1
|
Rusanganwa V, Nzabahimana I, Evander M. Quality and resilience of clinical laboratories in Rwanda: a need for sustainable strategies. Glob Health Action 2024; 17:2358633. [PMID: 38828509 PMCID: PMC11149573 DOI: 10.1080/16549716.2024.2358633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Quality healthcare is a global priority, reliant on robust health systems for evidence-based medicine. Clinical laboratories are the backbone of quality healthcare facilitating diagnostics, treatment, patient monitoring, and disease surveillance. Their effectiveness depends on sustainable delivery of accurate test results. Although the Strengthening Laboratory Management Towards Accreditation (SLMTA) programme has enhanced laboratory quality in low-income countries, the long-term sustainability of this improvement remains uncertain. OBJECTIVE To explore the sustainability of quality performance in clinical laboratories in Rwanda following the conclusion of SLMTA. METHODS A quasi-experimental design was adopted, involving 47 laboratories divided into three groups with distinct interventions. While one group received continuous mentorship and annual assessments (group two), interventions for the other groups (groups one and three) ceased following the conclusion of SLMTA. SLMTA experts collected data for 10 years through assessments using WHO's StepwiseLaboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. Descriptive and t-test analyses were conducted for statistical evaluation. RESULTS Improvements in quality were noted between baseline and exit assessments across all laboratory groups (mean baseline: 35.3%, exit: 65.8%, p < 0.001). However, groups one and three experienced performance declines following SLMTA phase-out (mean group one: 64.6% in reference to 85.8%, p = 0.01; mean group three: 57.3% in reference to 64.7%, p < 0.001). In contrast, group two continued to enhance performance even years later (mean: 86.6%compared to 70.6%, p = 0.03). CONCLUSION A coordinated implementation of quality improvement plan that enables regular laboratory assessments to pinpoint and address the quality gaps is essential for sustaining quality services in clinical laboratories.
Collapse
Affiliation(s)
| | | | - Magnus Evander
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| |
Collapse
|
2
|
Storms SM, Shisler J, Nguyen TH, Zuckermann FA, Lowe JF. Lateral flow paired with RT-LAMP: A speedy solution for Influenza A virus detection in swine. Vet Microbiol 2024; 296:110174. [PMID: 38981201 DOI: 10.1016/j.vetmic.2024.110174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/31/2024] [Accepted: 07/03/2024] [Indexed: 07/11/2024]
Abstract
Influenza A Virus in swine (IAV-S) is a zoonotic pathogen that is nearly ubiquitous in commercial swine in the USA. Swine possess sialic acid receptors that allow co-infection of human and avian viruses with the potential of pandemic reassortment. We aimed to develop a fast and robust testing method for IAV-S detection on swine farms. Two primers of the RT-LAMP assay were labeled for use in a lateral flow readout. A commercially available lateral flow kit was used to read the amplicon product. With a runtime of ∼ 45 minutes, the limit of detection for the assay is comparable with an RT-qPCR Cq less than 35, with a sensitivity of 83.5 % and a specificity of 89.6 %. This assay allows veterinarians and producers with limited access to diagnostic services to perform and detect Matrix gene amplification on-site with low equipment costs. The time from sample collection to detection is less than one hour, making this method an accessible, convenient, and affordable tool to prevent the spread of zoonotic disease.
Collapse
Affiliation(s)
- Suzanna M Storms
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, 2001 South Lincoln Ave, Urbana, IL 61802, USA.
| | - Joanna Shisler
- Department of Microbiology, University of Illinois at Urbana-Champaign. Chemical and Life Sciences Laboratory, B103 CLSL, MC-110, S Goodwin Ave, Urbana, IL 61801, USA.
| | - Thanh H Nguyen
- Department of Civil Engineering, University of Illinois at Urbana-Champaign, 205 N Mathews Ave, Urbana, IL 61801, USA.
| | - Federico A Zuckermann
- Department of Pathobiology, University of Illinois at Urbana-Champaign, 2001 South Lincoln Ave, Urbana, IL 61802, USA.
| | - James F Lowe
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, 2001 South Lincoln Ave, Urbana, IL 61802, USA.
| |
Collapse
|
3
|
Pighi L, Negrini D, Henry BM, Salvagno GL, Lippi G. Urine dipstick for screening plasma glucose and bilirubin in low resource settings: a proof-of-concept study. ADVANCES IN LABORATORY MEDICINE 2023; 4:431-434. [PMID: 38106501 PMCID: PMC10724854 DOI: 10.1515/almed-2023-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/08/2023] [Indexed: 12/19/2023]
Abstract
Objectives The purpose of this proof-of-concept study was to investigate whether a commercially available urine dipstick may provide potentially useful information for screening plasma glucose and bilirubin in human plasma samples. Methods Glucose and bilirubin were assayed in 60 anonymized lithium-heparin residual plasma samples using the Roche COBAS 8000 or after pipetting 10 µL of plasma onto the pads of a commercial urine dipstick. Semiquantitative urine test results obtained with the dipstick were directly compared to paired test results obtained with COBAS. Results Median plasma glucose values between COBAS and dipstick were slightly different (5.8 vs. 5.6 mmol/L; p=0.040), while no significant difference was found in bilirubin values between COBAS and dipstick (11.2 vs. 8.6 μmol/L; p=0.090). The Spearman's correlation between COBAS and dipstick was 0.83 (95% CI, 0.73-0.90; p<0.001) for plasma glucose and 0.78 (95% CI, 0.66-0.87; p<0.001) for plasma bilirubin, respectively. Cumulative agreement between COBAS and dipstick was high for both glucose (88%; kappa statistic statistics, 0.75; 95% CI, 0.58-0.92; p<0.001) and bilirubin (88%; kappa statistics, 0.76; 95% CI, 0.60-0.92; p<0.001). Conclusions The results of this proof-of-concept study indicate that the commercial urine test strip used in our study provides acceptable performance for screening plasma glucose and bilirubin levels compared with reference laboratory assays.
Collapse
Affiliation(s)
- Laura Pighi
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| | - Davide Negrini
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| | - Brandon M. Henry
- Clinical Laboratory, Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Gian Luca Salvagno
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| |
Collapse
|
4
|
Pighi L, Negrini D, Henry BM, Salvagno GL, Lippi G. Uso de una tira reactiva paraorina en la evaluación de las concentraciones de glucosa y bilirrubina en plasma en entornos con recursos limitados: un estudio de prueba de concepto. ADVANCES IN LABORATORY MEDICINE 2023; 4:435-438. [PMID: 38106491 PMCID: PMC10724853 DOI: 10.1515/almed-2023-0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/08/2023] [Indexed: 12/19/2023]
Abstract
Objetivos El objetivo del presente estudio de prueba de concepto, era investigar si una tira reactiva comercial para orina aporta información potencialmente útil para la evaluación de glucosa y bilirrubina en muestras de plasma humano. Métodos Se determinaron las concentraciones de glucosa y bilirrubina en 60 muestras anonimizadas de plasma residual de heparina de litio, en un analizador Roche COBAS 8000 y en la tira reactiva comercial para orina, tras pipetear 10 µL de plasma, en las almohadillas que ésta incorpora. Se llevó a cabo una comparación directa entre los resultados semicuantitativos de la tira reactiva y los de las muestras pareadas obtenidos con el analizador COBAS. Resultados Se observaron leves diferencias entre el analizador COBAS y la tira reactiva en relación a la mediana de la concentración de glucosa (5,8 frente a 5,6 mmol/L, respectivamente; p=0,040). Por otro lado, no se observaron diferencias estadísticamente significativas en los valores de bilirrubina entre COBAS y la tira reactiva (11,2 frente a 8,6 μmol/L; p=0,090). El coeficiente de correlación de Spearman entre COBAS y la tira reactiva fue de 0,83 (IC 95 %, 0,73–0,90; p<0,001) para la glucosa en plasma, y 0,78 (IC 95 %, 0,66–0,87; p<0,001) para la bilirrubina en plasma. La concordancia acumulada entre COBAS y la tira reactiva fue alta tanto para la glucosa (88 %; coeficiente kappa, 0.75; IC 95 %, 0,58–0,92; p<0,001) como para la bilirrubina (88 %; coeficiente kappa, 0,76; IC 95 %, 0,60–0.92; p<0,001). Conclusiones Los resultados del estudio de prueba de concepto indican que la tira reactiva comercial para orina de nuestro estudio posee un rendimiento aceptable en la determinación de las concentraciones de glucosa y bilirrubina en plasma, en comparación con las pruebas analíticas de referencia.
Collapse
Affiliation(s)
- Laura Pighi
- Sección de bioquímica clínica y Facultad de Medicina, Universidad de Verona, Verona, Italia
| | - Davide Negrini
- Sección de bioquímica clínica y Facultad de Medicina, Universidad de Verona, Verona, Italia
| | - Brandon M. Henry
- Laboratorio clínico, División de nefrología e hipertensión, Hospital Pediátrico de, Cincinnati, OH, EE.UU.
| | - Gian Luca Salvagno
- Sección de bioquímica clínica y Facultad de Medicina, Universidad de Verona, Verona, Italia
| | - Giuseppe Lippi
- Sección de bioquímica clínica y Facultad de Medicina, Universidad de Verona, Verona, Italia
| |
Collapse
|
5
|
Geldsetzer P, Flores S, Flores B, Rogers AB, Chang AY. Healthcare provider-targeted mobile applications to diagnose, screen, or monitor communicable diseases of public health importance in low- and middle-income countries: A systematic review. PLOS DIGITAL HEALTH 2023; 2:e0000156. [PMID: 37801442 PMCID: PMC10558072 DOI: 10.1371/journal.pdig.0000156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/11/2023] [Indexed: 10/08/2023]
Abstract
Communicable diseases remain a leading cause of death and disability in low- and middle-income countries (LMICs). mHealth technologies carry considerable promise for managing these disorders within resource-poor settings, but many existing applications exclusively represent digital versions of existing guidelines or clinical calculators, communication facilitators, or patient self-management tools. We thus systematically searched PubMed, Web of Science, and Cochrane Central for studies published between January 2007 and October 2019 involving technologies that were mobile phone- or tablet-based; able to screen for, diagnose, or monitor a communicable disease of importance in LMICs; and targeted health professionals as primary users. We excluded technologies that digitized existing paper-based tools or facilitated communication (i.e., knowledge-based algorithms). Extracted data included disease category, pathogen type, diagnostic method, intervention purpose, study/target population, sample size, study methodology, development stage, accessory requirement, country of development, operating system, and cost. Given the search timeline, studies involving COVID-19 were not included in the analysis. Of 13,262 studies identified by the screen, 33 met inclusion criteria. 12% were randomized clinical trials (RCTs), with 58% of publications representing technical descriptions. 62% of studies had 100 or fewer subjects. All studied technologies involved diagnosis or screening steps; none addressed the monitoring of infections. 52% focused on priority diseases (HIV, malaria, tuberculosis), but only 12% addressed a neglected tropical disease. Although most reported studies were priced under 20USD at time of publication, two thirds of the records did not yet specify a cost for the study technology. We conclude that there are only a small number of mHealth technologies focusing on innovative methods of screening and diagnosing communicable diseases potentially of use in LMICs. Rigorous RCTs, analyses with large sample size, and technologies assisting in the monitoring of diseases are needed.
Collapse
Affiliation(s)
- Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University; Stanford, California; United States of America
- Chan Zuckerberg Biohub; San Francisco, California; United States of America
- Center for Innovation in Global Health, Stanford University; Stanford, California; United States of America
| | - Sergio Flores
- Department of Public Health and Caring Sciences, Uppsala University; Sweden
| | | | - Abu Bakarr Rogers
- Stanford University School of Medicine; Stanford, California; United States of America
| | - Andrew Y. Chang
- Center for Innovation in Global Health, Stanford University; Stanford, California; United States of America
- Department of Epidemiology and Population Health, Stanford University; Stanford, California; United States of America
- Stanford Cardiovascular Institute, Stanford University; Stanford, California; United States of America
| |
Collapse
|
6
|
Ahamed R, Ahmed I, Bari LF, Dewan SMR. An observation: Could the spread of Adenovirus in South Asia pose a hazard to global public health? Health Sci Rep 2023; 6:e1567. [PMID: 37711675 PMCID: PMC10497803 DOI: 10.1002/hsr2.1567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/15/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023] Open
Abstract
Background One of the most pressing issues in healthcare today is the prevention of Adenovirus (AdV) infections. Children and the elderly, both of whom have weaker immune systems than healthy adults, are more vulnerable to infection. Discussion India has been the epicenter of a recent AdV epidemic in the South Asian area. Most of the nations, bordering India are still developing and have very low per capita incomes, yet their citizens often cross into India for trade, medical care, and vacation. Conclusion We are concerned that an epidemic of the AdV might occur in the Indian subcontinent, spread to other nations, and eventually affect the whole world if effective preventative and diagnostic measures are not taken.
Collapse
Affiliation(s)
- Rayhan Ahamed
- Department of Pharmacy, School of MedicineUniversity of Asia PacificDhakaBangladesh
| | - Iftekhar Ahmed
- Department of Pharmacy, School of MedicineUniversity of Asia PacificDhakaBangladesh
| | - Lazima Faiah Bari
- Department of Pharmacy, School of MedicineUniversity of Asia PacificDhakaBangladesh
| | | |
Collapse
|
7
|
Kumar P, Ahmad S, Kumar S, K G N, Kumar P, Kumar N, Pandey S. Situational Analysis of Healthcare and Medical Diagnostic Testing Facility Availability in Selected Blocks of Muzaffarpur District, Bihar, India: A Cross-Sectional Study. Cureus 2023; 15:e46037. [PMID: 37900506 PMCID: PMC10603600 DOI: 10.7759/cureus.46037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION This study presents a comprehensive assessment of healthcare facilities, focusing on workforce composition, operational dynamics, diagnostic laboratory services, and accessibility considerations. The comparison between government and private healthcare sectors provides insights into service delivery and potential disparities. The study's rationale, objectives, and methodology are explored in the context of the Indian healthcare landscape. METHODS A cross-sectional analysis was conducted in Muzaffarpur district, Bihar, targeting selected urban and rural blocks. The study employed geolocation data to analyze accessibility to healthcare facilities. Data collection involved on-site visits, structured questionnaires, and consultation of the Indian Council of Medical Research (ICMR)'s framework. The assessment concentrated on the availability of tests offered by the LaBike platform, and workforce compositions were compared. RESULTS Government healthcare facilities exhibited a balanced distribution of doctors, nurses, and grassroot workers, reflecting comprehensive healthcare provisions. Private facilities, although featuring moderate doctor and nurse presence, lacked grassroot workers. Diagnostic test prevalence was evident, with core tests, such as CBC and blood glucose, available in over 85% of facilities. Government facilities provided tests free of charge, while private facilities showcased a diverse cost spectrum. Proposed interventions received strong support from both sectors, indicating the potential for innovative healthcare solutions. Accessibility analysis: Urban intervention and control sites demonstrated comparable accessibility, with facilities located within 2 km. In rural intervention and control sites, distances varied significantly. Mushahari, a rural intervention site, required participants to travel 6 km to the nearest facility, impacting healthcare access. By contrast, Marwan, a rural control site, featured a shorter distance of 3 km. CONCLUSION This study's comprehensive evaluation of healthcare facilities offers valuable insights into workforce dynamics, diagnostic services, and healthcare interventions in the context of government and private sectors. The findings underscore the significance of addressing workforce gaps and promoting equitable access to diagnostics. By informing evidence-based decision-making, this study contributes to the optimization of healthcare service delivery, aiming to enhance healthcare quality and accessibility for all.
Collapse
Affiliation(s)
- Pragya Kumar
- Community and Family Medicine, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Shamshad Ahmad
- Community and Family Medicine, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Saurabh Kumar
- Epidemiology and Public Health, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Naveen K G
- Community and Family Medicine, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Purushottam Kumar
- Community and Family Medicine, Maharshi Devraha Baba Medical College, Deoria, Patna, IND
| | - Neeta Kumar
- Epidemiology and Public Health, Indian Council of Medical Research, New Delhi, IND
| | - Sanjay Pandey
- Community and Family Medicine, All India Institute of Medical Sciences, Patna, Patna, IND
| |
Collapse
|
8
|
RT-LAMP as Diagnostic Tool for Influenza—A Virus Detection in Swine. Vet Sci 2023; 10:vetsci10030220. [PMID: 36977259 PMCID: PMC10051247 DOI: 10.3390/vetsci10030220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
Point-of-care diagnostic technologies are becoming more widely available for production species. Here, we describe the application of reverse transcription loop-mediated isothermal amplification (RT-LAMP) to detect the matrix (M) gene of influenza A virus in swine (IAV-S). M-specific LAMP primers were designed based on M gene sequences from IAV-S isolated in the USA between 2017 and 2020. The LAMP assay was incubated at 65 °C for 30 min, with the fluorescent signal read every 20 s. The assay’s limit of detection (LOD) was 20 M gene copies for direct LAMP of the matrix gene standard, and 100 M gene copies when using spiked extraction kits. The LOD was 1000 M genes when using cell culture samples. Detection in clinical samples showed a sensitivity of 94.3% and a specificity of 94.9%. These results show that the influenza M gene RT-LAMP assay can detect the presence of IAV in research laboratory conditions. With the appropriate fluorescent reader and heat block, the assay could be quickly validated as a low-cost, rapid, IAV-S screening tool for use on farms or in clinical diagnostic labs.
Collapse
|
9
|
Beck S, Shin D, Kim SJ, Hedde PN, Zhao W. Digital Protein Detection in Bulk Solutions. ACS OMEGA 2022; 7:37714-37723. [PMID: 36312374 PMCID: PMC9608401 DOI: 10.1021/acsomega.2c04666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
Quick and accurate molecular diagnostics in protein detection can greatly benefit medicine in disease diagnosis and lead to positive patient outcomes. However, specialized equipment used in clinical laboratories often comes with trade-offs between operation and function serving a single role for very specific needs. For example, to achieve high analytical sensitivity and specificity, instruments such as high-performance liquid chromatography and/or liquid chromatography-mass spectrometry use a complex instrument design and require thorough training of the users. On the other hand, simple tests such as protein detection in urinary tract infection using dip-stick assays provide very quick results but suffer from poor analytical sensitivity. Here, we present an application study for the 3D particle counter technology, which is based on optical confocal detection in order to scan large sample volumes (0.5-3 mL) in glass cuvettes, that aims to close the gap between analytical sensitivity and turnover assay time and simplify protein detection by adopting bead-based immunoassays. Combining the 3D particle counter technology with bead-based immunoassays, a subpicomolar limit of detection-ranging from 119 to 346 fM-was achieved within 3.5-hour assay time for recombinant mouse interleukin 6 detection. As an alternative instrument to a flow cytometer, the 3D particle counter takes advantages of bead-based immunoassays and provides unique accessibility and flexibility for users.
Collapse
Affiliation(s)
- Sungjun Beck
- Department
of Biological Chemistry, University of California,
Irvine, Irvine, California 92697, United States
| | - Donghae Shin
- Department
of Biological Chemistry, University of California,
Irvine, Irvine, California 92697, United States
| | - Sun Jin Kim
- Department
of Pharmaceutical Sciences, University of
California, Irvine, Irvine, California 92697, United States
| | - Per Niklas Hedde
- Department
of Pharmaceutical Sciences, University of
California, Irvine, Irvine, California 92697, United States
- Laboratory
for Fluorescence Dynamics, University of
California, Irvine, Irvine, California 92697, United States
- Beckman
Laser Institute & Medical Clinic, University
of California, Irvine, Irvine, California 92697, United States
| | - Weian Zhao
- Department
of Biological Chemistry, University of California,
Irvine, Irvine, California 92697, United States
- Department
of Pharmaceutical Sciences, University of
California, Irvine, Irvine, California 92697, United States
- Institute
for Immunology, University of California,
Irvine, Irvine, California 92697, United States
- Sue and Bill
Gross Stem Cell Research Center, University
of California, Irvine, Irvine, California 92697, United States
- Chao
Family Comprehensive Cancer Center, University
of California, Irvine, Irvine, California 92697, United States
- Edwards
Life Sciences Center for Advanced Cardiovascular Technology, University of California, Irvine, Irvine, California 92697, United States
- Department
of Biomedical Engineering, University of
California, Irvine, Irvine, California 92697, United States
| |
Collapse
|
10
|
Advancements in Skin Delivery of Natural Bioactive Products for Wound Management: A Brief Review of Two Decades. Pharmaceutics 2022; 14:pharmaceutics14051072. [PMID: 35631658 PMCID: PMC9143175 DOI: 10.3390/pharmaceutics14051072] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/25/2022] [Accepted: 05/13/2022] [Indexed: 02/06/2023] Open
Abstract
Application of modern delivery techniques to natural bioactive products improves their permeability, bioavailability, and therapeutic efficacy. Many natural products have desirable biological properties applicable to wound healing but are limited by their inability to cross the stratum corneum to access the wound. Over the past two decades, modern systems such as microneedles, lipid-based vesicles, hydrogels, composite dressings, and responsive formulations have been applied to natural products such as curcumin or aloe vera to improve their delivery and efficacy. This article reviews which natural products and techniques have been formulated together in the past two decades and the success of these applications for wound healing. Many cultures prefer natural-product-based traditional therapies which are often cheaper and more available than their synthetic counterparts. Improving natural products’ effect can provide novel wound-healing therapies for those who trust traditional compounds over synthetic drugs to reduce medical inequalities.
Collapse
|
11
|
Hybrid 3D printed integrated microdevice for the determination of copper ions in human body fluids. Anal Bioanal Chem 2022; 414:4047-4057. [PMID: 35396610 PMCID: PMC8993678 DOI: 10.1007/s00216-022-04049-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 12/29/2022]
Abstract
On-site screening of copper ions in body fluid plays a critical role in monitoring human health, especially in heavy pollution areas. In this study, we have developed a hybrid 3D printed integrated microdevice for the determination of copper ions in human body fluids. A fixed and low volume of sample was detected by using the integrated microdevice without any preprocessing. The hybrid channel enables sample uniform mixing and quantitative dilution with buffer solution by inducing the “horseshoe vortex” phenomenon. The electrolytic microcell based on the flow detection system shows a more effective copper ion reaction ratio and, as a result, a better sensitivity. The simulation of the finite element method (FEM) determined the relevant optimum parameters of the hybrid channel and the microcell. The design, fabrication, and detection procedure of the integrated microdevice are here illustrated. The microdevice presented superior detection properties towards copper ions. The calibration curves covered two linear ranges varying from 20 to 100 ppb and 100 to 400 ppb, respectively. The limit of detection was estimated to be 15 ppb (S/N = 3). The relative standard deviation of the peak current measurements was 2.26%. The designed microdevice was further applied to detect copper ions in practical samples (calf serum sample and synthetic human urine sample) using a standard addition method, and the average recovery was found to be 95–104%. The performance of copper ion detection with the integrated microdevice was consistent with that of the inductively coupled plasma mass spectrometry (ICP-MS) in the same practical samples, demonstrating significant practicality in the test of body fluidics. The portable integrated microdevice is an excellent choice for on-site detection and has a promising prospect in the point-of-care testing (POCT) applications.
Collapse
|
12
|
Luka G, Samiei E, Tasnim N, Dalili A, Najjaran H, Hoorfar M. Comprehensive review of conventional and state-of-the-art detection methods of Cryptosporidium. JOURNAL OF HAZARDOUS MATERIALS 2022; 421:126714. [PMID: 34325293 DOI: 10.1016/j.jhazmat.2021.126714] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/06/2021] [Accepted: 07/19/2021] [Indexed: 06/13/2023]
Abstract
Cryptosporidium is a critical waterborne protozoan pathogen found in water resources that have been a major cause of death and serious illnesses worldwide, costing millions of dollars annually for its detection and treatment. Over the past several decades, substantial efforts have been made towards developing techniques for the detection of Cryptosporidium. Early diagnostic techniques were established based on the existing tools in laboratories, such as microscopes. Advancements in fluorescence microscopy, immunological, and molecular techniques have led to the development of several kits for the detection of Cryptosporidium spp. However, these methods have several limitations, such as long processing times, large sample volumes, the requirement for bulky and expensive laboratory tools, and the high cost of reagents. There is an urgent need to improve these existing techniques and develop low-cost, portable and rapid detection tools for applications in the water quality industry. In this review, we compare recent advances in nanotechnology, biosensing and microfluidics that have facilitated the development of sophisticated tools for the detection of Cryptosporidium spp.Finally, we highlight the advantages and disadvantages, of these state-of-the-art detection methods compared to current analytical methodologies and discuss the need for future developments to improve such methods for detecting Cryptosporidium in the water supply chain to enable real-time and on-site monitoring in water resources and remote areas.
Collapse
Affiliation(s)
- George Luka
- School of Engineering, University of British Columbia, 3333 University Way, Kelowna, BC V1V1V7, Canada.
| | - Ehsan Samiei
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, ON M5S 3G8, Canada.
| | - Nishat Tasnim
- School of Engineering, University of British Columbia, 3333 University Way, Kelowna, BC V1V1V7, Canada.
| | - Arash Dalili
- School of Engineering, University of British Columbia, 3333 University Way, Kelowna, BC V1V1V7, Canada.
| | - Homayoun Najjaran
- School of Engineering, University of British Columbia, 3333 University Way, Kelowna, BC V1V1V7, Canada.
| | - Mina Hoorfar
- School of Engineering, University of British Columbia, 3333 University Way, Kelowna, BC V1V1V7, Canada.
| |
Collapse
|
13
|
Colucci G, Uceda Renteria S, Ceriotti F, Lampertico P. Clinical Evaluation of Plasma Separation Cards as a Tool to Collect, Store, and Test Blood Samples for Hepatitis B and C Serological Markers. Clin Chem 2021; 68:214-217. [PMID: 34969104 DOI: 10.1093/clinchem/hvab170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/16/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND The plasma separation card (PSC) is a new device for collecting finger-pricking-derived small amount of blood in a solid support that is stable at room temperature and can be archived, mailed, and processed at a later time. This tool can facilitate screening at risk populations located in rural areas without local health care infrastructures. We evaluated the performance of PSC in the collection and preparation of blood samples for the determination of hepatitis B and C serological markers. METHODS Blood obtained from 334 consecutive patients referred for the detection of hepatitis B surface antigens (HBsAg), hepatitis B surface antibodies (anti-HBs) and hepatitis C antibodies (anti-HCV) was analyzed in parallel using standard (STD) and PSC-based sample collection and preparation procedures. Results obtained from STD or PSC processed samples were compared for their detection rate and correlation. RESULTS Using STD, we detected 5 samples positive for HBsAg, 150 for anti-HBs, and 23 for anti-HCV with a rate of concordance with PSC of 100%, 100%, and 91% respectively. The 100% concordance observed for anti-HBs was based on a cutoff of 2.6 IU/L for PSC-derived sample corresponding to the 10 IU/L threshold associated with immunity to hepatitis B. STD and PSC showed a good correlation (R2 = 0.85) in the detection of anti-HBs titers. The 2 anti-HCV PSC negative samples had no detectable viremia. CONCLUSIONS These data confirm the utility of PSC as a tool to support viral hepatitis screening programs in rural areas lacking local clinical infrastructures and testing facilities.
Collapse
Affiliation(s)
- Giuseppe Colucci
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Uceda Renteria
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Laboratory, Virology Unit, Milan, Italy
| | - Ferruccio Ceriotti
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Laboratory, Virology Unit, Milan, Italy
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- CRC "A. M. and A. Migliavacca" Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| |
Collapse
|
14
|
Pulingam T, Parumasivam T, Gazzali AM, Sulaiman AM, Chee JY, Lakshmanan M, Chin CF, Sudesh K. Antimicrobial resistance: Prevalence, economic burden, mechanisms of resistance and strategies to overcome. Eur J Pharm Sci 2021; 170:106103. [PMID: 34936936 DOI: 10.1016/j.ejps.2021.106103] [Citation(s) in RCA: 143] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/25/2021] [Accepted: 12/17/2021] [Indexed: 12/13/2022]
Abstract
Antibiotic resistance is a major health concern globally and has been estimated to cause 10 million deaths worldwide by year 2050 if the current trend of inappropriate and excessive use of antibiotics continues. Although, the discovery of antibiotics has saved countless of lives for the past 80 years, increasing levels of bacterial resistance to antibiotics would jeopardize the progress in clinical and agricultural sectors and may cause life-threatening situations even for previously treatable bacterial infections. Antibiotic resistance would increase the levels of poverty of low-middle income countries mostly due to extended hospital stays, higher cost of treatment and untimely deaths that directly affect the total productivity rate. Recent incidences of antibiotic resistance have been gradually increasing globally and this may potentiate horizontal transmission of the resistant gene and have been linked with cross-resistance to other antibiotic families as well. This review summarizes the global burden of antibiotic resistance from the economic viewpoint, highlights the recent incidences of antibiotic resistance mainly related to Escherichia coli, Acinetobacter baumannii, Klebsiella pneumoniae, Salmonella spp. and Staphylococcus aureus, describes the common mechanistic actions of antibiotic resistance and potential strategies to overcome antibiotic resistance.
Collapse
Affiliation(s)
- Thiruchelvi Pulingam
- School of Biological Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia
| | | | - Amirah Mohd Gazzali
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia
| | | | - Jiun Yee Chee
- School of Biological Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Manoj Lakshmanan
- School of Biological Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia; USM-RIKEN Centre for Aging Science (URICAS), Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Chai Fung Chin
- School of Biological Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Kumar Sudesh
- School of Biological Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia; USM-RIKEN Centre for Aging Science (URICAS), Universiti Sains Malaysia, Penang 11800, Malaysia.
| |
Collapse
|
15
|
Abstract
More than 60 years ago, Richard Feynman gave a lecture titled "There's Plenty of Room at the Bottom: An Invitation to Enter a New Field of Physics", where he called on others to join the then-nascent field of nanotechnology. In a similar spirit, we wish to invite chemists, biologists, physicists, bioengineers, educators, high school students, and inventors of all backgrounds to join us in the emerging field of frugal science. In this Review, we define frugal science and use six case studies to describe the broad applications of frugal science, from synthetic biology to disease diagnostics. We conclude by establishing an argument for curiosity-driven research through frugal science to enable broader access in chemical and bioengineering research and drive innovation.
Collapse
Affiliation(s)
- Gaurav Byagathvalli
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Elio J Challita
- Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia 30311, United States
| | - M Saad Bhamla
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| |
Collapse
|
16
|
New microfluidic paper-based analytical device for iron determination in urine samples. Anal Bioanal Chem 2021; 413:7463-7472. [PMID: 34654951 DOI: 10.1007/s00216-021-03706-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
Iron is an important micronutrient involved in several mechanisms in the human body and can be an important biomarker. In this work, a simple and disposable microfluidic paper-based analytical device (µPAD) was developed for the quantification of iron in urine samples. The detection was based on the colorimetric reaction between iron(II) and bathophenanthroline and the reduction of iron(III) to iron(II) with hydroxylamine. The developed µPAD enabled iron determination in the range 0.07-1.2 mg/L, with a limit of detection of 20 µg/L and a limit of quantification of 65 µg/L, thus suitable for the expected values in human urine. Additionally, targeting urine samples, the potential interference of the samples color was overcome by incorporating a sample blank assessment for absorbance subtraction. Stability studies revealed that the device was stable for 15 days prior to usage and that the formed colored product was stable for scanning up to 3 h. The accuracy of the developed device was established by analyzing urine samples (#26) with the developed µPAD and with the atomic absorption spectrometry method; the relative deviation between the two sets of results was below 9.5%.
Collapse
|
17
|
Jiang N, Tansukawat ND, Gonzalez-Macia L, Ates HC, Dincer C, Güder F, Tasoglu S, Yetisen AK. Low-Cost Optical Assays for Point-of-Care Diagnosis in Resource-Limited Settings. ACS Sens 2021; 6:2108-2124. [PMID: 34076428 DOI: 10.1021/acssensors.1c00669] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Readily deployable, low-cost point-of-care medical devices such as lateral flow assays (LFAs), microfluidic paper-based analytical devices (μPADs), and microfluidic thread-based analytical devices (μTADs) are urgently needed in resource-poor settings. Governed by the ASSURED criteria (affordable, sensitive, specific, user-friendly, rapid and robust, equipment-free, and deliverability) set by the World Health Organization, these reliable platforms can screen a myriad of chemical and biological analytes including viruses, bacteria, proteins, electrolytes, and narcotics. The Ebola epidemic in 2014 and the ongoing pandemic of SARS-CoV-2 have exemplified the ever-increasing importance of timely diagnostics to limit the spread of diseases. This review provides a comprehensive survey of LFAs, μPADs, and μTADs that can be deployed in resource-limited settings. The subsequent commercialization of these technologies will benefit the public health, especially in areas where access to healthcare is limited.
Collapse
Affiliation(s)
- Nan Jiang
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China
- Department of Chemical Engineering, Imperial College London, London SW7 2AZ, United Kingdom
| | - Natha Dean Tansukawat
- Department of Chemical Engineering, Imperial College London, London SW7 2AZ, United Kingdom
| | - Laura Gonzalez-Macia
- Department of Bioengineering, Imperial College London, London SW7 2AZ, United Kingdom
| | - H. Ceren Ates
- Freiburg Center for Interactive Materials and Bioinspired Technologies (FIT), University of Freiburg, Freiburg 79110, Germany
- Department of Microsystems Engineering (IMTEK), Laboratory for Sensors, University of Freiburg, Freiburg 79110, Germany
| | - Can Dincer
- Freiburg Center for Interactive Materials and Bioinspired Technologies (FIT), University of Freiburg, Freiburg 79110, Germany
- Department of Microsystems Engineering (IMTEK), Laboratory for Sensors, University of Freiburg, Freiburg 79110, Germany
| | - Firat Güder
- Department of Bioengineering, Imperial College London, London SW7 2AZ, United Kingdom
| | - Savas Tasoglu
- Department of Mechanical Engineering, Koc University, Sariyer, Istanbul 34450, Turkey
| | - Ali K. Yetisen
- Department of Chemical Engineering, Imperial College London, London SW7 2AZ, United Kingdom
| |
Collapse
|
18
|
Naseri M, Ziora ZM, Simon GP, Batchelor W. ASSURED‐compliant point‐of‐care diagnostics for the detection of human viral infections. Rev Med Virol 2021. [DOI: 10.1002/rmv.2263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Mahdi Naseri
- Department of Chemical Engineering Bioresource Processing Research Institute of Australia (BioPRIA) Monash University Clayton VIC Australia
| | - Zyta M Ziora
- Institute for Molecular Bioscience The University of Queensland St Lucia QLD Australia
| | - George P Simon
- Department of Materials Science and Engineering Monash University Clayton VIC Australia
| | - Warren Batchelor
- Department of Chemical Engineering Bioresource Processing Research Institute of Australia (BioPRIA) Monash University Clayton VIC Australia
| |
Collapse
|
19
|
Novel microfluidic paper-based analytical devices (μPADs) for the determination of nitrate and nitrite in human saliva. Talanta 2020; 219:121183. [DOI: 10.1016/j.talanta.2020.121183] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/14/2020] [Accepted: 05/16/2020] [Indexed: 12/15/2022]
|
20
|
Engel N, Wolffs PFG. Aligning diagnostics to the point-of-care: lessons for innovators, evaluators and decision-makers from tuberculosis and HIV. BMJ Glob Health 2020; 5:e003457. [PMID: 33208314 PMCID: PMC7677375 DOI: 10.1136/bmjgh-2020-003457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 11/18/2022] Open
Abstract
Diagnostics, including those that work at point-of-care, are an essential part of successful public health responses to infectious diseases and pandemics. Yet, they are not always used or fit intended use settings. This paper reports on key insights from a qualitative study on how those engaged with developing and implementing new point-of-care (POC) diagnostics for tuberculosis (TB) and HIV ensure these technologies work at POC. Ethnographic fieldwork between 2015 and 2017 consisting of 53 semistructured interviews with global stakeholders and visits to workshops, companies, and conferences was combined with 15 semistructured interviews with stakeholders in India including providers, decision-makers, scientists and developers and visits to companies, clinics and laboratories. Our results show how developers and implementer of HIV and TB POC diagnostics aim to know and align their diagnostics to elements in more settings than just intended use, but also the setting of the developer, the global intermediaries, the bug/disease and the competitor. Actors and elements across these five settings define what a good diagnostic is, yet their needs might conflict or change and they are difficult to access. Aligning diagnostics to the POC requires continuous needs assessment throughout development and implementation phases as well as substantive, ongoing investment in relationships with users. The flexibility required for such continuous realigning and iteration clashes with established evaluation procedures and business models in global health and risks favouring certain products over others. The paper concludes with suggestions to strengthen this alignment work and applies this framework to research needs in the wake of COVID-19.
Collapse
Affiliation(s)
- Nora Engel
- Health, Ethics & Society/Care and Public Health Research Institute, Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
| | - Petra F G Wolffs
- Department of Medical Microbiology, Care and Public Health Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
| |
Collapse
|
21
|
Lu HW, Sakamuri R, Kumar P, Ferguson TM, Doebler RW, Herrington KD, Talbot RP, Weigel KM, Nguyen FK, Cangelosi GA, Narita M, Boyle DS, Niemz A. Integrated nucleic acid testing system to enable TB diagnosis in peripheral settings. LAB ON A CHIP 2020; 20:4071-4081. [PMID: 33021611 PMCID: PMC7787164 DOI: 10.1039/d0lc00445f] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
To facilitate treatment and limit transmission of tuberculosis (TB), new methods are needed to enable rapid and affordable diagnosis of the disease in high-burden low-resource settings. We have developed a prototype integrated nucleic acid testing device to detect Mycobacterium tuberculosis (M.tb) in sputum. The device consists of a disposable cartridge and compact, inexpensive instrument that automates pathogen lysis, nucleic acid extraction, isothermal DNA amplification and lateral flow detection. A liquefied and disinfected sputum sample is manually injected into the cartridge, and all other steps are automated, with a result provided in <1.5 h. Cell disruption and DNA extraction is executed within a four-port active valve containing a miniature bead blender (based on PureLyse® technology, Claremont BioSolutions LLC). The DNA-containing eluate is combined with dry master-mix reagents and target DNA is isothermally amplified. Amplified master-mix is then pumped into a lateral flow strip chamber for detection. The entire process is performed in a single-use closed-system cartridge to prevent amplicon carryover. For testing of M.tb-spiked sputum the system provided a limit of detection of 5 × 103 colony forming units (CFU) per mL. None of the negative sputum-only controls yielded a false-positive result. Testing of 45 clinical sputum specimens from TB cases and controls relative to a validated manual qPCR-based comparator method revealed a preliminary sensitivity of 90% and specificity of 96%. With further development, the herein described integrated nucleic acid testing device can enable TB diagnosis and treatment initiation in the same clinical encounter in near-patient low-resource settings of high TB burden countries.
Collapse
Affiliation(s)
- Hsiang-Wei Lu
- Riggs School of Applied Life Sciences, Keck Graduate Institute, 535 Watson Drive, Claremont, CA 91711, USA.
| | - Rama Sakamuri
- Riggs School of Applied Life Sciences, Keck Graduate Institute, 535 Watson Drive, Claremont, CA 91711, USA.
| | - Pranav Kumar
- Riggs School of Applied Life Sciences, Keck Graduate Institute, 535 Watson Drive, Claremont, CA 91711, USA.
| | - Tanya M Ferguson
- Claremont BioSolutions, 1182 Monte Vista Ave # 11, Upland, CA 91786, USA
| | - Robert W Doebler
- Claremont BioSolutions, 1182 Monte Vista Ave # 11, Upland, CA 91786, USA
| | - Keith D Herrington
- Claremont BioSolutions, 1182 Monte Vista Ave # 11, Upland, CA 91786, USA
| | - Ryan P Talbot
- Claremont BioSolutions, 1182 Monte Vista Ave # 11, Upland, CA 91786, USA
| | - Kris M Weigel
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA
| | - Felicia K Nguyen
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA
| | - Gerard A Cangelosi
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA
| | - Masahiro Narita
- Seattle & King County Tuberculosis Control Clinic, Harborview Medical Center, 325 9th Ave, Seattle, WA 98104, USA
| | | | - Angelika Niemz
- Riggs School of Applied Life Sciences, Keck Graduate Institute, 535 Watson Drive, Claremont, CA 91711, USA.
| |
Collapse
|
22
|
Bengtson M, Bharadwaj M, Bosch AT, Nyakundi H, Matoke-Muhia D, Dekker C, Diehl JC. Matching Development of Point-of-Care Diagnostic Tests to the Local Context: A Case Study of Visceral Leishmaniasis in Kenya and Uganda. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:549-565. [PMID: 33008863 PMCID: PMC7541118 DOI: 10.9745/ghsp-d-20-00028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 08/11/2020] [Indexed: 01/18/2023]
Abstract
We provide a new protocol to connect how findings from field research on the local health care setting in resource-limited regions can inform researchers that are working toward developing a new point-of-care diagnostic test for neglected tropical diseases. The rapid growth of point-of-care (POC) diagnostic tests necessitates a clear vision of when, where, and why a new POC diagnostic test needs to be developed and how it can be used in a way that matches a local health care context. Here, we present an innovative approach toward developing a concept target product profile (CTPP), which is a new mapping tool that helps researchers match a new diagnostic test to a specific local health care context early in the research and development process. As a case study, we focus on the diagnosis of visceral leishmaniasis (VL) in rural resource-limited regions of Kenya and Uganda. Our stepwise approach integrates elements of design thinking and uses a combination of literature reviews and field research for a context analysis of local health care systems and practices. We then use visual thinking in the form of Gigamaps and patient journeys to identify use case scenarios and to present our findings from the field research to key stakeholders. The use case scenarios describe the diagnostic scope of a new POC test based on the feasibility of the new test, the local need, and the contextual fit. For our case study of VL, we identify 2 valuable use case scenarios, namely test-of-cure and screening and confirmation, and we formulate a CTPP. We anticipate that a CTPP will enable researchers to match a new POC diagnostic test during the research and development process to the local health care context in which it will be used.
Collapse
Affiliation(s)
- Michel Bengtson
- Department of Bionanoscience, Kavli Institute of Nanoscience Delft, Delft University of Technology, The Netherlands
| | - Mitasha Bharadwaj
- Department of Bionanoscience, Kavli Institute of Nanoscience Delft, Delft University of Technology, The Netherlands
| | - Astrid Ten Bosch
- Department of Sustainable Design Engineering, Section of Design for Sustainability, Faculty of Industrial Design Engineering, Delft University of Technology, The Netherlands
| | | | - Damaris Matoke-Muhia
- Centre for Biotechnology Research and Development, Kenya Medical Research Institute, Kenya
| | - Cees Dekker
- Department of Bionanoscience, Kavli Institute of Nanoscience Delft, Delft University of Technology, The Netherlands
| | - Jan-Carel Diehl
- Department of Sustainable Design Engineering, Section of Design for Sustainability, Faculty of Industrial Design Engineering, Delft University of Technology, The Netherlands.
| |
Collapse
|
23
|
Point of Care Diagnostics in Resource-Limited Settings: A Review of the Present and Future of PoC in Its Most Needed Environment. BIOSENSORS-BASEL 2020; 10:bios10100133. [PMID: 32987809 PMCID: PMC7598644 DOI: 10.3390/bios10100133] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 12/11/2022]
Abstract
Point of care (PoC) diagnostics are at the focus of government initiatives, NGOs and fundamental research alike. In high-income countries, the hope is to streamline the diagnostic procedure, minimize costs and make healthcare processes more efficient and faster, which, in some cases, can be more a matter of convenience than necessity. However, in resource-limited settings such as low-income countries, PoC-diagnostics might be the only viable route, when the next laboratory is hours away. Therefore, it is especially important to focus research into novel diagnostics for these countries in order to alleviate suffering due to infectious disease. In this review, the current research describing the use of PoC diagnostics in resource-limited settings and the potential bottlenecks along the value chain that prevent their widespread application is summarized. To this end, we will look at literature that investigates different parts of the value chain, such as fundamental research and market economics, as well as actual use at healthcare providers. We aim to create an integrated picture of potential PoC barriers, from the first start of research at universities to patient treatment in the field. Results from the literature will be discussed with the aim to bring all important steps and aspects together in order to illustrate how effectively PoC is being used in low-income countries. In addition, we discuss what is needed to improve the situation further, in order to use this technology to its fullest advantage and avoid “leaks in the pipeline”, when a promising device fails to take the next step of the valorization pathway and is abandoned.
Collapse
|
24
|
Joshi K, Velasco V, Esfandyarpour R. A Low-Cost, Disposable and Portable Inkjet-Printed Biochip for the Developing World. SENSORS 2020; 20:s20123593. [PMID: 32630509 PMCID: PMC7348740 DOI: 10.3390/s20123593] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/15/2020] [Accepted: 06/19/2020] [Indexed: 12/31/2022]
Abstract
Electrowetting on dielectric-based digital microfluidic platforms (EWOD-DMF) have a potential to impact point-of-care diagnostics. Conventionally, EWOD-DMF platforms are manufactured in cleanrooms by expert technicians using costly and time consuming micro-nanofabrication processes such as optical lithography, depositions and etching. However, such high-end microfabrication facilities are extremely challenging to establish in resource-poor and low-income countries, due to their high capital investment and operating costs. This makes the fabrication of EWOD-DMF platforms extremely challenging in low-income countries, where such platforms are most needed for many applications such as point-of-care testing applications. To address this challenge, we present a low-cost and simple fabrication procedure for EWOD-DMF electrode arrays, which can be performed anywhere with a commercial office inkjet printer without the need of expensive cleanroom facilities. We demonstrate the utility of our platform to move and mix droplets of different reagents and physiologically conductive buffers, thereby showing its capability to potentially perform a variety of biochemical assays. By combining our low-cost, inkjet-printed EWOD-DMF platform with smartphone imaging technology and a compact control system for droplet manipulation, we also demonstrate a portable and hand-held device which can be programmed to potentially perform a variety of biochemical assays.
Collapse
Affiliation(s)
- Kushal Joshi
- Department of Biomedical Engineering, University of California, Irvine, CA 92697, USA;
| | - Vanessa Velasco
- Biochemistry Department, Stanford University, Palo Alto, CA 92697, USA;
| | - Rahim Esfandyarpour
- Department of Biomedical Engineering, University of California, Irvine, CA 92697, USA;
- Department of Electrical Engineering, University of California, Irvine, CA 92697, USA
- Henry Samueli School of Engineering, University of California, Irvine, CA 92697, USA
- Correspondence:
| |
Collapse
|
25
|
Mbano IM, Mandizvo T, Rogich J, Kunota TTR, Mackenzie JS, Pillay M, Balagaddé FK. Light Forge: A Microfluidic DNA Melting-based Tuberculosis Test. J Appl Lab Med 2020; 5:440-453. [PMID: 32445364 PMCID: PMC7192548 DOI: 10.1093/jalm/jfaa019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/15/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is a well-documented lack of rapid, low-cost tuberculosis (TB) drug resistance diagnostics in low-income settings across the globe. It is these areas that are plagued with a disproportionately high disease burden and in greatest need of these diagnostics. METHODS In this study, we compared the performance of Light Forge, a microfluidic high-resolution melting analysis (HRMA) prototype for rapid low-cost detection of TB drug resistance with a commercial HRMA device, a predictive "nearest-neighbor" thermodynamic model, DNA sequencing, and phenotypic drug susceptibility testing (DST). The initial development and assessment of the Light Forge assay was performed with 7 phenotypically drug resistant strains of Mycobacterium tuberculosis (M.tb) that had their rpoB gene subsequently sequenced to confirm resistance to Rifampin. These isolates of M.tb were then compared against a drug-susceptible standard, H37Rv. Seven strains of M.tb were isolated from clinical specimens and individually analyzed to characterize the unique melting profile of each strain. RESULTS Light Forge was able to detect drug-resistance linked mutations with 100% concordance to the sequencing, phenotypic DST and the "nearest neighbor" thermodynamic model. Researchers were then blinded to the resistance profile of the seven M.tb strains. In this experiment, Light Forge correctly classified 7 out of 9 strains as either drug resistant or drug susceptible. CONCLUSIONS Light Forge represents a promising prototype for a fast, low-cost diagnostic alternative for detection of drug resistant strains of TB in resource constrained settings.
Collapse
Affiliation(s)
- Ian M Mbano
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Tawanda Mandizvo
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Jerome Rogich
- University of Massachusetts Medical School, Worcester, MA
| | - Tafara T R Kunota
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Jared S Mackenzie
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Manormoney Pillay
- Medical Microbiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Frederick K Balagaddé
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa
| |
Collapse
|
26
|
Narayanamurthy V, Jeroish ZE, Bhuvaneshwari KS, Bayat P, Premkumar R, Samsuri F, Yusoff MM. Advances in passively driven microfluidics and lab-on-chip devices: a comprehensive literature review and patent analysis. RSC Adv 2020; 10:11652-11680. [PMID: 35496619 PMCID: PMC9050787 DOI: 10.1039/d0ra00263a] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/20/2020] [Indexed: 12/15/2022] Open
Abstract
The development of passively driven microfluidic labs on chips has been increasing over the years. In the passive approach, the microfluids are usually driven and operated without any external actuators, fields, or power sources. Passive microfluidic techniques adopt osmosis, capillary action, surface tension, pressure, gravity-driven flow, hydrostatic flow, and vacuums to achieve fluid flow. There is a great need to explore labs on chips that are rapid, compact, portable, and easy to use. The evolution of these techniques is essential to meet current needs. Researchers have highlighted the vast potential in the field that needs to be explored to develop rapid passive labs on chips to suit market/researcher demands. A comprehensive review, along with patent analysis, is presented here, listing the latest advances in passive microfluidic techniques, along with the related mechanisms and applications.
Collapse
Affiliation(s)
- Vigneswaran Narayanamurthy
- Department of Electronics and Computer Engineering Technology, Faculty of Electrical and Electronic Engineering Technology, Universiti Teknikal Malaysia Melaka Hang Tuah Jaya 76100 Durian Tunggal Melaka Malaysia
- InnoFuTech No: 42/12, 7th Street, Vallalar Nagar Chennai Tamil Nadu 600072 India
- Centre of Excellence for Advanced Research in Fluid Flow, University Malaysia Pahang Kuantan 26300 Malaysia
| | - Z E Jeroish
- Department of Biomedical Engineering, Rajalakshmi Engineering College Chennai 602105 India
- Faculty of Electrical and Electronics Engineering, University Malaysia Pahang Pekan 26600 Malaysia
| | - K S Bhuvaneshwari
- Department of Biomedical Engineering, Rajalakshmi Engineering College Chennai 602105 India
- Faculty of Electronics and Computer Engineering, Universiti Teknikal Malaysia Melaka Hang Tuah Jaya 76100 Durian Tunggal Melaka Malaysia
| | - Pouriya Bayat
- Department of Bioengineering, McGill University Montreal QC Canada H3A 0E9
| | - R Premkumar
- Department of Biomedical Engineering, Rajalakshmi Engineering College Chennai 602105 India
| | - Fahmi Samsuri
- Faculty of Electrical and Electronics Engineering, University Malaysia Pahang Pekan 26600 Malaysia
| | - Mashitah M Yusoff
- Faculty of Industrial Sciences and Technology, University Malaysia Pahang Kuantan 26300 Malaysia
| |
Collapse
|
27
|
Aydın HB, Cheema JA, Ammanath G, Toklucu C, Yucel M, Özenler S, Palaniappan A, Liedberg B, Yildiz UH. Pixelated colorimetric nucleic acid assay. Talanta 2020; 209:120581. [PMID: 31892020 PMCID: PMC7111824 DOI: 10.1016/j.talanta.2019.120581] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/17/2019] [Accepted: 11/19/2019] [Indexed: 12/12/2022]
Abstract
Conjugated polyelectrolytes (CPEs) have been widely used as reporters in colorimetric assays targeting nucleic acids. CPEs provide naked eye detection possibility by their superior optical properties however, as concentration of target analytes decrease, trace amounts of nucleic acid typically yield colorimetric responses that are not readily perceivable by naked eye. Herein, we report a pixelated analysis approach for correlating colorimetric responses of CPE with nucleic acid concentrations down to 1 nM, in plasma samples, utilizing a smart phone with an algorithm that can perform analytical testing and data processing. The detection strategy employed relies on conformational transitions between single stranded nucleic acid-cationic CPE duplexes and double stranded nucleic acid-CPE triplexes that yield distinct colorimetric responses for enabling naked eye detection of nucleic acids. Cationic poly[N,N,N-triethyl-3-((4-methylthiophen-3-yl)oxy)propan-1-aminium bromide] is utilized as the CPE reporter deposited on a polyvinylidene fluoride (PVDF) membrane for nucleic acid assay. A smart phone application is developed to capture and digitize the colorimetric response of the individual pixels of the digital images of CPE on the PVDF membrane, followed by an analysis using the algorithm. The proposed pixelated approach enables precise quantification of nucleic acid assay concentrations, thereby eliminating the margin of error involved in conventional methodologies adopted for interpretation of colorimetric responses, for instance, RGB analysis. The obtained results illustrate that a ubiquitous smart phone could be utilized for point of care colorimetric nucleic acids assays in complex matrices without requiring sophisticated software or instrumentation.
Collapse
Affiliation(s)
- Hakan Berk Aydın
- Department of Chemistry, Izmir Institute of Technology, Urla, 35430, Izmir, Turkey
| | - Jamal Ahmed Cheema
- Center for Biomimetic Sensor Science, Nanyang Technological University, 637553, Singapore; School of Materials Science and Engineering, Nanyang Technological University, 639798, Singapore
| | - Gopal Ammanath
- Center for Biomimetic Sensor Science, Nanyang Technological University, 637553, Singapore; Nanyang Institute of Technology in Health and Medicine, Interdisciplinary Graduate School, Nanyang Technological University, 637553, Singapore; School of Materials Science and Engineering, Nanyang Technological University, 639798, Singapore
| | - Cihan Toklucu
- Department of Computer Engineering, Izmir Institute of Technology, Urla, 35430, Izmir, Turkey
| | - Muge Yucel
- Department of Bioengineering, Izmir Institute of Technology, Urla, 35430, Izmir, Turkey
| | - Sezer Özenler
- Department of Chemistry, Izmir Institute of Technology, Urla, 35430, Izmir, Turkey
| | - Alagappan Palaniappan
- Center for Biomimetic Sensor Science, Nanyang Technological University, 637553, Singapore; School of Materials Science and Engineering, Nanyang Technological University, 639798, Singapore
| | - Bo Liedberg
- Center for Biomimetic Sensor Science, Nanyang Technological University, 637553, Singapore; School of Materials Science and Engineering, Nanyang Technological University, 639798, Singapore.
| | - Umit Hakan Yildiz
- Department of Chemistry, Izmir Institute of Technology, Urla, 35430, Izmir, Turkey.
| |
Collapse
|
28
|
Srinivas ML, Yang EJ, Shrestha P, Wu D, Peeling RW, Tucker JD. Social innovation in diagnostics: three case studies. Infect Dis Poverty 2020; 9:20. [PMID: 32070433 PMCID: PMC7029594 DOI: 10.1186/s40249-020-0633-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/23/2020] [Indexed: 01/04/2023] Open
Abstract
Background Diagnostics are essential for identifying and controlling diseases. However, limited access to diagnostics hinders public health efforts in many settings. Social innovation may provide a framework for expanding access to diagnostics in the global south. Here social innovation is defined as implementing a known public health tool via a novel, community-driven technique. Main Body In this article, we discuss three diverse cases that show the potential for using social innovation in diagnostics. The cases chosen for inclusion here demonstrate the importance of social innovation in diagnostics across different geographic, cultural, and health system contexts. They include malaria testing via schools in Malawi, cervical human papillomavirus (HPV) sample self-collection in Peru, and crowdsourcing human immunodeficiency virus (HIV) testing in China. For each case, we present the public health problem and the impact of using social innovation to increase accessibility of diagnostics. We discuss implications of each diagnostic approach and the importance of social innovation in creating these potential solutions. We argue that social innovation is useful in improving the delivery of essential diagnostic tools in low- and middle-income countries. Conclusions Interventions in Malawi, Peru, and China suggest social innovation increases uptake of diagnostics. The same tools and principles utilized in these cases can be adapted for use in other contexts. Such diagnostic innovations may help improve identification of and linkage to care for many diseases. The approach presents a unique opportunity to better address public health issues and increase accessibility in LMIC health systems.
Collapse
Affiliation(s)
- Megan L Srinivas
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Eileen J Yang
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,International Diagnostics Centre, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Priyanka Shrestha
- International Diagnostics Centre, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Special Programme for Research & Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Dan Wu
- International Diagnostics Centre, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Rosanna W Peeling
- International Diagnostics Centre, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph D Tucker
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,International Diagnostics Centre, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
29
|
Rosqvist E, Niemelä E, Frisk J, Öblom H, Koppolu R, Abdelkader H, Soto Véliz D, Mennillo M, Venu AP, Ihalainen P, Aubert M, Sandler N, Wilén CE, Toivakka M, Eriksson JE, Österbacka R, Peltonen J. A low-cost paper-based platform for fast and reliable screening of cellular interactions with materials. J Mater Chem B 2020; 8:1146-1156. [PMID: 32011620 DOI: 10.1039/c9tb01958h] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A paper-based platform was developed and tested for studies on basic cell culture, material biocompatibility, and activity of pharmaceuticals in order to provide a reliable, robust and low-cost cell study platform. It is based upon a paper or paperboard support, with a nanostructured latex coating to provide an enhanced cell growth and sufficient barrier properties. Wetting is limited to regions of interest using a flexographically printed hydrophobic polydimethylsiloxane layer with circular non-print areas. The nanostructured coating can be substituted for another coating of interest, or the regions of interest functionalized with a material to be studied. The platform is fully up-scalable, being produced with roll-to-roll rod coating, flexographic and inkjet printing methods. Results show that the platform efficiency is comparable to multi-well plates in colorimetric assays in three separate studies: a cell culture study, a biocompatibility study, and a drug screening study. The color intensity is quantified by using a common office scanner or an imaging device and the data is analyzed by a custom computer software without the need for expensive screening or analysis equipment.
Collapse
Affiliation(s)
- E Rosqvist
- Laboratory of Physical Chemistry, Center for Functional Materials, Åbo Akademi University, Porthansgatan 3-5, 20500 Åbo, Finland.
| | - E Niemelä
- Laboratory of Cell Biology, Center for Functional Materials, Åbo Akademi University, Bio City, Artillerigatan 6B, 20521 Åbo, Finland and Turku Bioscience Centre, University of Turku and Åbo Akademi University, 20520 Åbo, Finland
| | - J Frisk
- Laboratory of Physics, Center for Functional Materials, Åbo Akademi University, Porthansgatan 3-5, 20500 Åbo, Finland
| | - H Öblom
- Pharmaceutical Sciences Laboratory, Åbo Akademi University, Artillerigatan 6A, 20520 Åbo, Finland
| | - R Koppolu
- Laboratory of Paper Coating, Center for Functional Materials, Åbo Akademi University, Porthansgatan 3-5, 20500 Åbo, Finland
| | - H Abdelkader
- Laboratory of Cell Biology, Center for Functional Materials, Åbo Akademi University, Bio City, Artillerigatan 6B, 20521 Åbo, Finland and Turku Bioscience Centre, University of Turku and Åbo Akademi University, 20520 Åbo, Finland
| | - D Soto Véliz
- Laboratory of Paper Coating, Center for Functional Materials, Åbo Akademi University, Porthansgatan 3-5, 20500 Åbo, Finland
| | - M Mennillo
- Laboratory of Polymer Technology, Center for Functional Materials, Åbo Akademi University, Biskopsgatan 3-5, 20500 Åbo, Finland
| | - A P Venu
- Laboratory of Cell Biology, Center for Functional Materials, Åbo Akademi University, Bio City, Artillerigatan 6B, 20521 Åbo, Finland and Turku Bioscience Centre, University of Turku and Åbo Akademi University, 20520 Åbo, Finland
| | - P Ihalainen
- Laboratory of Physical Chemistry, Center for Functional Materials, Åbo Akademi University, Porthansgatan 3-5, 20500 Åbo, Finland.
| | - M Aubert
- Laboratory of Polymer Technology, Center for Functional Materials, Åbo Akademi University, Biskopsgatan 3-5, 20500 Åbo, Finland
| | - N Sandler
- Pharmaceutical Sciences Laboratory, Åbo Akademi University, Artillerigatan 6A, 20520 Åbo, Finland
| | - C-E Wilén
- Laboratory of Polymer Technology, Center for Functional Materials, Åbo Akademi University, Biskopsgatan 3-5, 20500 Åbo, Finland
| | - M Toivakka
- Laboratory of Paper Coating, Center for Functional Materials, Åbo Akademi University, Porthansgatan 3-5, 20500 Åbo, Finland
| | - J E Eriksson
- Laboratory of Cell Biology, Center for Functional Materials, Åbo Akademi University, Bio City, Artillerigatan 6B, 20521 Åbo, Finland and Turku Bioscience Centre, University of Turku and Åbo Akademi University, 20520 Åbo, Finland
| | - R Österbacka
- Laboratory of Physics, Center for Functional Materials, Åbo Akademi University, Porthansgatan 3-5, 20500 Åbo, Finland
| | - J Peltonen
- Laboratory of Physical Chemistry, Center for Functional Materials, Åbo Akademi University, Porthansgatan 3-5, 20500 Åbo, Finland.
| |
Collapse
|
30
|
Mesman AW, Bangura M, Kanawa SM, Gassimu JS, Dierberg KL, Sheku MM, Orozco JD, Marsh RH. A comprehensive district-level laboratory intervention after the Ebola epidemic in Sierra Leone. Afr J Lab Med 2019; 8:885. [PMID: 31745458 PMCID: PMC6852544 DOI: 10.4102/ajlm.v8i1.885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 03/18/2019] [Indexed: 01/27/2023] Open
Abstract
Background The 2014–2016 Ebola outbreak exposed the poor laboratory systems in Sierra Leone. Immense needs were recognised across all areas, from facilities, diagnostic capacity, supplies, trained personnel to quality assurance mechanisms. Objective We aimed to describe the first year of a comprehensive intervention, which started in 2015, in a public hospital’s general laboratory serving a population of over 500 000 in a rural district. Methods The intervention focused on (1) supporting local authorities and healthcare workers in policy implementation and developing procedures to enhance access to services, (2) addressing gaps by investing in infrastructure, supplies, and equipment, (3) development of quality assurance mechanisms via mentorship, bench-side training, and the introduction of quality control and information systems. All work was performed alongside counterparts from the Ministry of Health and Sanitation. Results We observed a strong increase in patient visits and inpatient and outpatient testing volumes. Novel techniques and procedures were taken up well by staff, leading to improved and expanded service and safety, laying foundations for further improvements. Conclusion This comprehensive approach was successful and the results suggest an increase in trust from patients and healthcare workers.
Collapse
Affiliation(s)
- Annelies W Mesman
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States.,Partners In Health, Boston, Massachusetts, United States
| | - Musa Bangura
- Partners In Health, Boston, Massachusetts, United States
| | - Sahr M Kanawa
- Ministry of Health and Sanitation, Koidu, Sierra Leone
| | | | - Kerry L Dierberg
- Partners In Health, Boston, Massachusetts, United States.,Division of Infectious Diseases and Immunology, New York University, New York, New York, United States
| | | | | | - Regan H Marsh
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States.,Partners In Health, Boston, Massachusetts, United States.,Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
| |
Collapse
|
31
|
Morin S, Bazarova N, Jacon P, Vella S. The Manufacturers' Perspective on World Health Organization Prequalification of In Vitro Diagnostics. Clin Infect Dis 2019; 66:301-305. [PMID: 29020182 PMCID: PMC5848238 DOI: 10.1093/cid/cix719] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/16/2017] [Indexed: 11/12/2022] Open
Abstract
In vitro diagnostic devices (IVDs) help clinicians determine specific conditions, monitor therapeutic efficacy, and prevent drug resistance development. While stringent regulatory authorities (SRAs) regulate IVDs in most high-income countries, regulatory authorities in many low- and middle-income countries (LMICs) are nonexistent or do not enforce rigorous standards. In 2010, the World Health Organization established its Prequalification of In Vitro Diagnostics (PQDx) program to ensure "access to safe, appropriate and affordable" IVDs, especially in LMICs with little or no domestic regulatory frameworks, thereby reaching underserved populations. However, challenges in PQDx policies and procedures include an overloaded pipeline, timelines not publicly available, confusion about which products PQDx focuses on, perceived burden for documenting changes to prequalified products, overlap with SRA approvals, and uncertainty around long-term financing. PQDx can maximize its impact by considering the perspective of IVD manufacturers; similarly, IVD manufacturers should exercise adequate quality control over their submissions and associated processes.
Collapse
Affiliation(s)
- Sébastien Morin
- HIV Programmes and Advocacy, International AIDS Society, Geneva, Switzerland
| | - Nelli Bazarova
- HIV Programmes and Advocacy, International AIDS Society, Geneva, Switzerland
| | | | - Stefano Vella
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| |
Collapse
|
32
|
Djigo OKM, Bollahi MA, Hasni Ebou M, Ould Ahmedou Salem MS, Tahar R, Bogreau H, Basco L, Ould Mohamed Salem Boukhary A. Assessment of glucose-6-phosphate dehydrogenase activity using CareStart G6PD rapid diagnostic test and associated genetic variants in Plasmodium vivax malaria endemic setting in Mauritania. PLoS One 2019; 14:e0220977. [PMID: 31525211 PMCID: PMC6746352 DOI: 10.1371/journal.pone.0220977] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/26/2019] [Indexed: 02/06/2023] Open
Abstract
Background Primaquine is recommended by the World Health Organization (WHO) for radical treatment of Plasmodium vivax malaria. This drug is known to provoke acute hemolytic anemia in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Due to lack of data on G6PD deficiency, the use of primaquine has been limited in Africa. In the present study, G6PD deficiency was investigated in blood donors of various ethnic groups living in Nouakchott, a P. vivax endemic area in Mauritania. Methodology/Principal findings Venous blood samples from 443 healthy blood donors recruited at the National Transfusion Center in Nouakchott were screened for G6PD activity using the CareStart G6PD deficiency rapid diagnostic test. G6PD allelic variants were investigated using DiaPlexC G6PD genotyping kit that detects African (A-) and Mediterranean (B-) variants. Overall, 50 of 443 (11.3%) individuals (49 [11.8%] men and 1 [3.7%] woman) were phenotypically deficient. Amongst men, Black Africans had the highest prevalence of G6PD deficiency (15 of 100 [15%]) and White Moors the lowest (10 of 168, [5.9%]). The most commonly observed G6PD allelic variants among 44 tested G6PD-deficient men were the African variant A- (202A/376G) in 14 (31.8%), the Mediterranean variant B- (563T) in 13 (29.5%), and the Betica-Selma A- (376G/968C) allelic variant in 6 (13.6%). The Santamaria A- variant (376G/542T) and A variant (376G) were observed in only one and two individuals, respectively. None of the expected variants was observed in 8 (18.2%) of the tested phenotypically G6PD-deficient men. Conclusion This is the first published data on G6PD deficiency in Mauritanians. The prevalence of phenotypic G6PD deficiency was relatively high (11.3%). It was mostly associated with either African or Mediterranean variants, in agreement with diverse Arab and Black African origins of the Mauritanian population.
Collapse
Affiliation(s)
- Oum kelthoum Mamadou Djigo
- Unité de recherche Génomes et Milieux, Faculté des Sciences et Techniques, Université de Nouakchott Al-Aasriya, Nouveau Campus Universitaire, Nouakchott, Mauritania
| | | | - Moina Hasni Ebou
- Unité de recherche Génomes et Milieux, Faculté des Sciences et Techniques, Université de Nouakchott Al-Aasriya, Nouveau Campus Universitaire, Nouakchott, Mauritania
| | - Mohamed Salem Ould Ahmedou Salem
- Unité de recherche Génomes et Milieux, Faculté des Sciences et Techniques, Université de Nouakchott Al-Aasriya, Nouveau Campus Universitaire, Nouakchott, Mauritania
| | - Rachida Tahar
- UMR 216 MERIT, IRD, Faculté de Pharmacie, Univ. Paris Descartes, Paris, France
| | - Hervé Bogreau
- Unité de Parasitologie et d’Entomologie, Institut de Recherche Biomédicale des Armées, IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
- Centre National de Référence du Paludisme, Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Marseille, France
| | - Leonardo Basco
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
| | - Ali Ould Mohamed Salem Boukhary
- Unité de recherche Génomes et Milieux, Faculté des Sciences et Techniques, Université de Nouakchott Al-Aasriya, Nouveau Campus Universitaire, Nouakchott, Mauritania
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- * E-mail:
| |
Collapse
|
33
|
Lu S, Cottone CM, Yoon R, Jefferson FA, Sung JM, Okhunov Z, Tapiero S, Patel RM, Landman J, Clayman RV. Endockscope: A Disruptive Endoscopic Technology. J Endourol 2019; 33:960-965. [PMID: 31195831 DOI: 10.1089/end.2019.0252] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective: To assess optical performance and diagnostic capability of the Endockscope system (ES) vs the standard endoscopic system (SES) using four rigid/semi-rigid endoscopes. The ES combines a smartphone, lens system, and a rechargeable light-emitting diode (LED) light source to provide a low-cost alternative ($45) to the standard camera and high-powered light source ($45,000) used in endoscopic procedures. Materials and Methods: Video clips (<20 seconds) of standard rigid nephroscopy, semi-rigid ureteroscopy, rigid cystoscopy, and laparoscopy in two adult male cadavers were recorded using the ES combined with either the Apple iPhone X or Samsung Galaxy S9+ and also with the high-definition SES (Karl Storz). Sixteen urologists blinded to the camera modality assessed the image resolution, brightness, color, sharpness, and overall quality using a Likert-type scale; acceptability for diagnostic purposes was judged on a binary scale (yes/no). Results: For rigid cystoscopy, there was no statistical difference between both ES systems and the SES. For semi-rigid ureteroscopy the two ES systems performed equal to or better than the SES. For rigid nephroscopy, the ES plus Galaxy was comparable to the SES, except in brightness (p < 0.05), whereas the ES plus iPhone was inferior in various parameters. For laparoscopy, the ES plus Galaxy was inferior to the SES in brightness and overall quality (p < 0.05); the ES plus iPhone was inferior for all laparoscopic image parameters compared with the SES. For diagnostic purposes, the ES plus Galaxy was equivalent to the SES for all endoscopes; the ES plus iPhone was equivalent to the SES for cystoscopy, ureteroscopy, and nephroscopy. Conclusion: The ES plus the Apple iPhone X or Samsung Galaxy S9+ offers comparable imaging and provides diagnostic information equivalent to the standard system for rigid endoscopy of the kidney, ureter, and bladder; the Galaxy S9+ provides comparable imaging and diagnostic capabilities for evaluation of the abdomen.
Collapse
Affiliation(s)
- Sherry Lu
- Department of Urology, University of California, Irvine, Orange, California
| | - Courtney M Cottone
- Department of Urology, University of California, Irvine, Orange, California
| | - Renai Yoon
- Department of Urology, University of California, Irvine, Orange, California
| | | | - John M Sung
- Department of Urology, University of California, Irvine, Orange, California
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, Orange, California
| | - Shlomi Tapiero
- Department of Urology, University of California, Irvine, Orange, California
| | - Roshan M Patel
- Department of Urology, University of California, Irvine, Orange, California
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, California
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, Orange, California
| |
Collapse
|
34
|
Tola HH, Holakouie-Naieni K, Lejisa T, Mansournia MA, Yaseri M, Tesfaye E, Mola M. Is hypothyroidism rare in multidrug resistance tuberculosis patients on treatment? A systematic review and meta-analysis. PLoS One 2019; 14:e0218487. [PMID: 31211809 PMCID: PMC6581430 DOI: 10.1371/journal.pone.0218487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 06/03/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Hypothyroidism is one of the adverse drug reactions that associated with Multidrug Resistant Tuberculosis (MDR-TB) medications. Extremely variable magnitude of hypothyroidism in MDR-TB patients has been reported from different parts of the world. However, there is no evidence that tried to estimate the pooled prevalence of hypothyroidism to confirm the rareness of hypothyroidism in MDR-TB patients on treatment. Therefore, we did a systematic review and meta-analysis to estimate the prevalence of hypothyroidism in MDR-TB patients on treatment, and to summarize the demographic and clinical characteristics of the patients. METHODS We conducted a systematic review and meta-analysis on studies reported around the world on the prevalence of hypothyroidism in MDR-TB patients on treatment. We searched electronic databases: PubMed/Medline, EMBASE, CINAHL, Science Direct, Academic Search Complete and Google scholar for English language articles without limiting publication year. We also reviewed the bibliographies of relevant studies and conducted an electronic search for relevant conference abstracts. Eligible studies were cross-sectional and cohort studies that included at least five participants. We used a random-effects model to estimate the pooled prevalence of hypothyroidism. The registration number of this review study protocol is CRD42018109237. RESULTS We included 30 studies and pooled data on a total of 6,241 MDR-TB patients. The crude prevalence of hypothyroidism was extremely heterogeneous. The pooled prevalence of hypothyroidism in MDR-TB patients on treatment was 17.0% (95% CI: 13.0-20.0). Ethionamide and para-aminosalicylic acid (PAS) were the most frequently reported drugs that associated with the occurrence of hypothyroidism. CONCLUSION This review revealed that hypothyroidism is not a rare adverse drug reaction in MDR-TB patients on treatment. Ethionamide and PAS were the most frequently reported drugs that associated with the occurrence of hypothyroidism. Screening of hypothyroidism in MDR-TB patients on treatment is important while targeting patients on Ethionamide and PAS based treatment regimen.
Collapse
Affiliation(s)
- Habteyes Hailu Tola
- Tehran University of Medical Sciences-International Campus, School of Public Health, Department of Epidemiology and Biostatistics, Tehran, Iran
- Ethiopian Public Health Institute, Tuberculosis/HIV Research Directorate, Addis Ababa, Ethiopia
| | - Kourosh Holakouie-Naieni
- Tehran University of Medical Sciences-International Campus, School of Public Health, Department of Epidemiology and Biostatistics, Tehran, Iran
| | - Tadesse Lejisa
- Ethiopian Public Health Institute, Tuberculosis/HIV Research Directorate, Addis Ababa, Ethiopia
| | - Mohammad Ali Mansournia
- Tehran University of Medical Sciences-International Campus, School of Public Health, Department of Epidemiology and Biostatistics, Tehran, Iran
| | - Mehdi Yaseri
- Tehran University of Medical Sciences-International Campus, School of Public Health, Department of Epidemiology and Biostatistics, Tehran, Iran
| | - Ephrem Tesfaye
- Ethiopian Public Health Institute, Tuberculosis/HIV Research Directorate, Addis Ababa, Ethiopia
| | - Million Mola
- St. Peter's Specialized Hospital, Research and Evidence Generation Directorate, Addis Ababa, Ethiopia
| |
Collapse
|
35
|
Paramasivam OR, Trivedi S, Sangith N, Sankaran K. Active sulfite oxidase domain of Salmonella enterica pathogenic protein small intestine invasive factor E (SiiE): a potential diagnostic target. Appl Microbiol Biotechnol 2019; 103:5679-5688. [PMID: 31104097 DOI: 10.1007/s00253-019-09894-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/23/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
Serovars of Salmonella enterica are common food-borne bacterial pathogens. Salmonella typhi, which causes typhoid, is the most dangerous of them. Though detailed molecular pathogenesis studies reveal many virulence factors, inability to identify their biochemical functions hampers the development of diagnostic methods and therapeutic leads. Lack of quicker diagnosis is an impediment in starting early antibiotic treatment to reduce the severe morbidity and mortality in typhoid. In this study, employing bioinformatic prediction, biochemical analysis, and recombinantly cloning the active region, we show that extracellularly secreted virulence-associated protein, small intestinal invasion factor E (SiiE), possesses a sulfite oxidase (SO) domain that catalyzes the conversion of sodium sulfite to sodium sulfate using tungsten as the cofactor. This activity common to Salmonella enterica serovars seems to be specific to them from bioinformatic analysis of available bacterial genomes. Along with the ability of this large non-fimbrial adhesin of 600 kDa binding to sialic acid on the host cells, this activity could aid in subverting the host defense mechanism by destroying sulfites released by the immune cells and colonize the host gastrointestinal epithelium. Being an extracellular enzyme, it could be an ideal candidate for developing diagnostics of S. enterica, particularly S. typhi.
Collapse
Affiliation(s)
| | - Swati Trivedi
- Centre for Biotechnology, Anna University, Chennai, 600020, India
| | - Nikhil Sangith
- Centre for Biotechnology, Anna University, Chennai, 600020, India.
| | | |
Collapse
|
36
|
Chamane N, Kuupiel D, Mashamba-Thompson TP. Experiential learning for primary healthcare workers in low- and middle-income countries: a scoping review protocol. Syst Rev 2019; 8:123. [PMID: 31109377 PMCID: PMC6528328 DOI: 10.1186/s13643-019-1040-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/10/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Improving the quality of primary healthcare services is one of the global health priorities. Literature shows that the incompetency of healthcare providers has the potential to negatively affect the quality of the services provided. Experiential learning is one of the educational models that can be used to help improve healthcare service delivery. The main objective of this study is to systematically map literature on the evidence of experiential learning for primary healthcare workers in low- and middle-income countries (LMICs). METHODS This systematic scoping review's search strategy will involve the following electronic databases: PubMed, Google Scholar, EBSOhost (Academic search complete, Health Source: Nursing/Academic Addition, MEDLINE) and open access for unpublished theses and dissertations. Websites such as the World Health Organization (WHO) and the departments of health website will be searched for policies and guidelines on experiential learning training programs. Following title searching, two-independent reviewers will conduct screening of abstracts and full articles. The screenings will be guided by the eligibility criteria. Data will be extracted from the included studies and the emerging themes will be analysed. The review team will analyse the implications of the findings in relation to the research question and aim of the study. The Mixed Method Appraisal Tool (MMAT) will be employed for quality appraisal of included studies. DISCUSSION We anticipate finding a significant number of studies on the applications of experiential learning in resource-limited settings. Findings will be disseminated through publication in a peer-reviewed journal, peer presentations as well as presentations at relevant conferences.
Collapse
Affiliation(s)
- Nkosinothando Chamane
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Desmond Kuupiel
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Research for Sustainable Development Consult, Sunyani, Ghana
| | - Tivani Phosa Mashamba-Thompson
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
37
|
Assessment of eight nucleic acid amplification technologies for potential use to detect infectious agents in low-resource settings. PLoS One 2019; 14:e0215756. [PMID: 31009510 PMCID: PMC6476514 DOI: 10.1371/journal.pone.0215756] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 02/26/2019] [Indexed: 02/07/2023] Open
Abstract
Nucleic acid amplification technologies (NAATs) are high-performance tools for rapidly and accurately detecting infectious agents. They are widely used in high-income countries to diagnose disease and improve patient care. The complexities associated with test methods, reagents, equipment, quality control and assurance require dedicated laboratories with trained staff, which can exclude their use in low-resource and decentralized healthcare settings. For certain diseases, fully integrated NAAT devices and assays are available for use in environmentally-controlled clinics or emergency rooms where relatively untrained staff can perform testing. However, decentralized settings in many low- and middle-income countries with large burdens of infectious disease are challenged by extreme environments, poor infrastructure, few trained staff and limited financial resources. Therefore, there is an urgent need for low-cost, integrated NAAT tools specifically designed for use in low-resource settings (LRS). Two essential components of integrated NAAT tools are: 1) efficient nucleic acid extraction technologies for diverse and complex sample types; and 2) robust and sensitive nucleic acid amplification and detection technologies. In prior work we reported the performance and workflow capacity for the nucleic acid extraction component. In the current study we evaluated performance of eight novel nucleic acid amplification and detection technologies from seven developers using blinded panels of RNA and/or DNA from three pathogens to assess both diagnostic accuracy and suitability as an essential component for low-cost NAAT in LRS. In this exercise, we noted significant differences in performance among these technologies and identified those most promising for potential further development.
Collapse
|
38
|
Cnop K, Martinez B, Austad KE. Resistant dermatomyositis in a rural indigenous Maya woman. BMJ Case Rep 2019; 12:e223886. [PMID: 30796072 PMCID: PMC6388881 DOI: 10.1136/bcr-2017-223886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2019] [Indexed: 11/03/2022] Open
Abstract
A 28-year-old indigenous Guatemalan woman presented with 7 months of progressive weakness and numerous dermatological findings. She initially sought care within the free government-run health system and was treated with oral steroids for presumed dermatomyositis. Her symptoms progressed, including severe dysphagia, hypophonia and weakness preventing sitting. She was lost to follow-up in the public system due to financial and cultural barriers. A non-governmental organisation tailored to the needs of Maya patients provided home intravenous pulse dose methylprednisolone in the absence of first-line biologicals. With longitudinal home-based care, she achieved symptom free recovery. The rising burden of chronic non-communicable diseases highlights shortcomings in health systems evident in this case, including lack of provider capacity, limited infrastructure to test for and treat rare diseases and poor continuity of care. We provide potential solutions to help care delivery in low-resource settings adapt to the demans of chronic disease control with particular attention to social determinants of health.
Collapse
Affiliation(s)
- Katia Cnop
- Wuqu' Kawoq, Maya Health Alliance, Santiago, Guatemala
- Burrell College of Osteopathic Medicine, Las Cruces, New Mexico, USA
| | - Boris Martinez
- Wuqu' Kawoq, Maya Health Alliance, Santiago, Guatemala
- Internal Medicine, Saint Peter's University Hospital, Rutgers University, New Brunswick, New Jersey, USA
| | - Kirsten E Austad
- Wuqu' Kawoq, Maya Health Alliance, Santiago, Guatemala
- Internal Medicine Division of Women's Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
39
|
Accessibility of pregnancy-related point-of-care diagnostic tests for maternal healthcare in rural primary healthcare facilities in Northern Ghana: A cross-sectional survey. Heliyon 2019; 5:e01236. [PMID: 30828664 PMCID: PMC6383048 DOI: 10.1016/j.heliyon.2019.e01236] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 12/25/2018] [Accepted: 02/11/2019] [Indexed: 01/07/2023] Open
Abstract
Background Improving access to maternal healthcare in resource-limited settings plays a critical role in improving maternal health outcomes and reducing maternal deaths. However, barriers and challenges may exist in rural clinics and could affect successful implementation. This study assessed the current accessibility of pregnancy-related point-of-care (POC) diagnostic tests for maternal healthcare in rural primary healthcare (PHC) clinics in northern Ghana. Method We randomly selected 100 PHC clinics providing maternal healthcare from a total list of 356 PHC clinicss obtained from the Regional Health Directorate. Selected clinics were surveyed from February to March 2018, using an adopted survey tool. We obtained data for clinic-level staffing, availability, usage, and desired POC diagnostic tests. Stata 14 was used for data analysis. Findings Majority (64%) of the respondents were midwives. The mean ± standard deviation (SD) years of work experience and working hours per week were estimated at 5.6 years ± 0.4 and 122 hours ± 5.2 respectively. Average antenatal clinic attendance (clinic census) per month was 65 ± 67 pregnant women (Range: 3–360). The mean ± SD POC tests available and use was 4.9 tests ± 2.2. POC tests for malaria, HIV, urine pregnancy, and blood pressure monitoring devices were available in most clinics. POC tests requested by the clinics to assist them care for pregnant women included: Glucose-6-phosphate dehydrogenase (95%); hepatitis C (94%); sickling (91%); tuberculosis, blood glucose and blood type (89%) each; urinary tract infection (87%); urine protein (81%); hepatitis B (78%); haemoglobin (76%); and syphilis (76%). Interpretation There is poor accessibility to pregnancy-related POC diagnostic tests for maternal healthcare due to low availability (≤5 tests per PHC clinic) of POC tests in rural PHC clinics in northern Ghana.
Collapse
|
40
|
Henderson CJ, Pumford E, Seevaratnam DJ, Daly R, Hall EAH. Gene to diagnostic: Self immobilizing protein for silica microparticle biosensor, modelled with sarcosine oxidase. Biomaterials 2019; 193:58-70. [PMID: 30562636 DOI: 10.1016/j.biomaterials.2018.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/07/2018] [Accepted: 12/07/2018] [Indexed: 02/08/2023]
Abstract
A rational design approach is proposed for a multifunctional enzyme reagent for point-of-care diagnostics. The biomaterial reduces downstream isolation steps and eliminates immobilization coupling chemicals for integration in a diagnostic platform. Fusion constructs combined the central functional assay protein (e.g. monomeric sarcosine oxidase, mSOx, horseradish peroxidase, HRP), a visualizing protein (e.g. mCherry) and an in-built immobilization peptide (e.g. R5). Monitoring protein expression in E.coli was facilitated by following the increase in mCherry fluorescence, which could be matched to a color card, indicating when good protein expression has occurred. The R5 peptide (SSKKSGSYSGSKGSKRRIL) provided inbuilt affinity for silica and an immobilization capability for a silica based diagnostic, without requiring additional chemical coupling reagents. Silica particles extracted from beach sand were used to collect protein from crude protein extract with 85-95% selective uptake. The silica immobilized R5 proteins were stable for more than 2 months at room temperature. The Km for the silica-R52-mCh-mSOx-R5-6H was 16.5 ± 0.9 mM (compared with 16.5 ± 0.4 mM, 16.3 ± 0.3 mM, and 16.1 ± 0.4 mM for R52-mCh-mSOx-R5-6H, mSOx-R5-6H and mSOx-6H respectively in solution). The use of the "silica-enzymes" in sarcosine and peroxide assays was shown, and a design using particle sedimentation through the sample was examined. Using shadowgraphy and particle image velocimetry the particle trajectory through the sample was mapped and an hourglass design with a narrow waist shown to give good control of particle position. The hourglass biosensor was demonstrated for sarcosine assay in the clinically useful range of 2.5-10 μM in both a dynamic and end point measurement regime.
Collapse
Affiliation(s)
- Cassi J Henderson
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, UK; Department of Engineering, University of Cambridge, Charles Babbage Road, Cambridge, CB3 0FS, UK
| | - Elizabeth Pumford
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, UK
| | - Dushanth J Seevaratnam
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, UK
| | - Ronan Daly
- Department of Engineering, University of Cambridge, Charles Babbage Road, Cambridge, CB3 0FS, UK
| | - Elizabeth A H Hall
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, UK.
| |
Collapse
|
41
|
Measuring Relevant Information in Health Social Network Conversations and Clinical Diagnosis Cases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122787. [PMID: 30544845 PMCID: PMC6313597 DOI: 10.3390/ijerph15122787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/29/2018] [Accepted: 12/05/2018] [Indexed: 11/28/2022]
Abstract
The Internet and social media is an enormous source of information. Health social networks and online collaborative environments enable users to create shared content that afterwards can be discussed. The aim of this paper is to present a novel methodology designed for quantifying relevant information provided by different participants in clinical online discussions. The main goal of the methodology is to facilitate the comparison of participant interactions in clinical conversations. A set of key indicators for different aspects of clinical conversations and specific clinical contributions within a discussion have been defined. Particularly, three new indicators have been proposed to make use of biomedical knowledge extraction based on standard terminologies and ontologies. These indicators allow measuring the relevance of information of each participant of the clinical conversation. Proposed indicators have been applied to one discussion extracted from PatientsLikeMe, as well as to two real clinical cases from the Sanar collaborative discussion system. Results obtained from indicators in the tested cases have been compared with clinical expert opinions to check indicators validity. The methodology has been successfully used for describing participant interactions in real clinical cases belonging to a collaborative clinical case discussion tool and from a conversation from a health social network. This work can be applied to assess collaborative diagnoses, discussions among patients, and the participation of students in clinical case discussions. It permits moderators and educators to obtain a quantitatively measure of the contribution of each participant.
Collapse
|
42
|
Mugambi ML, Peter T, F Martins S, Giachetti C. How to implement new diagnostic products in low-resource settings: an end-to-end framework. BMJ Glob Health 2018; 3:e000914. [PMID: 30498586 PMCID: PMC6254739 DOI: 10.1136/bmjgh-2018-000914] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 12/05/2022] Open
Abstract
Diagnostics developers often face challenges introducing in-vitro diagnostic (IVD) products to low- and middle-income countries (LMICs) because of difficulty in accessing robust market data, navigating policy and regulatory requirements and implementing and supporting products in healthcare systems with limited infrastructure. Best practices recommend the use of a phase-gate model with defined activities and milestones by phase to successfully move a product from concept to commercialisation. While activities for commercialisation of products in high-income countries (HICs) are well understood, the activities required for introduction of IVDs in LMICs are not. In this paper, we identify the key activities needed for IVD product development and implementation and map them to the various phases of the model, paying particular attention to those activities that might be conducted differently in LMICs.
Collapse
Affiliation(s)
| | - Trevor Peter
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Cristina Giachetti
- Bill and Melinda Gates Foundation, Seattle, Washington, USA.,AdvantDx, San Diego, California, USA
| |
Collapse
|
43
|
Rapid Low-Cost Microfluidic Detection in Point of Care Diagnostics. J Med Syst 2018; 42:184. [DOI: 10.1007/s10916-018-1043-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 08/21/2018] [Indexed: 11/27/2022]
|
44
|
Aung NM, Nyein PP, Htut TY, Htet ZW, Kyi TT, Anstey NM, Kyi MM, Hanson J. Antibiotic Therapy in Adults with Malaria (ANTHEM): High Rate of Clinically Significant Bacteremia in Hospitalized Adults Diagnosed with Falciparum Malaria. Am J Trop Med Hyg 2018; 99:688-696. [PMID: 30014826 DOI: 10.4269/ajtmh.18-0378] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
It has been believed that concomitant bacteremia is uncommon in adults hospitalized with falciparum malaria. Accordingly, the World Health Organization treatment guidelines presently only recommended additional antibacterial therapy in these patients if they have a clinical syndrome compatible with serious bacterial infection. Admission blood cultures were collected from 20 consecutive adults in Myanmar, hospitalized with a positive immunochromatographic test and blood film, suggesting a diagnosis of falciparum malaria; four (20%) had bacteremia with a clinically significant pathogen. These case series' data were pooled with a previously published multicenter study from Myanmar which had also collected blood cultures in adults hospitalized with a diagnosis of falciparum malaria. Among 87 patients in the two studies, 13 (15%) had clinically significant bacteremia on admission, with Gram-negative organisms in 10 (77%) and Staphylococcus aureus in the remaining three (23%). Bacteremic patients had more severe disease than non-bacteremic patients (median [interquartile range] respiratory coma acidosis malaria score 2 [1-4] versus 1 [1-2], P = 0.02) and were more likely to die (2/13 [15%] versus 1/74 [1%], P = 0.01). However, bacterial coinfection was suspected clinically in a minority of bacteremic patients (5/13 [38%] compared with 13/70 [19%] of non-bacteremic patients, P = 0.11). Concomitant bacteremia in adults diagnosed with falciparum malaria may be more common than previously believed and is difficult to identify clinically in resource-poor settings. Death is more common in these patients, suggesting that clinicians should have a lower threshold for commencing empirical antibacterial therapy in adults diagnosed with falciparum malaria in these locations than is presently recommended.
Collapse
Affiliation(s)
- Ne Myo Aung
- University of Medicine 2, Yangon, Myanmar.,Insein General Hospital, Yangon, Myanmar
| | | | | | | | - Tint Tint Kyi
- Department of Medical Care, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Nicholas M Anstey
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Mar Mar Kyi
- University of Medicine 2, Yangon, Myanmar.,Insein General Hospital, Yangon, Myanmar
| | - Josh Hanson
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Kirby Institute, University of New South Wales, Sydney, Australia.,University of Medicine 2, Yangon, Myanmar
| |
Collapse
|
45
|
Contopoulos-Ioannidis D, Newman-Lindsay S, Chow C, LaBeaud AD. Mother-to-child transmission of Chikungunya virus: A systematic review and meta-analysis. PLoS Negl Trop Dis 2018; 12:e0006510. [PMID: 29897898 PMCID: PMC6075784 DOI: 10.1371/journal.pntd.0006510] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 08/03/2018] [Accepted: 05/08/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Chikungunya virus (CHIKV) is an emerging arboviral infection with a global distribution and may cause fetal and neonatal infections after maternal CHIKV-infections during gestation. METHODOLOGY We performed a systematic review to evaluate the risk for: a) mother-to-child transmission (MTCT), b) antepartum fetal deaths (APFD), c) symptomatic neonatal disease, and d) neonatal deaths from maternal CHIKV-infections during gestation. We also recorded the neonatal clinical manifestations after such maternal infections (qualitative data synthesis). We searched PubMed (last search 3/2017) for articles, of any study design, with any of the above outcomes. We calculated the overall risk of MTCT, APFDs and risk of symptomatic neonatal disease by simple pooling. For endpoints with ≥5 events in more than one study, we also synthesized the data by random-effect-model (REM) meta-analysis. PRINCIPAL FINDINGS Among 563 identified articles, 13 articles from 8 cohorts were included in the quantitative data synthesis and 33 articles in the qualitative data synthesis. Most cohorts reported data only on symptomatic rather than on all neonatal infections. By extrapolation also of these data, the overall pooled-MTCT-risk across cohorts was at least 15.5% (206/1331), (12.6% by REMs). The pooled APFD-risk was 1.7% (20/1203); while the risk of CHIKV-confirmed-APFDs was 0.3% (3/1203). Overall, the pooled-risk of symptomatic neonatal disease was 15.3% (203/1331), (11.9% by REMs). The pooled risk of symptomatic disease was 50.0% (23/46) among intrapartum vs 0% (0/712) among antepartum/peripartum maternal infections. Infected newborns, from maternal infections during gestation were either asymptomatic or presented within their first week of life, but not at birth, with fever, irritability, hyperalgesia, diffuse limb edema, rashes and occasionally sepsis-like illness and meningoencephalitis. The pooled-risk of neonatal death was 0.6% (5/832) among maternal infections and 2.8% (5/182) among neonatal infections; long-term neurodevelopmental delays occurred in 50% of symptomatic neonatal infections. CONCLUSIONS/SIGNIFICANCE Published cohorts with data on the risk to the fetus and/or newborn from maternal CHIKV-infections during gestation were sparse compared to the number of recently reported CHIKV-infection outbreaks worldwide; however perinatal infections do occur, at high rates during intrapartum period, and can be related to neonatal death and long-term disabilities.
Collapse
Affiliation(s)
- Despina Contopoulos-Ioannidis
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Shoshana Newman-Lindsay
- Department of Pediatrics, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Camille Chow
- Department of Internal Medicine, St. Agnes Medical Center, Fresno, CA, United States of America
| | - A. Desiree LaBeaud
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA, United States of America
| |
Collapse
|
46
|
Mashamba-Thompson TP, Sartorius B, Drain PK. Operational assessment of point-of-care diagnostics in rural primary healthcare clinics of KwaZulu-Natal, South Africa: a cross-sectional survey. BMC Health Serv Res 2018; 18:380. [PMID: 29843711 PMCID: PMC5975682 DOI: 10.1186/s12913-018-3207-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/15/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) called for new clinical diagnostic for settings with limited access to laboratory services. Access to diagnostic testing may not be uniform in rural settings, which may result in poor access to essential healthcare services. The aim of this study is to determine the availability, current usage, and need for point-of-care (POC) diagnostic tests among rural primary healthcare (PHC) clinics in South Africa's KwaZulu-Natal (KZN) province. METHODS We used the KZN's Department of Health (DoH) clinic classification to identify the 232 rural PHC clinics in KZN, South Africa. We then randomly sampled 100 of 232 rural PHC clinics. Selected health clinics were surveyed between April to August 2015 to obtain clinic-level data for health-worker volume and to determine the accessibility, availability, usage and need for POC tests. Professional healthcare workers responsible for POC testing at each clinic were interviewed to assess the awareness of POC testing. Data were survey weighted and analysed using Stata 13. RESULTS Among 100 rural clinics, the average number of patients seen per week was 2865 ± 2231 (range 374-11,731). The average number of POC tests available and in use was 6.3 (CI: 6.2-6.5) out of a potential of 51 tests. The following POC tests were universally available in all rural clinics: urine total protein, urine leukocytes, urine nitrate, urine pregnancy, HIV antibody and blood glucose test. The average number of desired POC diagnostic tests reported by the clinical staff was estimated at 15 (CI: 13-17) per clinic. The most requested POC tests reported were serum creatinine (37%), CD4 count (37%), cholesterol (32%), tuberculosis (31%), and HIV viral load (23%). CONCLUSION Several POC tests are widely available and in use at rural PHC clinics in South Africa's KZN province. However, healthcare workers have requested additional POC tests to improve detection and management of priority disease conditions. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT02692274.
Collapse
Affiliation(s)
- T P Mashamba-Thompson
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor, George Campbell Building, Science Drive, Howard College Campus, Durban, 4001, South Africa.
| | - B Sartorius
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor, George Campbell Building, Science Drive, Howard College Campus, Durban, 4001, South Africa
| | - P K Drain
- International Clinical Research Center, Department of Global Health, University of Washington, Seattle, USA.,Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, USA.,Department of Epidemiology, University of Washington, Seattle, USA.,Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
47
|
Duchesne L, Lacombe K. Innovative technologies for point-of-care testing of viral hepatitis in low-resource and decentralized settings. J Viral Hepat 2018; 25:108-117. [PMID: 29134742 DOI: 10.1111/jvh.12827] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 09/18/2017] [Indexed: 12/13/2022]
Abstract
According to the Global Burden of Diseases, chronic viral hepatitis B and C are one of the most challenging global health conditions that rank among the first causes of morbidity and mortality worldwide. Low- and middle-income countries are particularly affected by the health burden associated with HBV or HCV infection. One major gap in efficiently addressing the issue of viral hepatitis is universal screening. However, the costs and chronic lack of human resources for using traditional screening strategies based on serology and molecular biology preclude any scaling-up. Point-of-care tests have been deemed a powerful potential solution to fill the current diagnostics gap in low-resource and decentralized settings. Despite high interest resulting from their development in recent years, very few point-of-care devices have reached the market. Scaling down and automating all testing steps in 1 single device (eg, sample preparation, detection and readout) is indeed challenging. But innovations in multiple disciplines such as nanotechnologies, microfluidics, biosensors and synthetic biology have led to the creation of chip-sized laboratory systems called "lab-on-a-chip" devices. This review aims to explain how these innovations can overcome technological barriers that usually arise for each testing step while developing integrated point-of-care tests. Point-of-care test prototypes rarely meet the requirements for mass production, which also hinders their large-scale production. In addition to logistical hurdles, legal and economic constraints specific to the commercialization of in vitro diagnostics, which have also participated in the low transfer of innovative point-of-care tests to the field, are discussed.
Collapse
Affiliation(s)
- L Duchesne
- Sorbonne Universités, UPMC Univ Paris, Paris, France.,Inserm, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - K Lacombe
- Sorbonne Universités, UPMC Univ Paris, Paris, France.,Inserm, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.,Service de maladies infectieuses et tropicales, Hôpital Saint-Antoine, Paris, France
| |
Collapse
|
48
|
Kuupiel D, Bawontuo V, Mashamba-Thompson TP. Improving the Accessibility and Efficiency of Point-of-Care Diagnostics Services in Low- and Middle-Income Countries: Lean and Agile Supply Chain Management. Diagnostics (Basel) 2017; 7:E58. [PMID: 29186013 PMCID: PMC5745394 DOI: 10.3390/diagnostics7040058] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/11/2017] [Accepted: 11/14/2017] [Indexed: 01/07/2023] Open
Abstract
Access to point-of-care (POC) diagnostics services is essential for ensuring rapid disease diagnosis, management, control, and surveillance. POC testing services can improve access to healthcare especially where healthcare infrastructure is weak and access to quality and timely medical care is a challenge. Improving the accessibility and efficiency of POC diagnostics services, particularly in resource-limited settings, may be a promising route to improving healthcare outcomes. In this review, the accessibility of POC testing is defined as the distance/proximity to the nearest healthcare facility for POC diagnostics service. This review provides an overview of the impact of POC diagnostics on healthcare outcomes in low- and middle-income countries (LMICs) and factors contributing to the accessibility of POC testing services in LMICs, focusing on characteristics of the supply chain management and quality systems management, characteristics of the geographical location, health infrastructure, and an enabling policy framework for POC diagnostics services. Barriers and challenges related to the accessibility of POC diagnostics in LMICs were also discussed. Bearing in mind the reported barriers and challenges as well as the disease epidemiology in LMICs, we propose a lean and agile supply chain management framework for improving the accessibility and efficiency of POC diagnostics services in these settings.
Collapse
Affiliation(s)
- Desmond Kuupiel
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, 4001 Durban, South Africa.
| | - Vitalis Bawontuo
- Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana.
| | - Tivani P Mashamba-Thompson
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, 4001 Durban, South Africa.
| |
Collapse
|
49
|
Heffernan A, Barber E, Cook NA, Gomaa AI, Harley YX, Jones CR, Lim AG, Mohamed Z, Nayagam S, Ndow G, Shah R, Sonderup MW, Spearman CW, Waked I, Wilkinson RJ, Taylor-Robinson SD. Aiming at the Global Elimination of Viral Hepatitis: Challenges Along the Care Continuum. Open Forum Infect Dis 2017; 5:ofx252. [PMID: 29354656 PMCID: PMC5767952 DOI: 10.1093/ofid/ofx252] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A recent international workshop, organized by the authors, analyzed the obstacles facing the ambitious goal of eliminating viral hepatitis globally. We identified several policy areas critical to reaching elimination targets. These include providing hepatitis B birth-dose vaccination to all infants within 24 hours of birth, preventing the transmission of blood-borne viruses through the expansion of national hemovigilance schemes, implementing the lessons learned from the HIV epidemic regarding safe medical practices to eliminate iatrogenic infection, adopting point-of-care testing to improve coverage of diagnosis, and providing free or affordable hepatitis C treatment to all. We introduce Egypt as a case study for rapid testing and treatment scale-up: this country offers valuable insights to policy makers internationally, not only regarding how hepatitis C interventions can be expeditiously scaled-up, but also as a guide for how to tackle the problems encountered with such ambitious testing and treatment programs.
Collapse
Affiliation(s)
- Alastair Heffernan
- Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK
| | - Ella Barber
- Division of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK.,Médecins Sans Frontières, London, UK
| | - Nicola A Cook
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Asmaa I Gomaa
- Hepatology Department, National Liver Institute, Menoufiya University, Shebeen El-Kom, Egypt
| | - Yolande X Harley
- Research Office, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Christopher R Jones
- Division of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Zameer Mohamed
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Liver and Antiviral Unit, Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK
| | - Shevanthi Nayagam
- Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK.,Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Gibril Ndow
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Hepatitis Unit, Disease Control and Elimination, MRC Unit, Banjul, The Gambia
| | - Rajiv Shah
- Infectious Diseases Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Mark W Sonderup
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Imam Waked
- Hepatology Department, National Liver Institute, Menoufiya University, Shebeen El-Kom, Egypt
| | - Robert J Wilkinson
- Division of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK.,Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Tuberculosis Laboratory, The Francis Crick Institute, London, UK
| | | |
Collapse
|
50
|
Mumba C, Häsler B, Muma JB, Munyeme M, Sitali DC, Skjerve E, Rich KM. Practices of traditional beef farmers in their production and marketing of cattle in Zambia. Trop Anim Health Prod 2017; 50:49-62. [DOI: 10.1007/s11250-017-1399-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
|