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Low resource diagnostics

E A R Engku Nur Syafirah, A B Nurul Najian, Phiaw Chong Foo, Mohammad Ridhuan Mohd Ali, Maizan Mohamed, Chan Yean Yean
Cholera, caused by Vibrio cholerae is a foodborne disease that frequently reported in food and water related outbreak. Rapid diagnosis of cholera infection is important to avoid potential spread of disease. Among available diagnostic platforms, loop-mediated isothermal amplification (LAMP) is regarded as a potential diagnostic tool due to its rapidity, high sensitivity and specificity and independent of sophisticated thermalcycler. However, the current LAMP often requires multiple pipetting steps, hence is susceptible to cross contamination...
March 12, 2018: Acta Tropica
Qiang Lu, Guanghui Liu, Chuanli Xiao, Chuanzhen Hu, Shiwu Zhang, Ronald X Xu, Kaiqin Chu, Qianming Xu, Zachary J Smith
In this paper we report the development of a cost-effective, modular, open source, and fully automated slide-scanning microscope, composed entirely of easily available off-the-shelf parts, and capable of bright field and fluorescence modes. The automated X-Y stage is composed of two low-cost micrometer stages coupled to stepper motors operated in open-loop mode. The microscope is composed of a low-cost CMOS sensor and low-cost board lenses placed in a 4f configuration. The system has approximately 1 micron resolution, limited by the f/# of available board lenses...
2018: PloS One
Maria Lucia Specchia, Giuseppe La Torre, Giovanna Elisa Calabrò, Paolo Villari, Roberto Grilli, Antonio Federici, Walter Ricciardi, Chiara de Waure
Background: The current economic context calls for rationalizing health resources that can be pursued through disinvestment from low value health technologies to invest in the best performing ones, ensuring high healthcare quality. Oncology is a field where, because of high costs of health technologies and rapid innovation, disinvestment is crucial. Methods: On this basis, the research team investigated through a survey, based on a questionnaire, opinions and views of representatives of European countries about disinvestment, in terms of fields of application, potential advocates and barriers, specifically focusing on cancer care...
March 12, 2018: European Journal of Public Health
Vanessa A Thomas, Heather L Crouse, Kristy O Murray, Deborah C Hsu, Elizabeth A Camp, Andrea T Cruz
OBJECTIVE: The aim of this study was to perform a needs assessment of pediatric (PEM) and general emergency medicine (EM) provider knowledge, comfort, and current practice patterns in the evaluation of pediatric tropical infectious diseases. METHODS: An online survey was developed based on educational priorities identified by an expert panel via modified Delphi methodology. The survey included assessment of providers' typical evaluation, diagnosis, and treatment of tropical diseases and was distributed to PEM and EM providers in 2 large professional organizations...
March 12, 2018: Pediatric Emergency Care
David E Newman-Toker, J Matthew Austin, Jordan Derk, Melissa Danforth, Mark L Graber
BACKGROUND: A 2015 National Academy of Medicine report on improving diagnosis in health care made recommendations for direct action by hospitals and health systems. Little is known about how health care provider organizations are addressing diagnostic safety/quality. METHODS: This study is an anonymous online survey of safety professionals from US hospitals and health systems in July-August 2016. The survey was sent to those attending a Leapfrog Group webinar on misdiagnosis (n=188)...
June 27, 2017: Diagnosis
Kathleen J Finlayson, Christina N Parker, Charne Miller, Michelle Gibb, Suzanne Kapp, Rajna Ogrin, Jacinta Anderson, Kerrie Coleman, Dianne Smith, Helen E Edwards
The aim of this study was to validate a newly developed tool for predicting the risk of recurrence within 12 months of a venous leg ulcer healing. Performance of the tool to predict recurrence within a 12-month period was assessed using Area Under the Receiver Operating Characteristic Curve (AUC) analysis. Multi-site retrospective and prospective longitudinal studies were undertaken to validate a risk assessment tool for the recurrence of venous leg ulcers within 12 months. In the retrospective study (n = 250), 55% of venous leg ulcers recurred within 12 months, and the risk assessment total score had excellent discrimination and goodness of fit with an AUC of 0...
March 13, 2018: International Wound Journal
Rumina Hasan, Sadia Shakoor, Johanna Hanefeld, Mishal Khan
Many low- and middle-income countries facing high levels of antimicrobial resistance, and the associated morbidity from ineffective treatment, also have a high burden of tuberculosis. Over recent decades many countries have developed effective laboratory and information systems for tuberculosis control. In this paper we describe how existing tuberculosis laboratory systems can be expanded to accommodate antimicrobial resistance functions. We show how such expansion in services may benefit tuberculosis case-finding and laboratory capacity through integration of laboratory services...
March 1, 2018: Bulletin of the World Health Organization
Yogendra Amatya, Jordan Rupp, Frances M Russell, Jason Saunders, Brian Bales, Darlene R House
BACKGROUND: Lung ultrasound is an effective tool for diagnosing pneumonia in developed countries. Diagnostic accuracy in resource-limited countries where pneumonia is the leading cause of death is unknown. The objective of this study was to evaluate the sensitivity of bedside lung ultrasound compared to chest X-ray for pneumonia in adults presenting for emergency care in a low-income country. METHODS: Patients presenting to the emergency department with suspected pneumonia were evaluated with bedside lung ultrasound, single posterioranterior chest radiograph, and computed tomography (CT)...
March 12, 2018: International Journal of Emergency Medicine
Nguyen Vu Quoc Huy, Le Minh Tam, Ngo Viet Quynh Tram, Dang Cong Thuan, Truong Quang Vinh, Cao Ngoc Thanh, Linus Chuang
This study aims to determine the diagnostic values of visual inspection with acetic acid (VIA) and Pap smear in a cervical cancer screening program at a community level in Vietnam. A cross-sectional analysis was obtained, including 1034 women of reproductive age from Thua Thien Hue Province, Vietnam from 09/2012 to 09/2013. Samples were taken from cervixes for Pap smear testing, followed by visual inspection with acetic acid. Subjects with abnormal VIA and/or positive cytology results were invited for colposcopy and biopsy...
May 2018: Gynecologic Oncology Reports
Tony Lough, Qingyang Luo, Carthika Luxmanan, Alastair Anderson, Jimmy Suttie, Paul O'Sullivan, David Darling
BACKGROUND: The non-invasive Cxbladder urine test system has demonstrated clinical utility in ruling out urothelial carcinoma (UC) in patients with asymptomatic microscopic hematuria (AMH), suggesting that the number of invasive diagnostic tests, including cystoscopy, used in this patient population may be reduced by Cxbladder testing prior to conducting a full urological work-up. The aim of this study was to demonstrate the enhanced clinical utility of communicating objective information on diagnostic decisions made by individual physicians on individual patients with AMH...
March 9, 2018: BMC Urology
Sien Ombelet, Jean-Baptiste Ronat, Timothy Walsh, Cedric P Yansouni, Janneke Cox, Erika Vlieghe, Delphine Martiny, Makeda Semret, Olivier Vandenberg, Jan Jacobs
Low-resource settings are disproportionately burdened by infectious diseases and antimicrobial resistance. Good quality clinical bacteriology through a well functioning reference laboratory network is necessary for effective resistance control, but low-resource settings face infrastructural, technical, and behavioural challenges in the implementation of clinical bacteriology. In this Personal View, we explore what constitutes successful implementation of clinical bacteriology in low-resource settings and describe a framework for implementation that is suitable for general referral hospitals in low-income and middle-income countries with a moderate infrastructure...
March 5, 2018: Lancet Infectious Diseases
Leslee J Shaw, Abhinav Goyal, Christina Mehta, Joe Xie, Lawrence Phillips, Anita Kelkar, Joseph Knapper, Daniel S Berman, Khurram Nasir, Emir Veledar, Michael J Blaha, Roger Blumenthal, James K Min, Reza Fazel, Peter W F Wilson, Matthew J Budoff
BACKGROUND: Cardiovascular disease (CVD) imparts a heavy economic burden on the U.S. health care system. Evidence regarding the long-term costs after comprehensive CVD screening is limited. OBJECTIVES: This study calculated 10-year health care costs for 6,814 asymptomatic participants enrolled in MESA (Multi-Ethnic Study of Atherosclerosis), a registry sponsored by the National Heart, Lung, and Blood Institute, National Institutes of Health. METHODS: Cumulative 10-year costs for CVD medications, office visits, diagnostic procedures, coronary revascularization, and hospitalizations were calculated from detailed follow-up data...
March 13, 2018: Journal of the American College of Cardiology
Laura M F Kuijpers, Panha Chung, Marjan Peeters, Marie-France Phoba, Chun Kham, Barbara Barbé, Octavie Lunguya, Jan Jacobs
BACKGROUND: In low resource settings, Salmonella serovars frequently cause bloodstream infections. This study investigated the diagnostic performance of immunochromatographic rapid diagnostic tests (RDTs), which detect Salmonella antigens, when applied to stored grown blood culture broth. MATERIAL/METHODS: The SD Bioline One Step Salmonella Typhi Ag Rapid Detection Kit (Standard Diagnostics, Republic of Korea), marketed for the detection of Salmonella enterica serovar Typhi (Salmonella Typhi) in stool and the Salmonella Ag Rapid Test (Creative Diagnostics, USA), marketed for the detection of all Salmonella serotypes in stool, were selected for evaluation based on a pre-test evaluation of six RDT products...
2018: PloS One
Konrad Gwozdzinski, Saina Azarderakhsh, Can Imirzalioglu, Linda Falgenhauer, Trinad Chakraborty
The plasmid-located colistin resistance gene ( mcr - 1 ) confers low-level resistance to colistin, a last-line antibiotic against multidrug-resistant Gram-negative bacteria. Current EUCAST/CLSI recommendations require the use of a broth microdilution (BMD) method in cation-adjusted Mueller-Hinton (CA-MH) for colistin susceptibility testing, but approximately 15% of all MCR-1-producers classify as sensitive in this medium. Here we report on an improved calcium-enhanced Mueller-Hinton (CE-MH) medium that permits simple and reliable determination of mcr-1 -producing Enterobacteriaceae Colistin susceptibility for 50 mcr-1 -encoding isolates of E...
March 7, 2018: Journal of Clinical Microbiology
Margot P Bickler, Laura J Rhodes
Detecting life-threatening common dyshemoglobins such as carboxyhemoglobin (COHb, resulting from carbon monoxide poisoning) or methemoglobin (MetHb, caused by exposure to nitrates) typically requires a laboratory CO-oximeter. Because of cost, these spectrophotometer-based instrument are often inaccessible in resource-poor settings. The aim of this study was to determine if an inexpensive pocket infrared spectrometer and smartphone (SCiO®Pocket Molecular Sensor, Consumer Physics Ltd., Israel) accurately detects COHb and MetHb in single drops of blood...
2018: PloS One
Shazia Mehmood Siddique, Meghan Lane-Fall, Matthew J McConnell, Neha Jakhete, James Crismale, Stefanie Porges, Vandana Khungar, Shivan J Mehta, David Goldberg, Zhiping Li, Thomas Schiano, Linda Regan, Clinton Orloski, Judy A Shea
Patients with cirrhosis have high admission and readmission rates, and it is estimated that a quarter are potentially preventable. Little data are available regarding nonmedical factors impacting triage decisions in this patient population. This study sought to explore such factors as well as to determine provider perspectives on low-acuity clinical presentations to the emergency department, including ascites and hepatic encephalopathy. A survey was distributed in four liver transplant centers to both emergency medicine and hepatology providers, who included attending physicians, house staff, and advanced practitioners; 196 surveys were returned (estimated response rate 50...
March 2018: Hepatology Communications
Anvita Bhardwaj, Christine Bourey, Sauharda Rai, Ramesh Prasad Adhikari, Carol M Worthman, Brandon A Kohrt
Background: Suicide risk reduction is crucial for 15-29-year-old youth, who account for 46% of suicide deaths in low- and middle-income countries. Suicide predictors in high-resource settings, specifically depression, do not adequately predict suicidality in these settings. We explored if interpersonal violence (IPV) was associated with suicidality, independent of depression, in Nepal. Methods: A longitudinal cohort of child soldiers and matched civilian children, enrolled in 2007 after the People's War in Nepal, were re-interviewed in 2012...
2018: Global Mental Health
J Patel, S Lal, K Nuss, S P Wilshaw, B von Rechenberg, R M Hall, J L Tipper
Less than optimal particle isolation techniques have impeded analysis of orthopaedic wear debris in vivo. The purpose of this research was to develop and test an improved method for particle isolation from tissue. A volume of 0.018 mm3 of clinically relevant CoCrMo, Ti-6Al-4V or Si3 N4 particles was injected into rat stifle joints for seven days of in vivo exposure. Following sacrifice, particles were located within tissues using histology. The particles were recovered by enzymatic digestion of periarticular tissue with papain and proteinase K, followed by ultracentrifugation using a sodium polytungstate density gradient...
March 2, 2018: Acta Biomaterialia
Onarheim Kristine Husøy, Sisay Mitike Molla, Gizaw Muluken, Moland Karen Marie, Norheim Ole Frithof, Miljeteig Ingrid
BACKGROUND: The first month of life is the period with the highest risk of dying. Despite knowledge of effective interventions, newborn mortality is high and utilization of health care services remains low in Ethiopia. In settings without universal health coverage, the economy of a household is vulnerable to illness, and out-of-pocket payments may limit families' opportunities to seek health care for newborns. In this paper we explore intra-household resource allocation, focusing on how families prioritize newborn health versus other household needs and their coping strategies for managing these priorities...
March 2, 2018: BMC Health Services Research
Marco J Haenssgen, Nutcha Charoenboon, Thomas Althaus, Rachel C Greer, Daranee Intralawan, Yoel Lubell
New and affordable point-of-care testing (POCT) solutions are hoped to guide antibiotic prescription and to help limit antimicrobial resistance (AMR)-especially in low- and middle-income countries where resource constraints often prevent extensive diagnostic testing. Anthropological and sociological research has illuminated the role and impact of rapid point-of-care malaria testing. This paper expands our knowledge about the social implications of non-malarial POCT, using the case study of a C-reactive-protein point-of-care testing (CRP POCT) clinical trial with febrile patients at primary-care-level health centres in Chiang Rai province, northern Thailand...
February 23, 2018: Social Science & Medicine
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