An embedded barcode for "connected" malaria rapid diagnostic tests

UbiNAAT: a multiplexed point-of-care nucleic acid diagnostic platform for rapid at-home pathogen detection

The COVID-19 pandemic increased demands for respiratory disease testing to facilitate treatment and limit transmission, demonstrating in the process that most existing test options were too complex and expensive to perform in point-of-care or home scenarios. Lab-based molecular techniques can detect viral RNA in respiratory illnesses but are expensive and require trained personnel, while affordable antigen-based home tests lack sensitivity for early detection in newly infected or asymptomatic individuals. The few home RNA detection tests deployed were prohibitively expensive. Here, we demonstrate a point-of-care, paper-based rapid analysis device that simultaneously detects multiple viral RNAs; it is demonstrated on two common respiratory viruses (COVID-19 and influenza A) spiked onto a commercial nasal swab. The automated device requires no sample preparation by the user after insertion of the swab, minimizing user operation steps. We incorporated lyophilized amplification reagents immobilized in a porous matrix, a novel thermally actuated valve for multiplexed fluidic control, a printed circuit board that performs on-device lysis and amplification within a cell-phone-sized disposable device. Reverse transcription loop-mediated isothermal amplification (RT-LAMP) products are visualized via fluorescent dyes using a modified cell phone, resulting in detection of as few as 104 viral copies per swab across both pathogens within 30 minutes. This integrated platform could be commercialized in a form that would be inexpensive, portable, and sensitive; it can readily be multiplexed to detect as many as 8 different RNA or DNA sequences, and adapted to any desired RNA or DNA detection assays.

Nanotechnology in the Diagnosis and Treatment of Antibiotic-Resistant Infections

The development of antimicrobial resistance (AMR), along with the relative reduction in the production of new antimicrobials, significantly limits the therapeutic options in infectious diseases. Thus, novel treatments, especially in the current era, where AMR is increasing, are urgently needed. There are several ongoing studies on non-classical therapies for infectious diseases, such as bacteriophages, antimicrobial peptides, and nanotechnology, among others. Nanomaterials involve materials on the nanoscale that could be used in the diagnosis, treatment, and prevention of infectious diseases. This review provides an overview of the applications of nanotechnology in the diagnosis and treatment of infectious diseases from a clinician's perspective, with a focus on pathogens with AMR. Applications of nanomaterials in diagnosis, by taking advantage of their electrochemical, optic, magnetic, and fluorescent properties, are described. Moreover, the potential of metallic or organic nanoparticles (NPs) in the treatment of infections is also addressed. Finally, the potential use of NPs in the development of safe and efficient vaccines is also reviewed. Further studies are needed to prove the safety and efficacy of NPs that would facilitate their approval by regulatory authorities for clinical use.

A QR code-integrated chromogenic paper strip for detection of hydrogen peroxide in aqueous samples

Hydrogen peroxide (H2O2) is commonly used as a preservative, disinfectant, bleach, and oxidizing agent. The prolonged consumption of H2O2 adulterated milk is harmful to human health when consumed in the diet. Exposure to H2O2 can lead to oxidative stress, cell damage and tissue injury. Due to the potential adverse effects, the use of hydrogen peroxide is regulated in certain applications, such as in food, water treatment plants and medical products. Several methods are available for the detection of H2O2 in various matrices. Here, a method and QR code-integrated chromogenic paper strip for the detection of H2O2 in aqueous samples has been developed. The spectrophotometric method showed an LOD and LOQ of 0.00087 ± 8.70 ×10-5% (v/v) and 0.0037 ± 0.0003% (v/v), respectively. The paper-based chromogenic strip prepared by immobilizing recognition solution onto a QR code was able to detect 0.0005% v/v of H2O2 in aqueous samples. The QR integrated chromogenic paper strip sensors can serve as a useful tool for consumers, regulatory agencies, and the food industry to assess food quality and authenticity.

Micropatterning of functional lipid bilayer assays for quantitative bioanalysis

Interactions of the cell with its environment are mediated by the cell membrane and membrane-localized molecules. Supported lipid bilayers have enabled the recapitulation of the basic properties of cell membranes and have been broadly used to further our understanding of cellular behavior. Coupled with micropatterning techniques, lipid bilayer platforms have allowed for high throughput assays capable of performing quantitative analysis at a high spatiotemporal resolution. Here, an overview of the current methods of the lipid membrane patterning is presented. The fabrication and pattern characteristics are briefly described to present an idea of the quality and notable features of the methods, their utilizations for quantitative bioanalysis, as well as to highlight possible directions for the advanced micropatterning lipid membrane assays.

A card instead of a lab: A ligand embedded in a bio-composite of starch/gelatin intelligent film for milk quality test followed by colorimetric analysis

Milk adulteration analysis at different stages of the production chain, which profiteers widely use to mask milk quality parameters, is problematic. We prepared selective intelligent thin bio-films and a dedicated app to test milk adulteration in an out-of-lab setting. In this regard, each reagent is immobilized on a piece of starch/gelatin film as color-changeable polymeric support, which is then pasted onto a transparent test card. Incorporating starch and gelatin as the backbone of these composite films can significantly improve the mechanical properties, color, and potential applications in real-time monitoring. After 5 min floating of the card on the surface of the milk, our developed software as a Progressive Web Application can be used to locate and read the QR codes of the samples to estimate qualitative and quantitative information about the presence of some preservatives. These preservatives ranged from 0.1 to 200.0 mg/L, 1.0-100.0 mg/L, 0.001-0.05 mol/L in 10 mL of milk with the LODs of 0.1, 1.0 mg/L, and 0.001 mmol/L, for H₂O₂, Cr(VI), and salicylic acid, respectively. The pH monitoring film also indicates the freshness/spoilage of the milk. The portability, ease of use, and low cost of testing coupled with the app, make it an attractive alternative to lab-based analysis.

Progression of Paper-Based Point-of-Care Testing toward Being an Indispensable Diagnostic Tool in Future Healthcare

Point-of-care (POC) diagnostics in particular focuses on the timely identification of harmful conditions close to the patients' needs. For future healthcare these diagnostics could be an invaluable tool especially in a digitalized or telemedicine-based system. However, while paper-based POC tests, with the most prominent example being the lateral flow assay (LFA), have been especially successful due to their simplicity and timely response, the COVID-19 pandemic highlighted their limitations, such as low sensitivity and ambiguous responses. This perspective discusses strategies that are currently being pursued to evolve such paper-based POC tests toward a superior diagnostic tool that provides high sensitivities, objective result interpretation, and multiplexing options. Here, we pinpoint the challenges with respect to (i) measurability and (ii) public applicability, exemplified with select cases. Furthermore, we highlight promising endeavors focused on (iii) increasing the sensitivity, (iv) multiplexing capability, and (v) objective evaluation to also ready the technology for integration with machine learning into digital diagnostics and telemedicine. The status quo in academic research and industry is outlined, and the likely highly relevant role of paper-based POC tests in future healthcare is suggested.

Towards digital diagnosis of malaria: How far have we reached?

The need for precise and early diagnosis of malaria and its distinction from other febrile illnesses is no doubt a prerequisite, primarily when standard rapid diagnostic tests (RDTs) cannot be totally relied upon. At the time of disease outbreaks, the pressure on hospital staff remains high and the chances of human error increase. Therefore, in the era of digitalisation of medicine as well as diagnostic approaches, various technologies such as artificial intelligence (AI) and machine learning (ML) should be deployed to further aid the diagnosis, especially in endemic and epidemic situations. Computational techniques are now more at the forefront than ever, and the interest in developing such efficient technologies is continuously increasing. A comprehensive understanding of these digital technologies is needed to maintain the scientific rigour in these attempts. This would enhance the implementation of these novel technologies for malaria diagnosis. This review highlights the progression, strengths, and limitations of various computing techniques so far employed to diagnose malaria.

Toward Smart Diagnostics in a Pandemic Scenario: COVID-19

The incredible spread rate of coronavirus disease 2019 (COVID-19) outbreak has shocked the world. More than ever before, this dramatic scenario proved the significance of diagnostics as a cornerstone to make life-saving decisions. In this context, novel diagnostics that generates smart data leading to superior strategies for treatment, control, surveillance, prediction, prevention, and management of pandemic diseases is vital. Herein, we discuss the characteristics that should be met by COVID-19 diagnostics to become smart diagnostics enabled by industry 4.0 especially Internet of Things (IoT). The challenges ahead and our recommendations for moving faster from pure diagnostics toward smart diagnostics of COVID-19 and other possible epidemic/pandemic diseases are also outlined. An IoT-Fog-Cloud model based on smartphones as IoT gateways for smart diagnostics with unified strategies for data collection/transmission/interpretation is also proposed to integrate new digital technologies into a single platform for smarter decisions. Last but not least, we believe that "smart diagnostics" is a perspective that should be realized sooner before we encounter a pandemic far worse than the present one.

Capillary Microfluidics for Monitoring Medication Adherence

Medication adherence is a medical and societal issue worldwide, with approximately half of patients failing to adhere to prescribed treatments. The goal of this Minireview is to examine how recent work on microfluidics for point-of-care diagnostics may be used to enhance adherence to medication. It specifically focuses on capillary microfluidics since these devices are self-powered, easy to use, and well established for diagnostics and drug monitoring. Considering that an improvement in medication adherence can have a much larger effect than the development of new medical treatments, it is long overdue for the research communities working in chemistry, biology, pharmacology, and material sciences to consider developing technologies to enhance medication adherence. For these reasons, this Minireview is not meant to be exhaustive but rather to provide a quick starting point for researchers interested in joining this complex but intriguing and exciting field of research.

Deterministic droplet coding via acoustofluidics

Droplet microfluidics has become an indispensable tool for biomedical research and lab-on-a-chip applications owing to its unprecedented throughput, precision, and cost-effectiveness. Although droplets can be generated and screened in a high-throughput manner, the inability to label the inordinate amounts of droplets hinders identifying the individual droplets after generation. Herein, we demonstrate an acoustofluidic platform that enables on-demand, real-time dispensing, and deterministic coding of droplets based on their volumes. By dynamically splitting the aqueous flow using an oil jet triggered by focused traveling surface acoustic waves, a sequence of droplets with deterministic volumes can be continuously dispensed at a throughput of 100 Hz. These sequences encode barcoding information through the combination of various droplet lengths. As a proof-of-concept, we encoded droplet sequences into end-to-end packages (e.g., a series of 50 droplets), which consisted of an address barcode with binary volumetric combinations and a sample package with consistent volumes for hosting analytes. This acoustofluidics-based, deterministic droplet coding technique enables the tagging of droplets with high capacity and high error-tolerance, and can potentially benefit various applications involving single cell phenotyping and multiplexed screening.

Implementing COVID-19 (SARS-CoV-2) Rapid Diagnostic Tests in Sub-Saharan Africa: A Review

Introduction: For the COVID-19 (SARS-CoV-2) response, COVID-19 antigen (Ag), and antibody (Ab) rapid diagnostic tests (RDTs) are expected to complement central molecular testing particularly in low-resource settings. The present review assesses requirements for implementation of COVID-19 RDTs in sub-Saharan Africa. Methods: Review of PubMed-published articles assessing COVID-19 RDTs complemented with Instructions for Use (IFU) of products. Results: In total 47 articles on two COVID-19 Ag RDTs and 54 COVID-19 Ab RDTs and IFUs of 20 COVID-19 Ab RDTs were retrieved. Only five COVID-19 Ab RDTs (9.3%) were assessed with capillary blood sampling at the point-of-care; none of the studies were conducted in sub-Saharan Africa. Sampling: Challenges for COVID-19 Ag RDTs include nasopharyngeal sampling (technique, biosafety) and sample stability; for COVID-19 Ab RDTs equivalence of whole blood vs. plasma/serum needs further validation (assessed for only eight (14.8%) products). Sensitivity-Specificity: sensitivity of COVID-19 Ag and Ab RDTs depend on viral load (antigen) and timeframe (antibody), respectively; COVID-19 Ab tests have lower sensitivity compared to laboratory test platforms and the kinetics of IgM and IgG are very similar. Reported specificity was high but has not yet been assessed against tropical pathogens. Kit configuration: For COVID-19 Ag RDTs, flocked swabs should be added to the kit; for COVID-19 Ab RDTs, finger prick sampling materials, transfer devices, and controls should be added (currently only supplied in 15, 5, and 1/20 products). Usability and Robustness: some COVID-19 Ab RDTs showed high proportions of faint lines (>40%) or invalid results (>20%). Shortcomings were reported for buffer vials (spills, air bubbles) and their instructions for use. Stability: storage temperature was ≤ 30°C for all but one RDT, in-use and result stability were maximal at 1 h and 30 min, respectively. Integration in the healthcare setting requires a target product profile, landscape overview of technologies, certified manufacturing capacity, a sustainable market, and a stringent but timely regulation. In-country deployment depends on integration in the national laboratory network. Discussion/Conclusion: Despite these limitations, successful implementation models in triage, contact tracing, and surveillance have been proposed, in particular for COVID-19 Ab RDTs. Valuable experience is available from implementation of other disease-specific RDTs in sub-Saharan Africa.

Rapid Yeast Cell Viability Analysis by Using a Portable Microscope Based on the Fiber Optic Array and Simple Image Processing

A fiber optic array (FOA) can be used as an alternative or a supplement to the lens in a microscope due to its large magnification, high coupling efficiency and extremely low distortion. Based on our previous research, this paper first demonstrated the resolution and field-of-view (FOV) of the microscope based on the FOA. To further validate the FOA microscope’s imaging capability, yeast activity and concentration were investigated by simple image processing. The results showed that the percentages of live and dead yeast cells correctly identified were 92.1% and 84.8%, except for the clusters, which agreed well with the manual counting methods. Then, the performances of the portable microscopes based on the FOA and lens were compared and the factors that affect the FOA microscope imaging performance were analyzed.

Microfluidics-Implemented Biochemical Assays: From the Perspective of Readout

Over the past decades, microfluidics has emerged as an increasingly important tool to perform biochemical assays for diagnosis and healthcare. The precise fluid control and molecule manipulation within microfluidics greatly contribute to developing assays with simplicity and convenience. The advantages of microfluidics, including decreased consumption of reagents and samples, lower operating and analysis time, much lower cost, and higher integration and automation over traditional systems, offer a great platform to meet the needs of point-of-care applications. In this Review, versatile strategies are outlined and recent advances in microfluidics-implemented assays are discussed from the perspective of readout, because a convenient and straightforward readout is what a biochemical assay requires and the end user desires. Functions and properties arising from each readout are reviewed and the advantages and limitations of each readout are discussed together with current challenges and future perspectives.

All-printed semiquantitative paper-based analytical devices relying on QR code array readout

Colorimetric assay enabling user independent semiquantitative result readout through an array of sequentially unmasked QR codes.

Inorganic Complexes and Metal-Based Nanomaterials for Infectious Disease Diagnostics

Infectious diseases claim millions of lives each year. Robust and accurate diagnostics are essential tools for identifying those who are at risk and in need of treatment in low-resource settings. Inorganic complexes and metal-based nanomaterials continue to drive the development of diagnostic platforms and strategies that enable infectious disease detection in low-resource settings. In this review, we highlight works from the past 20 years in which inorganic chemistry and nanotechnology were implemented in each of the core components that make up a diagnostic test. First, we present how inorganic biomarkers and their properties are leveraged for infectious disease detection. In the following section, we detail metal-based technologies that have been employed for sample preparation and biomarker isolation from sample matrices. We then describe how inorganic- and nanomaterial-based probes have been utilized in point-of-care diagnostics for signal generation. The following section discusses instrumentation for signal readout in resource-limited settings. Next, we highlight the detection of nucleic acids at the point of care as an emerging application of inorganic chemistry. Lastly, we consider the challenges that remain for translation of the aforementioned diagnostic platforms to low-resource settings.

Barcoded point-of-care bioassays

Barcoded bioassays are ready to promote bioanalysis and biomedicine toward the point of care.

Self-Healing Label Materials Based on Photo-Cross-Linkable Polymeric Films with Dynamic Surface Structures

Spatially controlling the evolution of surface structures may provide an effective strategy for patterning surface roughness and facilitating the construction of various functional surfaces. In this study, we report a photo-cross-linkable polymeric film with dynamic surface micro/nanostructures. The surface structures of the un-cross-linked regions can be eliminated under saturated humidity, which can be utilized to create patterned roughness on the film. One potential application of this patternable platform is as a "smart" label material for graphical symbols. Various graphical symbols can be programmed onto this film by partially erasing its surface roughness, enabling visibility due to the difference in light scattering between different areas of the film. When a thus-prepared label was blurred by mechanical scratches, it could be healed under saturated humidity, and its original readability could be fully restored. Furthermore, the patterned rough surface created using our approach can also be very useful in many other research fields, such as surface wettability and cell behavior manipulation.

"Smart Diagnosis" of Parasitic Diseases by Use of Smartphones

Accurate and rapid diagnosis is crucial in combating parasitic diseases that cause millions of deaths worldwide. However, the scarcity of specialized diagnostic equipment in low- and middle-income countries is one of the barriers to effective management of parasitic diseases and warrants the need for alternative, inexpensive, point-of-care diagnostic tools. Due to their multiple built-in sensors, smartphones offer cost-effective alternative to expensive diagnostic devices. However, the use of smartphones in parasitic diagnoses remains in its infancy. This minireview describes various smartphone-based devices applied specifically for the diagnosis of parasitic diseases and discusses challenges and potential implications for their use in future.

Point-of-care diagnostics to improve maternal and neonatal health in low-resource settings

Each day, approximately 830 women and 7400 newborns die from complications during pregnancy and childbirth. Improving maternal and neonatal health will require bringing rapid diagnosis and treatment to the point of care in low-resource settings. However, to date there are few diagnostic tools available that can be used at the point of care to detect the leading causes of maternal and neonatal mortality in low-resource settings. Here we review both commercially available diagnostics and technologies that are currently in development to detect the leading causes of maternal and neonatal mortality, highlighting key gaps in development where innovative design could increase access to technology and enable rapid diagnosis at the bedside.