Colorimetric detection of serum creatinine on a miniaturized platform using hue-saturation-value space analysis.

Chronic kidney disease (CKD) is a widespread condition with considerable health and economic impacts globally. However, existing methodologies for serum creatinine assessment often involve prolonged wait times and sophisticated equipment, such as spectrometers, hindering real-time diagnosis and care. Innovative solutions like point-of-care (POC) devices are emerging to address these challenges. In this context, there is a recognized need for remote, regular, automated, and low-cost analysis of serum creatinine levels, given its role as a critical parameter for CKD diagnosis and management. This study introduces a miniaturized system with integrated heater elements designed for precise serum creatinine measurement. The system operates based on the Jaffe method and accurate serum creatinine measurement within a microreservoir chip. Smartphone-based image processing using the hue-saturation-value (HSV) color space was applied to captured images of microreservoirs. The creatinine analyses were conducted in serum with a limit of detection of ~ 0.4 mg/dL and limit of quantification of ~ 1.3 mg/dL. Smartphone-based image processing employing the HSV color space outperformed spectrometric analysis for creatinine measurement conducted in serum. This pioneering technology and smartphone-based processing offer the potential for decentralized renal function testing, which could significantly contribute to improved patient care. The miniaturized system offers a low-cost alternative ($87 per device), potentially reducing healthcare expenditures (~ $0.5 per test) associated with CKD diagnosis and management. This innovation could greatly improve access to diagnosis and monitoring of CKD, especially in regions where access to sophisticated laboratory equipment is limited.

Microfluidic-based technologies for diagnosis, prevention, and treatment of COVID-19: recent advances and future directions.

The COVID-19 pandemic has posed significant challenges to existing healthcare systems around the world. The urgent need for the development of diagnostic and therapeutic strategies for COVID-19 has boomed the demand for new technologies that can improve current healthcare approaches, moving towards more advanced, digitalized, personalized, and patient-oriented systems. Microfluidic-based technologies involve the miniaturization of large-scale devices and laboratory-based procedures, enabling complex chemical and biological operations that are conventionally performed at the macro-scale to be carried out on the microscale or less. The advantages microfluidic systems offer such as rapid, low-cost, accurate, and on-site solutions make these tools extremely useful and effective in the fight against COVID-19. In particular, microfluidic-assisted systems are of great interest in different COVID-19-related domains, varying from direct and indirect detection of COVID-19 infections to drug and vaccine discovery and their targeted delivery. Here, we review recent advances in the use of microfluidic platforms to diagnose, treat or prevent COVID-19. We start by summarizing recent microfluidic-based diagnostic solutions applicable to COVID-19. We then highlight the key roles microfluidics play in developing COVID-19 vaccines and testing how vaccine candidates perform, with a focus on RNA-delivery technologies and nano-carriers. Next, microfluidic-based efforts devoted to assessing the efficacy of potential COVID-19 drugs, either repurposed or new, and their targeted delivery to infected sites are summarized. We conclude by providing future perspectives and research directions that are critical to effectively prevent or respond to future pandemics.

Electromechanical RT-LAMP device for portable SARS-CoV-2 detection.

Rapid point-of-care tests for infectious diseases are essential, especially in pandemic conditions. We have developed a point-of-care electromechanical device to detect SARS-CoV-2 viral RNA using the reverse-transcription loop-mediated isothermal amplification (RT-LAMP) principle. The developed device can detect SARS-CoV-2 viral RNA down to 103 copies/mL and from a low amount of sample volumes (2 µL) in less than an hour of standalone operation without the need for professional labor and equipment. Integrated Peltier elements in the device keep the sample at a constant temperature, and an integrated camera allows automated monitoring of LAMP reaction in a stirring sample by using colorimetric analysis of unfocused sample images in the hue/saturation/value color space. This palm-fitting, portable and low-cost device does not require a fully focused sample image for analysis, and the operation could be stopped automatically through image analysis when the positive test results are obtained. Hence, viral infections can be detected with the portable device produced without the need for long, expensive, and labor-intensive tests and equipment, which can make the viral tests disseminated at the point-of-care.

Microfluidic-based virus detection methods for respiratory diseases.

With the recent SARS-CoV-2 outbreak, the importance of rapid and direct detection of respiratory disease viruses has been well recognized. The detection of these viruses with novel technologies is vital in timely prevention and treatment strategies for epidemics and pandemics. Respiratory viruses can be detected from saliva, swab samples, nasal fluid, and blood, and collected samples can be analyzed by various techniques. Conventional methods for virus detection are based on techniques relying on cell culture, antigen-antibody interactions, and nucleic acids. However, these methods require trained personnel as well as expensive equipment. Microfluidic technologies, on the other hand, are one of the most accurate and specific methods to directly detect respiratory tract viruses. During viral infections, the production of detectable amounts of relevant antibodies takes a few days to weeks, hampering the aim of prevention. Alternatively, nucleic acid-based methods can directly detect the virus-specific RNA or DNA region, even before the immune response. There are numerous methods to detect respiratory viruses, but direct detection techniques have higher specificity and sensitivity than other techniques. This review aims to summarize the methods and technologies developed for microfluidic-based direct detection of viruses that cause respiratory infection using different detection techniques. Microfluidics enables the use of minimal sample volumes and thereby leading to a time, cost, and labor effective operation. Microfluidic-based detection technologies provide affordable, portable, rapid, and sensitive analysis of intact virus or virus genetic material, which is very important in pandemic and epidemic events to control outbreaks with an effective diagnosis.

Low molecular weight heparin and first trimester maternal PAPP-A and hCG levels, fetal nuchal translucency in the first trimester of pregnancy.

PURPOSE OF INVESTIGATION: We studied the relation of first trimester nuchal translucency and first trimester biochemical markers using low molecular weight heparin (LMWH) at 11-14 weeks of gestation. METHODS: This retrospective study was conducted at our university between January 2007 and July 2009. Ninety-six patients were treated with low-dose LMWHs (enoxaparine 40 mg) from the beginning of pregnancy to 36 weeks of gestation and low-dose aspirin (100 mg) to 32 weeks (group 1) and 100 control subjects (group 2) were included in the study. Transabdominal ultrasound examination was performed to diagnose any major fetal defects and for measurement of crown rump length (CRL) and fetal nuchal translucency (NT) thickness. Blood samples were drawn from each women PAPP-A and free beta hCG levels. RESULTS: There were no significant differences with respect to age, gestational age at the first trimester, and gestational age at birth between the groups. The mean birth weight of babies in the LMWH group was lower than the control (p = 0.026). There were also no significant differences with respect to CRL, serum PAPP-A and hCG at 11-14 weeks of gestation. However, NT of group 1 was significantly lower than group 2 (p = 0.000). In the Spearman correlation, LMWH was negatively correlated with only NT (r = -0.298, p = 0.000). NT in the first trimester (95% CI -0.632-0.230, p = 0.000) was an independent parameter related to using LMWH. CONCLUSION: Women who used LMWH during pregnancy had decreased NT compared with unaffected women.

Ethical considerations regarding parental decisions for termination following prenatal diagnosis of sex chromosome abnormalities.

Termination rates following prenatal diagnosis of sex chromosome abnormalities have been reported to be in a very wide spectrum (12.7-86.5%) in various studies. The different attitudes in management of prenatal diagnosed sex chromosome abnormalities may depend on several factors as the type of the abnormality, the indication for prenatal testing, the number of previous healthy children and whether the pregnancy was assisted or spontaneous. In the current study, we look at prenatal diagnostic procedures carried out in our department over a period of 5 years (2002-2007). We did not detect sex chromosome abnormalities in the 43 cordocenteses and the 26 chorionic villus samples. Among the 1130 amniocentesis patients, 12 cases (1.06%) were diagnosed as having sex chromosome abnormalities. Five (41.67%) of 12 pregnancies with sex chromosome abnormalities were terminated (one case with 47,XXY, one case with 46,X,del(X), and three cases with 45,X karyotype); whereas seven pregnancies (58.33%) continued. Among the factors influencing parents' decision-making, the attitude of the health-care professional giving the post-diagnosis counseling seems to be the most important, next to the socio-economic and educational status of the parents.

Prenatal diagnosis of mosaicism identified in amniotic fluid cell cultures.

Chromosomal mosaicism in prenatal diagnosis is an important problem to be solved immediately and the probable phenotypic reflections should be explained to the family. We report two numerical and two structural mosaicisms detected in amniocyte cultures. The first fetus had a 47,XY,+mar[10]/46,XY[10] karyotype. The marker chromosome was shown to be derived from chromosome 15 by FISH method. The newborn had intrauterine growth retardation and cerebral thrombosis and died at the 29th day of age. The second fetus had a 45,X[4]/46,XX[26] karyotype. The parents refused cordocentesis and decided to terminate pregnancy in the 21st week. The third case, presented with bilateral large choroid plexus cysts, had a 46,XX, dup(1)(q22-q32)[9]/46,XX[21] karyotype. The parents' karyotypes were normal and the pregnancy was aborted in the 23rd week of gestation. The second structural abnormality was reported as 46,XX,t(6;11)(q23; p13)[3]/46,XX[20]. The mosaicism was detected in only one flask. The parents decided to continue pregnancy and cordocentesis could not be performed due to the fetal and placental position. The baby was born at term. Peripheral blood lymphocyte culture resulted in a 46,XX normal karyotype. Information and risks were explained to all families during genetic counseling. Mosaicism in prenatal diagnosis needs both detailed examination and follow up, since clinical findings depend on the type of abnormality.

Gastrointestinal stromal tumors presenting as pelvic masses: report of two cases.

We present two cases of gastrointestinal stromal tumors (GISTs) that presented as pelvic masses. These tumors can present diagnostic problems and they may be difficult to discover preoperatively. GISTs are neoplasms that can be diagnosed utilizing immunohistochemistry, especially detecting CD117 (c-kit) reactivity along with associated histological features. GISTs, should be considered in the differential diagnosis of ovarian tumors especially when imaging studies and rectovaginal examination findings are inconclusive and vague. Histologic diagnosis of these tumors are important considering the efficacy of tyrosine kinase inhibitor therapy after surgery in such cases.

Early onset of subclinical atherosclerosis in women with gestational diabetes mellitus.

OBJECTIVE: Common carotid artery intima-media thickness (CIMT) is a non-invasively assessed marker of subclinical atherosclerosis. Our aim in this study was to investigate CIMT in women with gestational diabetes mellitus (GDM). METHODS: Thirty women with GDM and 40 unaffected women (as a control group) were included in the study. Blood samples were drawn from each woman in the morning after they had fasted for at least 8 h, and levels of fasting glucose, insulin, homocysteine, total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, low-density lipoprotein (LDL) cholesterol and very low-density lipoprotein (VLDL) cholesterol were measured, along with the CIMT in the two groups. RESULTS: The mean triglyceride (P = 0.016) and VLDL cholesterol (P = 0.011) levels in the GDM group were significantly higher than those in the unaffected women. There were no significant differences between the groups with respect to plasma levels of total cholesterol, HDL cholesterol, LDL cholesterol and insulin. The mean homocysteine (P = 0.027) and fasting glucose (P = 0.019) levels in women with GDM were significantly higher than those in the control group. Patients with GDM had significantly higher CIMT than did the unaffected women (0.582 +/- 0.066 mm vs. 0.543 +/- 0.049 mm, P = 0.006). CIMT correlated positively with maternal age (r = 0.316, P = 0.008), body mass index (BMI) at the time of a 50-g oral glucose load test (r = 0.414, P = 0.001) and homocysteine levels (r = 0.332, P = 0.008), and fasting glucose (r = 0.265, P = 0.031) and 1-h glucose value (r = 0.410, P = 0.001) at the time of the oral glucose tolerance test. There was a positive correlation between the presence of GDM and CIMT (r = 0.372, P = 0.001). However, stepwise multiple regression analysis showed that GDM/no GDM (95% CI +0.012 to +0.076, P = 0.008) and BMI at the time of the 50-g test (95% CI +0.001 to +0.009, P = 0.011) were independent parameters related to CIMT. CONCLUSION: Women with GDM have increased CIMT compared with unaffected women.

Submucosal leiomyoma of the uterus incorporated into the fetal membranes and mimicking a placental neoplasm: a case report.

Leiomyoma of the placenta is uncommon. We present a leiomyoma of the fetal membranes that was incidentally discovered on examination of a spontaneously expulsed placenta following Caesarean section. Although it is an uncommon entity, it is known that leiomyomas may arise from the vasculature nourishing the fetal membranes. The baby was male and genetic studies were performed to detect Y chromosome in tumoral tissue. Polymerase chain reaction technique demonstrated Y chromosome in placental tissue but not in tumour tissue. Thus the tumour was finally diagnosed as incorporated benign uterine leiomyoma.

Detection of insulin resistance in Turkish adults: a hospital-based study.

AIM: The aim of the present study was to investigate the usefulness of insulin sensitivity check indices in our hospital population. METHODS: Both HOMA (insulin X glucose in mmol/l/22.5) and QUICKI (1/log insulin in microu/ml + log glucose in mg/dl) indices were calculated from fasting values in 1,774 subjects from the medical records of Baskent University Adana Hospital. RESULTS: Subjects with diabetes, hyperlipidaemia and central obesity were characterized by significantly higher HOMA and lower QUICKI indices than those of healthy subjects. A fall in the QUICKI index (0.3469 +/- 0.028 in healthy subjects and 0.3247 +/- 0.025 in non-obese diabetics) as well as an increase in HOMA index (2.24 +/- 1.26 in healthy subjects and 3.59 +/- 2.08 in non-obese diabetics) corresponded to metabolic and clinical manifestations of insulin resistance in various groups of subjects. Age, low HDL cholesterol, male sex, type 2 DM and hypertension were independent risk factors for CAD. Age, male sex, waist circumference and CAD were found to be risk factors for hypertension. Fasting insulin and glucose levels contain sufficient information to assess insulin sensitivity over a wide range in a diverse population. The following can be accepted as mean values to assess insulin resistance in our hospital population: 0.3469 +/- 0.028 for the QUICKI index and 2.24 +/- 1.26 for the HOMA index CONCLUSIONS: HOMA and QUICKI indices are simple and reproducible methods for determining insulin sensitivity in humans.

Endoscopy in hyperemesis gravidarum and Helicobacter pylori infection.

OBJECTIVES: To establish a relationship between hyperemesis gravidarum (HG) and Helicobacter pylori (H. Pylori) infection by histologic testing. METHODS: Twenty patients with severe HG (Group I) and 10 volunteer pregnant women without gastric complaints (Group II) were included in the study. Endoscopic evaluations were done in both groups and biopsies were obtained from the antrum and corpus for the histopathologic diagnosis of H. pylori. The groups were compared with the chi(2)-test and Fisher's exact test where appropriate. RESULTS: H. pylori was diagnosed in 19 (95%) of 20 patients in Group I and 5 (50%) of 10 patients in group II. H. pylori densities in the antrum and corpus were higher in Group I and the differences between the two groups were statistically significant. The biopsy specimens revealed significant inflammation and H. pylori activation processes in patients with HG, and in 18 of 19 patients inflammation scores were greater than +2 on the scale. Pangastritis was demonstrated by endoscopic examination in 17 of 20 patients with HG. Enterogastric reflux was also diagnosed in 10 patients. In the control group, three patients had antral gastritis. CONCLUSIONS: We suggest that in patients with intractable nausea and vomiting during pregnancy, pangastritis and enterogastric reflux are the main endoscopic findings and that these findings are closely associated with H. pylori infection, which can be diagnosed histologically. The degree of gastric complaints may be associated with the density of H. pylori infection.

Comparison of the criteria forgestational diabetes mellitus by NDDG and Carpenter and Coustan, and the outcomes of pregnancy.

This is a retrospective study to compare the criteria for diagnosis of gestational diabetes mellitus (GDM) by the National Diabetes Data Group (NDDG), and Carpenter and Coustan criteria, and to study the outcome of GDM when diagnosed by the more sensitive criteria. Six hundred and sixty-two pregnant women were included in this study from the medical records between September 1998 and April 2001. GDM was positive in 6.50% of patients according to Carpenter and Coustan and in 4.08% of patients according to NDDG criteria. Women with GDM were older, had higher fasting and glucose challenge test (GCT) glucose levels, and fetal weight than the normal women. Hypoglycemia was observed only in one infant. Regarding pre-term delivery and pre-eclampsia, there was no significant difference between the groups. Age, delivery week and fetal weight of patients who had caesarian delivery were significantly higher than spontaneous vaginal delivery. Prevalence of macrosomia in GDM group was higher than in the normal group. There was a significant correlation between the macrosomia and number of positive blood glucose values during OGTT. In multivariate analyses, fasting, GCT and second hour OGTT blood glucose levels, mean parity, and delivery week were independent risk factors for fetal weight. Carpenter and Coustan criteria is more sensitive than the NDDG criteria and women with GDM had a higher frequency of macrosomia and the frequency of macrosomia increases by the number of positive blood glucose levels during OGTT. Tight glycemic control might decrease the prevalence of caesarian delivery, pre-eclampsia, pre-term delivery and hypoglycemia of the infant.