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1.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 6131-6134, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019370

RESUMO

Point-of-care diagnostic devices aid in the early and rapid detection of immunological markers leading to better medical outcomes. Lateral flow immunoassays (LFIA) are fast assays that provide both qualitative and semi-quantitative results on site. Sample preparation for LFIA tests is usually done manually with multiple mixing steps and is prone to errors. The iQuant Auto is an entirely automated system that can handle sample preparation, effective transfer to lateral flow test membrane, and subsequent result estimation. The system uses a pneumatic system for fluid handling and sample preparation, and an image-based fluorescence reader for reaction visualization. The device works with test specific milli-fluidic lateral flow kit called iQPrep Kit, which has integrated reagent storage areas and valves for fluid control. The test kit can be manufactured using standard manufacturing techniques and can be produced at scale cheaply. The iQPrep Kit can be modified to test for various markers like HbA1c, Vitamin D, and TSH, while the hardware for sample preparation and the fluorescence reader remains the same. The device has a minimalist and intelligible graphical interface aiding smooth operation by less skilled people at resource-limited settings. Standard reference cartridges of different volume ratios were used to validate the functionality of the instrument. The intra- instrument coefficient of variation (CoV) of the mobile kit reader was found to be less than 0.62%. The positional accuracy of the system to ensure precise kit engagement with the other auxiliary systems was checked, and the CoV was 0.16%. The fluid handling capabilities were tested, and it was found that an average fluid loss of 10 µl results due to the liquid adherence to fluid channel walls and valve interfaces. The iQuant Auto is an easily operable, total analysis system for immunodiagnostics.


Assuntos
Imunoensaio , Testes Imunológicos , Sistemas Automatizados de Assistência Junto ao Leito , Biomarcadores , Humanos , Tempo de Protrombina , Kit de Reagentes para Diagnóstico
2.
Br J Community Nurs ; 25(Sup10): S12-S16, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33030379

RESUMO

The COVID-19 pandemic of 2020 has led to considerable changes in how healthcare is delivered, as it has pushed people to think outside the box technologically. Mobile working is becoming more widespread, useful and valuable in this innovative period in the NHS. Point-of-care (POC) technology encompasses mobile devices and systems that support health professionals in their daily activities of patient care. It allows the user to safely assess and diagnose individuals at the point of care, providing actionable information to allow rapid clinical decision-making. POC technology also has the ability to support and educate patients with health needs, encouraging patients and their carers to assume greater more control of and responsibility over their health. Providing patients individual care plans to maintain their health will help realise the future of self-care. This article describe the development of a mobile app-Juzo Care-designed to enhance the management of chronic oedema and lymphoedema in mobile working settings.


Assuntos
Enfermagem em Saúde Comunitária , Edema/enfermagem , Linfedema/enfermagem , Aplicativos Móveis , Educação de Pacientes como Assunto , Sistemas Automatizados de Assistência Junto ao Leito , Autocuidado , Betacoronavirus , Doença Crônica , Infecções por Coronavirus , Assistência à Saúde , Humanos , Pandemias , Pneumonia Viral , Guias de Prática Clínica como Assunto , Medicina Estatal , Reino Unido
3.
Acute Med ; 19(3): 162-167, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33020762

RESUMO

COVID-19 pneumonia produces a heterogeneous array of clinical, biochemical, and radiological findings. Over the last few months of global hurry to optimize a testing strategy, it has been suggested that bedside point-of-care lung ultrasound may have a diagnostic role. We present 3 patients with RT-PCR nasopharyngeal swab-confirmed COVID-19 pneumonia, who had an admission plain chest film reported to be normal by a consultant radiologist, but with significant sonographic abnormalities on bedside ultrasound performed within 24 hours of the chest radiograph. Lung ultrasound may better correlate with the oxygen requirement and overall condition of the patient than chest radiographs - a pertinent consideration given the imminent advance of the pandemic into resource-poor zones where timely access to roentgenological imaging may be sparse.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia , Betacoronavirus , Humanos , Pandemias , Radiografia Torácica
5.
Emergencias ; 32(5): 340-344, 2020 09.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33006834

RESUMO

OBJECTIVES: To assess the diagnostic yield of point-of-care ultrasound imaging in patients suspected of having noncritical severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection but no apparent changes on a chest radiograph. MATERIAL AND METHODS: Cross-sectional analysis of a case series including patients coming to an emergency department in March and April 2020 with mild-moderate respiratory symptoms suspected to be caused by SARS-CoV-2. A point-of-care ultrasound examination of the lungs was performed on all participants as part of routine clinical care. Ultrasound findings were compared according to the results of SARS-CoV-2 test results. RESULTS: Fifty-eight patients with a median (interquartile range) age of 44.5 (34-67) years were enrolled; 42 (72.4%) were women. Twenty-seven (46.5%) had confirmed SARS-CoV-2 infection. Ultrasound findings were consistent with interstitial pneumonia due to coronavirus disease 2019 (COVID-19) in 33 (56.9%). Most were in cases with testconfirmed COVID-19 (100% vs 22.2% of cases with no confirmation; P < .001). The most common ultrasound findings in confirmed COVID-19 cases were focal and confluent B-lines in the basal and posterior regions of the lung (R1, 85.2%; R2, 77.8%; L1, 88.9%; and L2, 88.9%) and associated pleural involvement (70.4%, 70.4%, 81.5%, and 85.2%, respectively). The sensitivity of point-of-care ultrasound in the diagnosis of COVID-19 was 92.6% (95% CI, 75.7%-99.1%). Specificity was 85.2% (95% CI, 66.3%-95.8%); positive predictive value, 75.8% (95% CI, 59.6%- 91.9%); negative predictive value, 92% (95% CI, 74.0%-99.0%); and positive and negative likelihood ratios, 6.2 (95% CI, 6.0-6.5) and 0.1 (95% CI, 0.1-0.1), respectively. CONCLUSION: Point-of-care lung ultrasound could be useful for the diagnosis of noncritical SARS-CoV-2 infection when chest radiographs are inconclusive.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pandemias , Pneumonia Viral/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Adulto , Idoso , Infecções por Coronavirus/diagnóstico , Estudos Transversais , Diagnóstico Precoce , Feminino , Humanos , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Design de Software , Ultrassonografia
6.
PLoS Pathog ; 16(9): e1008817, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32970782

RESUMO

There is a clear requirement for an accurate SARS-CoV-2 antibody test, both as a complement to existing diagnostic capabilities and for determining community seroprevalence. We therefore evaluated the performance of a variety of antibody testing technologies and their potential use as diagnostic tools. Highly specific in-house ELISAs were developed for the detection of anti-spike (S), -receptor binding domain (RBD) and -nucleocapsid (N) antibodies and used for the cross-comparison of ten commercial serological assays-a chemiluminescence-based platform, two ELISAs and seven colloidal gold lateral flow immunoassays (LFIAs)-on an identical panel of 110 SARS-CoV-2-positive samples and 50 pre-pandemic negatives. There was a wide variation in the performance of the different platforms, with specificity ranging from 82% to 100%, and overall sensitivity from 60.9% to 87.3%. However, the head-to-head comparison of multiple sero-diagnostic assays on identical sample sets revealed that performance is highly dependent on the time of sampling, with sensitivities of over 95% seen in several tests when assessing samples from more than 20 days post onset of symptoms. Furthermore, these analyses identified clear outlying samples that were negative in all tests, but were later shown to be from individuals with mildest disease presentation. Rigorous comparison of antibody testing platforms will inform the deployment of point-of-care technologies in healthcare settings and their use in the monitoring of SARS-CoV-2 infections.


Assuntos
Anticorpos Antivirais/análise , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Sistemas Automatizados de Assistência Junto ao Leito , Testes Sorológicos/métodos , Adulto , Idoso , Betacoronavirus , Técnicas de Laboratório Clínico , Serviços de Saúde Comunitária , Ensaio de Imunoadsorção Enzimática , Feminino , Hospitais , Humanos , Imunoensaio , Medições Luminescentes , Masculino , Pessoa de Meia-Idade , Proteínas do Nucleocapsídeo/imunologia , Pandemias , Sensibilidade e Especificidade , Glicoproteína da Espícula de Coronavírus/imunologia
7.
Emerg Med J ; 37(10): 644-649, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32907844

RESUMO

The current COVID-19 pandemic is causing diagnostic and risk stratification difficulties in Emergency Departments (ED) worldwide. Molecular tests are not sufficiently sensitive, and results are usually not available in time for decision making in the ED. Chest x-ray (CXR) is a poor diagnostic test for COVID-19, and computed tomography (CT), while sensitive, is impractical as a diagnostic test for all patients. Lung ultrasound (LUS) has an established role in the evaluation of acute respiratory failure and has been used during the COVID-19 outbreak as a decision support tool. LUS shows characteristic changes in viral pneumonitis, and while these changes are not specific for COVID-19, it may be a useful adjunct during the diagnostic process. It is quick to perform and repeat and may be done at the bedside. The authors believe that LUS can help to mitigate uncertainty in undifferentiated patients with respiratory symptoms. This review aims to provide guidance regarding indications for LUS, describe the typical sonographic abnormalities seen in patients with COVID-19 and provide recommendations around the logistics of performing LUS on patients with COVID-19 and managing the infection control risk of the procedure. The risk of anchoring bias during a pandemic and the need to consider alternative pathologies are emphasised throughout this review. LUS may be a useful point-of-care test for emergency care providers during the current COVID-19 pandemic if used within a strict framework that governs education, quality assurance and proctored scanning protocols.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pulmão/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito/organização & administração , Síndrome Respiratória Aguda Grave/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Pulmão/fisiopatologia , Masculino , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Síndrome Respiratória Aguda Grave/epidemiologia , Índice de Gravidade de Doença , Ultrassonografia Doppler/estatística & dados numéricos , Reino Unido
8.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(8): 994-997, 2020 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-32912416

RESUMO

OBJECTIVE: To investigate the effect of thromboelastography (TEG) combined with point-of-care ultrasound (POCUS) guidance on the prevention of internal jugular vein catheterization related thrombosis. METHODS: The patients who required internal jugular vein catheterization admitted to the department of critical medicine of Beihai People's Hospital from December 2018 to April 2020 were enrolled. Patients were divided into two groups according to the random number table method. For the combined cathetherization group, ultrasound was used to examine bilateral internal jugular veins before catheterization. The larger diameter and better filled vein and site were selected for puncture. If both internal jugular veins were not fulfilled well, puncture were performed after fluid administration. At the same time, anticoagulant, antiplatelet or reducing blood viscosity drugs were used according to coagulation function and bleeding risk under the monitoring of TEG. The hemodynamic state of the internal jugular vein was monitored by ultrasound every day. If the vein collapsed or the blood flow was slow, the cause should be tried to be found and improved. Once thrombosis was found, the catheter should be removed. For the routine cathetherization group, the right side internal jugular vein was prior to be punctured according to body surface symbols. The other treatment of the two groups were the same as routine treatment. The conditions of thrombosis and bleeding were recorded. RESULTS: Ninety-seven patients were selected, 51 cases in the combined cathetherization group and 46 cases in the routine cathetherization group. There was no significant differences in gender, age, acute physiology and chronic health evaluation II (APACHE II), risk of deep vein thrombosis score (Caprini), CRUSADE bleeding risk score, the proportion of high bleeding risk, disease types, the proportion of coagulation disorder and catheterization time between the two groups, but the anticoagulation treatment proportion in the combined cathetherization group was higher than that in the routine cathetherization group (66.7% vs. 30.4%, P < 0.01). The incidence of thrombosis in the combined cathetherization group was lower than that of the routine cathetherization group (39.2% vs. 78.3%, P < 0.01), and the thrombus of the combined cathetherization group was smaller than that of the routine cathetherization group [cm3: 0.077 (0.047, 0.089) vs. 0.341 (0.070, 0.378), P < 0.01]. There were no major bleeding events in the two groups. CONCLUSIONS: Based on TEG and POCUS, the antithrombotic bundles can reduce the incidence of thrombosis after internal jugular vein catheterization and the thrombus size, and does not increase the risk of bleeding, which is worthy of clinical application.


Assuntos
Cateterismo Venoso Central , Veias Jugulares , Tromboelastografia , Trombose , Humanos , Sistemas Automatizados de Assistência Junto ao Leito
9.
JCO Clin Cancer Inform ; 4: 794-798, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32897736

RESUMO

PURPOSE: COVID-19 is a rapidly emerging worldwide pandemic that has drastically changed health care across the United States. Oncology patients are especially vulnerable. Novel point-of-care resources may be useful to rapidly disseminate peer-reviewed information from oncology experts nationwide. We describe our initial experience with distributing this information through a private, curated, virtual collaboration question-and-answer (Q&A) platform for oncologists. METHODS: The Q&A database was queried for a 2-month period from March 12 to May 12, 2020. We collected the total number of views and unique viewers for the questions. We classified the questions according to their emphasis (practice management, clinical management, both) and disease type across radiation oncology, medical oncology, gynecologic oncology, and pediatric oncology. RESULTS: Seventy-nine questions were approved, 67 of which were answered and generated 49,494 views with 5,148 unique viewers. Most discussions covered clinical management, with breast cancer being the most active disease site. Ten questions covered pediatric oncology and gynecologic oncology. Forty-seven percent of the 11,010 users of the platform visited the website during the 2-month period. CONCLUSION: Discussions on the Q&A platform reached a substantial number of oncologists throughout the nation and may help oncologists to modify their treatment in real time with the rapidly evolving COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Prova Pericial , Disseminação de Informação , Oncologia , Neoplasias/terapia , Pandemias , Pneumonia Viral , Administração da Prática Médica , Betacoronavirus , Humanos , Internet , Oncologistas , Sistemas Automatizados de Assistência Junto ao Leito
10.
Emerg Med Clin North Am ; 38(4): 755-769, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981615

RESUMO

There are approximately 350,000 out-of-hospital cardiac arrests and 200,000 in-hospital cardiac arrests annually in the United States, with survival rates of approximately 5% to 10% and 24%, respectively. The critical factors that have an impact on cardiac arrest survival include prompt recognition and activation of prehospital care, early cardiopulmonary resuscitation, and rapid defibrillation. Advanced life support protocols are continually refined to optimize intracardiac arrest management and improve survival with favorable neurologic outcome. This article focuses on current treatment recommendations for adult nontraumatic cardiac arrest, with emphasis on the latest evidence and controversies regarding intracardiac arrest management.


Assuntos
Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Manuseio das Vias Aéreas , Antiarrítmicos/administração & dosagem , Pressão Sanguínea , Dióxido de Carbono/análise , Diástole , Ecocardiografia , Cardioversão Elétrica , Serviço Hospitalar de Emergência , Epinefrina/administração & dosagem , Humanos , Hipotermia Induzida , Infusões Intraósseas , Infusões Intravenosas , Monitorização Fisiológica , Sistemas Automatizados de Assistência Junto ao Leito , Guias de Prática Clínica como Assunto , Vasoconstritores/administração & dosagem
11.
Emerg Med Clin North Am ; 38(4): 931-944, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981627

RESUMO

Emergency physicians must be prepared to rapidly diagnose and resuscitate patients with pulmonary embolism (PE). Certain aspects of PE resuscitation run counter to typical approaches. A specific understanding of the pathophysiology of PE is required to avoid cardiovascular collapse potentially associated with excessive intravenous fluids and positive pressure ventilation. Once PE is diagnosed, rapid risk stratification should be performed and treatment guided by patient risk class. Although anticoagulation remains the mainstay of PE treatment, emergency physicians also must understand the indications and contraindications for thrombolysis and should be aware of new therapies and models of care that may improve outcomes.


Assuntos
Embolia Pulmonar/terapia , Anticoagulantes/uso terapêutico , Biomarcadores/sangue , Angiografia por Tomografia Computadorizada , Estado Terminal , Ecocardiografia , Eletrocardiografia , Serviço Hospitalar de Emergência , Oxigenação por Membrana Extracorpórea , Hidratação , Humanos , Intubação Intratraqueal , Ácido Láctico/sangue , Trombólise Mecânica , Peptídeo Natriurético Encefálico/sangue , Óxido Nítrico/uso terapêutico , Oxigenoterapia , Fragmentos de Peptídeos/sangue , Sistemas Automatizados de Assistência Junto ao Leito , Respiração com Pressão Positiva , Embolia Pulmonar/classificação , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/fisiopatologia , Ressuscitação/métodos , Medição de Risco , Índice de Gravidade de Doença , Terapia Trombolítica , Troponina/sangue , Vasoconstritores/uso terapêutico
12.
In Vivo ; 34(5): 3039-3045, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32871850

RESUMO

BACKGROUND: Antibody testing is necessary to identify immune individuals in the post-initial wave of the COVID-19 pandemic. PATIENTS AND METHODS: We prospectively evaluated the performance of a quantitative point-of-care test (POCT) for SARS-CoV-2 antibodies. The patient group (PG) comprised of hospitalized confirmed COVID-19 cases. Asymptomatic healthcare volunteers with negative rRT-PCR were included in the control group (CG). Measurement of IgM and IgG was obtained by dry fluorescence immunoassay. RESULTS: Twenty-six PG (65.9±15.4 years old, male 57.7%) and 18 CG (45.6±10.1 years old, male 33.3%) were included. By manufacturer's cut-off (≥0.04 mIU/ml), sensitivity and specificity were 73.08% and 88.89% for IgM and 88.46% and 33.33% for IgG, respectively. Estimated areas under the ROC curve were 0.907 and 0.848 for IgM and IgG, respectively. Results were improved using a cut-off of IgM ≥0.05 mIU/ml and IgG ≥0.10 mIU/ml. CONCLUSION: Using stringent cut-off values, SARS-CoV-2 antibody POCT detects immune people and can be used during socioeconomic normalization of communities.


Assuntos
Anticorpos Antivirais/isolamento & purificação , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Pandemias , Pneumonia Viral/diagnóstico , Idoso , Anticorpos Antivirais/sangue , Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Grécia/epidemiologia , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Sistemas Automatizados de Assistência Junto ao Leito , Sensibilidade e Especificidade
14.
West J Emerg Med ; 21(5): 1042-1045, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32970551

RESUMO

The novel coronavirus disease of 2019 (COVID-19) is associated with significant morbidity and mortality, as well as large numbers of patients requiring endotracheal intubation. While much of the literature has focused on the intubation technique, there is scant discussion of intubation confirmation. Herein, we discuss the limitations of traditional confirmatory approaches, summarize the literature supporting a role for point-of-care ultrasound in this application, and propose an algorithm for intubation confirmation among COVID-19 patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Intubação Intratraqueal/métodos , Pneumonia Viral/terapia , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia de Intervenção/métodos , Algoritmos , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/diagnóstico por imagem , Humanos , Pandemias , Pneumonia Viral/diagnóstico por imagem
16.
Asia Pac J Clin Nutr ; 29(3): 446-449, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32990602

RESUMO

The contributors to and consequences of disordered health are increasingly complex with sociodemographic, ecological, economic and food system change. But there are opportunities for any adversity to be mitigated by advances in the understanding of human, especially nutritional, ecobiology and in its more accessible and affordable evaluation and monitoring. Viral pandemics are on the rise with climate change and loss of ecosystems. They threaten human civilisation and planetary habitability. Human security is dependent on sustainable livelihoods of which food and water systems are a vital part. We are socioecological beings and depend for our health on biodiversity and the food diversity that ensures; and on connectedness and communication, made more difficult in pandemics. Rapid and accessible point-of-care (POC) tools are now becoming available to compliment other selfmonitoring network approaches, whether checklist or questionnaire, physical, chemical, or biological, for healthcare and nutritional health. They can provide information as several complimentary and interdependent health indices to facilitate personal, group and community action and management plans. This applies to indices of both communicable and non-communicable disease which problems separately and together are compromising health prospects. These indices include ones of physical and mental activities, dietary patterns, metabolites, blood pressure and now the presence and severity of viruses like Covid-19.Of imminent relevance and promise are optically- readable biosensor based strips for nasal, pharyngeal or salivary samples to check viral presence or finger prick blood for immunoglobulins and interleukins. These should allow less socially prohibitive measures to curb viral transmission and promote personal and societal wellbeing.


Assuntos
Infecções por Coronavirus/prevenção & controle , Comportamentos Relacionados com a Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Autocuidado , Comportamento Social , Betacoronavirus , Pressão Sanguínea , Mudança Climática , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Ecossistema , Abastecimento de Alimentos , Humanos , Hipertensão/dietoterapia , Exame Físico , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Sistemas Automatizados de Assistência Junto ao Leito , Glicoproteína da Espícula de Coronavírus , Telemedicina
17.
Radiologe ; 60(10): 919-926, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32909049

RESUMO

BACKGROUND: Point-of-care ultrasound (POCUS) of the lung in patients with COVID-19 plays a key role in the emergency room and intensive care unit. Lung ultrasound is able to depict typical pulmonary findings of COVID-19 and is therefore suitable for diagnosis and follow-up of these patients. CLINICAL/METHODOLOGICAL ISSUE: Lung ultrasound in COVID-19 patients in the emergency room and intensive care unit. STANDARD RADIOLOGICAL METHODS: Computed tomography (low-dose CT) and X­ray of the lung. METHODOLOGICAL INNOVATIONS: Lung ultrasound in COVID-19 patients. RECOMMENDATIONS: Lung ultrasound in patients with COVID-19 offers similar performance as CT and is superior when compared to X­ray in evaluating pneumonia and acute respiratory distress syndrome (ARDS). Lung ultrasound plays an important role in the emergency room and intensive care unit. POCUS reduces exposure to radiation, therapy delays, and minimizes transport of high-risk patients. Differential diagnoses can also be clarified.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Humanos , Pulmão , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia
18.
J Nanobiotechnology ; 18(1): 130, 2020 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-32912236

RESUMO

Fast point-of-care (POC) diagnostics represent an unmet medical need and include applications such as lateral flow assays (LFAs) for the diagnosis of sepsis and consequences of cytokine storms and for the treatment of COVID-19 and other systemic, inflammatory events not caused by infection. Because of the complex pathophysiology of sepsis, multiple biomarkers must be analyzed to compensate for the low sensitivity and specificity of single biomarker targets. Conventional LFAs, such as gold nanoparticle dyed assays, are limited to approximately five targets-the maximum number of test lines on an assay. To increase the information obtainable from each test line, we combined green and red emitting quantum dots (QDs) as labels for C-reactive protein (CRP) and interleukin-6 (IL-6) antibodies in an optical duplex immunoassay. CdSe-QDs with sharp and tunable emission bands were used to simultaneously quantify CRP and IL-6 in a single test line, by using a single UV-light source and two suitable emission filters for readout through a widely available BioImager device. For image and data processing, a customized software tool, the MultiFlow-Shiny app was used to accelerate and simplify the readout process. The app software provides advanced tools for image processing, including assisted extraction of line intensities, advanced background correction and an easy workflow for creation and handling of experimental data in quantitative LFAs. The results generated with our MultiFlow-Shiny app were superior to those generated with the popular software ImageJ and resulted in lower detection limits. Our assay is applicable for detecting clinically relevant ranges of both target proteins and therefore may serve as a powerful tool for POC diagnosis of inflammation and infectious events.


Assuntos
Biomarcadores/análise , Proteína C-Reativa/análise , Imunoensaio/métodos , Interleucina-6/análise , Pontos Quânticos/química , Sepse/diagnóstico , Anticorpos/imunologia , Betacoronavirus/isolamento & purificação , Proteína C-Reativa/imunologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Humanos , Interleucina-6/imunologia , Limite de Detecção , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Sistemas Automatizados de Assistência Junto ao Leito , Sepse/metabolismo , Software , Raios Ultravioleta
19.
BMC Infect Dis ; 20(1): 670, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32933492

RESUMO

BACKGROUND: The 2014/15 Ebola outbreak in West Africa resulted in 11,000 deaths and massive strain on local health systems, and the ongoing outbreak in Democratic Republic of Congo has afflicted more than 3000 people. Accurate, rapid Ebola diagnostics suitable for field deployment would enable prompt identification and effective response to future outbreaks, yet remain largely unavailable. The purpose of this study was to assess the accuracy of three novel rapid diagnostic tests (RDTs): an Ebola, an Ebola-Malaria, and a Fever Panel test that includes Ebola, all from a single manufacturer. METHODS: We evaluated the three RDTs in 109 Ebola-positive and 96 Ebola-negative stored serum samples collected during the outbreak in Guinea in 2014/15, and tested by real-time polymerase chain reaction (RT-PCR). Sensitivity, specificity, and overall percent agreement were calculated for each RDT using RT-PCR as a reference standard, stratified by Ct value ranges. RESULTS: All tests performed with high accuracy on samples with low Ct value (high viral load). The Fever Panel test performed with the highest accuracy, with a sensitivity of 89.9% and specificity of 90.6%. The Ebola and Ebola-Malaria tests performed comparably to each other: sensitivity was 77.1 and 78% respectively, and specificity was 91.7% for the Ebola test and 95.8% for the Ebola-Malaria test. CONCLUSIONS: This study evaluated the accuracy of three novel rapid diagnostic tests for Ebola. The tests may have significant public health relevance, particularly the Fever Panel test, which detects seven pathogens including Ebola. Given limitations to the study resulting from uncertain sample quality, further evaluation is warranted. All tests performed with highest accuracy on samples with low Ct value (high viral load), and the data presented here suggests that these RDTs may be useful for point-of-care diagnosis of cases in the context of an outbreak. Restrictions to their use in non-severe Ebola cases or for longitudinal monitoring, when viral loads are lower, may be appropriate. Highlighting the challenge in developing and evaluating Ebola RDTs, there were concerns regarding sample integrity and reference testing, and there is a need for additional research to validate these assays.


Assuntos
Doença pelo Vírus Ebola/diagnóstico , Sistemas Automatizados de Assistência Junto ao Leito , Surtos de Doenças , Ebolavirus/genética , Ebolavirus/isolamento & purificação , Guiné/epidemiologia , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/virologia , Humanos , RNA Viral/análise , RNA Viral/metabolismo , Kit de Reagentes para Diagnóstico , Reação em Cadeia da Polimerase em Tempo Real/métodos , Sensibilidade e Especificidade
20.
Biosens Bioelectron ; 169: 112592, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-32942143

RESUMO

Global health and food security constantly face the challenge of emerging human and plant diseases caused by bacteria, viruses, fungi, and other pathogens. Disease outbreaks such as SARS, MERS, Swine Flu, Ebola, and COVID-19 (on-going) have caused suffering, death, and economic losses worldwide. To prevent the spread of disease and protect human populations, rapid point-of-care (POC) molecular diagnosis of human and plant diseases play an increasingly crucial role. Nucleic acid-based molecular diagnosis reveals valuable information at the genomic level about the identity of the disease-causing pathogens and their pathogenesis, which help researchers, healthcare professionals, and patients to detect the presence of pathogens, track the spread of disease, and guide treatment more efficiently. A typical nucleic acid-based diagnostic test consists of three major steps: nucleic acid extraction, amplification, and amplicon detection. Among these steps, nucleic acid extraction is the first step of sample preparation, which remains one of the main challenges when converting laboratory molecular assays into POC tests. Sample preparation from human and plant specimens is a time-consuming and multi-step process, which requires well-equipped laboratories and skilled lab personnel. To perform rapid molecular diagnosis in resource-limited settings, simpler and instrument-free nucleic acid extraction techniques are required to improve the speed of field detection with minimal human intervention. This review summarizes the recent advances in POC nucleic acid extraction technologies. In particular, this review focuses on novel devices or methods that have demonstrated applicability and robustness for the isolation of high-quality nucleic acid from complex raw samples, such as human blood, saliva, sputum, nasal swabs, urine, and plant tissues. The integration of these rapid nucleic acid preparation methods with miniaturized assay and sensor technologies would pave the road for the "sample-in-result-out" diagnosis of human and plant diseases, especially in remote or resource-limited settings.


Assuntos
Doenças Transmissíveis/diagnóstico , Dispositivos Lab-On-A-Chip , Ácidos Nucleicos/isolamento & purificação , Doenças das Plantas , Sistemas Automatizados de Assistência Junto ao Leito , Betacoronavirus/isolamento & purificação , Fracionamento Químico/instrumentação , Fracionamento Químico/métodos , Doenças Transmissíveis/microbiologia , Doenças Transmissíveis/parasitologia , Doenças Transmissíveis/virologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Desenho de Equipamento , Humanos , Técnicas de Amplificação de Ácido Nucleico/instrumentação , Técnicas de Amplificação de Ácido Nucleico/métodos , Ácidos Nucleicos/sangue , Ácidos Nucleicos/urina , Pandemias , Doenças das Plantas/microbiologia , Doenças das Plantas/parasitologia , Doenças das Plantas/virologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia
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