimetric water quality detection based on the use of built-in camera for capturing a single-use reference image. A custom-developed app processes this image for training and creates a reference model to be used later in real experimental conditions to calculate the concentration of the unknown solution. This platform has been tested on four different water quality colorimetric assays with various concentration levels, and results show that the presented platform provides approximately 100% accuracy for colorimetric assays with noticeable color difference. This portable, cost-effective, and user-friendly platform is promising for application in water quality monitoring.

Lab-on-chip technology for chronic disease diagnosis

Various types of chronic diseases (CD) are the leading causes of disability and death worldwide. While those diseases are chronic in nature, accurate and timely clinical decision making is critically required. Current diagnosis procedures are often lengthy and costly, which present a major bottleneck for effective CD healthcare. Rapid, reliable and low-cost diagnostic tools at point-of-care (PoC) are therefore on high demand. Owing to miniaturization, lab-on-chip (LoC) technology has high potential to enable improved biomedical applications in terms of low-cost, high-throughput, ease-of-operation and analysis. In this direction, research toward developing new LoC-based PoC systems for CD diagnosis is fast growing into an emerging area. Some studies in this area began to incorporate digital and mobile technologies. Here we review the recent developments of this area with the focus on chronic respiratory diseases (CRD), diabetes, and chronic kidney diseases (CKD). We conclude by discussing the challenges, opportunities and future perspectives of this field.

Miniaturized Sample Preparation and Rapid Detection of Arsenite in Contaminated Soil Using a Smartphone

Conventional methods for analyzing heavy metal contamination in soil and water generally require laboratory equipped instruments, complex procedures, skilled personnel and a significant amount of time. With the advancement in computing and multitasking performances, smartphone-based sensors potentially allow the transition of the laboratory-based analytical processes to field applicable, simple methods. In the present work, we demonstrate the novel miniaturized setup for simultaneous sample preparation and smartphone-based optical sensing of arsenic As(III) in the contaminated soil. Colorimetric detection protocol utilizing aptamers, gold nanoparticles and NaCl have been optimized and tested on the PDMS-chip to obtain the high sensitivity with the limit of detection of 0.71 ppm (in the sample) and a correlation coefficient of 0.98. The performance of the device is further demonstrated through the comparative analysis of arsenic-spiked soil samples with standard laboratory method, and a good agreement with a correlation coefficient of 0.9917 and the average difference of 0.37 ppm, are experimentally achieved. With the android application on the device to run the experiment, the whole process from sample preparation to detection is completed within 3 hours without the necessity of skilled personnel. The approximate cost of setup is estimated around 1 USD, weight 55 g. Therefore, the presented method offers the simple, rapid, portable and cost-effective means for onsite sensing of arsenic in soil. Combined with the geometric information inside the smartphones, the system will allow the monitoring of the contamination status of soils in a nation-wide manner.

Infectious pathogens meet point-of-care diagnostics

The field of point-of-care (POC) diagnostics provides the rapid diagnosis of infectious diseases which is essential and critical for improving the general public health in resource-limited settings. POC platforms offer many advantages for detection of various pathogens including portability, automation, speed, cost, and efficiency. In this review, we provide an overview of the recent trends for POC diagnostics of infectious diseases with focus on portable platforms. We review here the present status of POC platforms, emphasizing in period of the past three years, then extrapolate their advance into the future applications for diagnosis of infectious pathogens.

Mobile diagnostics: next-generation technologies forin vitrodiagnostics

The emergence of a wide range of applications of smartphones along with advances in ‘liquid biopsy’ has significantly propelled medical research particularly in the field ofin vitrodiagnostics (IVD).

A smart supramolecular device for the detection of t,t-muconic acid in urine

An indicator displacement assay is applied in the fluorescence detection of urinary t,t-muconic acid at the occupational level.