Point-of-care test

即时测试
  • 文章类型: Journal Article
    性传播感染(STIs)是一个关键的全球健康问题,低收入和中等收入国家负担最大。快速护理点STI测试的发展使得在没有实验室访问的环境中进行筛查成为可能。然而,高需求环境面临着独特的挑战,这些挑战可能会影响性传播感染筛查的实施和采用。这篇文章讨论了在农村实施性传播感染筛查的经验教训,恰帕斯州的低资源环境,墨西哥。尽管隐私很少,员工与患者的比例也很低,开发了一种简化的方法来消除污名化并最大化性传播感染筛查。临床团队通过实践制定策略,包括将筛查纳入分诊程序,并为家庭成员提供筛查。该方案导致三个月内平均筛查率为37%,并接受了家庭单位的筛查。据观察,有必要获得治疗以减轻患者由于担心阳性结果而对筛查的犹豫。随着全球性传播感染筛查的增加,医疗保健系统必须发展强有力的治疗途径,以有效预防和治疗全世界的性传播感染。
    Sexually Transmitted Infections (STIs) are a critical global health concern, with low- and middle-income countries carrying the highest burden. The development of rapid point-of-care STI tests has enabled screening in settings without laboratory access. Yet, high-need settings face unique challenges that may influence the implementation and uptake of STI screening. This piece discusses lessons learned from the implementation of STI screening in a rural, low-resource setting in Chiapas, Mexico. Despite minimal privacy and a low staff-to-patient ratio, a streamlined approach was developed to destigmatize and maximize STI screening. The clinic team developed strategies through practice, including incorporating screening into triage procedures and offering screening to family members. This protocol led to an average screening rate of 37% within three months and acceptance of screening by family units. It was observed that access to treatment was necessary to alleviate patient hesitation to screening due to fears of a positive result. As STI screening increases globally, healthcare systems must develop robust access to treatment to effectively prevent and treat STIs worldwide.
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  • 文章类型: Journal Article
    本文报道了一种快速灵敏的传感器,用于通过电化学机理检测和定量COVID-19N蛋白(N-PROT)。单频电化学阻抗谱用作基于金缀合物修饰的碳网印刷电极(Cov-Ag-SPE)的免疫传感器系统中实时测量N-PROT的转导方法。该系统通过在300s内的100Hz下由0.0VDC电势和10mVRMS-1AC信号组成的最佳刺激信号实现了高选择性。Cov-Ag-SPE在1.0ngmL-1至10.0μgmL-1的浓度下对N-PROT检测显示出对数响应,相位(θ)变化的相关系数为0.977。可以使用从阳性和阴性样本中观察到的某些方面创建基于ML的方法;因此,可以对252个样本进行分类,灵敏度达到83.0、96.2和91.3%,特异性,和准确性,分别,置信区间(CI)为73.0至100.0%。因为阻抗谱测量可以用低成本的便携式仪器进行,这里提出的免疫传感器可以应用于大规模检测的即时诊断,即使在资源有限的地方,作为常见诊断方法的替代方案。
    This paper reports a rapid and sensitive sensor for the detection and quantification of the COVID-19 N-protein (N-PROT) via an electrochemical mechanism. Single-frequency electrochemical impedance spectroscopy was used as a transduction method for real-time measurement of the N-PROT in an immunosensor system based on gold-conjugate-modified carbon screen-printed electrodes (Cov-Ag-SPE). The system presents high selectivity attained through an optimal stimulation signal composed of a 0.0 V DC potential and 10 mV RMS-1 AC signal at 100 Hz over 300 s. The Cov-Ag-SPE showed a log response toward N-PROT detection at concentrations from 1.0 ng mL-1 to 10.0 μg mL-1, with a 0.977 correlation coefficient for the phase (θ) variation. An ML-based approach could be created using some aspects observed from the positive and negative samples; hence, it was possible to classify 252 samples, reaching 83.0, 96.2 and 91.3% sensitivity, specificity, and accuracy, respectively, with confidence intervals (CI) ranging from 73.0 to 100.0%. Because impedance spectroscopy measurements can be performed with low-cost portable instruments, the immunosensor proposed here can be applied in point-of-care diagnostics for mass testing, even in places with limited resources, as an alternative to the common diagnostics methods.
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  • 文章类型: Journal Article
    弓形虫病,虽然通常无症状且作为食源性疾病流行,对怀孕期间免疫功能低下的个体造成相当大的死亡风险。在有限的资源下检测患者血清中特异性IgG和IgM的即时血清学测试对于疾病管理至关重要。尽管在商业试剂盒中用重组抗原(rAgs)替换弓形虫总裂解物抗原(TLA)的许多努力,而IgG检测提供了显着的特异性和灵敏度,IgM检测的灵敏度仍然相对较低。在这项研究中,我们试图在早期感染中鉴定靶向IgM的新型抗原,从而建立IgM现场检测试剂盒。用双向凝胶电泳(2DE)和小鼠血清免疫印迹,三种新型抗原,包括EF1γ,PGKI,和GAP50,用于靶向弓形虫IgM。然而,在免疫印迹验证实验中,小鼠血清IgM检测不到rAgEF1γ,用PGKI包被的ELISA没有消除交叉反应性,与GAP50相比。随后,使用涂有0.3mg/mL纯化rAgGAP50的条带的侧流反应,与基于速殖子TLA的常规ELISA相比,具有显着的灵敏度,它成功地鉴定了感染了速殖子的小鼠血清中的IgM,在5dpi时从103到104,在7dpi时从104,分别。此外,通过使用世界卫生组织的标准弓形虫感染的人血清,使用GAP50的快速荧光免疫色谱检测(FICT)的检测限(LOD)为0.65IU(国际单位).这些发现强调了GAP50的特定免疫反应性,表明其作为特异性生物标志物的潜力,可提高FCT在IgM检测中的敏感性。
    Toxoplasmosis, while often asymptomatic and prevalent as a foodborne disease, poses a considerable mortality risk for immunocompromised individuals during pregnancy. Point-of-care serological tests that detect specific IgG and IgM in patient sera are critical for disease management under limited resources. Despite many efforts to replace the T. gondii total lysate antigens (TLAs) by recombinant antigens (rAgs) in commercial kits, while IgG detection provides significant specificity and sensitivity, IgM detection remains comparatively low in sensitivity. In this study, we attempted to identify novel antigens targeting IgM in early infection, thereby establishing an IgM on-site detection kit. Using two-dimensional gel electrophoresis (2DE) and mouse serum immunoblotting, three novel antigens, including EF1γ, PGKI, and GAP50, were indicated to target T. gondii IgM. However, rAg EF1γ was undetectable by IgM of mice sera in Western blotting verification experiments, and ELISA coated with PGKI did not eliminate cross-reactivity, in contrast to GAP50. Subsequently, the lateral flow reaction employing a strip coated with 0.3 mg/mL purified rAg GAP50 and exhibited remarkable sensitivity compared with the conventional ELISA based on tachyzoite TLA, which successfully identified IgM in mouse sera infected with tachyzoites, ranging from 103 to 104 at 5 dpi and 104 at 7 dpi, respectively. Furthermore, by using standard T. gondii-infected human sera from WHO, the limit of detection (LOD) for the rapid fluorescence immunochromatographic test (FICT) using GAP50 was observed at 0.65 IU (international unit). These findings underline the particular immunoreactivity of GAP50, suggesting its potential as a specific biomarker for increasing the sensitivity of the FICT in IgM detection.
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  • 文章类型: Journal Article
    在资源丰富的地区每天使用即时测试(POCT),然而,在全球南部是有限的,特别是在院前设置。关于社区卫生工作者(CHW)使用非疟疾性POCT的研究很少。此范围审查的目的是描述院前环境中评估的POCT的当前多样性和广度。
    由经验丰富的医学图书馆员对已知关键文章进行医学主题标题(MeSH)分析,并在每个数据库中进行范围搜索,以捕获“护理点测试”和“社区卫生工作者”。“这项审查是由PRISMA扩展进行范围审查的指导。
    返回了2735个出版物,185人被提名进行全文审查,110项研究被证实符合研究标准.大多数人关注疟疾(74/110;67%)或HIV(25/110;23%);9/110(8%)描述了其他测试。这篇综述的结果表明,地理范围很广,当地CHW的术语具有显著的异质性。
    新POCT的使用正在增加,并且可能会在有限的资源环境中改善早期风险分层。来自数十年疟疾POCT的当前证据可以指导未来的实施战略。
    Point-of-Care Tests (POCTs) are utilized daily in resource abundant regions, however, are limited in the global south, particularly in the prehospital setting. Few studies exist on the use of non-malarial POCTs by Community Health Workers (CHWs). The purpose of this scoping review is to delineate the current diversity in and breadth of POCTs evaluated in the prehospital setting.
    A medical subject heading (MeSH) analysis of known key articles was done by an experienced medical librarian and scoping searches were performed in each database to capture \"point of care testing\" and \"community health workers.\" This review was guided by the PRISMA Extension for scoping reviews.
    2735 publications were returned, 185 were nominated for full-text review, and 110 studies were confirmed to meet study criteria. Majority focused on malaria (74/110; 67%) or HIV (25/110; 23%); 9/110 (8%) described other tests administered. Results from this review demonstrate a broad geographic range with significant heterogeneity in terminology for local CHWs.
    The use of new POCTs is on the rise and may improve early risk stratification in limited resource settings. Current evidence from decades of malaria POCTs can guide future implementation strategies.
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  • 文章类型: Journal Article
    猫白血病病毒(FeLV)是家猫的猫白血病综合征的原因。由FeLV引起的疾病的预防和控制主要基于疫苗接种以及感染受试者的识别和隔离。抗原诊断方法,在临床实践中使用最广泛的,可以与分子测试相关联以表征检测到的FeLV。在这项研究中,使用定量SYBRGreenReal-TimePCR(qPCR)检测2018-2021年转诊至意大利北部兽医教学医院的抗原阳性猫血液样本中的FeLV前病毒DNA.为了对鉴定出的病毒进行基因表征,使用6个不同的终点PCR扩增病毒包膜(env)基因的一部分并进行测序.研究中包括的26只猫中的22只(84.6%)通过qPCR测定测试为阳性。这表明所采用的qPCR的高性能,但需要进一步的研究来调查四只猫的抗原测试和qPCR之间不一致结果的原因。从env基因分析,15/22qPCR阳性猫被FeLV亚型A感染,5/15与B亚型同时感染。
    Feline leukemia virus (FeLV) is responsible for feline leukemia syndrome in domestic cats. The prevention and control of disease caused by FeLV are primarily based on vaccination and identification and isolation of infected subjects. Antigen diagnostic methods, which are the most widely used in clinical practices, can be associated to molecular tests to characterize the FeLV detected. In this study, a quantitative SYBR Green Real-Time PCR (qPCR) assay was used to detect FeLV proviral DNA in blood samples from antigen positive cats referred to a veterinary teaching hospital in Northern Italy in 2018-2021. To genetically characterize the identified viruses, a portion of the viral envelope (env) gene was amplified using six different end-point PCRs and sequenced. Twenty-two of 26 (84.6%) cats included in the study tested positive by qPCR assay. This suggests a high performance of the qPCR adopted but further studies are required to investigate the cause of discordant results between the antigen test and qPCR in four cats. From env gene analysis, 15/22 qPCR-positive cats were infected by FeLV subtype A and 5/15 shown coinfection with subtype B.
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  • 文章类型: Journal Article
    印度需要进行广泛的检测,以阻止新型冠状病毒在人群中的传播。虽然RT-PCR是推荐的诊断技术,由于需要专门的仪器,它的使用仅限于设备齐全的实验室,试剂和训练有素的人员。WHO尚未推荐用于诊断活动性感染的免疫诊断测试。非常需要开发即时分子测试。根据我们过去使用paperfluid设备通过分子测试诊断细菌感染的经验,我们建议开发COVID-19的诊断测试。作为一种平台技术,它可以适应未来的其他病毒爆发。
    There is a need for widespread testing in India to stop the spread of the novel coronavirus in the population. While RT-PCR is the recommended diagnostic technique, its use is limited to well-equipped laboratories due to the need for specialized instrumentation, reagents and trained personnel. Immunodiagnostic tests are not yet recommended by the WHO for diagnosing active infections. There is a strong need for developing point-of-care molecular tests. Based on our past experience with paperfluidic devices for diagnosing bacterial infections by molecular tests, we propose the development of a diagnostic test for COVID-19. As a platform technology, it could be adapted to other viral outbreaks in future.
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  • 文章类型: Journal Article
    维生素D(维生素D)是一种脂溶性分子,作用类似于激素,它涉及几种生物学机制,如基因表达,钙稳态,骨代谢,免疫调节,病毒保护,和神经肌肉功能。维生素D缺乏可导致慢性低钙血症,甲状旁腺功能亢进,和许多其他病理状况;在这种情况下,25-羟基维生素D(25-OH-D)水平低和极低与COVID-19感染风险增加和许多严重疾病的可能性相关。由于所有这些原因,重要的是量化和监测25-OH-D水平,以确保血清/血液浓度在临床上不会次优.血清25-OH-D浓度是目前VitD状态的主要指标,目前通过不同的检测方法进行,但最常见的定量技术包括免疫计量学方法或色谱法。然而,其他定量技术和仪器正在出现,例如基于免疫荧光分析仪的AFIAS-1®和AFIAS-10®(Boditech和Menarini),这保证了一个自动系统的墨盒能够给出快速和可靠的结果作为一个即时测试(POCT)。这项工作旨在比较AFIAS-1®和AFIAS-10®(Boditech和Menarini)VitD定量与超高效液相色谱和串联质谱联用技术,该技术目前代表了VitD定量的黄金标准技术。对56个样品在不同条件下(来自新鲜和冷冻血浆)平行进行分析以评估结果的可靠性。方法上的任何统计学上的显著差异,固定的错误,并报告了与浓度成正比的误差。在所有条件下获得的结果显示AFIAS®仪器和LC-MS/MS之间具有良好的相关性,我们可以肯定的是,AFIAS-1®和AFIAS-10®是准确快速测量25-OH-D的可靠仪器。
    Vitamin D (Vit D) is a fat-soluble molecule acting like a hormone, and it is involved in several biological mechanisms such as gene expression, calcium homeostasis, bone metabolism, immune modulation, viral protection, and neuromuscular functions. Vit D deficiency can lead to chronic hypocalcemia, hyperparathyroidism, and many other pathological conditions; in this context, low and very low levels of 25-hydroxy-vitamin D (25-OH-D) were found to be associated with an increased risk of COVID-19 infection and the likelihood of many severe diseases. For all these reasons, it is important to quantify and monitor 25-OH-D levels to ensure that the serum/blood concentrations are not clinically suboptimal. Serum concentration of 25-OH-D is currently the main indicator of Vit D status, and it is currently performed by different assays, but the most common quantitation techniques involve immunometric methods or chromatography. Nevertheless, other quantitation techniques and instruments are now emerging, such as AFIAS-1® and AFIAS-10® (Boditech and Menarini) based on the immunofluorescence analyzer, that guarantee an automated system with cartridges able to give quick and reliable results as a point-of-care test (POCT). This work aims to compare AFIAS-1® and AFIAS-10® (Boditech and Menarini) Vit D quantitation with Ultra High-Performance Liquid Chromatography coupled with tandem mass spectrometry that currently represents the gold standard technique for Vit D quantitation. The analyses were performed in parallel on 56 samples and in different conditions (from fresh and frozen plasma) to assess the reliability of the results. Any statistically significant differences in methods, the fixed error, and the error proportional to concentration were reported. Results obtained in all conditions showed a good correlation between both AFIAS® instruments and LC-MS/MS, and we can affirm that AFIAS-1® and AFIAS-10® are reliable instruments for measuring 25-OH-D with accuracy and in a fast manner.
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  • 文章类型: Journal Article
    宫颈癌是全球威胁女性健康的第三大常见癌症,高危型人乳头瘤病毒(HR-HPV)感染是全球宫颈癌的主要病因。鉴于HR-HPV感染的复发性,准确的筛选对其控制至关重要。由于常用的聚合酶链反应(PCR)技术受到专业设备和人员的限制,仍然非常需要方便和超灵敏的HR-HPV检测方法.作为新的分子检测方法,基于核酸扩增的生物传感器具有灵敏度高的优点,快速操作,和便携性,这有助于农村和偏远地区的即时检测。本文综述了基于多种核酸扩增策略在改良PCR中用于HR-HPV筛查的核酸生物传感器。环介导等温扩增,重组酶聚合酶扩增,杂交链反应,催化发夹组件,和CRISPR/Cas系统。结合微流控技术,侧流测定,电化学分析和其他传感技术,HR-HPV核酸生物传感器具有高通量,响应时间短,高灵敏度和易于操作的领域。虽然还有不足之处,如成本高,重现性差,这种方法将适用于HR-HPV感染或宫颈癌的现场筛查,以及未来在复杂环境和贫困地区的辅助临床诊断.
    Cervical cancer is the third most common cancer threatening women\'s health globally, and high-risk human papillomavirus (HR-HPV) infection is the main cause of cervical cancer worldwide. Given the recurrent nature of HR-HPV infection, accurate screening is essential for its control. Since the commonly used polymerase chain reaction (PCR) technique is limited by professional equipment and personnel, convenient and ultrasensitive detection methods for HR-HPV are still highly needed. As new molecular detection methods, nucleic acid amplification-based biosensors have the advantages of high sensitivity, rapid operation, and portability, which are helpful for point-of-care testing in rural and remote areas. This review summarized nucleic acid biosensors for HR-HPV screening based on a variety of nucleic acid amplification strategies involved in improved PCR, loop-mediated isothermal amplification, recombinase polymerase amplification, hybridization chain reaction, catalyzed hairpin assembly, and CRISPR/Cas systems. In combination with microfluidic technology, lateral flow assays, electrochemical analysis and other sensing technologies, HR-HPV nucleic acid biosensors have the advantages of high throughput, short response time, high sensitivity and easy operation in the field. Although there are still shortcomings, such as high cost and poor reproducibility, this approach will be suitable for on-site screening of HR-HPV infection or cervical cancer and for auxiliary clinical diagnosis in complex environments and poor areas in the future.
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  • 文章类型: Journal Article
    简介:发烧是在实践中进行医学评估和抗生素处方的最常见原因之一。这项研究的目的是评估快速鼻咽拭子对呼吸道病原体的阳性和阴性预测值,以区分病毒与细菌感染。方法:我们前瞻性地测试了有感染体征和/或症状的儿童(例如,发烧,咳嗽,喘息,疑似尿路感染)入院儿科。放电后,临床表型被分配,定义一组可能/某些病毒感染的儿童,可能/某些细菌感染,其他炎症或健康对照。结果:在这项研究中,190名儿童入学(50.5%为女性,中位年龄30.5(8-86)个月)。总的来说,102名患者(53.7%)受到呼吸道病毒感染的影响,16(8.4%)细菌感染,29例(15.3%)是健康对照,43例(22.6%)受到另一种表现为发热的病理状况的影响。总的来说,84.3%分类为病毒感染的患者病毒检测呈阳性,与18.8%的细菌感染患者相比(p<0.001),18.6%的患者患有其他疾病(p<0.001)和17.2%的对照患者(p<0.001)。NPSs诊断病毒感染的阳性预测值为88.6%,阴性预测值为75.0%。结论:我们的发现表明,呼吸道病毒的快速NPS检测是确认发烧儿童病毒感染和改善抗生素使用的有用工具。
    Introduction: Fever is among the most common reason for medical assessment and antibiotic prescription in practice. The aim of this study was to evaluate positive and negative predictive values of rapid nasopharyngeal swabs for respiratory pathogens to discriminate viral from bacterial infections. Methods: We prospectively tested children with signs and/or symptoms of infections (e.g., fever, cough, wheezing, suspected urinary tract infection) admitted to a paediatric department. Following discharge, clinical phenotypes were assigned defining a cohort of children having probable/certain viral infection, probable/certain bacterial infection, other inflammatory conditions or healthy controls. Results: In this study, 190 children were enrolled (50.5% females, median age 30.5 (8-86) months). In total, 102 patients (53.7%) were affected by respiratory viral infections, 16 (8.4%) by bacterial infections, 29 (15.3%) were healthy controls and 43 (22.6%) were affected by another pathological condition manifested with fever. In total, 84.3% of patients classified as viral infection tested positive for viruses, compared with 18.8% of patients with bacterial infection (p < 0.001), 18.6% of patients with other condition (p < 0.001) and 17.2% of control patients (p < 0.001). The positive predictive value of NPSs in the diagnosis of viral infection was 88.6% and the negative predictive value was 75.0%. Conclusion: Our findings suggest that rapid NPS tests for respiratory viruses are a useful tool to confirm viral infections in children with fever and improve antibiotic use.
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  • 文章类型: Journal Article
    单孢子虫是牡蛎的主要病原。两个独立的实验室评估了用于快速检测这些寄生虫的荧光实时环介导等温扩增(LAMP)测定法。对BO肌动蛋白-1和BE肌动蛋白基因设计特异性LAMP测定。在18S基因的保守区域上构思了另一种通用测定法,以检测两种Bonamia物种。取决于测试和仪器,最佳反应温度在65至67°C之间变化。熔化温度为89.8-90.2°C,87.0-87.6°C,每个BO的温度为86.2-86.6°C,BE,和通用化验。这些测定的分析灵敏度在30分钟的运行中为50拷贝/μL。BO和BE测试灵敏度比实时PCR低1log,而通用测试灵敏度与实时PCR相似。BO和BE检测都被证明是特异性的;然而,该通用试验可能与厚皮单孢菌发生交叉反应。在已知状态的样品上评估的LAMP测定的性能在7-20分钟内检测到阳性,BO和通用测试的测试准确性为100%,BE的准确性为95.8%。易用性,这些测试的快速性和可负担性允许现场部署。
    The haplosporidian parasites Bonamia ostreae (BO) and B. exitiosa (BE) are serious oyster pathogens. Two independent laboratories evaluated fluorescence real-time loop-mediated isothermal amplification (LAMP) assays for rapidly detecting these parasites. Specific LAMP assays were designed on the BO actin-1 and BE actin genes. A further generic assay was conceived on a conserved region of the 18S gene to detect both Bonamia species. The optimal reaction temperature varied from 65 to 67 °C depending on the test and instrument. Melting temperatures were 89.8-90.2 °C, 87.0-87.6 °C, and 86.2-86.6 °C for each of the BO, BE, and generic assays. The analytical sensitivity of these assays was 50 copies/µL in a 30 min run. The BO and BE test sensitivity was ~1 log lower than a real-time PCR, while the generic test sensitivity was similar to the real-time PCR. Both the BO and BE assays were shown to be specific; however, the generic assay potentially cross-reacts with Haplosporidium costale. The performance of the LAMP assays evaluated on samples of known status detected positives within 7-20 min with a test accuracy of 100% for the BO and generic tests and a 95.8% accuracy for BE. The ease of use, rapidity and affordability of these tests allow for field deployment.
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