Rapid Diagnostic for Point-of-Care Malaria Screening

Advances in Malaria Diagnostic Methods in Resource-Limited Settings: A Systematic Review

Malaria continues to pose a health challenge globally, and its elimination has remained a major topic of public health discussions. A key factor in eliminating malaria is the early and accurate detection of the parasite, especially in asymptomatic individuals, and so the importance of enhanced diagnostic methods cannot be overemphasized. This paper reviewed the advances in malaria diagnostic tools and detection methods over recent years. The use of these advanced diagnostics in lower and lower-middle-income countries as compared to advanced economies has been highlighted. Scientific databases such as Google Scholar, PUBMED, and Multidisciplinary Digital Publishing Institute (MDPI), among others, were reviewed. The findings suggest important advancements in malaria detection, ranging from the use of rapid diagnostic tests (RDTs) and molecular-based technologies to advanced non-invasive detection methods and computerized technologies. Molecular tests, RDTs, and computerized tests were also seen to be in use in resource-limited settings. In all, only twenty-one out of a total of eighty (26%) low and lower-middle-income countries showed evidence of the use of modern malaria diagnostic methods. It is imperative for governments and other agencies to direct efforts toward malaria research to upscale progress towards malaria elimination globally, especially in endemic regions, which usually happen to be resource-limited regions.

Clinical significance of PLT for diagnosis and treatment monitoring in imported malaria

To evaluate the clinical significance of PLT, MPV, and PDW in monitoring malaria treatment efficacy and predicting disease progression. A total of 31 patients with imported malaria were selected as the observation group, while 31 non-malaria patients with fever were selected as controls. The observation group was subdivided into a complication group and a non-complication group according to the occurrence of complications during treatment. Additionally, on the 1st day (within 24 h), the 3rd day, and the 5th day following admission, a comprehensive blood routine examination, Plasmodium microscopic examination, and colloidal gold assay were conducted. The blood routine examination results were compared before and after treatment among patients in the observation group and the control group. Moreover, the study involved dynamic monitoring and analysis of the levels and variations in PLT, MPV, and PDW within both the complication group and the non-complication group. The Plasmodium density was negatively correlated with PLT before treatment. There were significant differences were observed in PLT, MPV, and PDW (P < 0.05) within the observation group before and after treatment. Notably, there were no significant alterations in red blood cell (RBC), hemoglobin (Hb), and white blood cell (WBC) counts (P > 0.05) within the observation group before and after treatment. The PLT, MPV, and PDW levels in the complication group and the non-complication group exhibited an upward trend after treatment. Further, the PLT of patients in the complication group was significantly lower than that in the non-complication group. Additionally, the PLT, MPV, and PDW levels in the complication group and the non-complication group increased gradually from the time of admission to the 3rd and 5th day of treatment. Notably, the PLT in the complication group was consistently lower than that in the non-complication group. The continuous monitoring of PLT, MPV, and PDW changes plays a crucial role in assessing malaria treatment efficacy and prognosis in these individuals.

The Laboratory Diagnosis of Malaria: A Focus on the Diagnostic Assays in Non-Endemic Areas

Even if malaria is rare in Europe, it is a medical emergency and programs for its control should ensure both an early diagnosis and a prompt treatment within 24-48 h from the onset of the symptoms. The increasing number of imported malaria cases as well as the risk of the reintroduction of autochthonous cases encouraged laboratories in non-endemic countries to adopt diagnostic methods/algorithms. Microscopy remains the gold standard, but with limitations. Rapid diagnostic tests have greatly expanded the ability to diagnose malaria for rapid results due to simplicity and low cost, but they lack sensitivity and specificity. PCR-based assays provide more relevant information but need well-trained technicians. As reported in the World Health Organization Global Technical Strategy for Malaria 2016-2030, the development of point-of-care testing is important for the improvement of diagnosis with beneficial consequences for prompt/accurate treatment and for preventing the spread of the disease. Despite their limitations, diagnostic methods contribute to the decline of malaria mortality. Recently, evidence suggested that artificial intelligence could be utilized for assisting pathologists in malaria diagnosis.

Emerging trends in nanomaterial design for the development of point-of-care platforms and practical applications

Nanomaterials and nanotechnology offer promising opportunities in point-of-care (POC) diagnostics and therapeutics due to their unique physical and chemical properties. POC platforms aim to provide rapid and portable diagnostic and therapeutic capabilities at the site of patient care, offering cost-effective solutions. Incorporating nanomaterials with distinct optical, electrical, and magnetic properties can revolutionize the POC industry, significantly enhancing the effectiveness and efficiency of diagnostic and theragnostic devices. By leveraging nanoparticles and nanofibers in POC devices, nanomaterials have the potential to improve the accuracy and speed of diagnostic tests, making them more practical for POC settings. Technological advancements, such as smartphone integration, imagery instruments, and attachments, complement and expand the application scope of POCs, reducing invasiveness by enabling analysis of various matrices like saliva and breath. These integrated testing platforms facilitate procedures without compromising diagnosis quality. This review provides a summary of recent trends in POC technologies utilizing nanomaterials and nanotechnologies for analyzing disease biomarkers. It highlights advances in device development, nanomaterial design, and their applications in POC. Additionally, complementary tools used in POC and nanomaterials are discussed, followed by critical analysis of challenges and future directions for these technologies.

Rapid Detection of Malaria Based on Hairpin-Mediated Amplification and Lateral Flow Detection

Malaria is listed as one of the three most hazardous infectious diseases worldwide. Travelers and migrants passing through exit and entry ports are important sources of malaria pandemics globally. Developing accurate and rapid detection technology for malaria is important. Here, a novel hairpin-mediated amplification (HMA) technique was proposed for the detection of four Plasmodium species, including P. falciparum, P. vivax, P. malariae, and P. ovale. Based on the conserved nucleotide sequence of Plasmodium, specific primers and probes were designed for the HMA process, and the amplicon can be detected using lateral flow detection (LFD); the results can be read visually without specialized equipment. The specificity of HMA-LFD was evaluated using nucleic acids extracted from four different Plasmodium species and two virus species. The sensitivity of HMA-LFD was valued using 10× serial dilutions of plasmid containing the template sequence. Moreover, 78 blood samples were collected to compare HMA-LFD and qPCR. The HMA-LFD results were all positive for four different Plasmodium species and negative for the other two virus species. The sensitivity of HMA-LFD was tested to be near five copies/μL. The analysis of clinical samples indicated that the consistency of HMA-LFD and qPCR was approximately 96.15%. Based on these results, the HMA-LFD assay was demonstrated to be a rapid, sensitive, and specific technique for the detection of Plasmodium and has great advantages for on-site detection in low-resource areas and exit and entry ports.

Impedance-Based Rapid Diagnostic Tool for Single Malaria Parasite Detection

This paper presents a custom, low-cost electronic system specifically designed for rapid and quantitative detection of the malaria parasite in a blood sample. The system exploits the paramagnetic properties of malaria-infected red blood cells (iRBCs) for their magnetophoretic capture on the surface of a silicon chip. A lattice of nickel magnetic micro-concentrators embedded in a silicon substrate concentrates the iRBCs above coplanar gold microelectrodes separated by 3 μm for their detection through an impedance measurement. The sensor is designed for a differential operation to remove the large contribution given by the blood sample. The electronic readout automatically balances the sensor before each experiment and reaches a resolution of 15 ppm in the impedance measurement at 1 MHz allowing a limit of detection of 40 parasite/μl with a capture time of 10 minutes. For better reliability of the results, four sensors are acquired during the same experiment. We demonstrate that the realized platform can also detect a single infected cell in real experimental conditions, measuring human blood infected by Plasmodium falciparum malaria specie.

Hybrid nanophotonic-microfluidic sensor for highly sensitive liquid and gas analyses

Today, a lab-on-a-chip is one of the most promising ways to create sensor devices for gas and liquid analysis for environmental monitoring, early diagnosis, and treatment effectiveness assessment. On the one hand, this requires a large number of measurements and, on the other hand, involves minimum consumption of the test analytes. Combination of highly sensitive photonic integrated circuits (PICs) with microfluidic channels (MFCs) is necessary to solve this problem. In this work, PICs based on a silicon nitride platform integrated with MFCs for studying liquids and gases were developed. Different concentrations of isopropanol in de-ionized water were used as the analyte. Based on this, the sensitivity (S) and detection limit (DL) of the analyzed solution were evaluated. Entire system calibration was carried out to calculate S and DL, considering experimental and numerical simulation data. This development may be of interest as a promising platform for environmental monitoring and realization of point-of-care strategy for biomedical applications.

Review of Microdevices for Hemozoin-Based Malaria Detection

Despite being preventable and treatable, malaria still puts almost half of the world's population at risk. Thus, prompt, accurate and sensitive malaria diagnosis is crucial for disease control and elimination. Optical microscopy and immuno-rapid tests are the standard malaria diagnostic methods in the field. However, these are time-consuming and fail to detect low-level parasitemia. Biosensors and lab-on-a-chip devices, as reported to different applications, usually offer high sensitivity, specificity, and ease of use at the point of care. Thus, these can be explored as an alternative for malaria diagnosis. Alongside malaria infection inside the human red blood cells, parasites consume host hemoglobin generating the hemozoin crystal as a by-product. Hemozoin is produced in all parasite species either in symptomatic and asymptomatic individuals. Furthermore, hemozoin crystals are produced as the parasites invade the red blood cells and their content relates to disease progression. Hemozoin is, therefore, a unique indicator of infection, being used as a malaria biomarker. Herein, the so-far developed biosensors and lab-on-a-chip devices aiming for malaria detection by targeting hemozoin as a biomarker are reviewed and discussed to fulfil all the medical demands for malaria management towards elimination.

The Future in Sensing Technologies for Malaria Surveillance: A Review of Hemozoin-Based Diagnosis

Early and effective malaria diagnosis is vital to control the disease spread and to prevent the emergence of severe cases and death. Currently, malaria diagnosis relies on optical microscopy and immuno-rapid tests; however, these require a drop of blood, are time-consuming, or are not specific and sensitive enough for reliable detection of low-level parasitaemia. Thus, there is an urge for simpler, prompt, and accurate alternative diagnostic methods. Particularly, hemozoin has been increasingly recognized as an attractive biomarker for malaria detection. As the disease proliferates, parasites digest host hemoglobin, in the process releasing toxic haem that is detoxified into an insoluble crystal, the hemozoin, which accumulates along with infection progression. Given its magnetic, optical, and acoustic unique features, hemozoin has been explored for new label-free diagnostic methods. Thereby, herein, we review the hemozoin-based malaria detection methods and critically discuss their challenges and potential for the development of an ideal diagnostic device.

Emerging point-of-care technologies for anemia detection

Anemia, characterized by low blood hemoglobin level, affects about 25% of the world's population with the heaviest burden borne by women and children. Anemia leads to impaired cognitive development in children, as well as high morbidity and early mortality among sufferers. Anemia can be caused by nutritional deficiencies, oncologic treatments and diseases, and infections such as malaria, as well as inherited hemoglobin or red cell disorders. Effective treatments are available for anemia upon early detection and the treatment method is highly dependent on the cause of anemia. There is a need for point-of-care (POC) screening, early diagnosis, and monitoring of anemia, which is currently not widely accessible due to technical challenges and cost, especially in low- and middle-income countries where anemia is most prevalent. This review first introduces the evolution of anemia detection methods followed by their implementation in current commercially available POC anemia diagnostic devices. Then, emerging POC anemia detection technologies leveraging new methods are reviewed. Finally, we highlight the future trends of integrating anemia detection with the diagnosis of relevant underlying disorders to accurately identify specific root causes and to facilitate personalized treatment and care.

An examination of nurse-authored patents: Implications for nursing practice

BACKGROUND

Recognition for medical inventions and innovations is largely associated with physician-researchers, scientists, and engineers. The term "nurse" is largely absent from patents awarded in the United States. Yet, as front-line healthcare providers, who better to add to the current population of inventors and innovators of new, meaningful scientific and engineering medical discoveries than specialized advanced practice nurses and their registered nurse colleagues? Although medical inventions and innovations are not entirely new activities for nurses, the authors speculate that greater opportunities exist for these healthcare professionals to lead in and be officially recognized for medical care discoveries and advancements by having their names on patents awarded. Also, we surmise that without the active and dedicated participation of nurses, important and significant discoveries may be missed.

AIMS

The purpose of this paper is to address the importance of having nurses at all levels and specialties engaged in healthcare inventions and innovations. The foundation for this thesis begins by describing the findings from the first quantitative analysis of nurses' participation and/or recognition for the invention and innovation of medical devices and instruments, defined by having their names on awarded United States patents. In addition, we identify meaningful pathways for nurses to engage in this space.

METHODS

Data to evaluate nurse participation and recognition for medical device and instrument inventions and innovations were collected through a publicly accessible website, the United States Patent and Trademark Office database, and analyzed with respect to whether the patent author(s) were nurses or nonnurses.

RESULTS

More than 65 000 patents were identified with the terms "medical device" and "medical instrument." From the 65 000+ patent-population, 100 random patents were analyzed for the purposes of this first study and none were determined to have a nurse listed as a participating inventor or innovator. As a result of this analysis, the authors: (a) identify that nurses are largely unrecognized in the medical device invention and innovation space and (b) create models that explain nurses' engagement in this space from (i) historical and contemporary perspectives and (ii) for enhanced future involvement in healthcare patent activities. The future model is especially important as it provides a pathway for nurses to enhance their inventive and innovative competencies, effectiveness, and efficiency through new professional roles, additional education, creation of new educational programs, and formation of professional collaborations. It also calls for organizations that employ nurses to overtly allocate time, resources, and support for invention and innovation activities. We posit that fostering and facilitating nurses to enter the medical invention and innovation space stimulates discoveries that can improve patient care experiences, operations, and outcomes, reduce healthcare costs and provide myriad benefits to these professionals and the organizations that employ them. Examples of benefits from nursing inventions and innovations include prestige, scholarship, and the financial assets associated with intellectual property (ie, patents awarded) for both the nurse and the employing institution. Furthermore, direct involvement and engagement in inventions and innovations define a new practice space and contribution for nurses.

Engineering photonics solutions for COVID-19

As the impact of COVID-19 on society became apparent, the engineering and scientific community recognized the need for innovative solutions. Two potential roadmaps emerged: developing short-term solutions to address the immediate needs of the healthcare communities and developing mid/long-term solutions to eliminate the over-arching threat. However, in a truly global effort, researchers from all backgrounds came together in tackling this challenge. Short-term efforts have focused on re-purposing existing technologies and leveraging additive manufacturing techniques to address shortages in personal protective equipment and disinfection. More basic research efforts with mid-term and long-term impact have emphasized developing novel diagnostics and accelerating vaccines. As a foundational technology, photonics has contributed directly and indirectly to all efforts. This perspective will provide an overview of the critical role that the photonics field has played in efforts to combat the immediate COVID-19 pandemic as well as how the photonics community could anticipate contributing to future pandemics of this nature.

Can Plasmodium's tricks for enhancing its transmission be turned against the parasite? New hopes for vector control

Approximately 120 years ago the link between mosquito and the malaria transmission was discovered. However, even today it remains an open question whether the parasite is able to direct the blood-seeking and feeding behavior of its mosquito vector to maximize the probability of transmission. If the parasite has this ability, could it occur only through the alteration of the vertebrate host's volatile organic compounds (VOCs) and/or the parasite alteration of the behavior of the infected vector in a manner that favors its transmission? Although some recent empirical evidence supports the hypothesis regarding the parasite ability in alteration of the vertebrate host's VOCs, the role of parasite alteration and behavioral differences between infected and uninfected female mosquitoes toward infected and uninfected hosts has not yet been considered in the implementation of control measures. This review will discuss the current evidence, which shows 1. Plasmodium can direct uninfected mosquito blood-seeking and feeding behavior via alteration of vertebrate-host odor profiles and production of phagostimulants and 2. Plasmodium also manipulates its vector during the sporogony cycle to increase transmission. Briefly, we also consider the next generation of methods for moving the empirical laboratory evidence to potential application in future integrated malaria control programs.

Geometrical-optics approach to increase the accuracy in LED-based photometers for point-of-care testing

A geometrical-optics approach is proposed to increase the accuracy in photometric measurements, using a point-of-care testing (POCT) LED-based sensor. Due to stray-light effects, the measurement accuracy depends on the dimension of the CMOS area, where the radiation is detected. We propose two image processing approaches and evaluate the influence of the sensor area. In addition, we demonstrate that with the same measurement, both absorption coefficient and refractive index can be determined, measuring the beam attenuation and the spot-size enlargement due to ray refraction.

Diamond Magnetic Microscopy of Malarial Hemozoin Nanocrystals

Magnetic microscopy of malarial hemozoin nanocrystals is performed by optically detected magnetic resonance imaging of near-surface diamond nitrogen-vacancy centers. Hemozoin crystals are extracted from Plasmodium falciparum-infected human blood cells and studied alongside synthetic hemozoin crystals. The stray magnetic fields produced by individual crystals are imaged at room temperature as a function of the applied field up to 350 mT. More than 100 nanocrystals are analyzed, revealing the distribution of their magnetic properties. Most crystals (96%) exhibit a linear dependence of the stray-field magnitude on the applied field, confirming hemozoin's paramagnetic nature. A volume magnetic susceptibility of 3.4 × 10-4 is inferred with use of a magnetostatic model informed by correlated scanning-electron-microscopy measurements of crystal dimensions. A small fraction of nanoparticles (4/82 for Plasmodium falciparum-produced nanoparticles and 1/41 for synthetic nanoparticles) exhibit a saturation behavior consistent with superparamagnetism. Translation of this platform to the study of living Plasmodium-infected cells may shed new light on hemozoin formation dynamics and their interaction with antimalarial drugs.