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1.
J Vet Intern Med ; 37(3): 1223-1232, 2023.
Article in English | MEDLINE | ID: covidwho-20233210

ABSTRACT

BACKGROUND: A point-of-care ultrasound (POCUS) protocol for evaluation of the cardiac and respiratory systems in horses does not exist. OBJECTIVES: (a) Describe the windows of a POCUS protocol for cardiorespiratory assessment of horses (CRASH); (b) Estimate the number of acoustic windows that can be acquired by a sonographer-in-training; (c) Estimate the time required to complete the protocol for specific groups of horses; (d) Describe the sonographic abnormalities detected in horses presented with cardiovascular, respiratory, or systemic disease. ANIMALS: Twenty-seven healthy horses, 14 horses competing in athletic events, and 120 horses with clinical disease. METHOD: A pocket-sized ultrasound device was used to acquire 7 sonographic cardiorespiratory windows in various clinical scenarios. The duration of the examination was timed, and images were evaluated for diagnostic quality. Abnormalities in horses with clinical disease were determined by an expert sonographer. RESULTS: The CRASH protocol could be performed in healthy and diseased horses in hospital, barn, and competition settings between 5.5 ± 0.9 (athletic horses) and 6.9 ± 1.9 min (horses with clinical disease). Thoracic windows were obtained most consistently, followed by right parasternal long-axis echocardiographic windows. Frequently detected abnormalities were pleural fluid, lung consolidation, B-lines, and moderate-to-severe left-sided heart disease. CONCLUSIONS: The CRASH protocol was feasible using a pocket-sized ultrasound device in various groups of horses, could be completed rapidly in a variety of settings, and frequently identified sonographic abnormalities when evaluated by an expert sonographer. The diagnostic accuracy, observer agreement, and utility of the CRASH protocol merit further evaluation.


Subject(s)
Point-of-Care Systems , Point-of-Care Testing , Horses , Animals , Feasibility Studies , Ultrasonography/veterinary , Ultrasonography/methods , Echocardiography/veterinary
2.
J Clin Virol ; 164: 105492, 2023 07.
Article in English | MEDLINE | ID: covidwho-2319271

ABSTRACT

Historically, the diagnosis of viral infections has been accomplished using a combination of laboratory-based methods, including culture, serology, antigen-based tests, and molecular (e.g., real-time PCR) assays. Although these methods provide an accurate way to detect viral pathogens, testing in a centralized laboratory may delay results, which could impact patient diagnosis and management. Point-of-care tests, including antigen- and molecular-based assays, have been developed to assist with the timely diagnosis of several viral infections, such as influenza, respiratory syncytial virus, and COVID-19. Despite the ability of point-of-care tests to provide rapid results (i.e., <30 min), there are issues to consider prior to their routine use, including test performance and specific regulatory requirements. This review will provide a summary of the regulatory landscape of point-of-care tests for viral infections in the United States, and address important considerations such as site certification, training and inspection readiness.


Subject(s)
COVID-19 , Respiratory Syncytial Virus, Human , Virus Diseases , Humans , United States , COVID-19/diagnosis , Molecular Diagnostic Techniques/methods , Point-of-Care Testing , Virus Diseases/diagnosis , Respiratory Syncytial Virus, Human/genetics , Sensitivity and Specificity , Point-of-Care Systems
3.
Analyst ; 148(11): 2573-2581, 2023 May 30.
Article in English | MEDLINE | ID: covidwho-2319237

ABSTRACT

The rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has promoted the development of nucleic acid diagnosis technology. Several platforms with isothermal amplification methods have achieved sensitive and specific detection of SARS-CoV-2. However, they still suffer from complicated operations, delicate instruments, and unintuitive signal output modes. Here, a system consisting of CRISPR Cas12a-based biosensors and commercial pregnancy test strips (CRISPR-PTS) was established for the point-of-care testing of SARS-CoV-2. The target viral nucleic acids were finally reflected on the test strips through four steps, namely sample pretreatment, RT-RAA amplification, CRISPR Cas12a reaction, and separation-free hCG detection. This CRISPR-PTS assay possessed an outstanding sensitivity of as low as 1 copy per µL for SARS-CoV-2 detection and showed an excellent specificity in distinguishing the SARS-CoV-2 pseudovirus as well as other SARS-like viral clinical samples. In addition, the CRISPR-PTS assay performed well in practical applications, with 96.3% agreement versus RT-qPCR in spiked samples. With the advantages of low reagent cost, simple operation procedure, and visible signal output, CRISPR-PTS assay was expected to provide a strong supplement in the prevention and early diagnosis of infectious diseases in resource-limited situations.


Subject(s)
COVID-19 , Nucleic Acids , Pregnancy Tests , Female , Pregnancy , Humans , COVID-19/diagnosis , CRISPR-Cas Systems/genetics , SARS-CoV-2/genetics , Point-of-Care Testing , Nucleic Acid Amplification Techniques , Sensitivity and Specificity , RNA, Viral/genetics
4.
J Intensive Care Med ; 38(6): 566-570, 2023 Jun.
Article in English | MEDLINE | ID: covidwho-2317252

ABSTRACT

Keeping up with the latest developments in the point-of-care ultrasound (POCUS) literature is challenging, as with any area of medicine. Our group of POCUS experts has selected 10 influential papers from the past 12 months and provided a short summary of each. We hope to provide emergency physicians, intensivists, and other acute care providers with a succinct update concerning some key areas of ultrasound interest.


Subject(s)
Point-of-Care Systems , Point-of-Care Testing , Humans , Ultrasonography
5.
Clin Infect Dis ; 75(4): 723-728, 2022 Sep 10.
Article in English | MEDLINE | ID: covidwho-2315683

ABSTRACT

Testing programs for severe acute respiratory syndrome coronavirus 2 have relied on high-throughput polymerase chain reaction laboratory tests and rapid antigen assays to meet diagnostic needs. Both technologies are essential; however, issues of cost, accessibility, manufacturing delays, and performance have limited their use in low-resource settings and contributed to the global inequity in coronavirus disease 2019 testing. Emerging low-cost, multidisease point-of-care nucleic acid tests may address these limitations and strengthen pandemic preparedness, especially within primary healthcare where most cases of disease first present. Widespread deployment of these novel technologies will also help close long-standing test access gaps for other diseases, including tuberculosis, human immunodeficiency virus, cervical cancer, viral hepatitis, and sexually transmitted infections. We propose a more optimized testing framework based on greater use of point-of-care nucleic acid tests together with rapid immunologic assays and high-throughput laboratory molecular tests to improve the diagnosis of priority endemic and epidemic diseases, as well as strengthen the overall delivery of primary healthcare services.


Subject(s)
COVID-19 , Nucleic Acids , COVID-19/diagnosis , COVID-19 Testing , Clinical Laboratory Techniques , Humans , Point-of-Care Testing
6.
Biosens Bioelectron ; 225: 115102, 2023 Apr 01.
Article in English | MEDLINE | ID: covidwho-2311842

ABSTRACT

Growing studies focusing on nuclear acid detection via the emerging CRISPR technique demonstrate its promising application. However, limited works solve the identification of non-nucleic acid targets, especially multiple small molecules. To address challenges for point-of-care testing (POCT) in complex matrices for healthcare, environment, and food safety, we developed CRISPR Cas12a-powered highly sensitive, high throughput, intelligent POCT (iPOCT) for multiple small molecules based on a smartphone-controlled reader. As a proof of concept, aflatoxin B1 (AFB1), benzo[a]pyrene (BaP), and capsaicin (CAP) were chosen as multiple targets. First, three antigens were preloaded in independent microwells. Then, the antibody/antigen-induced fluorescent signals were consecutively transferred from the biotin-streptavidin to CRISPR/Cas12a system. Third, the fluorescent signals were recorded by a smartphone-controlled handheld dark-box readout. Under optimization, detection limits in AFB1, BaP, and CAP were 0.00257, 4.971, and 794.6 fg/mL with wide linear ranges up to four orders of magnitude. Using urine, water, soybean oil, wheat, and peanuts as the complex matrix, we recorded high selectivity, considerable recovery, repeatability, and high consistency comparison to HPLC-MS/MS methods. This work promises a practical intelligent POCT platform for multiple targets in lipid-soluble and water-soluble matrices and could be extensively applied for healthcare, environment, and food safety.


Subject(s)
Biosensing Techniques , CRISPR-Cas Systems , Tandem Mass Spectrometry , Aflatoxin B1 , Capsaicin , Coloring Agents , Point-of-Care Testing , Delivery of Health Care
7.
Anal Chim Acta ; 1264: 341283, 2023 Jul 11.
Article in English | MEDLINE | ID: covidwho-2310886

ABSTRACT

In resource-limited conditions such as the COVID-19 pandemic, on-site detection of diseases using the Point-of-care testing (POCT) technique is becoming a key factor in overcoming crises and saving lives. For practical POCT in the field, affordable, sensitive, and rapid medical testing should be performed on simple and portable platforms, instead of laboratory facilities. In this review, we introduce recent approaches to the detection of respiratory virus targets, analysis trends, and prospects. Respiratory viruses occur everywhere and are one of the most common and widely spreading infectious diseases in the human global society. Seasonal influenza, avian influenza, coronavirus, and COVID-19 are examples of such diseases. On-site detection and POCT for respiratory viruses are state-of-the-art technologies in this field and are commercially valuable global healthcare topics. Cutting-edge POCT techniques have focused on the detection of respiratory viruses for early diagnosis, prevention, and monitoring to protect against the spread of COVID-19. In particular, we highlight the application of sensing techniques to each platform to reveal the challenges of the development stage. Recent POCT approaches have been summarized in terms of principle, sensitivity, analysis time, and convenience for field applications. Based on the analysis of current states, we also suggest the remaining challenges and prospects for the use of the POCT technique for respiratory virus detection to improve our protection ability and prevent the next pandemic.


Subject(s)
COVID-19 , Viruses , Humans , Point-of-Care Testing , Pandemics
8.
Biosensors (Basel) ; 13(2)2023 Jan 29.
Article in English | MEDLINE | ID: covidwho-2309398

ABSTRACT

With the move of molecular tests from diagnostic labs to on-site testing becoming more common, there is a sudden rise in demand for nucleic acid-based diagnostic tools that are selective, sensitive, flexible to terrain changes, and cost-effective to assist in point-of-care systems for large-scale screening and to be used in remote locations in cases of outbreaks and pandemics. CRISPR-based biosensors comprise a promising new approach to nucleic acid detection, which uses Cas effector proteins (Cas9, Cas12, and Cas13) as extremely specialized identification components that may be used in conjunction with a variety of readout approaches (such as fluorescence, colorimetry, potentiometry, lateral flow assay, etc.) for onsite analysis. In this review, we cover some technical aspects of integrating the CRISPR Cas system with traditional biosensing readout methods and amplification technologies such as polymerase chain reaction (PCR), loop-mediated isothermal amplification (LAMP), and recombinase polymerase amplification (RPA) and continue to elaborate on the prospects of the developed biosensor in the detection of some major viral and bacterial diseases. Within the scope of this article, we also discuss the recent COVID pandemic and the numerous CRISPR biosensors that have undergone development since its advent. Finally, we discuss some challenges and future prospects of CRISPR Cas systems in point-of-care testing.


Subject(s)
Biosensing Techniques , COVID-19 , Nucleic Acids , Humans , Point-of-Care Systems , Point-of-Care Testing , Biological Assay , Nucleic Acid Amplification Techniques , COVID-19 Testing
10.
Biosens Bioelectron ; 222: 114989, 2023 Feb 15.
Article in English | MEDLINE | ID: covidwho-2306553

ABSTRACT

For point-of-care testing (POCT), coupling isothermal nucleic acid amplification schemes (e.g., recombinase polymerase amplification, RPA) with lateral flow assay (LFA) readout is an ideal platform, since such integration offers both high sensitivity and deployability. However, isothermal schemes typically suffers from non-specific amplification, which is difficult to be differentiated by LFA and thus results in false-positives. Here, we proposed an accurate POCT platform by specific recognition of target amplicons with peptide nucleic acid (PNA, assisted by T7 Exonuclease), which could be directly plugged into the existing RPA kits and commercial LFA test strips. With SARS-CoV-2 as the model, the proposed method (RPA-TeaPNA-LFA) efficiently eliminated the false-positives, exhibiting a lowest detection concentration of 6.7 copies/µL of RNA and 90 copies/µL of virus. Using dual-gene (orf1ab and N genes of SARS-CoV-2) as the targets, RPA-TeaPNA-LFA offered a high specificity (100%) and sensitivity (RT-PCR Ct < 31, 100%; Ct < 40, 71.4%), and is valuable for on-site screening or self-testing during isolation. In addition, the dual test lines in the test strips were successfully explored for simultaneous detection of SARS-CoV-2 and H1N1, showing great potential in response to future pathogen-based pandemics.


Subject(s)
Biosensing Techniques , COVID-19 , Influenza A Virus, H1N1 Subtype , Nucleic Acids , Humans , Influenza A Virus, H1N1 Subtype/genetics , SARS-CoV-2/genetics , COVID-19/diagnosis , Nucleic Acid Amplification Techniques/methods , Point-of-Care Testing , Sensitivity and Specificity , Recombinases/genetics
11.
BMC Prim Care ; 24(1): 96, 2023 04 11.
Article in English | MEDLINE | ID: covidwho-2299748

ABSTRACT

BACKGROUND: Due to their fast turnaround time and user-friendliness, point-of-care tests (POCTs) possess a great potential in primary care. The purpose of the study was to assess general practitioners' (GPs) perspectives on POCT use in German primary care, including utilization, limitations and requirements. METHODS: We conducted a cross-sectional survey study among GPs in Germany (federal states of Thuringia, Bremen and Bavaria (Lower Franconia), study period: 04/22-06/2022). RESULTS: From 2,014 GPs reached, 292 participated in our study (response rate: 14.5%). The median number of POCTs used per GP was 7.0 (IQR: 5.0-8.0). Six POCTs are used by the majority of surveyed GPs (> 50%): urine dipstick tests (99%), glucose (urine [91%] and plasma [69%]), SARS-CoV-2 (80%), urine microalbumin (77%), troponin I/T (74%) and prothrombin time / international normalized ratio (65%). The number of utilized POCTs did not differ between GP practice type (p = 0.307) and population size of GP practice location (p = 0.099). The great majority of participating German GPs (93%) rated POCTs as useful diagnostic tools in the GP practice. GPs ranked immediate decisions on patient management and the increase in diagnostic certainty as the most important reasons for performing POCTs. The most frequently reported limitations of POCT use in the GP practice were economic aspects (high costs and inadequate reimbursement), concerns regarding diagnostic accuracy, and difficulties to integrate POCT-testing into practice routines (e.g. time and personnel expenses). CONCLUSION: Although participating German GPs generally perceive POCTs as useful diagnostic tools and numerous POCTs are available, several test-related and contextual factors contribute to the relatively low utilization of POCTs in primary care.


Subject(s)
COVID-19 , General Practitioners , Humans , Point-of-Care Systems , Cross-Sectional Studies , SARS-CoV-2 , Point-of-Care Testing , Primary Health Care , COVID-19 Testing
12.
Sci Adv ; 9(14): eade4962, 2023 04 07.
Article in English | MEDLINE | ID: covidwho-2299520

ABSTRACT

Engineering plays a critical role in the development of medical devices, and this has been magnified since 2020 as severe acute respiratory syndrome coronavirus 2 swept over the globe. In response to the coronavirus disease 2019, the National Institutes of Health launched the Rapid Acceleration of Diagnostics (RADx) initiative to help meet the testing needs of the United States and effectively manage the pandemic. As the Engineering and Human Factors team for the RADx Tech Test Verification Core, we directly assessed more than 30 technologies that ultimately contributed to an increase of the country's total testing capacity by 1.7 billion tests to date. In this review, we present central lessons learned from this "apples-to-apples" comparison of novel, rapidly developed diagnostic devices. Overall, the evaluation framework and lessons learned presented in this review may serve as a blueprint for engineers developing point-of-care diagnostics, leaving us better prepared to respond to the next global public health crisis rapidly and effectively.


Subject(s)
COVID-19 , Humans , United States , COVID-19/diagnosis , COVID-19/epidemiology , Clinical Laboratory Techniques , SARS-CoV-2 , COVID-19 Testing , Point-of-Care Testing
13.
Anal Methods ; 15(18): 2154-2180, 2023 05 11.
Article in English | MEDLINE | ID: covidwho-2296617

ABSTRACT

The Covid-19 pandemic has led to greater recognition of the importance of the fast and timely detection of pathogens. Recent advances in point-of-care testing (POCT) technology have shown promising results for rapid diagnosis. Immunoassays are among the most extensive POCT assays, in which specific labels are used to indicate and amplify the immune signal. Nanoparticles (NPs) are above the rest because of their versatile properties. Much work has been devoted to NPs to find more efficient immunoassays. Herein, we comprehensively describe NP-based immunoassays with a focus on particle species and their specific applications. This review describes immunoassays along with key concepts surrounding their preparation and bioconjugation to show their defining role in immunosensors. The specific mechanisms, microfluidic immunoassays, electrochemical immunoassays (ELCAs), immunochromatographic assays (ICAs), enzyme-linked immunosorbent assays (ELISA), and microarrays are covered herein. For each mechanism, a working explanation of the appropriate background theory and formalism is articulated before examining the biosensing and related point-of-care (POC) utility. Given their maturity, some specific applications using different nanomaterials are discussed in more detail. Finally, we outline future challenges and perspectives to give a brief guideline for the development of appropriate platforms.


Subject(s)
Biosensing Techniques , COVID-19 , Nanoparticles , Humans , Immunoassay/methods , Pandemics , COVID-19/diagnosis , Nanoparticles/chemistry , Point-of-Care Testing
14.
Biosensors (Basel) ; 11(9)2021 Aug 25.
Article in English | MEDLINE | ID: covidwho-2263330

ABSTRACT

The development of reliable and robust diagnostic tests is one of the most efficient methods to limit the spread of coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, most laboratory diagnostics for COVID-19, such as enzyme-linked immunosorbent assay (ELISA) and reverse transcriptase-polymerase chain reaction (RT-PCR), are expensive, time-consuming, and require highly trained professional operators. On the other hand, the lateral flow immunoassay (LFIA) is a simpler, cheaper device that can be operated by unskilled personnel easily. Unfortunately, the current technique has some limitations, mainly inaccuracy in detection. This review article aims to highlight recent advances in novel lateral flow technologies for detecting SARS-CoV-2 as well as innovative approaches to achieve highly sensitive and specific point-of-care testing. Lastly, we discuss future perspectives on how smartphones and Artificial Intelligence (AI) can be integrated to revolutionize disease detection as well as disease control and surveillance.


Subject(s)
COVID-19 Testing/instrumentation , COVID-19/diagnosis , SARS-CoV-2/isolation & purification , Artificial Intelligence , COVID-19/immunology , COVID-19 Testing/economics , Humans , Immunoassay , Point-of-Care Testing , SARS-CoV-2/genetics , SARS-CoV-2/immunology , Sensitivity and Specificity , Smartphone
15.
ACS Infect Dis ; 9(1): 9-22, 2023 01 13.
Article in English | MEDLINE | ID: covidwho-2275864

ABSTRACT

Screening of biomarkers is a powerful approach for providing a holistic view of the disease spectrum and facilitating the diagnosis and prognosis of the state of infectious diseases. Unaffected by the homeostasis mechanism in the human body, urine accommodates systemic changes and reflects the pathophysiological condition of an individual. Easy availability in large volumes and non-invasive sample collection have rendered urine an ideal source of biomarkers for various diseases. Infectious diseases may be communicable, and therefore early diagnosis and treatment are of immense importance. Current diagnostic approaches preclude the timely identification of clinical conditions and also lack portability. Point-of-care (POC) testing solutions have gained attention as alternative diagnostic measures due to their ability to provide rapid and on-site results. Lateral flow assays (LFAs) are the mainstay in POC device development and have attracted interest owing to their potential to provide instantaneous results in resource-limited settings. The discovery and optimization of a definitive biomarker can render POC testing an excellent platform, thus impacting unwarranted antibiotic administration and preventing the spread of infectious diseases. This Review summarizes the importance of urine as an emerging biological fluid in infectious disease research and diagnosis in clinical settings. We review the academic research related to LFAs. Further, we also describe commercial POC devices based on the identification of urinary biomarkers as diagnostic targets for infectious diseases. We also discuss the future use of LFAs in developing more effective POC tests for urinary biomarkers of various infections.


Subject(s)
Communicable Diseases , Humans , Communicable Diseases/diagnosis , Point-of-Care Testing , Biomarkers , Biological Assay , Early Diagnosis
17.
Biosensors (Basel) ; 12(12)2022 Nov 23.
Article in English | MEDLINE | ID: covidwho-2256287

ABSTRACT

Seeking optimized infectious pathogen detection tools is of primary importance to lessen the spread of infections, allowing prompt medical attention for the infected. Among nucleic-acid-based sensing techniques, loop-mediated isothermal amplification is a promising method, as it provides rapid, sensitive, and specific detection of microbial and viral pathogens and has enormous potential to transform current point-of-care molecular diagnostics. In this review, the advances in LAMP-based point-of-care diagnostics assays developed during the past few years for rapid and sensitive detection of infectious pathogens are outlined. The numerous detection methods of LAMP-based biosensors are discussed in an end-point and real-time manner with ideal examples. We also summarize the trends in LAMP-on-a-chip modalities, such as classical microfluidic, paper-based, and digital LAMP, with their merits and limitations. Finally, we provide our opinion on the future improvement of on-chip LAMP methods. This review serves as an overview of recent breakthroughs in the LAMP approach and their potential for use in the diagnosis of existing and emerging diseases.


Subject(s)
Biosensing Techniques , Communicable Diseases , Humans , Point-of-Care Systems , Nucleic Acid Amplification Techniques/methods , Point-of-Care Testing , Microfluidics , Molecular Diagnostic Techniques
20.
J Pharm Biomed Anal ; 225: 115213, 2023 Feb 20.
Article in English | MEDLINE | ID: covidwho-2248482

ABSTRACT

The innovative technology of a marketable lab-on-a-chip platform for point-of-care (POC) in vitro detection has recently attracted remarkable attention. The POC tests can significantly enhance the high standard of medicinal care. In the last decade, clinical diagnostic technology has been broadly advanced and successfully performed in several areas. It seems that lab-on-a-chip approaches play a significant role in these technologies. However, high-cost and time-consuming methods are increasing the challenge and the development of a cost-effective, rapid and efficient method for the detection of biomolecules is urgently needed. Recently, polymer-coated sensing platforms have been a promising area that can be employed in medical diagnosis, pharmaceutical bioassays, and environmental monitoring. The designed on-chip sensors are based on molecular imprinting polymers (MIPs) that use label-free detection technology. Molecular imprinting shines out as a potentially promising technique for creating artificial recognition material with molecular recognition sites. MIPs provide unique advantages such as excellent recognition specificity, high selectivity, and good reusability. This review article aims to define several methods using molecular imprinting for biomolecules and their incorporation with several lab-on-chip technologies to describe the most promising methods for the development of sensing systems based on molecularly imprinted polymers. The higher selectivity, more user-friendly operation is believed to provide MIP-based lab-on-a-chip devices with great potential academic and commercial value in on-site clinical diagnostics and other point-of-care assays.


Subject(s)
Biosensing Techniques , Molecular Imprinting , Molecular Imprinting/methods , Biosensing Techniques/methods , Point-of-Care Testing , Point-of-Care Systems , Polymers/metabolism
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