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Low resource diagnostics

Trevor Peter, Dennis Ellenberger, Andrea A Kim, Debrah Boeras, Tsehaynesh Messele, Teri Roberts, Wendy Stevens, Ilesh Jani, Alash'le Abimiku, Nathan Ford, Zachary Katz, John N Nkengasong
Scaling up access to HIV viral load testing for individuals undergoing antiretroviral therapy in low-resource settings is a global health priority, as emphasised by research showing the benefits of suppressed viral load for the individual and the whole population. Historically, large-scale diagnostic test implementation has been slow and incomplete because of service delivery and other challenges. Building on lessons from the past, in this Personal View we propose a new framework to accelerate viral load scale-up and ensure equitable access to this essential test...
October 20, 2016: Lancet Infectious Diseases
David E Clay, Annika C Linke, Daniel J Cameron, Bobby Stojanoski, Stephen Rulisa, Aggrey Wasunna, Sandrine de Ribaupierre, Rhodri Cusack
Neuroimaging is a valuable diagnostic tool for the early detection of neonatal brain injury, but equipment and radiologic staff are expensive and unavailable to most hospitals in developing countries. We evaluated an affordable, portable ultrasound machine as a quantitative and qualitative diagnostic tool and to establish whether a novice sonographer could effectively operate the equipment and obtain clinically important information. Cranial ultrasonography was performed on term healthy, pre-term and term asphyxiated neonates in Rwandan and Kenyan hospitals...
October 20, 2016: Ultrasound in Medicine & Biology
Minh D Pham, Paul A Agius, Lorena Romero, Peter McGlynn, David Anderson, Suzanne M Crowe, Stanley Luchters
BACKGROUND: Point-of-care (POC) CD4 testing increases patient accessibility to assessment of antiretroviral therapy eligibility. This review evaluates field performance in low and middle-income countries (LMICs) of currently available POC CD4 technologies. METHODS: Eight electronic databases were searched for field studies published between January 2005 and January 2015 of six POC CD4 platforms: PointCare NOW™, Alere Pima™ CD4, Daktari™ CD4 Counter, CyFlow® CD4 miniPOC, BD FACSPresto™, and MyT4™ CD4...
October 21, 2016: BMC Infectious Diseases
Robert F Riley, Chadwick D Miller, Gregory B Russell, Erin N Harper, Brian C Hiestand, James W Hoekstra, Cedric W Lefebvre, Bret A Nicks, David M Cline, Kim L Askew, Simon A Mahler
INTRODUCTION: The HEART Pathway is a diagnostic protocol designed to identify low-risk patients presenting to the emergency department with chest pain that are safe for early discharge. This protocol has been shown to significantly decrease health care resource utilization compared with usual care. However, the impact of the HEART Pathway on the cost of care has yet to be reported. METHODS AND RESULTS: We performed a cost analysis of patients enrolled in the HEART Pathway trial, which randomized participants to either usual care or the HEART Pathway protocol...
October 5, 2016: American Journal of Emergency Medicine
Yohannes W Woldeamanuel, Peter R Kamerman, Demetri G A Veliotes, Tudor J Phillips, David Asboe, Marta Boffito, Andrew S C Rice
HIV-associated sensory peripheral neuropathy (HIV-SN) afflicts approximately 50% of patients on antiretroviral therapy, and is associated with significant neuropathic pain. Simple accurate diagnostic instruments are required for clinical research and daily practice in both high- and low-resource setting. A 4-item clinical tool (CHANT: Clinical HIV-associated Neuropathy Tool) assessing symptoms (pain and numbness) and signs (ankle reflexes and vibration sense) was developed by selecting and combining the most accurate measurands from a deep phenotyping study of HIV positive people (Pain In Neuropathy Study-HIV-PINS)...
2016: PloS One
Gemma L Buckland Merrett, Gerald Bloom, Annie Wilkinson, Hayley MacGregor
The emergence and spread of antibiotic resistant pathogens poses a big challenge to policy-makers, who need to oversee the transformation of health systems that evolved to provide easy access to these drugs into ones that encourage appropriate use of antimicrobials, whilst reducing the risk of resistance. This is a particular challenge for low and middle-income countries with pluralistic health systems where antibiotics are available in a number of different markets. This review paper considers access and use of antibiotics in these countries from a complex adaptive system perspective...
2016: Journal of Pharmaceutical Policy and Practice
Janis L Vahldiek, Stefan Thieme, Bernd Hamm, Stefan M Niehues
BACKGROUND: The use of computed tomography (CT) scans of the head and cervical spine has markedly increased in patients with blunt minor trauma. The actual likelihood of a combined injury of head and cervical spine following a minor trauma is estimated to be low. PURPOSE: To determine the incidence of such combined injuries in patients with a blunt minor trauma in order to estimate the need to derive improved diagnostic guidelines. MATERIAL AND METHODS: A total of 1854 patients were retrospectively analyzed...
October 17, 2016: Acta Radiologica
Erina Takai, Yasushi Totoki, Hiromi Nakamura, Mamoru Kato, Tatsuhiro Shibata, Shinichi Yachida
Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies. The genomic landscape of the PDAC genome features four frequently mutated genes (KRAS, CDKN2A, TP53, and SMAD4) and dozens of candidate driver genes altered at low frequency, including potential clinical targets. Circulating cell-free DNA (cfDNA) is a promising resource to detect molecular characteristics of tumors, supporting the concept of "liquid biopsy".We determined the mutational status of KRAS in plasma cfDNA using multiplex droplet digital PCR in 259 patients with PDAC, retrospectively...
2016: Advances in Experimental Medicine and Biology
Michelle K Haas, Kristen Dalton, Bryan C Knepper, Sarah A Stella, Lilia Cervantes, Connie S Price, William J Burman, Philip S Mehler, Timothy C Jenkins
Background.  Syndrome-specific interventions are a recommended approach to antibiotic stewardship, but additional data are needed to understand their potential impact. We implemented an intervention to improve the management of inpatient community-acquired pneumonia (CAP) and evaluated its effects on antibiotic and resource utilization. Methods.  A stakeholder group developed and implemented a clinical practice guideline and order set for inpatient, non-intensive care unit CAP recommending a short course (5 days) of a fluoroquinolone-sparing antibiotic regimen in uncomplicated cases...
October 2016: Open Forum Infectious Diseases
Spoorthi Ravi Banavar, Prashanthi Chippagiri, Rohit Pandurangappa, Saileela Annavajjula, Premalatha Bidadi Rajashekaraiah
Background. Microscopes are omnipresent throughout the field of biological research. With microscopes one can see in detail what is going on at the cellular level in tissues. Though it is a ubiquitous tool, the limitation is that with high magnification there is a small field of view. It is often advantageous to see an entire sample at high magnification. Over the years technological advancements in optics have helped to provide solutions to this limitation of microscopes by creating the so-called dedicated "slide scanners" which can provide a "whole slide digital image...
2016: Analytical Cellular Pathology (Amsterdam)
Holly Depinet, Karen Copeland, Joseph Gogain, Halim Hennes, Norman A Paradis, Rebecca Andrews-Dickert, Cheryl W Vance, David S Huckins
BACKGROUND: The diagnosis of pediatric acute appendicitis can be difficult. Although scoring systems such as the Pediatric Appendicitis Score (PAS) are helpful, they lack adequate sensitivity and specificity as standalone diagnostics. When used for risk stratification, they often result in large percentages of moderate-risk patients requiring further diagnostic evaluation. METHODS: We applied a biomarker panel (the APPY1 Test) that has high sensitivity and negative predictive value (NPV) to patients with PAS in the moderate-risk range (3-7) and reclassified those patients with a negative result to the low-risk group...
August 10, 2016: American Journal of Emergency Medicine
Kimberly Plevniak, Matthew Campbell, Timothy Myers, Abby Hodges, Mei He
Clinical diagnosis requiring central facilities and site visits can be burdensome for patients in resource-limited or rural areas. Therefore, development of a low-cost test that utilizes smartphone data collection and transmission would beneficially enable disease self-management and point-of-care (POC) diagnosis. In this paper, we introduce a low-cost iPOC(3D) diagnostic strategy which integrates 3D design and printing of microfluidic POC device with smartphone-based disease diagnosis in one process as a stand-alone system, offering strong adaptability for establishing diagnostic capacity in resource-limited areas and low-income countries...
September 2016: Biomicrofluidics
Paul C Pearlman, Rao Divi, Michael Gwede, Pushpa Tandon, Brian S Sorg, Miguel R Ossandon, Lokesh Agrawal, Vinay Pai, Houston Baker, Tiffani Bailey Lash
Point-of-care (POC) technologies have proved valuable in cancer detection, diagnosis, monitoring, and treatment in the developed world, and have shown promise in low-and-middle-income countries (LMIC) as well. Despite this promise, the unique design constraints presented in low-resource settings, coupled with the variety of country-specific regulatory and institutional dynamics, have made it difficult for investigators to translate successful POC cancer interventions to the LMIC markets. In response to this need, the National Cancer Institute has partnered with the National Institute of Biomedical Imaging and Bioengineering to create the National Institutes of Health Affordable Cancer Technologies (ACTs) program...
2016: IEEE Journal of Translational Engineering in Health and Medicine
Hunter K Holt, Li Zhang, Fang Hui Zhao, Shang Ying Hu, Xue Lian Zhao, Xun Zhang, Qin Jing Pan, Wen Hua Zhang, Jennifer S Smith, You Lin Qiao
As China's population ages, the importance of determining prevalence of cervical disease and accurate cervical cancer screening strategies for postmenopausal women is increasing.17 population-based studies were analyzed to determine prevalence of cervical neoplasia in postmenopausal women. All women underwent HPV DNA testing, visual inspection with acetic acid (VIA), and cytology testing. Diagnostic values for primary and combinations screening methods included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), referral rate, and area under curve (AUC) were calculated using directed biopsy or 4 quadrants biopsy as reference standard...
October 11, 2016: International Journal of Cancer. Journal International du Cancer
Gaolian Xu, Hang Zhao, Jonathan M Cooper, Julien Reboud
We demonstrate a multiplexed loop mediated isothermal amplification (LAMP) assay for infectious disease diagnostics, where the analytical process flow of target pathogens genomic DNA is performed manually by moving magnetic beads through a series of plugs in a capillary. Heat is provided by a water bath and the results are read by the naked eye, enabling applications in low resource settings.
October 6, 2016: Chemical Communications: Chem Comm
Gihoon Choi, Daniel Song, Sony Shrestha, Jun Miao, Liwang Cui, Weihua Guan
In response to the urgent need of a field-deployable and highly sensitive malaria diagnosis, we developed a standalone, "sample-in-answer-out" molecular diagnostic system (AnyMDx) to enable quantitative molecular analysis of blood-borne malaria in low resource areas. The system consists of a durable battery-powered analyzer and a disposable microfluidic compact disc loaded with reagents ready for use. A low power thermal module and a novel fluorescence-sensing module are integrated into the analyzer for real-time monitoring of loop-mediated isothermal nucleic acid amplification (LAMP) of target parasite DNA...
October 10, 2016: Lab on a Chip
Zhihong Xuan, Mingmin Li, Pengfei Rong, Wei Wang, Yijun Li, Dingbin Liu
Herein, we demonstrate a plasmonic ELISA based on the alkaline phosphatase (ALP)-mediated growth of silver nanoparticles (AgNPs) for the sensitive, rapid, and naked-eye detection of cancer biomarkers in clinical serum samples. This approach was used to measure the low-abundance alpha fetal protein (AFP) in clinical sera, which demonstrates its great capability in the differentiation of cancers and evaluation of therapeutic responses. Impressively, the readout of the plasmonic assay depends on the rapid formation of Ag colloidal solutions with various degrees of yellow color, which can be distinguished by the naked eye, without the need for sophisticated platforms...
October 6, 2016: Nanoscale
Charifa Zemouri, Teodora Elvira Wi, James Kiarie, Armando Seuc, Vittal Mogasale, Ahmed Latif, Nathalie Broutet
BACKGROUND: This review aimed to synthesize and analyze the diagnostic accuracy and the likelihood of providing correct treatment of the syndromic approach Vaginal Discharge Flowchart in managing cervical infections caused by Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT), and vaginal infections caused by Trichomonas vaginalis (TV) and Bacterial vaginosis (BV) and Candida albicans. This review will inform updating the WHO 2003 guidelines on Vaginal Discharge syndromic case management...
2016: PloS One
Ousseynou Kâ, Awa Gaye, Mamadou Makhtar Mbacké Leye, Ndeye Fatou Ngom, Anta Tal Dia, Saïd Nourou Diop, Ahmédou Moustapha Sow
Senegal will not be spared by the process of the aging of its population. In fact, according to surveys, the demographic increase in the population of the old people, which is 3.5% higher than the national average (2.5%). But for the time being, gerontology problems are not arising in terms of demographic weight, but rather in terms of the breaking up of solidarity networks, uncontrolled urbanization and poverty. As far as health is concerned, the old people generally are faced with the same problems as their Northern counterparts; they are exposed to chronic diseases that demand their taking in charge in a long period of time...
September 29, 2016: Gériatrie et Psychologie Neuropsychiatrie du Vieillissement
Juan Pedro-Botet, Elisenda Climent, Eva Giralt Martínez, Juana A Flores-Le Roux
INTRODUCTION: Dyslipidaemia is a major modifiable determining factor of vascular risk and, despite this, a significant number of patients do not achieve lipid goals. The aim of this study is to describe the resources and current needs in clinical practice in Spain, through an analysis of management, organisation and the patient care circuit of dyslipidaemia patient. METHODS: A descriptive, cross-sectional, multicentre study, using a questionnaire, was conducted on physicians, 266 in primary care (PC) and 258 in specialised care (SC), who attended patients with dyslipidaemia in hospitals and centres within the National Health System...
September 27, 2016: Clínica e Investigación en Arteriosclerosis
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